title: Increased gender variance in autism spectrum disorders and attention deficit hyperactivity disorder.
abstract: Evidence suggests over-representation of autism spectrum disorders (ASDs) and behavioral difficulties among people referred for gender issues, but rates of the wish to be the other gender (gender variance) among different neurodevelopmental disorders are unknown. This chart review study explored rates of gender variance as reported by parents on the Child Behavior Checklist (CBCL) in children with different neurodevelopmental disorders: ASD (N = 147, 24 females and 123 males), attention deficit hyperactivity disorder (ADHD; N = 126, 38 females and 88 males), or a medical neurodevelopmental disorder (N = 116, 57 females and 59 males), were compared with two non-referred groups [control sample (N = 165, 61 females and 104 males) and non-referred participants in the CBCL standardization sample (N = 1,605, 754 females and 851 males)]. Significantly greater proportions of participants with ASD (5.4%) or ADHD (4.8%) had parent reported gender variance than in the combined medical group (1.7%) or non-referred comparison groups (0-0.7%). As compared to non-referred comparisons, participants with ASD were 7.59 times more likely to express gender variance; participants with ADHD were 6.64 times more likely to express gender variance. The medical neurodevelopmental disorder group did not differ from non-referred samples in likelihood to express gender variance. Gender variance was related to elevated emotional symptoms in ADHD, but not in ASD. After accounting for sex ratio differences between the neurodevelopmental disorder and non-referred comparison groups, gender variance occurred equally in females and males.
authors.affiliation: Center for Autism Spectrum Disorders, Children's National Medical Center, 15245 Shady Grove Road, Suite 350, Rockville, MD, 20850, USA, jstrang@cnmc.org.
authors.forename: John F
authors.initials: JF
authors.lastname: Strang
authors.forename: Lauren
authors.initials: L
authors.lastname: Kenworthy
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Dominska
authors.forename: Jennifer
authors.initials: J
authors.lastname: Sokoloff
authors.forename: Laura E
authors.initials: LE
authors.lastname: Kenealy
authors.forename: Madison
authors.initials: M
authors.lastname: Berl
authors.forename: Karin
authors.initials: K
authors.lastname: Walsh
authors.forename: Edgardo
authors.initials: E
authors.lastname: Menvielle
authors.forename: Graciela
authors.initials: G
authors.lastname: Slesaransky-Poe
authors.forename: Kyung-Eun
authors.initials: KE
authors.lastname: Kim
authors.forename: Caroline
authors.initials: C
authors.lastname: Luong-Tran
authors.forename: Haley
authors.initials: H
authors.lastname: Meagher
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Wallace
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D002648:Child; D002659:Child Development Disorders, Pervasive / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D003071:Cognition; D015897:Comorbidity; D005260:Female; D005783:Gender Identity; D006801:Humans; D008297:Male; D010290:Parents; D011569:Psychiatric Status Rating Scales; D012737:Sex Factors; D014189:Transsexualism / Q000150:complications* / Q000523:psychology; D014481:United States / Q000453:epidemiology