title: Initial Clinical Guidelines for Co-Occurring Autism Spectrum Disorder and Gender Dysphoria or Incongruence in Adolescents.
abstract: Evidence indicates an overrepresentation of youth with co-occurring autism spectrum disorders (ASD) and gender dysphoria (GD). The clinical assessment and treatment of adolescents with this co-occurrence is often complex, related to the developmental aspects of ASD. There are no guidelines for clinical care when ASD and GD co-occur; however, there are clinicians and researchers experienced in this co-occurrence. This study develops initial clinical consensus guidelines for the assessment and care of adolescents with co-occurring ASD and GD, from the best clinical practices of current experts in the field. Expert participants were identified through a comprehensive international search process and invited to participate in a two-stage Delphi procedure to form clinical consensus statements. The Delphi Method is a well-studied research methodology for obtaining consensus among experts to define appropriate clinical care. Of 30 potential experts identified, 22 met criteria as expert in co-occurring ASD and GD youth and participated. Textual data divided into the following data nodes: guidelines for assessment; guidelines for treatment; six primary clinical/psychosocial challenges: social functioning, medical treatments and medical safety, risk of victimization/safety, school, and transition to adulthood issues (i.e., employment and romantic relationships). With a cutoff of 75% consensus for inclusion, identified experts produced a set of initial guidelines for clinical care. Primary themes include the importance of assessment for GD in ASD, and vice versa, as well as an extended diagnostic period, often with overlap/blurring of treatment and assessment.
authors: a Division of Pediatric Neuropsychology , Children's National Health System.
authors: John F
authors: JF
authors: Strang
authors: a Division of Pediatric Neuropsychology , Children's National Health System.
authors: Haley
authors: H
authors: Meagher
authors: a Division of Pediatric Neuropsychology , Children's National Health System.
authors: Lauren
authors: L
authors: Kenworthy
authors: b Department of Child and Adolescent Psychiatry , VU University Medical Center.
authors: Annelou L C
authors: ALC
authors: de Vries
authors: c Division of Psychiatry and Behavioral Sciences , Children's National Health System.
authors: Edgardo
authors: E
authors: Menvielle
authors: d Department of Psychiatry and Behavioral Sciences , Northwestern University, Feinberg School of Medicine.
authors: Scott
authors: S
authors: Leibowitz
authors: e Department of Child and Adolescent Psychiatry , New York University School of Medicine.
authors: Aron
authors: A
authors: Janssen
authors: f Department of Medical Psychology , VU University Medical Center.
authors: Peggy
authors: P
authors: Cohen-Kettenis
authors: g Division of Pediatric Endocrinology , University of Michigan Health System.
authors: Daniel E
authors: DE
authors: Shumer
authors: h School of Professional Psychology , Pacific University.
authors: Laura
authors: L
authors: Edwards-Leeper
authors: i Division of Child & Adolescent Psychiatry , Hofstra Northwell School of Medicine.
authors: Richard R
authors: RR
authors: Pleak
authors: j Division of Endocrinology , Boston Children's Hospital.
authors: Norman
authors: N
authors: Spack
authors: k Department of Psychiatry , University of California San Francisco School of Medicine.
authors: Dan H
authors: DH
authors: Karasic
authors: l Department of Psychiatry , University of California San Francisco-Benioff-Children's Hospital Oakland.
authors: Herbert
authors: H
authors: Schreier
authors: f Department of Medical Psychology , VU University Medical Center.
authors: Anouk
authors: A
authors: Balleur
authors: m Departments of Psychiatry , Endocrinology and Urology, Boston Children's Hospital and Harvard Medical School.
authors: Amy
authors: A
authors: Tishelman
authors: n Child and Adolescent Gender Center , Department of Pediatrics, University of California San Francisco Benioff Children's Hospital.
authors: Diane
authors: D
authors: Ehrensaft
authors: o Division of Psychiatry and Behavioral Sciences, Children's National Health System.
authors: Leslie
authors: L
authors: Rodnan
authors: p Department of Radiology and Center for Autism Research , The Children's Hospital of Philadelphia.
authors: Emily S
authors: ES
authors: Kuschner
authors: q Divisions of Endocrinology and Social Work , Boston Children's Hospital.
authors: Francie
authors: F
authors: Mandel
authors: r Private Practice , Farmington Hills , MI.
authors: Antonia
authors: A
authors: Caretto
authors: s Division of Psychiatry and Pediatrics , University of Colorado.
authors: Hal C
authors: HC
authors: Lewis
authors: t Division of Pediatric Neuropsychology , Children's National Health System.
authors: Laura G
authors: LG
authors: Anthony
mesh_terms: D000293:Adolescent; D000067877:Autism Spectrum Disorder / Q000523:psychology*; D003697:Delphi Technique; D005260:Female; D000068116:Gender Dysphoria / Q000523:psychology*; D017408:Guidelines as Topic; D006801:Humans; D008297:Male