When it comes to the medical care of vulnerable children, you would think it would not be controversial to say no stone should be left unturned in pursuing an accurate diagnosis and then delivering appropriate care.
But as I know only too well, this is not always the case when it comes to the treatment of transgender children, and in particular, those assigned female at birth, who have sometimes been rushed down a path to puberty-blocking drugs, and even irreversible physical surgery.
So when I read this week that NHS England is reportedly planning a new framework for assessing these children, it was with some relief.
The suggestion is that they’ll be treated along the lines suggested in the recent Cass review into gender services, which said distressed children must be seen as a ‘whole person and not just through the lens of their gender identity’.
What this means in practice is that alongside looking at family relationships and their mental health, children who believe they are transgender will now also be assessed for neurodevelopmental conditions such as autism.
Why? In leaked documents, NHS England says: ‘Given the high prevalence of neurodiversity identified within this population, all those attending the NHS Children and Young People’s Gender Service should receive screening for neurodevelopmental conditions.’
Indeed, research shows that rates of autism are between three and six times higher in transgender and gender-diverse populations than in other populations.
Up to 15 per cent of autistic adults identify as trans or non-binary – but the rates are even higher among those assigned female at birth, possibly over 30 per cent.
Social rejection can be so painful that teenagers will go to great lengths to find acceptance
Another study reported that 7.8 per cent of children and adolescents diagnosed with gender dysphoria were also diagnosed with autism.
So this new approach by NHS England sounds sensible, you might think.
After all, being aware of this kind of co-occurrence of autism and gender dysphoria, and what that might mean to any individual child or young person, is essential, both to understand their individual experiences and identify any support needs.
But this is unlikely to play out well in certain quarters of the trans community.
I’m a professor of cognitive neuroimaging who uses state-of-the-art brain-imaging techniques to investigate autistic brains.
When I recently wrote in the Mail about my work investigating why girls and young women on the autistic spectrum are misdiagnosed or ignored, and exploring the links between autism and gender dysphoria, there were suggestions on social media that I should be cancelled because of my ‘transphobic views’. Furthermore, any book-related events of mine should be boycotted.
Yet I hold firm in my belief that the inclusion of autism assessments is necessary.
Of course, the need to at least be aware of the sensitivities must be acknowledged, but these new measures will put the child back at the centre of any treatment for gender dysphoria.
When I read this week that NHS England is reportedly planning a new framework for assessing trans children, it was with some relief, writes PROFESSOR GINA RIPPON
After all, the institutional ignorance and lack of care exposed by the case of Keira Bell, the teen who transitioned to becoming a male under the controversial regime of the Tavistock gender clinic and came to regret it, and Hannah Barnes’s excellent investigative book Time To Think, which exposed how ideological views took over the Tavistock, cannot be ignored.
Any move towards a more holistic viewpoint can and should be applauded.
This will also undoubtedly help the many autistic females who have been overlooked and misunderstood for so long.
The fact is that boys are four times more likely to be diagnosed as autistic than girls, and medics rely on skewed assessments that view autism through an almost entirely male lens.
If autism is seen as an overwhelmingly ‘male’ condition, it doesn’t require a sophisticated brain scanner to infer that overlooked autistic females are more likely to feel lost, as if they are square pegs seeking a round hole, for want of a better comparison.
The hyper-femininity you see in social media and marketing is also significant: if what’s thought to be female, whether it’s liking Taylor Swift or always wearing skirts doesn’t match with what you feel, you may well seek out a different, perhaps a more ‘male’ or non-binary identity as a reaction.
When speaking to many autistic girls and young women, I found they often spoke about uncertainties about their identity, including gender.
This was especially common in those who have not been diagnosed until well into adulthood.
A constant theme in our conversations was their joy with at last ‘finding my tribe’ when these women were finally diagnosed with autism.
It’s no surprise: after all, we know from research in neuroscience (using brain scans) and psychology, how much ‘belonging’ (ie finding your group) is a basic human need.
Social rejection can be so painful, young people will go to extraordinary lengths to find acceptance. Perhaps by rejecting the identity that society is imposing upon them and searching for an alternative. One of which could be to change gender.
We must also, though, proceed with caution.
Questions remain about how this will be rolled out. For example, might you treat those gender dysphoric children and young people who are not identified as autistic differently from those who are? This is an issue medics must address now.
This week’s news story sounded other alarm bells for me, not least on the practical issue of resources.
Last year, a survey by autism advocacy group Autistica reported that 187,567 people across England are currently waiting for an autism assessment, with the most frequently reported waiting time between one and one-and-a-half years. In an inevitable postcode lottery, in some areas the waiting time is more than five years.
So where is the NHS going to get these extra assessors for this holistic approach to children with gender dysphoria? And would a child presenting with gender dysphoria be placed above one who does not in order of priority for an assessment?
One can also imagine that the new ‘over-diagnosis’ lobby, who see diagnoses, of both physical and mental health conditions, as being handed out too freely, might view these new guidelines as an overreaction – autism is ‘just bad behaviour’ is a typical comment – and pathologising everyday problems.
Yet while it may be early days, I for one feel positive about this proposal (perhaps I’ll even be asked to join in the public consultation!).
Indeed, in the light of evidence of rising numbers of mental health issues in all children today, why not roll it out across the board? But that is probably a conversation for another day…
- Gina Rippon is a professor emeritus of cognitive neuroimaging at the Aston Brain Centre, Aston University. The Lost Girls Of Autism by Gina Rippon (Macmillan, £22) is out now. © Gina Rippon 2025
