Trans Activists and Autism: A Response to Susan Bradley

Are autistic young people capable of making informed decisions regarding their health care? Susan Bradley seems to think that they are not. In a January 12th article published in the National Post, the retired psychiatrist suggests that trans advocates induce a “foreclosure of reflective thinking about their own feelings and situation” in autistic children, causing them to mistakenly identify as transgender.

Her claim warrants some contextualisation.

Following several reports indicating that the Child and Adolescent Gender Identity Clinic which Susan Bradley worked at did not adhere to current best practices as well as a damning evaluation of the program, CAMH decided to close its Child and Adolescent Gender Identity Clinic in 2015. In doing so, the Medical Director of their Child, Youth & Family Program has apologised “for the fact that not all of the practices in our childhood gender identity clinic are in step with the latest thinking”. In a 2003 article, Dr. Simon D. Pickstone-Taylor highlighted that the approach employed by Bradley and Zucker, a longtime collaborator of Dr. Bradley, is “disturbingly close to reparative therapy for homosexuals”.

In other words, Dr. Bradley’s approach of seeking to discourage trans minors from transitioning has been discredited by contemporary research. Given how this experience is the basis for her claims to authority on the matter, her article must be read through a critical lens.

Bradley plays on the notion that trans people must have a “prior history of cross gender wishes” to infuse doubts into the transgender identity claims of patients whom she subsequently diagnosed with Autism Spectrum Disorder (ASD). This is misleading. Though a history of transgender identification suggests that the person is indeed trans, a number of trans people have no such history and are no less trans for it. This has been recognised by the medical literature.

As a matter of fact, adolescents’ gender identity claims are overwhelmingly reliable according to a 2010 study by Drs. de Vries, Steensma, Doreleijers and Cohen-Kettenis. Medical treatment such as puberty blockers is reserved for teenagers, eliminating concerns of overreaching medical treatment for young children. These blockers are fully reversible: all they do is temporarily prevent puberty, and may be stopped at any time. They allow trans and questioning teens to make an informed decision regarding hormone replacement therapy, freed from the pressures of puberty.

A diagnosis of ASD does not preclude being trans. In fact, recent research by the same Dutch gender identity clinic indicates that there is an overrepresentation of ASD diagnosed patients among trans people, both youth and adult. Though Dr. Bradley may feel that ASD explained her patients’ symptoms, many individuals diagnosed with ASD eventually come out as trans, upon realising that the diagnosis does not explain away their gendered feelings.

In the particular case of minors with undiagnosed autism, it’s not hard to see how complex relationships to oneself and to gendered norms that do not fall in line with social expectations might obscure underlying transgender feelings. Nevertheless, autistic people are perfectly capable of making healthcare decisions, and that includes decisions regarding transition-related care. That includes fully understanding that “there would be no going back”.

Preventing misguided medical treatment is a laudable goal. Indeed, it is one shared by trans advocates, who believe trans people should have all the information they need to make fully informed decisions. That goal is not served by caricaturing activists as pushing everyone to change their gender.

The culture of informed consent we want to cultivate begins with respecting trans and autistic individuals’ autonomy. Instead of singling out and infantilising autistic teenagers, we should seek to support their process of self-discovery by providing them with the best information available and, if they desire to transition, by supporting them with adequate social and medical services. This will also mean developing adequate protocols for autistic trans children and adults, whose experience of gender is often different from other trans people, just as non-trans autistic people live gender differently than non-autistic people.

The position suggested by trans activists, far from the dystopia Susan Bradley paints, puts the focus on respecting people’s autonomy, giving them both the time and information necessary to make an informed choice in a trans-friendly environment which does not discourage them from transitioning should they so desire. It is difficult to understand why anyone would oppose that.

This article was endorsed by the Conseil québécois LGBT, the Centre for Gender Advocacy, the LGBT Family Coalition, Gender Creative Kids Canada, and Mermaids U.K.

Florence Ashley Paré, at the time of publication, was a B.C.L./LL.B. candidate at the McGill University Faculty of Law and an advocate for trans well-being. The author would like to thank Caroline Trottier-Gascon, M.A. for her precious help with the present article.

The author welcomes re-publication.