Markers of Autism and Gender Incongruence in Children (MAGIC): Cognition in Autistic and Non-autistic Gender-incongruent Children and Their Families

该项目是肯特大学与塔维斯托克和波特曼NHS基金会信托基金的合作项目，该信托基金拥有欧洲最大的性别认同发展服务(GID)。我们的目的是了解性别不一致(出生分配的性别与有经验的性别不一致)及其与自闭症谱系障碍(ASD)的显著联系，自闭症谱系障碍在性别不一致的儿童中被诊断出的比例几乎是总人口的10倍。这种共现的性质和基础还没有得到系统的研究。因此，临床医生、教育工作者和家长正试图支持被边缘化和脆弱的儿童群体，他们对性别不一致或为什么它与自闭症以如此惊人的速度同时发生缺乏了解。最近的一项司法审查(Bell诉Tavistock，2020年12月)突显了调查这种共同发生的重要性，人们一致认为，需要为性别不一致的自闭症儿童及其家庭定制和调整服务。因此，这一项目是及时的，将解决当前研究中的一个重大空白。研究人员是领先的儿童心理学家和精神病学家，他们在与拟议人群合作和研究性别认同方面拥有丰富的经验。在三年的时间里，该小组建议在一系列研究中检查性别不一致如何与自闭症重叠，涉及200名7至14岁的儿童/青年及其家庭，他们属于以下四组之一：1)顺性别神经典型儿童(即性别认同与其出生时指定的性别相对应但没有自闭症的儿童)2)顺性别自闭症儿童3)性别不一致神经典型儿童4)性别不一致患有自闭症儿童研究小组将远程进行一系列研究，并将使用各种隐含和明确的性别认同不同方面的测量方法，以及这些方面的潜在认知标记物，以了解是否：-自闭症与顺性和性别不一致儿童的不同认知有关-自闭症儿童和非自闭症儿童的性别不一致与不同的认知-在神经分化和神经典型儿童中，性别认同在性别灵活性、性别典型性、性别表达和性别焦虑症的维度上发展不同-心理理论，认知灵活性，和/或述情障碍与性别认同的非典型形式的发展有关-自闭症和非自闭症家庭中的性别表达和强度，以及性别不一致的认知标志顺性和性别不一致儿童回答这些问题将找出性别不一致的可能的“认知标记物”，有可能彻底改变我们对性别不一致儿童的理解和支持，并为性别发展和自闭症提供理论依据。认知标记代表了基因和行为之间的中间水平，可以使用心理测量方法加以利用，它克服了仅根据(往往高度多样化的)行为陈述和自我报告来识别儿童的相关问题。这项研究无疑将加强对转至GID的儿童的评估，并帮助开发更个性化的支持。我们将让所有利益相关者参与进来，包括家长和年轻人、NHS儿童性别问题专业服务、CAMHS、学校和自闭症患者的支持服务(例如，全国自闭症协会)。我们还将创建一个网站，发布我们的研究结果，并将为家长、教师和临床医生提供免费研讨会。这项研究的独特性意味着它将产生具有国际意义的发现，可能会对英国国内外的理论建设、临床和教育实践以及社会理解产生影响。

This project is a collaboration between the University of Kent and the Tavistock and Portman NHS Foundation Trust, which hosts Europe's largest gender identity development service (GIDS). Our aim is to understand gender incongruence (when birth-assigned sex does not align with experienced gender) and its striking link with autism spectrum disorder (ASD), which is diagnosed in gender-incongruent children at almost 10 times the population rate. The nature and underpinnings of this co-occurrence have not yet been researched systematically. Hence, clinicians, educators, and parents are trying to support a marginalised and vulnerable population of children with insufficient understanding of gender incongruence, or why it co-occurs with ASD at such a striking rate.The importance of investigating this co-occurrence was highlighted by a recent judicial review (Bell v Tavistock, Dec 2020) and there is consensus that services need to be tailored and adapted for gender-incongruent autistic children and their families. Therefore, this project is timely, and will address a major gap in current research. The investigators are leading child psychologists and psychiatrists, with substantial experience of working with the proposed populations and researching gender identity. Over three years, the team proposes to examine how gender incongruence may overlap with ASD in a series of studies, involving 200, 7- to 14-year-old, children/young people and their families who fall into one of the following four groups:1) cisgender neurotypical children (i.e. children whose gender identity corresponds to their birth-assigned sex and who do not have ASD)2) cisgender children with ASD3) gender-incongruent neurotypical children4) gender-incongruent children with ASDThe series of studies will be conducted remotely by the research team and will use a wide range of implicit and explicit measures of various aspects of gender identity, as well as potential cognitive markers of these aspects, to understand whether:- ASD is associated with different cognitions in cisgender and gender-incongruent children- Gender incongruence is associated with different cognitions in autistic and non-autistic children- Gender identity develops differently in neurodivergent and neurotypical children across the dimensions of gender flexibility, gender typicality, gender expression, and gender dysphoria- Theory of mind, cognitive flexibility, and/or alexithymia relate to the development of atypical forms of gender identity- Expressions and strength of gender, as well as cognitive markers of gender incongruence, run in the families of autistic and non-autistic, cisgender and gender-incongruent childrenAnswering these questions will identify possible 'cognitive markers' of gender incongruence that have the potential to revolutionise our understanding and support of gender-incongruent children, and inform theories of gender development and ASD. Cognitive markers represent intermediate levels between genes and behaviour that can be tapped using psychological measures, and which overcome problems associated with identifying children only on the basis of (often highly diverse) behavioural presentations and self-reports. This research will undoubtedly allow for enhanced assessments of children referred to GIDS and aid the development of more personalised support. We will engage stakeholders throughout, including parents and young people, specialist NHS Gender Services for children, CAMHS, schools, and support services for autistic people (e.g., National Autistic Society, Autistica). We will also produce a website, will publish our findings open access, and will provide a free workshop for parents, teachers, and clinicians. The uniqueness of this study means that it will generate findings of international significance likely to have an impact on theory building, clinical and educational practice, and societal understanding in the UK and beyond.