Why the UK’s Autism “Tests” for Trans Youth Should Raise Alarms

Neurodivergence has been weaponized by bad faith, anti-LGBTQ forces in order to invalidate the existence of transgender people.

Photo by Mercedes Mehling on Unsplash

According to documents supposedly leaked to The Telegraph—a British tabloid—the National Health Service (NHS) in the United Kingdom “will test all children who believe they are transgender for autism.”

“Every child referred to a gender clinic will be ‘screened for neurodevelopmental conditions’ such as autism and ADHD under new guidance,’” The Telegraph reports. “In such cases, the team of doctors will have to determine if the child’s symptoms are caused by autism or whether they also need separate treatment for gender dysphoria.”

The NHS did not respond to Erin in the Morning’s request for comment, and Erin in the Morning could not independently verify these claims at this time.

So while the policy is not yet set in stone, it wouldn’t come as a surprise. It echoes the policy guidelines set out by the Cass Review, a 2024 document commissioned by NHS England. The Cass Review has been widely rebuked by trans people and experts in the trans healthcare field—none of whom were actually allowed to have any authority in the report’s creation.

The Cass Review asserts that this is part of a utilitarian effort to create “holistic” health care for transgender children. In reality, the UK’s proposed mandate on autism and ADHD assessments seems to be another intrusive, needless barrier disguised as “safeguarding,” yet another instance of anti-trans pseudoscience cloaked in the language of “caution.” And it’s part of a growing trend targeting both trans people and autistic people—groups with a statistically significant overlap.

Here’s a brief summary of some things you should know.

1. Autistic or not, most gender-affirming care is already impossible or near-impossible for minors in the United Kingdom.

Evidence-based best practices in gender health care, such as puberty blockers, are effectively banned for trans people under the age of 18. At this point, puberty has usually already occurred, rendering puberty blockers moot. (However, puberty blockers remain accessible to non-trans youth.)

Gender-affirming surgeries are also inaccessible for trans youth.

Current NHS guidelines state that starting at age 16, trans youth may access other hormone therapies, such as taking testosterone or estrogen, if they meet “strict criteria.” Their course of treatment must be approved by a clinical psychologist, a child psychotherapist, a child and adolescent psychiatrist, a family therapist, and a social worker. “The team will carry out a detailed assessment, usually over 3 to 6 appointments over a period of several months,” the NHS website says. A trans youth seeking hormone therapy would also have to be seen by a general practitioner and an endocrinologist. If a parent objects to their trans child receiving gender-affirming care, they may also be able to override their child's decision until the child turns 18.

However, it’s unlikely that most trans youth will even get to that point. Even for trans adults, the waiting list for gender identity clinics can be up to five years long. At this point, researchers say in an article for Scientific American, NHS gender clinics are “not allowed to offer affirming care,” as they are too busy “focusing on invasive and exhaustive assessment.”

2. Neurodivergence has been weaponized by bad-faith and anti-LGBTQ forces to invalidate the existence of transgender people.

Southern Poverty Law Center-designated hate groups have used ADHD, autism, and psychiatric mental health issues to write off all trans youth, framing transness and gender diversity as a mere symptom of neurodivergence that needs to be snuffed out. Alternatively, such talking points falsely imply that all people with ADHD and/or autism have intellectual disabilities so profound that they are unable to assert their gender identity.

These groups invoke a deep history of using autism to invalidate gender identity. For example, one case report dating back to the 1990s followed an autistic teen who was assigned female at birth. The patient rejected she/her pronouns and insisted on being addressed as “a boy.” That academic article, published in European Child & Adolescent Psychiatry, debates whether the teen’s gender nonconformity was a result of what was seen as legitimate “transsexualism,” or whether it was merely the product of the “poor understanding of social relations” due to the teenager’s autism.

The American College of Pediatricians—a pseudoscience organization with an intentionally misleading name which was founded by Christian fundamentalists for the purpose of rejecting LGBTQ rights within their field—further claimed that autistic people are transgender because they are easier to “be recruited” into being trans, which further plays into pseudoscientific talking points about queerness being a “social contagion.”

Today, leading experts on the intersection of autism and gender say that “attempts to restrict autistic transgender people's access to gender care are unsupported by existing research,” and denounced the misrepresentation of their work to support anti-trans agendas.

3. The proposed autism assessment mandate stems from the Cass Review, which experts say is not a scientific document.

The Cass Review was led by the eponymous Dr. Hillary Cass, whom countless scholars in trans health have denounced as having a clear bias and poor research practices. The Cass Review offered little to no new evidence or data, a report by the World Professional Association of Transgender Health (WPATH) found. Instead, it largely regurgitated existing data—including widely discredited studies and medical advocates pushing conversion therapy on trans kids—in order to manufacture doubt about trans people’s credulity and existence.

“The Cass Review process itself intentionally and explicitly excluded any oversight from patients and their families and trans healthcare experts,” the WPATH report says, noting that Dr. Cass had no clinical expertise or background in working with the trans community when she was tasked with creating the review. “The Cass Review relies on selective and inconsistent use of evidence, and its recommendations often do not follow from the data.”

The review also overstates the prevalence of so-called “detransitioners.” Rates of “detransition” have been artificially inflated by antiquated and methodologically unsound studies. In contrast to the fearmongering from conservatives, increased access to gender-affirming care has not, in fact, led to skyrocketing rates of trans people medically transitioning and then fully “detransitioning,” subsequently deciding they are actually cisgender, and experiencing “transition regret”—which itself a dubious and vague metric.

Erin in the Morning also published a detailed analysis of the scientific flaws of the Cass Review when it first came out.

4. While offering increased access to services and supports for autistic youth can be useful, that’s not the practical effect of this mandate.

Trans kids who are lucky enough to receive a rare placement at a gender clinic are already seen by a litany of mental health care experts; considerations of their mental health and cognitive abilities are already built into existing standards of care for trans people of all ages. Waiting lists for trans-affirming care can already be years-long; adding yet another barrier only serves to forcibly transition queer or gender-questioning youth through a puberty that does not align with their gender, resulting in long-term and potentially irreversible repercussions.

The supposed need for these extra hurdles is not supported by evidence. If the UK was really invested in helping neurodivergent people, they could start by providing autism assessments to the record-breaking 172,000 people in the United Kingdom who are already trying—and unable—to get one due to the backlog. Or perhaps the NHS could dedicate resources to the thousands upon thousands of people with ADHD who have been forced off of their medications due to global supply shortages.

This comes as similar tensions bubble across the pond in the United States, where just last week, the United States Secretary of Health and Human Services, Robert F. Kennedy, Jr., made sweeping blanket characterizations about autism, declaring that “autism destroys families” and that autistic people will never play baseball, write a poem, or get a job and pay taxes.

He also announced intentions to create a national autism registry, versions of which already exist in at least seven states. It is not clear how he will use the data or if there will be any privacy protections for registrants. We do know that RFK has a history of using autistic children to substantiate his dangerous, quack theories about vaccines—claiming the latter is caused by the former—regardless of what the actual research says.