(PS3-B38) Exploring Parent-reported “wish to Be of the Opposite Sex” in Relation to Suicidality Among Autistic Youth

Background: Research shows autistic youth are more likely to identify as gender diverse (for a review, see Kallitsounaki & Williams, 2022) and to experience increased suicidal and/or self-injurious behavior (SSIB) and suicide ideation (SI; Hunsche et al., 2020). Further, high levels of SSIB or SI among gender diverse youth have been reported in studies of non-autistic (Edwards-Leeper et al., 2019; De Graaf et al., 2022) and autistic youth (Strang et al., 2021; Strauss et al., 2021); however, these samples have often been small or clinically-referred. Demonstrating an association between suicidality and gender diversity in a large, community sample could help bolster and enhance the generalizability of these findings.

It is often difficult to empirically investigate the mental health of autistic, gender diverse youth, because paediatric autism clinics rarely collect demographic information on gender identity. As an alternative, Item 110 (“Does your child ever wish to be of the opposite sex?”) of the Child Behavior Checklist 6-18 (CBCL; Achenbach & Rescorla, 2001) has been utilized by researchers as a proxy to estimate rates of gender diversity in autistic samples. The CBCL, a parent-reported behavioral inventory, also queries SSIB and SI via Items 18 and 91, respectively.

Objective: We tested the hypothesis that autistic children with parental endorsement of “sometimes true” or “often true” on Item 110 would display elevated rates of SSIB and SI. We further tested the hypothesis that youth assigned female at birth (AFAB) display increased suicidality compared to youth assigned male at birth (AMAB), as found in existing non-autistic, gender diverse samples (e.g., De Graaf et al., 2022).

Method: Data were obtained from parents of 716 autistic youth (79.9% assigned male at birth [AMAB]; ages 8-17; Mage (SD) = 13.08 (2.79); 91.20% White; Mdn Household Income = $70,000 - $79,999) with communicative phrase speech recruited via the Interactive Autism Network, an autism research registry. 

Results: Over five percent (n = 41) of participants endorsed Item 110 (63.4% AMAB). A Fisher’s exact test showed that Item 110 endorsers were significantly more likely than non-endorsers to also report SSIB (22% v. 10.2% respectively, two-tailed p = .034) and SI (39% v. 15.8% respectively, two-tailed p < .001) in their children. There were no significant differences in SI or SSIB when comparing AFAB and AMAB Item 110 endorsers.


Discussion: In line with prior research on autistic, gender diverse youth (Strang et al., 2021), parents who endorsed Item 110 were also more likely to report elevated rates of SSIB and SI in their children than non-endorsers in this study. Rates of SSIB and SI were higher than those reported in a prior study of non-autistic gender diverse youth (Edwards-Leeper et al., 2019), suggesting those at the intersection of autistic and gender diverse identities may have heightened risk. Thus, despite ongoing debate regarding its utility, our finding suggest Item 110 may bring a more inclusive and gender-aware lens to clinicians’ and researchers’ suicide risk assessments.