(PS3-B35) Perceptions of Decision-making Autonomy Among Autistic Gender Minority Adults

Whereas personal autonomy typically increases with age, autistic people’s autonomy has often been restricted. In particular, autistic people’s freedom to make their own choices about their healthcare, living situations, or bodily autonomy may be reduced. Autistic people with additional marginalized identities, such as identifying as a gender minority (identify with a gender identity that is different from their sex presumed at birth) may experience even greater restrictions to their decision-making autonomy. While nearly 20% of autistic adults identify as a gender minority, little is known about the impact of gender identity on autistic adults’ sense of their freedom to make choices. The role of gender identity and its impact on an individual’s perceptions of freedom in various domains across the lifespan remains to be explored. In this study, we examined whether autistic adults’ perceived freedom to make choices differed as a function of gender identity and at different stages of adulthood.

Cross-sectional data were collected from 573 autistic adults (18-78 years) through Simons Powering Autism Research for Knowledge (SPARK), an online research registry for autistic individuals. Participants provided basic demographic information including gender identity, race, SES, and mental health symptoms (Table 1). The Academic Autism Spectrum Partnership in Research and Education (AASPIRE) Freedom to Make Choices scale asked respondents to rate freedom across 13 domains on a 0-100 scale (Table 2), with higher scores indicating greater perceived freedom to create a total mean score. ANCOVA analyses were used to examine the impact of age (younger [18-24 years], middle [25-39 years], and older [40+ years] adulthood) and group (gender minority [GM] and cisgender adults) on freedom scores, while controlling for anxiety and depression symptoms.  

Findings revealed that overall, freedom scores did not differ between cisgender and GM autistic adults. However, planned comparisons revealed that whereas freedom scores were significantly increased among cisgender adults at each increasing age group, they were only significantly different for GM adults in older adulthood compared with middle or younger adulthood. Specifically, in middle adulthood (25–39-year-olds) the GM group reported significantly lower freedom scores than did cisgender adults, after accounting for anxiety and depression symptoms (Fig. 1).

The findings of this study suggest that participants’ sense of freedom to make choices varied as a function of age. While freedom to make choices generally increased with age, gender minority autistic adults rated their freedom to make choices lower than cisgender autistic adults in middle adulthood, after accounting for anxiety and depression symptoms. There may be several possible reasons for this disparity, including that the need for gender minority autistic adults to continue to self-advocate for affirming care across their intersecting minoritized identities for a greater portion of adulthood reduces their perception of the ability to make choices freely. Ultimately, future work should explore the optimal type and timing of gender affirming supports and services to best support autistic individuals across the lifespan.