NHS England consultation on specialised treatments March to April 2016 – gender variant children and adolescents

NHS England recently ran a public consultation process on a number of specialised treatments. These include the treatments provided for gender variant children and adolescents.

Two documents were of key importance to gender variant children and adolescents:

  • A Policy Proposition which concludes that cross-sex hormones should not be provided before age 16
  • A Service Specification that does little to improve the way that all treatments are provided

GIRES has responded to each of the above documents.

The first of these, relates to the policy proposition in regard to cross-sex hormones:

Document: Prescribing Cross Sex-Hormones as part of the Gender Identity Development Service for Children and Adolescents (PDF, 528KB)

The 2nd document, relates to the Service Specification:

Document: NHS Standard Contract for Gender Identity Development Service for Children and Adolescents (PDF, 889KB)

Update to section 1.5 in GIRES response to NHS England Consultation on Specialised Treatments April 2016

The phenomenon of co-occurring ASD and gender diversity is well recognised in the UK. There is also research, for instance in The Netherlands, indicating that there is a higher proportion of ASD in the gender diverse population than in the cisgender population. In the general population the prevalence of autism is thought to be about 1%. However, among young people with gender dysphoria 7.8% were diagnosed with autism in the Dutch Clinic (De Vries 2010). In adult Gender Identity Clinics, 5.5% were deemed to be autistic. (Pasterski et al. 2014).

Surprisingly, there have been anecdotal reports of young people who, having been successfully treated for their gender dysphoria, then appear to have no residual ASD characteristics as adults. The symptoms seem to have disappeared completely once the dysphoria has been successfully treated.

Given the understanding of ASD as a persistent characteristic, the only explanation for this outcome is that, in these particular cases, the original diagnosis of ASD was an error. This condition does not disappear, but it may be that certain behavioural indicators in gender dysphoric and ASD groups appear similar in young people, and an assumption is made that ASD is co-occurring.

Even though it is possible, and likely, that social and/or medical transition may help to alleviate some of the difficulties related to autism, there is no evidence that treatment for gender dysphoria, or indeed any other condition, can ‘cure’ ASD.

GIRES’ conclusion:

Whereas there is good evidence that there is a raised incidence of ASD in gender diverse groups, there is no evidence that treatment targeting gender dysphoria, can overcome both gender dysphoria and autism. This confusion appears to arise because, in some young people, an incorrect assumption by clinicians gives rise to a speculative and erroneous diagnosis of ASD in these young people. ASD has not ‘disappeared’ as a result of such treatment; it wasn’t there in the first place. Clinicians working in the field, need to be aware of this possibility. When in doubt, it may be necessary to obtain an opinion from a paediatrician who specialises in ASD/autism. Where ASD is present, extra care must be taken to ensure that ‘informed consent’ for medical interventions is achieved before these are undertaken, without incurring unnecessary delay.

 

In the Policy Proposition response, for cross sex hormones, GIRES recommends that the London clinicians should now, urgently and in consultation with stakeholders, develop and apply a set of reasonable readiness criteria, excluding age.

The Policy proposition regarding cross-sex hormones may be viewed at:

https://www.engage.england.nhs.uk/consultation/clinical-commissioning-wave8/user_uploads/e03x16-policy-prop.pdf

The Service Specification proposition is on view at:

https://www.engage.england.nhs.uk/consultation/clinical-commissioning-wave8/user_uploads/gids-serv-spec-upd.pdf

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