|Tell me about|
|For our next session...|
|Popping into your mind|
“”If you were to get rid of all the autism genetics, there would be no more Silicon Valley.
Autism, also known as autism spectrum disorder, is an inborn and lifelong developmental disability that impacts - among other things - language, communication and socialization. It is often referred to as a spectrum, because different autistic people experience different traits in different ways.
Identification and classification
Since the 1920s, the traits correlated with Asperger's syndrome were thought to have been first described by a Soviet child psychiatrist named Grunya Sukhareva. It was later uncovered that her work on autism may have led to the foundation of the condition. In the 1940s, Austrian psychologist Hans Asperger published his first paper about what he called "autistic psychopathy," detailing traits Sukhareva first described decades before his interest into the condition. The psychiatric community has become increasingly aware that people with autistic traits are not "psychopaths", as they were once (and are sometimes still) labeled. We also now know that autism is a spectrum, with different people having different intensities of traits and needing different amounts of support.
While Hans Asperger was first believed to be a hero who protected his patients from the Nazis by emphasizing their positive traits, a closer investigation has revealed that he collaborated with Nazis.
Signs of autism
Autism is a lifelong developmental disability that impacts social skills, behavior, development, and the way a person experiences the world.
Being a demon
- Developmental delays in speech (except for Aspies with level 1 autism) and quirks
- Over- or under-sensitive senses (sight, hearing, smell, touch, taste, etc.)
- Appearing to be emotionless on the surface at all times
- Aloofness (except for Aspies)
- Repetitive self-calming behavior, known as "stimming” (e.g. repeating the same word, hand flapping, walking around in circles, rocking)
- Difficulty maintaining eye contact
- Need for routine
- Difficulty discerning what others are thinking through intuition alone (can be confused with lack of caring or a lack of empathy)
- Difficulty understanding and managing emotions or reading social cues
- Executive dysfunction
- Intense and obsessive passions, called "special interests"
- Difficulty recognizing faces (similar, but not quite as severe and with a different underlying cause, to prosopagnosia)
- Extreme sincerity
- Logical thinking
- Having a meltdown (such as headbanging) from over-stimulated loud noises or bright lights
- Burnout (as a result of a meltdown)
These signs aren’t diagnostic criteria; it's typical for each person to have different amounts of each trait, and not every autistic person may have every trait associated with autism. Some of these traits also manifest in other disorders such as ADHD, including executive dysfunction and emotional control issues.
Some autistic traits can be positive, such as pattern recognition skills and passionate interests. As with all people with mental health disorders, people with positive traits still require support in other areas, and people with high support needs can have positive traits too.
Testing for autism
Testing for autism can be difficult, since there are no distinct markers. People may be diagnosed through personal interviews and questionnaires, and sometimes by qualitative observation by a team of caregivers and professionals.
Getting a diagnosis can be harder for women and girls, and for people of color, as research on autism has historically been focused on white males, Research also continues to be heavily focused on infants and children, making it harder for adults to seek diagnosis or support.
Depending on the amount of woo involved, the fact that people who are unusual but not struggling can be diagnosed with autism (and suffer the consequences) can be used as rational criticism of modern clinical psychology, or as fodder for crank theories about autism being a higher level of evolution.
Subtypes of autism
Under the DSM-IV, autism was a subset of Pervasive Developmental Disorders, along with Asperger syndrome, Rett syndrome, Childhood Disintegrative Disorder, and pervasive developmental disorder not otherwise specified (PDD-NOS). Under the DSM-5, all previously distinct autistic disorders are now classified and diagnosed as Autism Spectrum Disorder, and Rett Syndrome (determined in the late 1990s to result from any of several X chromosome abnormalities) and CDD have been reclassified as distinct disorders.
While groups like aspie supremacists try to claim that there are distinct "types" of autism, the reality is that autistic people are so diverse that it is difficult to form any clear categories at all. Research has found that labels like "high-functioning" and "low-functioning" are meaningless and misleading.
Causes and controversy
The exact causes of autism are unclear, though it is believed a genetic component increases the likelihood.
People have proposed all kind of causes for autism. People have claimed that autism is linked to heavy metal exposure, a so-called "insanity virus" called human endogenous retrovirus W or HERV-W or the Herpes Simplex virus, maternal fever during pregnancy, and more. So many causes have been proposed that the autistic community has produced numerous parodies detailing "causes" of autism.
The vegan and animal rights activist group PETA has launched a scare campaign claiming that the ingestion of dairy products from cow's milk causes autism. There is no scientific basis for this belief.
Some people are concerned that looking for a genetic cause of autism could lead to prenatal testing and selective abortion.
There is a large controversy within the Autistic and Neurodiversity communities about supporting a "cure" or treatments "to reduce" one's autism, or autistic symptoms, with many autistics and ND people on both sides feeling very strongly with their beliefs, often greatly influenced from personal experience and often leads to great amounts of infighting within said communities. That being said however, there often tends to be certain groups from Neurotypicals on both the pro and anti cure axis who tend to generalize autistic peoples diverse thoughts and nuanced beliefs regarding a cure to suit their own agenda. A good example would again be Autism Speaks who assumes that most autistics would support or at least benefit from a cure whether or not they would want one. However this can also be applied to certain Neurotypicals or those who self-diagnose who advocate entirely for no cure or treatments whatsoever even for the most severe of people on the spectrum.
There likely is not a single one cause for autism. Most likely, a variety of factors increase the risk, and from there it's just luck of the draw. While not proven, it's believed that maternal inflammation early in pregnancy increases the risk of autism. Environmental factors also play a role, and it's believed that the chemical Bisphenol A (BPA), an additive to plastics that leaches into the water supply, can cause endocrine disruption during fetal development. Interestingly, this disruption seems to be linked to both autism and transsexuality, which may explain why there's an overlap between the two.
It has been recently shown that the deletion of a section of chromosome 17 results in a 14-fold increase in the chance of having schizophrenia or being on the autism spectrum. David H. Ledbetter, a genetics professor at Emory University stated "Not all people with autism, a developmental delay or schizophrenia have this deletion, but all people who have the chromosome change will develop some form of the disorders, whether it's mild or strong enough for a diagnosis".
The nonexistent epidemic
The increase in autism diagnoses has led to tales of an "autism epidemic." Yet a rise in diagnoses does not automatically mean a rise in autism.
- The definition of autism has changed to include more people.
- Increasing knowledge of autism may lead more autistic people to get diagnosed, instead of suffering in silence.
- Under-diagnosed groups, such as people of color and women, are now getting more diagnoses.
- In a few cases, children with Sensory Processing Disorder may be misdiagnosed as autistic so that they can access accommodations at school.
Some people believe that the incidence of autism may be rising due to more autistic and autistic-like people having children. Thanks to the rise of IT and other industries, "Guys who might never have had a prayer of finding a kindred spirit suddenly discover that she's hacking Perl scripts in the next cubicle."
Nevertheless, hype about an "epidemic" has not disappeared, and it continues to feed myths about causes of an increase in autism.
In the 1990s and the 2000s, vaccine hysteria linking childhood vaccinations to autism broke on both sides of the Atlantic. In the UK, it was fueled by Andrew Wakefield's fraudulent study claiming the MMR vaccine caused autism. In the US, the focus was on thimerosal, a preservative used in some "dead" vaccines. Both hypotheses have been thoroughly discredited by the medical community worldwide, yet some people still hold on to this idea.
Many autistic individuals point out, with appreciable validity, that even if vaccines caused autism, advising against vaccination sends a message that autistic people would be better off dead of horrible and easily preventable diseases. That's a pretty cruel and irresponsible thing to suggest, especially considering the high risk of suicide in autistic people.
The Autism omnibus trial settled the case.
The idea that autism is a fate worse than death can have devastating consequences. One example is the fate of Katie McCarron. Her mother felt guilty over "giving" her autism by vaccinating her, and then tried to atone for it with a "mercy killing". This phenomenon is neither unique nor isolated to autism.
A limited study suggested a link between antidepressants and autism. A different study found no link.
Antidepressants are good for pregnant mothers who need them. Researchers have also found some positive effects for the babies, who were less likely to be born preterm or to be born via c-section. Logically speaking, having a mother who is happier, following a better eating and sleeping schedule, and has less stress hormones is probably good for a baby. Moms who took antidepressants during pregnancy do not need to feel bad about it.
However, giving antidepressants to autistic people without medical reason may cause harm. It was noted that "We can't recommend SSRIs as treatments for children, or adults, with autism at this time. However, decisions about the use of SSRIs for co-occurring obsessive-compulsive disorder, aggression, anxiety or depression in individuals with autism should be made on a case by case basis." It is possible that in some cases autistic individuals, particularly those who have conditions such as anxiety or depression that may warrant SSRI use, may benefit from these drugs.
An outdated hypothesis of yore posited bad parenting (specifically cold, unloving parents; hence the comparison to refrigerators) as a cause of autism. This is now a discredited cause of autism, as it is now understood to be inborn and predominantly genetic. However, reactive attachment disorder in children, which can resemble autism, may be caused by unloving parents (though it has other potential causes too).
Leo Kanner blamed parents for autism as early as 1943, claiming that autism was caused by a "genuine lack of maternal warmth." He concluded that mothers just needed to be more affectionate. Bruno Bettleheim popularized the refrigerator mother theory in the 1950s and 1960s. His book The Empty Fortress: Infantile Autism and the Birth of the Self introduced the idea of the refrigerator mother (and plenty of other autism-related nonsense) to the general population. Bernard Rimland, a psychologist with an autistic son and the founder of the Autism Research Institute, criticized the idea of the refrigerator mother in 1964. By the 1970s, the idea fell from popularity.
“”If I use anti-virus on my computer will it get autism?
Because all the stigma and fearmongering about autism, parents of autistic children may feel desperate and hopeless. This makes them prime targets for the pseudoscience and alternative medicine communities. These individuals primarily prey on the parents of autistic children and make a fortune peddling false cures and therapies, including chelation therapy and lupron therapy. As with most alternative therapy, the results and effectiveness are not scientifically verified. Some therapies such as chelation and specialized diets can in fact be harmful.
“”I don’t like the idea of comparing autism to a cancer that requires a sort of educational chemotherapy. These charlatans and sharks circling round a vulnerable group of people throwing random science at it and then peddling it like snake oil over the fence.
|—Chris Pakham, autistic presenter and naturalist|
People who are told by the "establishment" that there is no hope are prime for manipulation. Parents of autistic children are in just such a category. The internet is full of worst-case scenarios and outright lies that lead people to believe that autism is way scarier than it actually is. Some parents end up desperate, helpless and clueless about how to help their children. They may then fall victim to the people who use them as a vehicle to push an anti-vaccination agenda.
Autism itself carries several things with it that make it more susceptible to cranks and quacks. Autism usually doesn't manifest itself in detectable symptoms until after the first year of life. This means many parents believe their child was totally "normal" and then, at around one year of age, suddenly changed. While this sometimes (but rarely) happens, the perception is real. The subtlety of this is lost on most people who search for the cause of the "change," and instead of looking at the beginning of development, they look for things that occurred right around the time of diagnosis. There are plenty of things that happen around the first year of life, and this leads many people to make the jump from correlation to causation.
Myths of an autism epidemic make it easier for quacks to claim that their issue is the cause.
All of this combines to lead people to believe there is an increasing "epidemic" of autism and that it's being caused by an external environmental toxin that the children are exposed to around their first year. None of this is true; our understanding of what autism is and how it emerges is increasing exponentially. Autism tends to run in families and is most likely strongly or completely based in genetics.
Applied behavior analysis
Applied behavior analysis (ABA) is a controversial, abusive, and pseudoscientific therapy involving rewards and punishments to influence a person's behavior. It is the most common therapy recommended for autistic children, in large part due to influential lobbyists and dedicated advertising campaigns.
Proponents of ABA argue that it has a solid evidence base. Use of ABA-based therapies early in life has been somewhat linked to improved language skills, social behaviour and academic performance in some autistic children, and there have been several alleged success stories of children who were greatly helped by ABA therapists.
On the other hand, critics of ABA, particularly in the Autism rights movement, have stated that ABA therapy is physically and emotionally damaging, especially if done in a improper manner. More extreme forms of ABA, such as using electric shocks and physical restraints as punishments and withholding food and water, are egregiously abusive, while other forms of ABA are less extreme, but still involve coercive and abusive tactics such as demanding total compliance under the threat of violence and wrongly teaching autistic children to bottle up stress and emotions instead of freely expressing their concerns. One study has revealed that exposure to ABA significantly increases a child's risk of developing PTSD, depression, and suicidal behaviour, a concern that many autistic people and their parents have been voicing as individuals, while other researchers have called the entire evidence rationale of ABA into question. As a result, many people have started advocating a shift away from forced compliance-based therapy, and towards support with issues like emotion regulation and social anxiety.
False therapies and cures
- Applied behavior analysis
- Facilitated communication
- Chelation therapy
- Lupron therapy
- Miracle Mineral Supplement
- Vibroacoustic therapy
- Holding therapy, a bizarre and
potentiallyinhumane "therapy". A child's caregiver holds the child down with the intention of causing a fit of rage.(!!!)
- Omega-3 fatty acids
- Mark and David Geier
- Rashid Buttar
- Robert Kennedy, Jr.
- Andrew Wakefield
- Autism Speaks
- CDC whistleblower controversy - William W. Thompson (the "whistleblower" who probably just gave way to pressure) and Brian Hooker (the incompetent epidemiologist)
Autistic people may benefit from therapies to help them live healthier and happier lives. The National Autistic Society recommends the SPELL and TEACCH approaches to help autistic people. Counselling may also help with co-occurring mental health problems like anxiety or depression. Because every autistic person has different needs, different people benefit from different therapies. Some autistics may also benefit from CBT treatment.
Some autistic people have difficulty speaking, and may be taught to use augmentative and alternative communication (AAC) to help with communication. This can include Picture Exchange Communication Systems (PECS), sign language, and use of tablets or computers for typing.
Some autistic people may benefit from medication. Pharmacotherapy with antipsychotics is well-documented to be effective, but only in particularly severe and self-destructive forms of autism. Antipsychotic medication such as Risperidone (Risperdal) and Aripiprazole (Abilify) are approved by the FDA for severe autism with uncontrollable aggression. Patients treated with either show reduced irritability, aggression and other antisocial behaviours, although many people have voiced concerns over the dangerous side effects of antipsychotic medication, along with incidents of unnecessary prescription of Risperidone to autistic children in an attempt to "cure" autism. Many autistic people benefit from over-the-counter melatonin as a sleep aid, and medication for anxiety or depression if they have it.
Savant syndrome (formerly known as "idiot savant syndrome") describes a person who has exceptional ability in one specialised field, with reduced ability in others. Only about half of all savants are actually autistic; the savant who inspired Rain Man, unlike the character, had an entirely unrelated disorder called FG syndrome.
Common savant skills include mental arithmetic, music, chess, memory (often photographic or eidetic) of life events or trivia, and art. One autistic artist describes her skill as instinctive.
Despite the fact that many savants appear in the media, some researchers estimate that only around 1 in 10 autistic people have savant skills. although this is highly contested in the scientific community, with other sources citing that only 1 in 200 autistic cases having savants skills or even less.
Autism and gender variance
There has been correlation (though not causation) established between an autism diagnosis and gender variance. Autistic people are over 7 times more likely to identify as transgender or nonbinary.
Some have speculated that those assigned female at birth (i.e. transgender men) and who are autistic will identify as such due to autism being a manifestation of the “extreme male brain.” The “extreme male brain” theory has been disregarded in recent years and would not account for autistic transgender women nor for truly neurotypical men assigned either gender at birth.
Autistic people tend to be nonconformist, and are less susceptible to peer pressure, meaning they are less likely to abuse drugs and alcohol as often as their neurotypical counterparts. This might encourage them to openly embrace their identity instead of staying in the closet.
- Autism rights movement - People who see autism not as an illness, but as a difference to be valued and supported
- Autism Speaks - A huge charity notorious for using scare tactics to earn money
- Autism omnibus trial - A trial that settled thousands of lawsuits over vaccines supposedly causing autism
- Rapid prompting method
- Indigo child
- Opposing Views: Are Autism and Vaccines Linked?
- Is There an Autism Epidemic? - Dr Steven Novella discusses the confounding variables when trying to claim that autism rates are on the rise.
- Research Autism: Evaluations of different autism therapies and treatments
- ↑ "How History Forgot the Woman Who Defined Autism". November 10, 2018.
- ↑ "What Are The Characteristics Of A Person With Asperger’s?". April 17, 2020.
- ↑ Sheffer, Edith (March 31, 2018). "The Nazi History behind "Asperger"".
- ↑ Autism aging - Gerontology & Geriatrics Education
- ↑ Autism in women 'significantly under-diagnosed'
- ↑ https://www.npr.org/sections/health-shots/2017/07/31/539123377/social-camouflage-may-lead-to-underdiagnosis-of-autism-in-girls 'Social Camouflage' May Lead To Underdiagnosis Of Autism In Girls]
- ↑ Children of Color and Autism: Too Little, Too Late
- ↑ ASAN Statement on 2018 CDC Prevalence Data
- ↑ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4940003/
- ↑ On the Diagnosis and Misdiagnosis of Autism Spectrum Disorder
- ↑ Organization for Autism Research: Accepting Others' Experiences
- ↑ The misnomer of 'high functioning autism': Intelligence is an imprecise predictor of functional abilities at diagnosis
- ↑ NIH - Baby teeth link autism and heavy metals, NIH study suggests
- ↑ 
- ↑ Fever During Pregnancy Tied to Autism in Study
- ↑ "Things That Cause Autism" (satire)
- ↑ This Just In ... Being Alive Linked to Autism
- ↑ Emily Willingham, PETA: Milk Linked To Scary Autism And Vegan Is Your Only Hope, Forbes, May 28, 2014
- ↑ I don't want to be 'cured' of autism, thanks
- ↑ Prenatal inflammation linked to autism risk, NIH
- ↑ Prenatal BPA exposure may contribute to the male bias of autism spectrum disorder, Science Daily
- ↑ Autism spectrum disorders and bisphenol A: Is serotonin the lacking link in the chain?, NIH
- ↑ An endocrine disrupting chemical, bisphenol A: could it be associated with sex differentiation in brain regarding to transsexuality? Endocrine Abstracts
- ↑ MSN - Study: Chromosome Change Points to Autism
- ↑ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2978962/
- ↑ Autism: Epidemic or Explosion? (And Why It Matters)
- ↑ Large Swedish study casts doubt on autism 'epidemic'
- ↑ The Real Reasons Autism Rates Are Up in the U.S.
- ↑ A Lost Generation: Growing Up with Autism Before the "Epidemic"
- ↑ The CDC just announced one in 59 children are autistic. Here's why that's not evidence of an epidemic.
- ↑ ASAN Statement on 2018 CDC Prevalence Data
- ↑ 5 Simple Reasons it Seems Like Everyone is Autistic Nowadays
- ↑ http://www.wired.com/wired/archive/9.12/aspergers_pr.html
- ↑ Retracted autism study an 'elaborate fraud,' British journal finds
- ↑ The Vaccine-Autism Myth Started 20 Years Ago. Here's Why It Still Endures Today
- ↑ Cohen-Rottenberg, R. (2013, January 18). Ableism in the Anti-Vaccination Movement: A Qualitative Content Analysis of the Great Mothers Facebook Page. Disability and Representation: Changing the Cultural Conversation.
- ↑ I’m Autistic, And Believe Me, It’s A Lot Better Than Measles
- ↑ The Effects of Stigmatizing Language on Suicidal Autistics
- ↑ Here’s How the Anti-Vaccination Movement Hurts Autistic People
- ↑ Katie McCarron - Not Dead Yet
- ↑ Drake, S. (2002). Mercy! Here we go again. Ragged Edge.
- ↑ Sobsey, D. (2001, March). Why we shouldn’t blame the murders of disabled kids on lousy services. Not Dead Yet.
- ↑ Rundle, D. P. (2006, April 23). Look for Annie, Abuse. The Wichita Eagle.
- ↑ Drake, S. (2002). From 'mercy killing' to 'domestic violence': Shirley Harrison, the Chicago Media and Not Dead Yet. Ragged Edge.
- ↑ The panic du jour: Antidepressants and autism - The Incidental Economist
- ↑ Prenatal antidepressant exposure is associated with risk for attention-deficit hyperactivity disorder but not autism spectrum disorder in a large health system.
- ↑ Pregnancy Complications Following Prenatal Exposure to SSRIs or Maternal Psychiatric Disorders: Results From Population-Based National Register Data.
- ↑ https://www.livescience.com/8457-study-antidepressants-autistic-children.html
- ↑ https://www.scientificamerican.com/article/autisms-drug-problem/
- ↑ Docs: Autism Starts in the 2nd Trimester of Pregnancy
- ↑ Autism mostly caused by genetics, study finds — Disability Scoop
- ↑ From Disorders of Affect to Mindblindness: Framing the History of Autism Spectrum Disorders (search "reactive attachment" for the relevant paragraph)
- ↑ DSM-5 Criteria for Reactive Attachment Disorder (RAD) The California Evidence-Based Clearinghouse for Child Welfare
- ↑ 54.0 54.1 54.2 The "Refrigerator Mother" Hypothesis of Autism - Autism Watch
- ↑ 55.0 55.1 Why "Refrigerator" Mothers Were Blamed For Autism - Very Well Health
- ↑ https://www.reddit.com/r/shittyaskscience/comments/35p34d/if_i_use_antivirus_on_my_computer_will_it_get/
- ↑ The Dangers of Snake-Oil Treatments for Autism
- ↑ Why are we still treating autism like an epidemic?
- ↑ Chris Packham on living with Asperger's: 'I’ve spent 30 years on the telly trying my best to act normal'
- ↑ Autistic Dreams: Autism and False Prophecies of Doom
- ↑ http://www.independent.co.uk/news/world/americas/us-politics/donald-trump-autism-anti-vaccination-vaxxer-myth-injection-health-campaigners-a7580941.html
- ↑ Myers, S.M.; Johnson, C.P.; Council on Children with Disabilities (2007). Management of children with autism spectrum disorders. Pediatrics.
- ↑ Cohen H, Amerine-Dickens M, Smith T. Early intensive behavioral treatment: replication of the UCLA model in a community setting. J Dev Behav Pediatr.2006;27(2 suppl) :S145– S155
- ↑ Eikeseth S, Smith T, Jahr E, Eldevik S. Intensive behavioral treatment at school for 4- to 7-year-old children with autism: a 1-year comparison controlled study. Behav Modif.2002;26 :49– 68
- ↑ Lovaas OI. Behavioral treatment and normal educational and intellectual functioning in young autistic children. J Consult Clin Psychol.1987;55 :3– 9
- ↑ Invisible Abuse: ABA and the things only autistic people can see
- ↑ Evidence of increased PTSD symptoms in autistics exposed to applied behavior analysis
- ↑ "ABA" by Maxfield Sparrow
- ↑ Thinking Person's Guide to Autism: Quiet Hands
- ↑ Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD)
- ↑ Thinking Person's Guide to Autism: The Cost of Compliance Is Unreasonable
- ↑ Compliance is not the goal: Letting go of control and rethinking support for autistic individuals (TED talk by Amy Laurent)
- ↑ http://bigthink.com/neurobonkers/blowing-the-whistle-on-institutionalised-child-abuse-in-the-uk
- ↑ Strategies and Approaches
- ↑ Lisa Westona, Joanne Hodgekins, Peter E.Langdon Effectiveness of cognitive behavioural therapy with people who have autistic spectrum disorders: A systematic review and meta-analysis Elsevier.2016;11 :41– 54
- ↑ Debbie Spain & Francesca Happé How to Optimise Cognitive Behaviour Therapy (CBT) for People with Autism Spectrum Disorders (ASD): A Delphi Study Journal of Rational-Emotive & Cognitive-Behavior Therapy.2019;12 :184– 208
- ↑ Antipsychotics in the treatment of autism. David J. Posey, Kimberly A. Stigler, Craig A. Erickson, and Christopher J. McDougle, 2008
- ↑ Raising Children: Melatonin
- ↑ Looking For A Diagnosis: My Art And Savant Syndrome - The Art of Autism
- ↑ Research: Autistic Savants
- ↑  - The savant syndrome: an extraordinary condition. A synopsis: past, present, future]
- ↑ The Link Between Autism and Trans Identity
- ↑ https://www.spectrumnews.org/news/study-strengthens-autisms-curious-link-gender-variance
- ↑ Children With Autism May Not Cave To Peer Pressure Like Non-Autistic Kids, Study Finds (the study involves an obvious optical illusion though)
- ↑ A Disproportionate Number of Autistic Youth Are Transgender. Why?
- ↑ Finn V. Gratton (12 October 2019). "Working with Families". Supporting Transgender Autistic Youth and Adults: A Guide for Professionals and Families. Jessica Kingsley Publishers. p. 110. ISBN 978-1-78450-830-2.