Some of the world’s leading experts in transgender healthcare convened in San Francisco last week where they shared their knowledge about how non-verbal autistic youth can communicate their transgender identities through drawing, and told anecdotes about the severely autistic children and adolescents they have set on the medical sex change pathway.
Psychiatrist Dan Karasic delivered a talk titled "Managing patients with co-occurring mental health diagnoses" at the San Francisco Trans Health Summit pre-conference event on May 5, and in the audience was none other than Dr. Diane Ehrensaft, a leading figure in the field of child sex changes, who shared baffling anecdotes about non-verbal children expressing their gender identities.
In an audio recording of the talk obtained by The Post Millennial, Karasic can be heard asserting that severe autism should not prevent a person from being approved for an experimental medical sex change, dismissing the common concern of parents that a fixation on gender is due to the intense focus of interests typical of autism spectrum disorder (ASD), and engaging in the bizarre exchange of ideas with Ehrensaft about youth communicating their transgender identity through drawing.
Karasic was the lead author of the mental health chapter of the World Professional Association for Transgender Health (WPATH) Standards of Care 8.
Karasic began his talk by noting that autism spectrum disorder overlaps with gender dysphoria “more than expected, for reasons we don’t know.”
“Anyone who is doing gender work sees a lot of people with autism spectrum disorder,” he said, without showing any signs of curiosity as to why that might be.
Then came an acknowledgment of the difficulties faced by gender clinicians treating this complex group, which ranged from communication issues due to many of the patients being quite “verbally impaired” and many lacking a strong social support network.
But Karasic doesn’t see these issues as insurmountable. The verbally impaired will find ways to make their feelings known, he assured the audience and many ASD patients who don’t have a strong support network in real life actually have “pretty robust” online support networks.
Karasic stated that it is often the parents who present the biggest challenge, especially those who “attribute gender diversity or gender dysphoria to the intense focus on circumscribed interests in ASD.”
He called it “really astonishing” how many parents over the years, in cases “where it’s very clear the kid is trans," have convinced themselves that their child’s issues around gender dysphoria and gender expression are just obsessive interests related to ASD.
Then came a question from the audience regarding how to handle pushback from more senior individuals who question the validity of assessments performed on verbally impaired autistic youth seeking sex changes. The audience member confessed to often “accidentally getting on [her] high horse” in such instances.
Following a brief anecdote from Karasic about a 17-year-old severely autistic male patient who “is very clearly trans,” is benefiting from being on estrogen, and “if anything is just impatient for more feminization and wishes they had gotten treated earlier,” Ehrensaft makes her first contribution to the discussion.
Ehrensaft suggests that the problem in such cases is with the assessment requirements being “neuro-typically designed,” which was met with a murmur of agreement from the audience. She advises explaining that other measures were used to find out information about the patient, and “simply educate people that there are different ways of knowing.”
“We may have to depend on parents; we may have to depend on drawings,” said Ehrensaft.
“We can’t just say, ‘Well until you can be verbal and answer these questions as we have in this assessment packet, we can’t clear you.’ This is really discriminatory,” she added.
“It’s interesting that you mention drawing because this particular patient is able to draw her feelings better than to speak them, and enjoys drawing much more than speaking basically so I think that’s a good point,” replies Karasic.
Then Ehrensaft tells “a really sad story” about a severely autistic 8-year-old who was a patient at the UCSF Benioff Children’s Hospital gender clinic where Ehrensaft is director of mental health. Ehrensaft is on record saying that the clinic sees children as young as 2.
This child was non-verbal and had been diagnosed with severe autism at age 2. According to Ehrensaft, the only time the child spoke during the initial session was when the parents and grandmother referred to her using female pronouns, and the non-verbal, severely autistic child would correct them, saying “not she - he.”
The child was already in precocious puberty, so puberty blockers were administered, and the child was allowed to socially transition, and, remarkably, the child began to thrive, at least according to Ehrensaft's version of events. But then the parents decide to get an independent evaluation and found a psychologist who told them it was impossible for their child to be transgender because “on anatomically correct dolls, they could not distinguish that there was a boy doll and a girl doll based on genitalia.”
“So how could they know they are transgender?” The psychologist asked, leading to the parents deciding to detransition their severely autistic daughter.
Ehrensaft saw this as reason to keep doing this work and keep educating as many people as possible.
Mentioning anatomically correct dolls was an interesting choice for Ehrensaft, who before her involvement in the gender movement was involved in spreading the Satanic Panic, during which therapists inappropriately used anatomically correct dolls to guide children into fabricating wild accusations of extreme sexual abuse at the hands of Satanic cults.
But Ehrensaft is perhaps most famous for a 2016 talk in which she explains that pre-verbal children are capable of sending “gender messages” to signal their transgender identities. The examples she gives are of an infant boy pulling at the snaps of his onesie in order to “make a dress,” and a toddler girl pulling barrettes out of her hair as a way to demonstrate that she is a boy.
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