When Romana Ingram came out as transgender to her parents, her mother cried: “That’s just not how we see you,” they told her. Wearing her sister’s hand-me-downs or changing her pronouns were out of the question.
Romana was 16. Now she’s 20 and fighting her parents in court.
Earlier this year, they brought an application in the Ontario Superior Court of Justice under the Substitute Decisions Act to take away Romana’s power to make her own decisions about her life, medical care, and gender expression.
Romana has Asperger’s Syndrome, a diagnosis historically understood to be a milder or higher-functioning form of autism but which has since been replaced by the umbrella diagnosis of autism spectrum disorder (ASD). She experiences light and sound sensitivities that require her to regulate her environment through noise-cancelling headphones and light dimmers. She also struggles with social awkwardness and social cues, and uses “self-stimulatory behaviour” like pacing and hand-flapping as a way of regulating her emotions.
But her disability doesn’t mean she should be legally prevented from deciding who she is.
The connection between ASD and gender dysphoria
Gender dysphoria—the distress some people experience because their felt gender differs from the sex they were assigned at birth (e.g., male or female)—is more common amongst those with ASD than amongst the general population.
Much of the research into the correlation between gender dysphoria and ASD has focused on children, but the evidence for this correlation has established a medical consensus. For instance, one particularly large study published in 2021 found that “transgender and gender-diverse individuals were 3.03 to 6.36 times as likely to be autistic [as] cisgender individuals.” These results were consistent with those of prior, smaller studies.
The practical implications of such research are profound.
The best care for those seeking transition-related care will often be intersectional, taking into account both a patient’s dysphoria and their ASD. For dysphoric individuals on the autism spectrum, moreover, the studies normalize their experience of double minoritization: that is, simultaneously identifying as members of two marginalized groups, the trans and the autistic communities.
In the hands of those opposed to transgender rights, however, research into the connection between gender dysphoria and ASD has become a weapon. And that’s a problem.
How anti-trans activists weaponize ASD
Correlation doesn’t imply causation—unless, apparently, you’re arguing against transgender rights.
For years, anti-trans activists have been spinning the line that ASD either causes gender dysphoria or leaves those on the spectrum uniquely vulnerable to the “transgender contagion.”
The argument is simple. Symptoms of ASD may include intense interests from which the person is unable to independently disengage; while the interpersonal aspects of ASD, such as difficulties interpreting nonverbal cues, may lead an autistic person to experience social anxiety and rejection. Wanting to transition might just be another one of these fixations—a fixation, moreover, that supposedly provides the autistic person with a degree of social acceptance.
Here as elsewhere in the debate over trans rights, gender-diverse children are centre stage.
Take Abigail Shrier’s piece on the transgender movement’s supposed threat to parental authority, published last year. There she bluntly suggests that “introducing gender ideology to [autistic] kids who tend to fixate is like introducing cocaine to those susceptible to addiction.” Shrier, of course, is the author of Irreversible Damage, a book widely criticized for stoking anti-trans sentiments.
Toronto child psychiatrist Susan Bradley is quoted in the same piece agreeing with Shrier’s suggestion, going on to explain that transitioning “has the same power to assuage all the alienation and grief and distress that [children with ASD] have been struggling with.” Bradley herself authored a commentary for the National Post in 2017 that alleged trans activists are “recruiting” autistic children to the transgender movement, apparently by preying on their failures to fit in with their peers.
Such arguments would be problematic in isolation. But they’re finding traction with more than just anti-trans activists themselves.
One example — the open letter from a concerned Canadian mother anonymously published in the transphobic forum Canadian Gender Report near the start of the pandemic.
The mother cancelled her 17-year-old child’s appointment at an endocrinology clinic, where her child planned to begin gender-affirming testosterone shots, because she and her husband “did not agree with the psychologist and the endocrinologist that [their] child was able to give informed consent.” Instead, she put her child in the queue for an ASD screening, which resulted in an autism diagnosis. Three years after the cancelled appointment, her child “is comfortable identifying with her biological sex,” the gender dysphoria having “resolved,” in the mother’s view, “because it is secondary to another condition.” Now she’s writing to an unspecified minister arguing that what Canada needs is better screening measures to ensure only those without conditions like ASD receive gender-affirming care and parents are allowed “to freely express their reasonable inquiries and concerns without fear of being accused of being negligent or abusive caregivers.”
Anti-trans activists are raising the alarm about the connection between ASD and gender dysphoria—transphobic parents are listening, and their children are bearing the consequences.
In Canada, there’s no equal right to decide
These arguments might not be new. But if the arguments haven’t changed over the years, neither have positive changes occurred to protect those most vulnerable to having the arguments used against them.
The problem is Canada’s guardianship laws, which allow the parents of disabled adults to seek the legal authority to make decisions about their children’s lives without their children’s consent.
One such law is Ontario’s Substitute Decisions Act.
Under it, every adult is presumed to be capable of making their own decisions about, among other things, their medical treatment. At the same time, anyone may request a formal assessment of any person’s decision-making capacity. That assessment asks whether the person in question is able “to understand information that is relevant to” decisions about their health care and can “appreciate the reasonably foreseeable consequences of a decision.” If a capacity assessor finds the person lacks this capacity, the Act allows a court to appoint someone like a blood relative to make decisions on the person’s behalf. When this happens, the person appointed becomes the disabled person’s “guardian.”
Disability rights groups have been organizing against guardianship laws like the Substitute Decisions Act for some time now.
Inclusion Canada is a national federation of organizations working for the full equality of persons with intellectual disabilities. They have been calling for an “equal right to decide” under which every person’s decision-making autonomy is respected: even if that autonomy must be exercised with the support of others, as is the case for some disabled persons. In other words, no one’s right to make decisions about their life would ever be fully taken away through court-imposed guardianship.
Everyone would have the power to build the life they want.
Disability rights are LGBTQ+ rights
Implementing this policy proposal and repealing or significantly amending Canada’s guardianship laws is a disability rights issue first and foremost. But it’s also a key issue for the LGBTQ+ community, as activists are increasingly recognizing.
The Autistic Self Advocacy Network (ASAN) is an American disability rights organization working to secure “equal access, rights, and opportunities” for autistic people. They have documented the use of guardianship laws to prevent transgender autistic people from accessing gender-affirming medical and transition-related care. “Autistic people,” ASAN found as far back as 2016, “are too often placed under guardianships, warehoused in institutions, or forced to depend on coercive or abusive caregivers, which can curtail their ability to make decisions about their own lives…some autistic people delay coming out or transitioning out of fear that unsupportive family members will place them under guardianships or force them into institutions in order to prevent them from living according to their gender.”
As Romana Ingram’s legal fight illustrates, these fears have merit on this side of the border.
So long as anti-trans activists continue pointing to the connection between ASD and gender dysphoria as a reason not to let autistic people transition, the risk that guardianship laws will be weaponized against transgender autistic people will remain acute.
That would be a problem even if the only people who suffered were autistic people themselves. But so long as anyone can request a capacity assessment of anyone, transphobic parents will be able to use the guardianship laws to try and prevent their adult children from transitioning even if those children are not neurodivergent.
In other words, guardianship laws like Ontario’s are a potential legal threat to every trans person’s ability to access gender-affirming care. Every trans person and every one of our allies should consequently take note.
The cost of fighting for your rights
The lawyer Romana’s parents chose to represent them has a questionable ethical background. Kenneth Pope advertises himself as “one of the most trusted advisors in Ontario providing solutions to families with a family member with a disability.” However, in 2016 Ontario’s Law Society fined him for having “deprived his clients, possibly vulnerable, or under disability, of funds [he held in trust] for which they likely had significant need, for a period of thirteen years.”
Dan Silver, one of the two capacity assessors Romana’s parents are relying upon to establish their daughter’s incapacity, advertises himself as someone who “won’t shy away from politically incorrect responses.” And, indeed, both his report and the parents’ guardianship application more generally deadname and misgender Romana throughout.
There are costs to fighting for your right to self-determination. To be sure, these include the legal expenses that go with defending yourself in court, which are not inconsiderable. But they also include the emotional and psychological costs of having a core element of who you are—your gender—questioned and potentially even denied by others: members of the legal profession, ethically compromised and otherwise; professional guardianship assessors who might show no respect for who you are; and potentially even those closest to you.
The latter costs are significant in their own right because what you are fighting is a kind of abusive coercion.
The seminal work on the traumatic impact of such coercion remains Judith Herman’s book Trauma and Recovery. She notes that when a person is dependent upon their guardian for the most basic things, above all the power to make decisions about who they are, the result is a form of captivity not unlike imprisonment. In such conditions, people lose their sense of self because who they are becomes entirely a matter of who their guardian says they are.
When an individual fights for self-determination, in other words, what they are ultimately fighting for is their right to be themselves—as a person independent of whoever would take that right away.
Nothing less is at stake in guardianship disputes.
It’s time to repeal Canada’s guardianship laws
Romana told me via email that she understands what her parents are doing, but that, mostly, she just wants to move on with her life.
While she was still living with them, her parents frequently brought up the connection between ASD and gender dysphoria. “It was part of the whole narrative they used about them being the sort of people who had the experience needed in order to judge ‘what made sense,’” Romana explains, “and how that meant [her gender dysphoria] wasn’t as real as I said it was.” Her parents even went so far as to suggest that Romana’s autism “‘made’ [her] trans in a way that was kind of implied to be illusory.”
At the end of the day, however, being neuro-typical shouldn’t be a license to tell an autistic woman like Romana who she really is any more than being cisgender should be a license to tell trans women who they really are. Gender affirmation isn’t just for the able-bodied, and trans people—disabled or not—shouldn’t have to go to court to prove this fact.
But the only way to make sure transphobic parents don’t use guardianship laws to try and coerce their adult trans children into being cisgender is to make those laws a thing of the past. Both the disabled and the LGBTQ+ communities need to come together to repeal them.
Nothing less is necessary to build a truly trans- and neuro-inclusive society.
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Nick Seebruch, editor
