NESCA is currently accepting Therapy and Executive Function Coaching clients from middle school-age through adulthood with Therapist/Executive Function Coach/Parent Coach Carly Loureiro, MSW, LCSW. Carly specializes in the ASD population and also sees individuals who are highly anxious, depressed, or suffer with low self-esteem. She also offers parent coaching and family sessions when needed. For more information or to schedule appointments, please complete our Intake Form.

Tag

transgender

48

Correct Pronoun Use Saves Lives

By | NESCA Notes 2024

By: Kelley Challen, Ed.M., CAS
Director of Transition Services, NESCA

Let me explain…

For anyone who is working with children, teenagers, or young adults in 2024, there is no question that we are working with more openly transgender and nonbinary youth than we were in 2004. Because of this, NESCA recently held a staff seminar led by Dr. Sebastian Barr, speaking about the Psychosocial Wellbeing of Trans & Nonbinary Youth.

As Dr. Barr eloquently identified, “more people are recognizing their trans and nonbinary identities earlier in life.” These youth “have more unique needs” and are “more likely to struggle and need services.” But, for most of us working in education or health care, our academic experiences taught us very little, if anything, about supporting trans and nonbinary youth. Fortunately, in current times, there is research and publishing around this topic. And I was lucky to be able to absorb some of that research in just 75-minutes listening to Dr. Barr.

I learn well in lectures, and there is a lot that will stick with me from the presentation, but the most impactful point made was that “correct pronouns are suicide prevention.” If we care about kids and people, we should do whatever work we need to ourselves in order to learn and use correct pronouns. Trans and nonbinary individuals, especially teens and young adults, are at much greater risk of experiencing mental health issues, and suicidal thinking. There are many studies identifying factors associated with this risk such as bias, non-affirmation, exclusion, marginalization, trauma, etc. Fortunately, there are also studies identifying protective factors that are associated with wellbeing. Some of these variables include:

  • Parental and sibling acceptance
  • General affirmation of gender, like correct pronoun use
  • Access to competent medical support
  • Community support

Importantly, research from the Trevor Project, indicates that “transgender and nonbinary youth who reported having pronouns respected by all or most of the people in their lives attempted suicide at half the rate of those who did not have their pronouns respected.” *

This is why Dr. Barr indicated that many people in the field will say “correct pronouns are suicide prevention.” He emphasized that if you do make a mistake, you should “correct it quickly, not draw attention, and practice so you don’t repeat the mistake multiple times.”

I am not sharing this with any interest in getting into a debate about feelings or beliefs. I am sharing this in hopes that someone reads this, finds it useful in their parenting or professional work, and makes an effort to use correct pronouns in order to potentially save a life.

Resources:

If you want more information about Dr. Barr or his work, you can visit: https://www.sebastianmitchellbarr.com/

To download a Pronoun Fact Sheet from the @American Psychological Association, you can click here: https://www.apadivisions.org/division-44/resources/pronouns-fact-sheet.pdf

*For more information and data regarding #LGBTQ Youth Mental Health, check out the National Survey on LGBTQ Youth Mental Health 2020: https://www.thetrevorproject.org/survey-2020/

 

About the Author
Kelley Challen, Ed.M., CAS, is an expert transition specialist and national speaker who has been engaged in evaluation, development, and direction of transition-focused programming for teenagers and young adults with a wide array of developmental and learning abilities since 2004. While Ms. Challen has special expertise in working with youth with autism, she enjoys working with students with a range of cognitive, learning, communication, social, emotional and/or behavioral needs.

Ms. Challen joined NESCA as Director of Transition Services in 2013. She believes that the transition to postsecondary adulthood activities such as learning, living, and working is an ongoing process–and that there is no age too early or too late to begin planning. Moreover, any transition plan should be person-centered, individualized and include steps beyond the completion of secondary school.

Through her role at NESCA, Ms. Challen provides a wide array of services including individualized transition assessment, planning, consultation, training, and program development services, as well as pre-college coaching. She is particularly skilled in providing transition assessment and consultation aimed at determining optimal timing for a student’s transition to college, technical training, adult learning, and/or employment as well as identifying and developing appropriate programs and services necessary for minimizing critical skill gaps.

Ms. Challen is one of the only professionals in New England who specializes in assisting families in selecting or developing programming as a steppingstone between special education and college participation and has a unique understanding of local postgraduate, pre-college, college support, college transition, postsecondary transition, and 18-22 programs. She is additionally familiar with a great number of approved high school and postsecondary special education placements for students from Massachusetts including public, collaborative, and private programs.

Ms. Challen enjoys the creative and collaborative problem-solving process necessary for successfully transitioning students with complex profiles toward independent adulthood. As such, she is regularly engaged in IEP Team Meetings, program consultations, and case management or student coaching as part of individualized post-12th grade programming. Moreover, she continually works to enhance and expand NESCA’s service offerings in order to meet the growing needs of the families, schools and communities we serve.

When appropriate, Ms. Challen has additionally provided expert witness testimony for families and school districts engaged in due process hearings or engaged in legal proceedings centering on transition assessment, services and/or programming—locally and nationally.

Nearly two decades ago, Ms. Challen began her work with youth with special needs working as a counselor for children and adolescents at Camp Good Times, a former program of Milestones Day School. She then spent several years at the Aspire Program (a Mass General for Children program; formerly YouthCare) where she founded an array of social, life and career skill development programs for teens and young adults with Asperger’s Syndrome and related profiles. Also, she worked at the Northeast Arc as Program Director for the Spotlight Program, a drama-based social pragmatics program, serving youth with a wide range of diagnoses and collaborating with several school districts to design in-house social skill and transition programs.

Ms. Challen received her Master’s Degree and Certificate of Advanced Graduate Study in Risk and Prevention Counseling from the Harvard University Graduate School of Education. While training and obtaining certification as a school guidance counselor, she completed her practicum work at Boston Latin School focusing on competitive college counseling.

Ms. Challen has worked on multiple committees involved in the Massachusetts DESE IEP Improvement Project, served as a Mentor for the Transition Leadership Program at UMass Boston, participated as a member of B-SET Boston Workforce Development Task Force, been an ongoing member of the Program Committee for the Association for Autism and Neurodiversity (AANE), and is a member of the New Hampshire Transition State Community of Practice (COP).

She is also co-author of the chapter, “Technologies to Support Interventions for Social-Emotional Intelligence, Self-Awareness, Personality Style, and Self-Regulation,” for the book Technology Tools for Students with Autism: Innovations that Enhance Independence and Learning.

To schedule an appointment with one of NESCA’s transition specialists, please complete our online intake form. 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; the greater Burlington, Vermont region; and Brooklyn, NY (coaching services only) serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

8

Double Rainbow: The Intersectionality of Autism Spectrum Disorders and gender variance

By | NESCA Notes 2018

By: Jacquelyn Reinert, Psy.D., LMHC
Pediatric Neuropsychologist, NESCA

“Transgender and autism, that’s not a thing, is it?” Since joining NESCA last September, I have encountered countless parents, teachers, and professionals who ask this exact question in feedback sessions, case consultations, and team meetings. The conversation that typically follows often calls into question the validity of the intersectionality of Autism Spectrum Disorder (ASD), Asperger Syndrome, and trans-identities and gender variance, as well as that of sexual orientation.

ASD is a neurodevelopmental disorder which impacts an individual’s communication, social interactions, play, interests, and behaviors. ASD presentations vary according to age, gender, and development. While functionally these communication and behavior patterns can assist clinicians to make diagnoses and inform interventions, we recognize that there can also be a stigma attached to diagnostic codes and labels. As such, we embrace an affirming stance, recognizing neurodiversity within the ASD community.

One commonly utilized phrase at NESCA is Stephen Shore’s quote, “If you have met a person with autism, then you have met one person with autism.” The same can be said for an individual who questions or is exploring their gender expression. There is a spectrum of gender diversity, ranging from gender non-conforming to non-binary, to transgender, and so on. The terminology and classifications within the community are fluid and ever-evolving, but for now, key terms are provided below. It is estimated that gender diverse youth may make up 5 to 12% of birth assigned females, and 2 to 6% of birth-assigned males; transgender youth, 0.5% (APA Fact Sheet). Of those, how many are also neurodiverse?

 

Key Terms*:

Courtesy of the Boston Children’s GeMS Clinic and the American Psychological Association

Sex: the biological category or identity that a person belongs to; based upon chromosomes, genetic makeup, and internal/external reproductive organs.

Gender identity: a person’s inner sense of oneself as either a woman (female), a man (male), or other/something different.

Gender expression: refers to the way in which we display our gender identity to other individuals and to the world around us.

Cisgender: a person whose gender identity and/or expression are aligned with the sex/gender that they were assigned at birth.

Non-binary: identifying as a gender other than exclusively female/woman or male/man.

Gender nonconforming, gender variant, or gender diverse: an individual who has a gender identity and/or gender expression that does not conform to the gender they were assigned at birth. They may prefer clothing, accessories, hair length/styles, and activities that are not expected in the culture based on their sex assigned at birth.

Transgender: individuals who typically consistently, persistently, and insistently express a cross-gender identity and feel that their gender is different from their assigned sex.

Gender dysphoria (GD): the distress an individual experiences when their assigned gender does not match their gender identity.

* In April, NESCA had the opportunity to meet with Dr. Kerry McGregor, Attending Psychologist at Boston Children’s Hospital in the Division of Endocrinology and Gender Management Service (GeMS) to learn more about the intersectionality of ASD and gender dysphoria and ways in which NESCA clinicians can provide gender affirmative care.

 

Emerging research suggests that indeed there is a relationship between gender variance and autism, although not without reservation and mixed approval. Researchers exploring the link between these spectrums suggest that gender variance is present in 5 to 7% of adolescents with ASD (Van Der Miesen, Hurley, & De Vries, 2016). Opponents suggest that the co-occurrence is merely a manifestation of restrictive, repetitive behavior, interests, and or activities, a hallmark symptom of ASD. Further, they suggest that due to the inherently negative experiences gender variant adolescents face, these individuals are more likely to demonstrate behaviors consistent with social impairments rather than a primary diagnosis of ASD (Turban & van Schalkwyk, 2018).

Regardless of whether a link is clearly identified at this point in time, individuals, families, clinicians, and communities are faced with navigating the complexities of the intersectionality of gender variance and ASD. Further, they face the complex dilemma of who to seek out should a child, adolescent, or family need support, guidance or targeted intervention to address gender dysphoria and other co-occurring challenges, such as anxiety and depression.

Where to start and what can families do to help?

  1. This is a marathon, not a sprint, and the race begins with balanced acceptance. Validating an individual’s disclosure with empathy and understanding is the first step in providing children and adolescents the space to begin exploration. Parents and caregivers should try to avoid either quick dismissal or accelerated enthusiasm. For many adolescents (gender variant, neurodiverse, or not), self-exploration is an essential part of growing up and being allowed a space with which to question and explore in a safe way is key.
  2. Be an advocate for your child or adolescent; ask questions and be curious. If adolescents are disclosing, be willing to have an open conversation. When you are unsure of what a term is, ask permission to clarify. Promoting a culture of acceptance and validation is essential.
  3. Not all challenges are central to either gender exploration or ASD. Navigating adolescence is difficult and although neurodiverse adolescents exploring gender expression may struggle, these concerns may be attributed to other emerging challenges. Parsing out typical adolescence and emerging mental health difficulties should be done in partnership with knowledgeable professionals who can thoroughly explore the issues.
  4. Be kind to yourselves and know that you will not have all the answers immediately. Parents and caregivers can often experience elevations in stress, particularly when outcomes are vague and without the opportunity to truly digest information. Resources provided below are initial starting points to learn more about gender variance, as well as the intersectionality with the neurodiverse community.
  5. Seek support for yourself. Parents and caregivers can benefit from working through concerns and worries, such as how other family members may react to an adolescent’s gender exploration. Working with an individual therapist or in a support group can be highly beneficial in providing the space for adults to process outside of the relationship with your child.
  6. Seek support for the child or adolescent. If your child is currently working with a mental health provider, working with an existing person in tandem with a gender specialist can be highly beneficial. One excellent area resource is Boston Children’s Gender Management Service (GeMS) Program which provides physical and psychological evaluations which inform individualized treatment plans for children. With a comprehensive plan, GeMS multi-disciplinary team can coordinate with existing providers (e.g., clinicians, primary care physicians) and can make referrals as needed. NESCA also has clinicians who provide a variety of services including individual therapy and neuropsychological and psychological evaluations and who are highly versed in the literature surrounding the intersectionality of neurodiversity and gender.

Resources

Books:
Gender Born, Gender Made by Diane Ehrensaft, Ph.D.

The Gender Creative Child: Pathways for Nurturing and Supporting Children by Diane Ehrensaft, Ph.D.

The Transgender Teen: A Handbook for Parents and Professionals Supporting Transgender and Non-Binary Teens by Stephanie Brill and Lisa Kenney

Support Groups:
AANE Gender Identity and the Autism Spectrum Support Group for Transgender Adults on the Spectrum (link: https://www.aane.org/event/gender-identity-autism-spectrum-support-group-transgender-adults-spectrum-13/)

Online Resources:
ASAN, NCTE, and LGBTQ Task Force Joint Statement on the Rights of Transgender and Gender Non-Conforming Autistic People (link: http://www.thetaskforce.org/wp-content/uploads/2016/06/joint_statement_trans_autistic_GNC_people.pdf)

Family Acceptance Project (link: http://familyproject.sfsu.edu/publications) Spectrum News – Living Between Genders (Link: https://www.spectrumnews.org/features/deep-dive/living-between-genders/)

Boston Children’s Gender Management Services (GeMS) Program (link: http://www.childrenshospital.org/centers-and-services/programs/a-_-e/disorders-of-sexual-development-dsd-and-gender-management-service-program

Sexual Orientation, Gender Identity, and Asperger/Autism by Jamie Freed, MSW for AANE
(link: https://www.aane.org/sexual-orientation-gender-identity-aspergerautism/)

 

About the Author: 

Dr. Reinert is a Pediatric Neuropsychology Postdoctoral Fellow who joined NESCA in September 2017. Dr. Reinert assists with neuropsychological and psychological (projective) assessments in the Newton office and in the Londonderry office. In addition to assisting with neuropsychological evaluations, Dr. Reinert co-facilitates parent-child groups and provides clinical consultation. Before joining NESCA Dr. Reinert worked in a variety of clinical settings, including therapeutic schools, residential treatment programs and in community mental health. She has comprehensive training in psychological assessment, conducting testing with children, adolescents, and transitional-aged adults with complex trauma. Dr. Reinert is particularly interested in researching the intersectionality of ASD and gender exploration.

Reach out if you would like to work with Dr. Reinert:  Email jreinert@nesca-newton.com

 

 

 

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.