Tejal Somvanshi
The NHS will soon require all children referred to gender clinics to be screened for autism and other neurodevelopmental conditions, according to new guidelines developed following the Cass Review. This significant change moves care away from a primarily medical approach toward a more comprehensive assessment model.
Children seeking support for gender dysphoria will undergo evaluations examining their mental health, family relationships, social development, and potential neurodevelopmental conditions before receiving specialized gender care. The new approach responds to research showing that young people with gender dysphoria have significantly higher rates of autism and ADHD than the general population.
“Given the high prevalence of neurodiversity identified within this population, all those attending the NHS Children and Young People’s Gender Service should receive screening for neurodevelopmental conditions,” states the soon-to-be-released guidance.
Health Minister Stephen Kinnock emphasized the need for individualized care: “Rather than taking a blanket position, it’s much more about really understanding the specific circumstances, because each case is very different.”
The new assessment framework will explore eight key areas of a child’s life, including development, mental health, family context, and sexual development. If screening identifies autism or other neurodevelopmental conditions, a referral to specialized services will be considered to determine whether symptoms relate to autism, gender dysphoria, or both.
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This shift follows the closure of the controversial Gender Identity Development Service at the Tavistock Centre, with new regional gender clinics being established in London and Manchester. The guidance has been reviewed by Lady Cass, whose independent review highlighted serious concerns about previous approaches to care.
Cases of both gender dysphoria and autism diagnoses have risen sharply in recent years. Recorded rates of gender confusion in under-18s increased from 0.14 per 10,000 people in 2011 to 4.4 per 10,000 in 2021, primarily among adolescent girls. During a similar period, autism diagnoses rose from approximately one in 2,500 children to one in 34 children aged 10-14.
Professor Michael Craig, former clinical lead for the NHS National Autism Unit, previously estimated that half of patients seen at the Tavistock clinic had autism. Lady Cass identified undiagnosed autism as a “common denominator” among teenage girls struggling with gender identity issues, noting research finding transgender people are three to six times more likely to be autistic than the general population.
The NHS has already changed referral pathways so children can only access gender services if referred by a paediatrician or child mental health worker. The draft guidance will soon undergo public consultation before implementation later this year.
Responses to the proposed changes have been mixed. The Clinical Advisory Network on Sex and Gender welcomed the “holistic approach and prioritisation of psychological interventions,” but expressed concern that the policy “leaves the door open for referral of children and young people under 18 for cross-sex hormones.”
A spokesperson for Bayswater Support Group, representing 600 families with trans-identifying children, said the more careful assessment was welcome but noted “there is still scant recognition of the environmental factors influencing children’s understanding of gender issues.”
The changes come after the UK government permanently banned puberty blockers for transgender youth, following the Cass Review’s finding that evidence for their benefits was “threadbare.” Currently, according to UK advocacy group TransActual, wait times for gender identity services range from approximately eight months to over eight years.
