Autism Diagnostic Assessments for Gender-Diverse Individuals: A Modified Delphi Study of Clinician Experts in the Fields of Autism and Gender Diversity

Objective: There is limited evidence-based guidance about how autism diagnostic assessments should be conducted for gender-diverse people. This study aimed to integrate expert knowledge on key clinical considerations for these assessments. Method: A modified Delphi study was conducted. World experts in the field (N = 21) were invited to complete 2 rounds of surveys. Survey one collected open-text responses about key clinical considerations when conducting diagnostic assessments, structured around the DSM-5-TR criteria for autism, across age ranges. Experts were asked to rate the importance of each consideration they listed. A content analysis was conducted to synthesize and collate similar considerations, alongside descriptive statistics of importance ratings. Survey two presented the resulting considerations and mean importance ratings, with experts rerating their importance. Statements rated as at least “important” and that had an SD of less than 1.0 were reported. Results: Round one resulted in 65 individual statements, of which 37 met our definition for reporting. These statements, summarizing expert opinions, were categorized as being general considerations for assessments, linked to the DSM-5-TR autism criteria (A-E), or practical considerations for working with the gender-diverse population. They highlighted areas to be considered during assessments, such as ways in which the features of autism may intersect with gender diversity, and practical considerations for increasing comfort and engagement of gender-diverse individuals undergoing an autism assessment. Conclusion: The summary of expert opinions provides preliminary considerations for clinicians working in this field and for researchers to use as hypotheses for empirical investigations.