When Gender Dysphoria is Autism in Disguise

The doctors thought I had OCD. I thought I was a trans boy. In reality, I was a girl who had ADHD & undiagnosed autism. Part two.

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Recap & Roadmap

In my first essay, titled “The Misunderstood Autistic Girl to Trans Boy Pipeline” I described how I spent my childhood years and early adolescence consumed by the belief that something was deeply wrong with me. Those early years were defined by a mixture of developmental delays and giftedness, in a pattern which I often describe as high-functioning autism, hidden in plain sight.

My obsessive mental rituals and hair pulling—were misread as signs of moral anxiety and overachievement, rather than what they were: early markers of neurodivergence. I was diagnosed with OCD, but the diagnosis never fit. It explained my behavior only in fragments, but never in full. When I was 12, I stumbled upon the concept of gender dysphoria, it offered a framework that seemed to make more sense—it gave form to my alienation and a name to the strange, disembodied way I had always experienced myself. 

But what I couldn’t see then, and what no adult around me helped to uncover, was that my obsessive need for explanation, my rigid thinking, and my emotional overwhelm, my discomfort in my own body, were not evidence that I was trans—they were signs of something else entirely.

In this second essay of my autism in girls series, I’ll explore what happened after my gender identity declaration: the psychiatric involvement that followed, the much more accurate ADHD diagnosis I finally received, and my deepening obsession with autism—a fixation that came far closer to the truth of who I was than any clinical label I had been given before.

My ADHD diagnosis gave me so much clarity about the nature of my academic struggles, but still did not get to the core of my feelings of difference, and so it alone offered no competition to the transgender self-perception I had already adopted. By the end of this essay, I hope to underscore the importance of getting girls like me diagnosed with (level one) autism, the condition we actually have. I will do so by highlighting the many ways in which the “experts” get things wrong when assessing girls whose presentation of autistic and ADHD traits differ from the male-centric diagnostic criteria.

I also hope that parents of gifted and neurodivergent kids will see their children within my essays, through this series of vignettes from my adolescent years. Let me know how I do in the comments.

If you haven’t read the first essay in this series, please do so before continuing:

The IQ Test that Missed What Was Hidden in Plain Sight. (Age 13)

I traveled with my baby blanket, affectionately named “Quilty” until I was 17 and my relatives in Russia who were supposed to fix the worn quilt, made it totally unrecognizable and broke my heart.

My parents had spent my entire life trying to fix my every developmental glitch, shuffling me from one specialist and tutor to the next. At some point, they realized they’d have to tutor me themselves, because I could sit in class all day and absorb nothing unless it related to a subject I was obsessed with. By the summer between seventh and eighth grade, I had already been enrolled in four different schools—each one failing to meet my needs in some crucial way, or deciding I wasn’t progressing fast enough to keep up.

Despite their relentless efforts, I was still floundering. That’s when they decided to have me evaluated, shortly after I turned thirteen, with what turned out to be a seven-hour-long IQ test. I was given the option to split it over two days, but told my mom that if she got me a chocolate muffin and a bottle of Coke, I’d power through it in one. I was determined to prove something—not just to her or the evaluator, but to myself. I wanted evidence that I wasn’t broken. That I wasn’t, as I often feared, simply stupid.

Here are the results:

I had such a perplexing mix of strengths and weaknesses that the evaluator struggled to draw a clear conclusion. My verbal and abstract reasoning skills were in the very superior range—well above the 95th percentile—which meant I could make complex connections, use advanced vocabulary, and articulate ideas like someone much older. My reading and writing scores, too, reflected a kind of fluency and creativity that confirmed I wasn’t just imagining the flashes of brilliant excitement I felt as I strung precise, individual words into ornate quilted drafts.

But buried underneath these impressive scores were deep processing deficits: my visual-motor speed was in the 7th percentile, and my ability to switch attention, follow sequences, or respond quickly was startlingly low. It was as if the gears in my brain spun in different directions—some running on rocket fuel, others grinding under molasses.

My verbal intelligence couldn’t be properly scored because I beat a test designed to be impossible to finish. My reading comprehension was comparatively, strikingly low. You’d think that great writers would be voracious readers who would comprehend much more of what they read than I demonstrated on that test. But, no one paid particular attention to this peculiarity because reading comprehension was only comparatively low with my writing scores, but ultimately that score was still average. I had an average ability to comprehend texts I found to be not even remotely interesting, on a good day when I tried my hardest to score well. I had an extensive vocabulary because I harvested books for words to use, rather than to extract meaning or entertainment, and for this reason always preferred non-fiction. If someone had tried to look at the IQ test, not as a set of separate scores to identify weaknesses and strengths, but to figure out what the interplay between them might signify, they may have been able to get to the root of such a disparate set of gifts and deficits. They may have been able to see the autistic traits.

The results of this test, in retrospect, should have explained so much. Why I could speak like an adult but forget a teacher’s instructions halfway through. Why I could obsess over a rare brain tumor for hours, but struggle to finish math homework. Why I sometimes felt like both a genius and a complete idiot throughout the same day. The testing revealed what no teacher had been able to see: I wasn’t lazy or stupid, but a gifted kid with serious executive functioning issues—what would later be called twice-exceptional. It was the first time anyone had put some metrics to the mismatch I felt living inside my own mind, but from what I remember, I was not privy to the results of my own test.

The PHD who conducted my assessment somehow, despite seeing my abnormally high writing skills and my extremely low processing and executive function skills, wrote this cutesy little note instead of recommending any further testing for any learning disorders. Did she think I couldn’t handle seeing the horrifically poor visual-motor processing score I got? She knew I was obsessed with learning disabilities. To this day, I wonder why the evaluator thought she couldn’t just be honest with me.

That cutesy little note explained to me nothing about why I was struggling, gave me no answers and only tried to reassure me that things would just “work themselves out.”

The note written about me at about 13 years old following my assessment reads: “bright, creative, unique, seeking stimulation, connection and acceptance. Amazing gifts. Anxiety about performance and judgement, perfectionism and a desire to please. Teen years compound identity and autonomy, and navigating new dynamics with parents. Goals: self-acceptance and love.” She also gave me some tips: “relax, honor strengths, persevere, use strategies to channel gifts” without giving me any such strategies— mind you. And her assessment report finishes with a quote from Ellen DeGeneres, whom I was obsessed with at the time stating “beauty is about being comfortable in your own skin… knowing and accepting who you are.”

Looking back, I’m still confused by how nothing came of my IQ test—despite the abnormal presentation of both my extreme verbal gifts and profound processing deficits. Despite the fact that I spent my breaks with the tester ranting about Ellen DeGeneres and explaining my theories about how understanding ADHD brain waves could help us detect autism in the brain—there was no follow-up. The purpose of the evaluation had been to identify potential learning disabilities, and the results were right there in black and white. Yet no referrals were made. No further testing was recommended.

A few years later, around age sixteen, I finally saw the report myself. I was genuinely shocked that a pathologically low processing speed, alongside verbal scores so high they couldn’t even be properly scored, hadn’t raised red flags for anyone.

Me at 10. My preferred greeting method was a handshake. The good old days.

My parents remained convinced that the real issue was discipline. They believed all I needed was to study math—and every other subject—even harder. The idea that something deeper was going on, never stuck.

So, for that entire eighth grade year, I continued to flounder under the weight of extreme executive dysfunction, which no amount of “staying on me” could resolve. I was even evaluated for vision therapy, because the tester assumed a visual issue might explain the slow processing speed. I was already diagnosed with a few neurologically-based vision problems and wearing bifocals by the age of 11. Vision therapy just gave me headaches. It didn’t help me turn my homework in on time or to comprehend boring (fictional) books.

Meanwhile, the transgender identity I had quietly adopted remained a secret. After previous attempts to share it only made things worse, I kept it to myself. But while I fixated on gender in private, another obsession began to take hold: autism.

As readers of my first essay know, I had already developed an intense interest in parenting books, which introduced me to a wide range of neurological conditions. In my desperate attempt to understand what was “wrong” with me, I had stumbled upon ADHD—only to be told my IQ test had ruled it out. Never mind that my executive functioning scores were abysmally low—there had been no referral. So instead, I began to pour my energy into what would become a more sustained and meaningful intellectual obsession: autism.

The Autism Society (Age 13)

As my eighth-grade year progressed, my obsession with all things “transgender” was in full force—but had also gone fully underground. I continued researching the topic on the school Wi-Fi, since mine had been taken away after my trans identity declaration. But I needed another obsession to occupy my time at home, and so my fascination with autism flourished. I was reading and watching everything I could find about autism and autistic people. By this point, my parents had forbidden any discussion of the trans issue, but at least they could get behind my new fixation with the autistic mind.

At first, I didn’t think I had autism—or even Asperger’s, as it was then called. I read the diagnostic criteria and didn’t relate to most of them. Sure, I didn’t have close friendships, but I was incredibly well-liked at school. I never shied away from talking to other kids, though I always preferred the company of my teachers because the other kids seemed like aliens who obsessed over inconsequential trends instead of solving complex neuroscientific puzzles. I didn’t think anything about me was socially awkward.

My mom had already started teaching me about social cues when she realized I wasn’t picking up on them, and we practiced how to have conversations—including the all-important skill of asking questions of others instead of just ranting at them about my personal topics of interest and hoping they’d interject with theirs.

I had tried to organize an Autism Awareness Day at my middle school. I made an entire lesson plan, pitched it to the guidance counselors and the principal—and they rejected it. That only intensified my resolve to lecture everyone I met about the condition I had become newly obsessed with. To their credit, my parents had always nurtured my niche interests—except, of course, for the one involving trying to change sex. So, my mom arranged for me to meet with the head of the Autism Society in our state to explore some kind of internship related to my latest passion.

I strolled into the Autism Society building on a spring day in 2013, accompanied by my mom. We met a kind woman named Toni, who had curly hair and an inviting smile. Her office was crammed with stacks of boxes, even taller stacks of paper, and dingy metal cabinets that barely closed. I had no idea who Toni was beyond being “the boss.” My mom explained that her 13-year-old daughter wanted to “work with autistic children,” and Toni asked what I knew about autism. We sat on a couch across from her and talked for a while. Toni said she had a lot of tasks I could help with and tried to figure out where to place me.

I talked her ear off about my autism obsession. I shared some of the thoughts I’d been incubating—like how research on brain waves in people with ADHD might be used to detect autism in the brain. I was eager to know if I was on the right track with my theory that all the neurological conditions I’d studied were interconnected. Toni wasn’t a scientific expert, or an autism expert— so my theories fell on deaf ears. But, she was a mom to an autistic son named Bill, who was obsessed with ancient Egypt and wore an Egyptian hat he refused to remove, even to wash.

At first, Toni thought I could volunteer with their playgroup for girls ages 9–18, to help teach them about social interaction. By the end of our talk, she sent me home with a book about a nonverbal girl who communicated using a computer, joked to my mom that maybe I should be tested, and gave me the most mundane task imaginable: data entry.

I actually thought the idea of an autism test sounded like great fun. I really enjoyed the seven hour IQ test I had taken the previous year, and anything labeled “autism” was something I wanted to dive into. I figured that by being tested, I could deduce all sorts of insights about the autistic brain from the structure of the test itself. What I didn't want to do was enter names from handwritten forms into a spreadsheet. I didn’t come to the Autism Society to type—I wanted someone to listen to my ideas and point me toward future research.

So instead of devoting myself to the task Toni assigned, I continued talking her ear off. Eventually, she just put me in the playgroup. My only task was to exist there and help out wherever needed.

I walked into the playgroup and saw a bunch of girls, some younger than me and some older, doing their own things. One girl sat perched on a windowsill, drawing dark and depressing images in a sketchbook. Another was playing mini-golf in a makeshift cardboard box structure. I found it notable that none of the girls were doing the same thing—each was absorbed in her own world, with occasional redirection from the adults. No one was following a group activity. There was no set curriculum. Just islands of quiet focus and self-directed play. I wasn’t given any real tasks to help out, so I just tried to observe my surroundings.

Eventually, I stopped going to the Autism Society. I wrote a few essays about what I’d observed and realized pretty quickly that it wasn’t the think tank experience I’d hoped it would be. I did become obsessed with Temple Grandin and felt like I was meeting a celebrity when she came to my city to speak.

Me, meeting Temple Grandin the summer before ninth grade

The ADHD Diagnosis (Age 14)

I liked funny t-shirts

Two days before Thanksgiving in 2013, my parents finally decided to seek psychiatric help for my attention issues rather than continuing to try to do so with academic discipline involving daily study sessions until midnight to valiantly attempt to "catch me up” for my eight hours of schoolday daydreaming. By then, I had entered high school, and my grades were beginning to matter for college—something that would shape my entire future. So that morning, I found myself sitting in a psychiatrist’s office, missing my first few classes to get evaluated for ADHD.

The psychiatrist, Dr. H, had an office crammed with things to look at—including a poster detailing the different parts of the brain. As he chatted with my mom about my history, I sat there rapidly bouncing my leg, filling out the questionnaire he handed me. That sheet of paper, he said, would help determine whether or not I had ADHD. I’m surprised he had me fill out a questionnaire, considering I had made it clear to him that I had already previously been obsessed with studying ADHD and had the diagnostic criteria memorized.

After a brief glance at my answers and a few minutes of observing me, he turned to my mom and said, “Why didn’t you bring her in sooner? This is the most obvious case of attention deficit I’ve ever seen.” He prescribed me medication on the spot, and I took my first dose that same day. It changed my life.

I was instructed to take the medication every morning—before doing anything, even writing an email or leaving the house. Oddly, the IQ test I’d taken the year before—which clearly reflected attention issues, executive dysfunction and visual-motor delays—wasn’t even referenced in the diagnostic process.

For the first two weeks on the meds, I was furious. For the first time in my life, I was forced to pay attention to things I found completely uninteresting. I couldn’t mentally escape during math class or wander off into thought experiments at a crosswalk as I walked into traffic, unaware of the dangers. I was, for the first time, both able and forced to notice the things I’d always tuned out. It was deeply distressing. I felt like I had lost the brain I was used to, and it was replaced with a more boring, focussed one.

But after those initial two weeks on ADHD medication, I started to realize the upside of having a brain that would cooperate with my continued existence. I could focus in class. I could learn. I realized that this was, in fact, the point of going to school. And most shockingly, I could start catching up on all the things that had passed me by. For the first time in my life, I realized that for the past fourteen years, I’d been living on my own planet—completely unaware of what the kids around me were doing or even what we were learning in school.

That year, because I was medicated, I gained a whole set of foundational skills. I finally learned how to tie my shoes. I could pay attention long enough for my speech therapist to teach me how to control the muscles in the back of my throat so I wouldn’t choke on liquids or leave suction bruises on my upper lip from drinking out of bottles. I stopped needing to study with my mom until midnight just to keep up—my grades improved, and so did my independence.

The medication also helped me navigate the real world more safely and capably. I could now get on the correct bus instead of hopping on the first one that showed up. I could manage multi-step tasks. I could tune out overwhelming sensory input. I no longer felt like I had ants crawling in my skin. I stopped pulling out my eyelashes and began twirling my hair instead—still a stim, but a more socially tolerable one. Or so I thought.

The adults around me didn’t see it that way. They slapped my hand away when they caught me twirling, insisting it was strange. But now that I had the attention span to notice a few social cues, I had tried to adjust. The hair twirling was my compromise—and even that was too weird. Each slap felt like a rejection of the self-regulation I had fought so hard to redirect, and it became yet another source of tension.

Still, overall, I finally felt like I was capable of existing—both with myself and with other people. But I was operating on what felt like a fourteen-year delay. I became newly and acutely aware of just how strange I really was. That strangeness wasn’t fixed by the ADHD medication, and it didn’t have a name—except, of course, for “trans” and “gender dysphoria.” So I kept holding onto that explanation.

But now, medicated, I could at least shift some of my focus away from gender and toward the rest of adolescence. For the first time, I could direct my attention not just toward what fascinated me, but toward what was simply necessary.

Support Group for Socially Awkward Teens (Age 14)

A few months after my ADHD diagnosis, I was enrolled—according to my family—in a support group for “socially awkward teens.” I walked into a somewhat dilapidated building that smelled like old dust, clutching my pocket-sized copy of the United States Constitution and rocking a bowl cut, completely unaware of what I was walking into.

We teens sat in a circle on uncomfortable metal chairs while a man—whose energy could best be described as uncharismatic—led us through various activities meant to encourage social interaction. Once, he had us play a game of Hangman, which triggered one of the girls in the group to burst into tears. Apparently, it brought back memories of her suicide attempt. That moment deeply unsettled me.

Most of the kids were painfully shy. But then there was Levi—just as obsessive and verbose as I was. He was fixated on trains; I was fixated on the brain and neurological disorders. We bounced off each other, talking nonstop while everyone else sat in awkward silence. I’m fairly certain that being in this group actually made me more socially awkward. I left with a surplus of train facts and tried repeating them to kids at school, thinking trains were a socially acceptable interest for someone my age.

At the end of each session, the guy who’d run the group would gather our parents in a separate room to show them videotapes of us participating—presumably to analyze our behavior. Meanwhile, we teens were taken into another room and babysat by someone everyone referred to as a young guy named Jesse. But I knew Jesse was a trans man—or more precisely, a woman on testosterone and wearing a binder. By that point, I had already spent two years immersed in trans content, and I could spot it instantly. I was far more interested in talking to Jesse than I was in talking about trains with Levi—though Levi was still the only other person in the group who used words like paradox and idiosyncrasies, and the only kid there I could stand.

By the time my parents finished watching the tapes, I think they realized that while I was certainly socially odd, I didn’t belong in that group. But in my own mind, I didn’t belong anywhere—especially not in any setting with girls my age. That became painfully clear that year, as I was attending an all-girls school. Surely, I thought, there would be at least one girl there who was like me. I had crushes on many of them, but they also felt like an alien species—fascinating, distant, and incomprehensible.

Those experiences only reinforced my belief that I had been born in the wrong body. And just as my parents had been wrong about me not having ADHD, and wrong that putting me in that support group would help my social skills which I thought were good enough as is, I became more and more convinced they were also wrong to dismiss the idea that being trans was the explanation for why I so obviously failed at being just like the other girls.

Conclusion: Here’s What I Want Readers to Take Away

Following my ADHD diagnosis, the world finally began to make more sense to me. On stimulant medication, my body became a much more tolerable place to exist. I began to truly thrive in so many ways. But the things that made me feel different—and be different—weren’t resolved. They just became impossible to ignore.

I didn’t initially have a problem with myself being an “odd duck,” but once I realized that medication couldn’t smooth out all my quirks, a new kind of inadequacy set in. Now I had the “tool”—the ADHD pill—and still couldn’t act 100% normal. By all measurable metrics, I had made huge improvements. But the progress wasn’t fast enough. And now, for the first time, I was aware of how far behind I had been.

To distract myself from that awareness—from the aching sense that I was still fundamentally different—I threw myself into other pursuits. I became a debate champion, gained local recognition for spoken word poetry, and emerged as a teenage political activist. In those spaces, my quirks became assets. My intensity, my obsessiveness, and my tendency to fixate endlessly on one topic, were seen as signs of brilliance. But no matter how much I excelled, I couldn’t shake the nagging feeling that I still wasn’t becoming normal.

Telling gifted kids who have significant delays in social, emotional and executive functioning that they are “just different and that’s ok” isn’t a good substitute for seeking an autism diagnosis. These kids will search until the ends of the Earth for an answer about why things that make sense to others, do not make sense to them.

They are already painfully aware of their differences from their peers. If they aren’t given a reality-based explanation, they will find the trans explanation. Once they latch on, it is way more difficult to overcome their rigid thinking mechanisms and propose another explanation, especially when its relevance to your specific child is not explained to them in ways which make as much sense to them as the trans framework does.

In my case, the older I got, the more I tried to resist the trans explanation for my differences—not because it didn’t still deeply resonate and not because it wouldn’t pose a threat as soon as I turned 18— but because I wasn’t allowed to explore it openly, with critical thinking injected by adults. I wasn’t allowed to question, to think about it, or to talk it through. The belief that something about me was so strange, so irreparably wrong that even medication couldn’t fix it—that feeling only grew.

Eventually, I couldn’t take the pressure. I ran off to college and began to transition—not because anyone encouraged me to, but precisely because they had discouraged my thinking about it so much that it became the forbidden fruit. Once the idea of transition had been planted in my mind, it became a forbidden hypothesis I was never allowed to test. And yet, it explained everything: my confusion, my failure to conform, my intense desire to understand myself. Transition, for me, was a desperate, valiant attempt to fix what I thought was broken. If I couldn’t be the kind of girl the world wanted me to be, maybe I could become a man instead.

But a crucial piece had been missed. I was never assessed for autism. The ADHD diagnosis was treated as the full answer to my struggles. It didn’t address my identity questioning, discomfort with my own embodiment, and social confusion. One key part of understanding how my brain worked—why I experienced the world the way I did—was never explored. I was given no tools to make sense of my own experience or to feel at home in my body without constantly questioning why I was like this.

Had I been diagnosed with autism—or even had someone help me interpret my experiences through that lens—I believe I could have found clarity about myself in a reality-based way. Instead, I embarked on a path that, in trying to answer my questions, robbed me of critical years of development and self-discovery, while damaging my breasts and permanently and painfully contorting my rib cage through breast binding.

What I needed was someone to help me understand my brain, and my fraught experience of embodiment, as a normal autistic experience—not as a failure of womanhood. These are the insights I’ve had to piece together for myself, through years of experience, transition, and detransition.

Now, I help parents guide their neurodivergent kids toward a more reality-based understanding of who they are. I help them see gender questioning not as a problem in itself, but as a sign of deeper needs—a combination of identity exploration, unmet developmental needs, and a gifted mind searching for answers. I give parents the tools I wish mine had, so they can help their children find more grounded, compassionate, and informed paths forward.

If your child is struggling with gender identity—whether they’re in early ideation, socially or medically transitioning, or facing estrangement—I can help you craft a strategic, individualized plan for how to guide your child through this. My coaching is especially focused on how neurodivergence affects (trans)gender identity development, and how you can guide your child back to reality with more tools than they had before their trans identification began. If you'd like to book a session with me, feel free to send me a message.

In the third essay of this series, I’ll explore how giving girls autism diagnoses—and more broadly, deepening our understanding of how high-functioning autism manifests across sexes—can offer an alternative to the “trans” explanation many are now given. I’ll look at the rise of autism, the rise of gender dysphoria, and the ways these phenomena intersect. And I’ll examine how misdiagnosis—or no diagnosis at all—can create specific vulnerabilities that make girls on the spectrum especially susceptible to developing what we now call gender dysphoria.

A Note on My Perspective, and How I Can Help:

Coaching for Parents of Gender-Questioning Kids With an Emphasis on Neurodivergence and Family Dynamics.

If you see your child in any part of my story—intensely curious, profoundly gifted, but struggling to function or fit in—please know you're not alone, and neither are they. I was once that child: misunderstood, misdiagnosed, and desperate for answers. My gender identity confusion wasn’t the root problem—it was a symptom of deeper, unrecognized neurodevelopmental needs.

I now work directly with parents to help them see past the surface of a trans identification, and instead understand what's really going on beneath it. Through one-on-one coaching, I offer the tools I wish my own parents had when I was thirteen—tools grounded in developmental psychology, lived experience, and deep insight into how giftedness, ADHD, autism, and adolescent identity formation interact within family dynamics.

Whether your child is just starting to question their gender, has socially or medically transitioned, or your family is navigating estrangement or confusion—I can help you build a clear, compassionate, and reality-based strategy that addresses the whole child, not just their label.

You don’t need to walk this road alone or try to guess what’s behind your child’s gender distress. Let’s work together to give your child the understanding, containment, and support they actually need.

📩 To book a parent coaching session, send me a direct message.

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