Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington.
Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington.
J Adolesc Health. 2021 Jun;68(6):1215-1219. doi: 10.1016/j.jadohealth.2020.12.143. Epub 2021 Mar 9.
Transgender youth with autism spectrum disorder (ASD) may experience complex relationships with eating because of cognitive rigidity, including inflexible thoughts and behaviors around food and/or their body. Yet, there is no research that provides guidance to clinicians providing care for youth with the unique triad of gender dysphoria, ASD, and disordered eating. This case series discusses trends in presentation and management of three cases from a multidisciplinary gender care clinic. All three individuals endorsed rigid thoughts around food and/or body appearance, which affected nutritional intake; however, their presenting eating disorder behaviors, described etiology for disordered thoughts, diagnosis, and level of engagement in a multidisciplinary treatment model varied. Based on these cases we hypothesize several strategies including early engagement with ASD specialists, proactive screening and discussions around eating with all transgender youth with suspected/confirmed ASD, continued discussions throughout care, as disordered eating behaviors may change after the initiation of gender-affirming medications, dietician visits early in treatment regardless of endorsed thoughts and behaviors, tailored management to the unique needs of each individual and their eating thoughts/behaviors, and consistent multidisciplinary collaboration.
患有自闭症谱系障碍（ASD）的跨性别青年可能会因为认知僵化而与饮食产生复杂的关系，包括对食物和/或身体的刻板思维和行为。然而，目前没有研究为为同时患有性别焦虑、自闭症谱系障碍和饮食失调的青年提供护理的临床医生提供指导。本病例系列讨论了来自多学科性别护理诊所的三个病例的表现和管理趋势。所有三个人都对食物和/或身体外观的僵化思维表示认可，这影响了营养摄入；然而，他们表现出的饮食失调行为、描述的失调思维病因、诊断以及对多学科治疗模式的参与程度各不相同。基于这些病例，我们假设了几种策略，包括早期与自闭症专家合作、对所有疑似/确诊患有 ASD 的跨性别青年进行主动筛查和饮食讨论、在整个护理过程中持续进行讨论，因为在开始使用性别肯定药物后，饮食失调行为可能会发生变化、无论是否存在认可的思维和行为，在治疗早期就进行营养师就诊、根据每个人的独特需求和他们的饮食思维/行为进行量身定制的管理，以及持续的多学科合作。
