Remembering to ask: National survey on the management of young people with co-occurring autism and gender diversity

This study examines the practices and training needs of clinicians supporting autistic gender-diverse adolescents in Aotearoa New Zealand. A national survey of 43 clinicians revealed moderate confidence (62/100) in providing care. Screening for gender diversity in autistic adolescents was universal, while screening for autism in gender-diverse adolescents was less common (85–92%), showing a gap in bidirectional assessment. Clinicians working across both public and private services had slightly lower screening rates for autism. Key barriers identified were limited clinician knowledge, a lack of formal guidelines, and insufficient funding. Most clinicians (86%) reported no specific care pathways for this co-occurring condition, relying instead on generic interventions. Regional disparities in screening practices were also evident. Clinicians expressed a strong preference for accredited, in-person training and clearer national guidelines to improve care. The findings underscore an urgent need for improved practitioner guidance, interdisciplinary collaboration, and tailored resources to meet the complex needs of autistic gender-diverse youth. The study calls for policy and practice reforms to ensure equitable and affirming care across the country. This study looked at how clinicians in Aotearoa New Zealand support adolescents who are both autistic and gender diverse. Autism is a neurodivergent way of experiencing the world, and gender diversity means a person’s gender identity differs from the sex they were assigned at birth. These adolescents often face unique challenges, such as difficulties accessing care or being misunderstood by families and healthcare providers. Researchers surveyed 43 clinicians working with autistic and/or gender-diverse adolescents to understand their practices, challenges, and training needs. Key findings showed: • Screening : Clinicians were more likely to check for gender diversity in autistic adolescents (100%) than for autism in gender-diverse adolescents (85–92%). • Care Pathways : Most clinicians (86%) had no specific care plans for autistic gender-diverse adolescents, relying instead on general autism or gender support. Barriers included lack of guidelines, training, and funding. • Regional Differences : Auckland clinicians screened more frequently than those in other regions, highlighting uneven access to care. • Training Needs : Few clinicians (21%) had formal training in this area. Most wanted accredited in-person or online training (68%) and clearer national guidelines. The study highlights gaps in care, such as inconsistent screening and limited resources, which can leave autistic gender-diverse adolescents without the support they need. Clinicians called for better training, interdisciplinary collaboration, and standardized guidelines to improve care. This research is a first step toward ensuring these adolescents receive affirming, equitable care across Aotearoa New Zealand. Future work should include the voices of autistic gender-diverse adolescents to guide policy and practice changes. • Autistic gender diverse young people face unique challenges, including difficulties accessing care and being misunderstood. • During this study, healthcare providers revealed a moderate level of confidence in supporting this group. • Providers working in both autism and gender clinics were more likely to engage in bidirectional screening. • There is a need for more standardized screening protocols, interdisciplinary collaboration, and resources to address the needs of this group.