Autism and Gender Diversity

Research indicates that autistic individuals are more likely to identify as transgender or gender diverse compared to the general population. Studies show that people who do not identify with the sex assigned at birth are more likely to be autistic than cisgender individuals. This overlap between autism and gender diversity may be confusing to some parents.. Parenting a child who is gender diverse and autistic can feel complex, and supporting them may at times feel overwhelming, so we’re going to get into the complexity in today’s episode. We’ve invited Dr. Theresa Lyons,  international autism educator, to share her unique blend of science and real-world experience to try to give our listeners clarity, confidence, and a roadmap to better supporting their autistic children. 

Special Guest: Dr. Theresa Lyons

Dr. Lyons is an international autism educator, Ivy League scientist, and autism parent. She’s the founder and CEO of Navigating AWEtism, a groundbreaking platform that transforms the overwhelming complexity of autism science into clear, actionable steps for families. With a Ph.D. from Yale and a deeply personal mission, Dr. Lyons has worked with parents in over 21 countries, bringing evidence-based strategies that change lives. She shares her unique blend of rigorous science and real-world experience while giving parents what they’ve never had before: clarity, confidence, and a roadmap for progress.

Links from the Show:

• Navigating Awetism on YouTube
• Navigating Awetism on IG
• Navigating Awetism on FB
• Find Theresa on LinkedIn
• Navigating Awetism on TikTok
• Navigating Awetism website
• Awestism.net  
• Join Mama Dragons today

In the Den is made possible by generous donors like you. Help us continue to deliver quality content by becoming a donor today at www.mamadragons.org. 

Transcript

SARA: Hi everyone. Welcome to In the Den with Mama Dragons, a podcast and community to support, educate, and empower parents on the journey of raising happy and healthy LGBTQ+ humans. I’m your host, Sara LaWall. I’m a Mama Dragon myself and an advocate for our queer community. And I’m so glad to be part of this wild and wonderful parenting journey with all of you. Thanks for joining us. We’re so glad you’re here.

SHAUNA: Welcome back, friends, to another episode of In the Den with Mama Dragons. This is Shauna filling in for Sara on the podcast today. Research indicates that autistic individuals are more likely to identify as transgender or gender diverse compared to the general population. Studies show that people who do not identify with the sex assigned at birth are more likely to be autistic than cisgender individuals. This overlap between autism and gender diversity may be confusing to some parents. And parenting a child who is gender diverse and autistic can feel complex. And supporting them at times might feel overwhelming. So we're going to get into the complexity of it all in today's episode. We've invited Dr. Theresa Lyons, an international autism educator, to share her unique blend of science and real-world experience to try to give our listeners clarity, confidence, and a roadmap to better support our queer, autistic children. So, welcome to the Den, Dr. Lyons.

THERESA: Thank you for having me! I'm excited to be here.

SHAUNA: It's great to have you. I'm the mom of a couple of autistic young adults, and one of them is non-binary. And they were very helpful in helping me craft the questions for today. So first of all, what does the research show about the overlap between gender diversity and autism?

THERESA: So, there is an overlap. And in 2025, there was a meta-analysis that was done, meaning that it looked at all the different studies in which looked at this, and about 7% of autistic individuals identify also as gender diverse. So that is far exceeding general population. So it's a scientific fact. I would say that it's not really disputed. But I think a lot of people are not aware of the commonality in which that can happen.

SHAUNA: Yeah, are there ideas around what's behind that?

THERESA: Okay, now that's where it gets – we can say the, you know, 7%, that's pretty much agreed upon. But then when you get into, okay, the Why, that there's not a consistent answer that is universally accepted, right? So, there are different studies that say, well, with autism, there's less conformity to norms. Right? And so you have more of that exploration and being okay with doing certain things. Whereas someone without autism might not do that, even if they might want to. But it's really more of a conforming aspect to it. There's also hormone levels, so that is an established fact that testosterone can be higher in females with autism, and the reverse is true as well. I would not say that is a consistent thing found across all people on the autism spectrum. And this is where it gets difficult to answer that Why question. I don't think we'd ever be able to answer that one question with one answer that would explain that 7%, right, explain it all. So, it's important to have these ideas and know that they have been studied. So hormone levels definitely have been studied, and there are some trends. But it's not a definitive answer so far.

SHAUNA: I feel like in talking to parents of kids who are autistic and also gender diverse, sometimes there's a mistrust or a stigmatization of autistic people and their ability to know who they are. Like, “Well, my kid is autistic, so how can they really know who they are?” There feels like there's this stigma between autistic people and their ability to understand who they are. Can you talk a little bit about what that stigma is about, and how do we get over that?

THERESA: Well, first, I would like to say that many people with autism do not get the medical and the healthcare that they should, that someone without an autism diagnosis would get. So there is a strong bias. And this is universally from what I've seen across the autism spectrum, gender diversity or not, as soon as you put someone with an autism label, for some reason, the healthcare institutions just start saying, “Oh, well, you know, that's just autism. That's just the way it is.” And it's a struggle, for sure, even for basic things like constipation, and potty training, some really basic things. So that is something to know from the start, that getting healthcare, proper healthcare, is difficult when there is an autism diagnosis. And the stigma and distrust of autistic people – not everybody is like that, but you definitely will come across and have this experience – So the first thing is to know that not everyone is like that. And if you're dealing with someone like that, just deal with a different person. Just go “Next”, and continue on. But just to explore that a little bit. There is a strong relationship between autism and a variety of mental health problems. So people with autism get exposed to different stigma, because they're seeking out help for different things, right? So that's one thing that is different when you have an autism diagnosis. And then you also tend to be excluded socially, right? Which then can compound a lot of these mental health issues. And then some will camouflage. So we'll mask, which then compounds problems even more. So, the stigma a lot of times is to try and fit in, in one sense. And then, when people see someone trying to be someone who they're not, many people can recognize that. So then that's where the distrust comes from. There's so many reasons, right? So, that's kind of one aspect when you start to layer in mental health. The other thing is unreliable speech. So that's something that's not really talked about with autism, right? We always think of someone who has the ability to speak, but maybe they're very focused on certain topics. And then we think of the other end of the spectrum, where someone might not be able to speak at all, right? But there's unreliable speech, so sometimes people are talking, and they might seem like they're answering questions. Sometimes parents notice this when they say, “You know, whenever I ask my child a yes-no question, or any question, they always say whatever the last word was.” Right? So that's unreliable speech. So this is when maybe you have a healthcare professional or a teacher and they'll ask someone with autism a question, and they'll start to notice, let's say, this unreliable speech pattern. But then they just apply it  to the person entirely without the health understanding of what unreliable speech really is and how someone might be saying something, but that's not their true intention, right? So this can get very confusing. And then when someone is not well educated on topics like this, then they can start to apply it, “Well people with autism don't know how to answer questions, so I can't really trust what they're saying.” And that's totally unfair. So it really stems from a lack of understanding just the nuances that are involved in autism, and also speech and interactions Another example would be asking questions. So some people, not all people, but some people with autism are more literal than others. So, when you ask someone a question, they might give you an answer which the person might take as meaning one thing, and the person with autism is really involved in what the words and the structure of that sentence and question was. So a simple example, you ask someone with autism, “Do you want to go for a walk?” And they say yes, but they don't move, right? Because now you think, “Are you being difficult? Did you not hear me? Did you not understand the question? You said yes. But you're not moving,” right? So, these are all the areas where people can get confused about autism and then not know what to do. And that's when stigma starts to grow and you say, “Well, I can't trust someone with autism to say what they really mean, or what they're really feeling.” So then what do you do, right? So that person that you asked, do you want to go for a walk and they say yes, but they don't move, there needs to be an additional question, right? So you can say “What is preventing you from getting up and going on to a walk?” Could be, “I don't feel good,” right? They could be, “I don't want to go out when it's raining, but I want to go for a walk. But I don't want to get wet,” right? So it becomes a communication problem and then all of these experiences is what leads up to people distrusting autistic people. So I would say it's really just miscommunication. It's not having good interactions. It's developing a bias. And it's also people on the other end of it just get a little flustered, and then it's easier to just say, “Well I just can't trust you,” right? Because then it kind of takes the responsibility off me. So that's a very long answer to that question, but those are all the things that kind of roll up into it, and it's different for each person.

SHAUNA: I think that's so great. And what I'm hearing is you have to understand how your autistic child communicates . . .

THERESA: Yes.

SHAUNA: . . . In order to understand them, right? Like if you know, if you ask them this question, and they're going to say yes to whatever you said last, or they're going to whatever, like change up how you're asking, and because they communicate differently doesn't mean they don't know who they are, or what they want.

THERESA: Correct, correct. It means that they might be answering your questions differently, not the way you expected, right? So you have two people who have two different perspectives, and they're just not lining up. And then that's when that other person starts to form their opinion of,  “I just can't trust autistic people, and they don't know what's going on, and they don't know how to communicate,” right? And so it's so easy for that person to just start putting all this they, they, they, and that's really where it leads to. And then, unfortunately, some of these people are teachers, or therapists, or doctors. And they've had these experiences over decades or so. And then they just become quite jaded.

SHAUNA: That makes sense. I have a couple of autistic kids. My autistic cisgender son was diagnosed at 2. And my autistic non-binary child, who was assigned female at birth, wasn't diagnosed until their late teens and early 20s. I feel like that's a common – boys are often diagnosed younger. And I'm interested in why that is, and what are the different ways that autism shows up in kids?

THERESA: Sure, so autism looks very differently, right? So with the spectrum it's easier to see more on the profound side, so when someone isn't speaking at all, when they're having really strong rigidity for schedules or repetitive behavior. So that part of the spectrum is easier to see. For autism and being diagnosed so, in girls, many times people say the signs are more subtle. So, we can go back to what an autism diagnosis is. And it's based on observation. Right? There's no urine test, blood test, MRI, there's nothing along those lines currently that can be done, and then you know for sure, okay this is autism, or no it is not. So many times, doctors are just waiting for there to be developmental problems that are so large, it is obvious. And then that's how you can get an autism diagnosis. So different autism tools have been developed, really, more from the male lens. And criteria are a bit more male-focused so there might need to be a conversation with different medical organizations. And these are not easy conversations to have. These things don't change overnight. So it takes decades, a lot of times, for a simple change, which we would think is simple. But for things to be a diagnostic criteria, it really ends up being vetted and thousands, tens of thousands of data points. So different studies and this is what takes so long for things to change. And if there isn't someone or some organization that keeps driving this conversation, it just gets tossed by the wayside. So masking really is one of those things that prevent girls from being diagnosed sometimes earlier just because they can look at what society norm is, and then, okay, let me just do that. Whereas with a male, with a boy, they might not do that social masking. They're just like, they don't have that reference point. So when you're looking just for observations, that's why it seems that a lot of girls are being diagnosed later on, it's because it does become more obvious, then, that you can't really deny it.

SHAUNA: Yeah, how commonly is neurodivergence ignored, even when seeking a diagnosis? Sometimes it can feel hard to get an official diagnosis for your kid. And you see the signs as a parent. But when you go in, depending on the doctor, it can feel difficult to know how to get a diagnosis and to get a diagnosis, especially if some of the symptoms are not as profound as they can speak, or they can mask.

THERESA: Right. So since diagnosis is based on observation, you want to be very, very specific about which doctor you go in front of. So this matters. It's really the only thing that matters. So, a general pediatrician is not able to make an autism diagnosis. They don't have the training. They don't have the expertise. The only thing they can do is refer out, right? And if any parent has any concern, the pediatrician should not say, “No, I'm not going to write a referral,” it should just be, “Okay. Let's keep with this going forwards.” So a pediatric neurologist or developmental pediatrician are the two specialists that are most commonly used to get an autism diagnosis. And you really want to go to those who are only dealing with autism, right? So there's neurologists who might deal with seizures, and a variety of other maybe genetic issues, and maybe they do autism as well, right? That person is not going to be as well-versed as someone who 90% of their patients are autism, right? So, you want to get your child in front of someone who has the most experience in seeing this, because that's how the diagnosis is made. You want someone to be able to see the difference between autism and ADHD. And they can, so there was a meta-analysis done a few years ago as well, and 40% of those with autism also have an ADHD diagnosis. So it's really important to understand that there are such intricacies with autism, with ADHD, and then when they're together, right? So the level of skill of the doctor you're in front of is what's going to make the difference.

SHAUNA: That's great advice. I love that. Can we talk about school and autism for a minute?

THERESA: For sure.

SHAUNA: That feels like a big pain point for a lot of families. Classrooms are not always neurodivergent friendly. How do we ask for help? How can we see when there's a problem? Like, any general advice for parents whose autistic kid is struggling in school, but they're not sure how to help them fit in or make school work if it can work for them?

THERESA: Yeah, this -- I mean, we could have a whole conversation, right? I'm trying to keep my answers like answering it, but, like, short and everything. So the first thing really is having that diagnosis. So that is why it's important to get in front of the right doctor so you have the right diagnosis, so then you can start to think about what does success look like for this child? Also when you have a diagnosis, there's 13 qualifying diagnoses to get an IEP. So, when you have a diagnosis, then accommodations are legally required. If you don't have that diagnosis, that's when a lot of parents struggle to get the support their child needs. It's because there's not a legal requirement from the school. So the importance of a diagnosis certainly is there. And school is complex, right?

SHAUNA: Yeah.

THERESA: So, school is very complex. So when you're home with your child, you want to really look at them and their academics, and instead of just saying, what's wrong with them, which is what happens a lot in school, like, they're not doing XYZ, right? We get told of all these things that they're not doing. It takes time and patience to just kind of flip that question and say, “How does this child learn?” And a lot of times, you have to kind of figure it out, because they might not tell you. But then you have these instances where it's like, “I know my child knows this. They learned this. How did they do it?” right?

SHAUNA: Yeah.

THERESA: So we as parents, we might not have time to take the time to figure out how are they learning. But you can start to play around with text, with audio, with visuals, right? There's so many different ways that someone can learn. We're used to the traditional way of learning, where you have the textbooks, you take notes, and you sat at the desk, and it was very rigid. But that's not really the way the environment is in school anymore. So in schools there's a lot of learning with YouTube. There's a lot of learning on you know, doing different AI searches even now I’ve started to see. There's a lot of different ways that schools are trying to incorporate learning which is great. But not all schools do that. And not every teacher does that, right? So you might have a school which is really supportive. But then you have a teacher who's just like, “No, I'm doing this, and too bad.” And that's when you have to have the IEP. And you have to have the meetings. And that's when a parent really has to advocate. So many times, it doesn't look the way your child needs, and you have to advocate. And that really becomes very heavy for a lot of parents, for sure. But it's really important to understand that people with autism are smart. They have different ways of learning, which is not wrong, and it's really “How does this person learn?” And that's that first step because too many times, people with autism feel “Okay, I don't learn the way everybody else does,” and then it feels isolating. Right? And that then compounds and starts to have mental health impacts, right? And then you might need to go to a doctor to figure out, “Okay, what is it that I want to do?” And that doctor might not be supportive, right? So you start to get yourself in this whole cycle of just a lot of stress. And it feels like you are the one who is broken. But it's really important to take that step back and just say, “Okay, I am smart.” Or even you might have to say this to your child, “You are smart. You are smart. You are smart. We just have to figure out how you like to learn.” And really normalize that, show different people in history how they've learned. I mean, there's great children's books now about autobiographies of so many great scientists and architects and just the way people think, even ballerinas, right? I've read all different kinds of books, where people are starting to talk more about how they learn, and what their thoughts and their feelings, and normalizing that struggle, and finding out more about themselves. So, school is challenging in many ways. It can be very successful in other ways. But really, when you learn how that child learns, that's what opens the doors, so you can advocate, so then the school can provide the child with what they need, and then they can display their intelligence. Because that's what, unfortunately, we have to do at school, we have to demonstrate what we have learned. And then as that becomes easier, then biases change, teachers' opinions change, kids start to become a lot more curious and more involved. And every teacher loves that child whose, “Oh, they're willing to learn and stuff.” So there definitely is a lot to overcome. But starting first with the parent and saying, “How does my child learn?” That's really the place to start.

SHAUNA: That's great. Can you, for any who may not know, explain what is an IEP and how is it different than a 504?

THERESA: So an IEP is an Individualized Education Plan. And there are qualifying diagnoses, and this is for when the diagnosis actually impacts the learning. So just to give an example, if someone struggles with reading, whether it's dyslexia – which is a qualifying diagnosis – or autism and they respond like – you have learned, my child is an audio learner. They need to hear things. So when other people are assigned, okay, here's 10 pages to read. Everyone sit and read chapters 1 and 2, right? The IEP would be in place so that that teacher would need to provide audio for that student during that lesson. Technically, that is what it is supposed to be done. And that's why knowing how your child learns is really important, so those things can be on the IEP. And once they're on the IEP, then that's what guarantees certain aspects, so that their education isn't impacted by their disability.

SHAUNA: Yeah. an IEP is like a step up from a 504, right? A 504 is more of a . . .

THERESA: Correct.

SHAUNA: Yeah and in my experience, sometimes schools will offer a 504 and they don't want to do an IEP, because an IEP is maybe more work for them. I don't know.

THERESA: Yeah. An IEP is really more of a legal document. So, you know, if someone has an IEP, you want to make sure you put in there what your child needs because then, if the school district does not give your child what is in the IEP, that is non-compliance. You can file a whole host of legal stuff, right? You can file different state complaints, and each state is different how they process it. You can file due process. You can file a civil rights violation. So there is a lot of recourse that is there for a school district if they don't follow what's in the IEP. So that's why parents are usually very diligent, and they fight very hard to get stuff on the IEP. And the whole reason why is for the accountability.

SHAUNA: That's awesome. Okay, some of the most common accommodations that you can ask for from a school? Do you have a list because I think sometimes parents are like, “I don't even know what to ask.” I kind of felt that, like, I don't know what they can offer me, I don't know. I know my autistic son struggled with timed things, that would just shut him down. And so he had extra time on assignments and tests and things like that. Are there things like that that parents could know that they could ask for?

THERESA: You can pretty much ask for anything? So I mean, there's, again, it's figuring out what it is that your child needs. So, extra time is definitely something that is, certainly would be considered one of the standards, so additional time. This is when you might get a TA, a teaching assistant, or an aide, or a shadow. And maybe for some kids, they don't need it all the time. Maybe the time they need it for is in a class maybe where there's a lot of motor control challenges, right? So, biology labs and things along those lines when sensory plays in. So something common is sensory breaks, and a resource room is something that can be built. And I'm talking these are schedules more for older kids. Resource room is really more middle school, high school. For elementary, sensory breaks usually are just built into the child's schedule. They're not moving around as much and things like that. So it could be, you know, every 15 minutes, or every hour, you have a dedicated place that this child can go to, whether they request it, or whether it's on a  time schedule, and have that sensory break whether it's just going into a quiet room, or there might be different sensory toys to kind of play with. And the whole idea here is calming the nervous system. So sensory breaks, and the sensory diets, a lot of times the phrasing of it can really put parents off like, “I don’t want to ask for a sensory break, that seems unnecessary, or… that's not what we did when we were kids.” And just the environment is a lot more stressful, right? And you really have to think of it from the perspective of the person. If they're having trouble with communication, right, they're going to have a higher baseline of stress because they want to communicate, and they know they are having difficulty, or that they can't. And then there might be different health issues, right? We didn't even get into health issues, right? There might be, if someone is an extremely picky eater, there might be nutrition gaps. Right? Which then cause, sometimes sensory overload and sensory issues, right? So, you have a lot of things that can be compounding. But having different breaks, a lot of times has to do with the nervous system. And that's why putting additional stress and pressure on someone who's already in fight or flight does not help. So these are all things that parents need to think about in the child's schedule during the day, but also then when they come home. Like, really build into time for the child to unwind and relax that nervous system. A lot of parents see a lot of benefit when that's done in homework, so later on in the day. And there's so much that goes into being successful at school that you really have to look at where are the big problem areas for my child? And then how do we really resolve them? Because it is resolvable.

SHAUNA: My autistic kids would skip assemblies, even in high school, because of the sensory overload, things like that. Yeah, so school and sensory overload, I feel like, is a big – even if the classroom, like hallways and the bells and all of those things can be really hard. So, I hear you suggesting sensory breaks. Are there any other things that autistic kids, or we as parents, can do to help school not be such a sensory nightmare?

THERESA: There's different – so, we could talk about fidgets for a little bit. So, fidget toys, some people can use them in a calming way. Kids with autism sometimes use a fidget toy, and it's calming until a point where it's actually then causing problems. So, unfortunately, a lot of people give people with autism fidget toys as a way to calm them down without fully understanding. So, on an IEP, fidget toys can be listed, different chew toys can be listed, different seating arrangements could be listed, different chairs, a ball, you could have those little bands on your chair so that you're kicking the band instead of the chair, right? So there are all those kinds of accommodations that can be used. But there's always that point of, “Is that really helpful for my child?” And many kids, the fidget toys get put on the IEP, but then they cause problems. So now more body engagers is the language that's being used. And it's using motor skills purposefully. So, parents can ask for body engagers, right? You might not get someone who will say, “Okay, we're going to put body engagers on the IEP,” like that phrase. But it could be doodling. So doodling is more purposeful motor. When someone has that motor control and your coloring in the lines and doing things like that. There's different you know, like, finger knitting is a body engager. So there's just different purposeful motor. All of those things can be put on the IEP. It's just important to know what really works. And some schools just automatically put on fidget toys, but you then have to advocate. You have to say, “No, those fidget toys, they end up really getting my child worked up after a point. And then it's really becoming a problem.” So it's important to have that open dialogue with the school, so you can really get what your child needs. I mean, there's so many things that can be put on the IEP. Like I mentioned, the chairs and different ways of learning, breaks, I mean, that's in addition to occupational therapy, speech therapy, physical therapy, AAC devices, so if someone does have unreliable speech that really might be something that is more beneficial for them, right? A person with autism gets to choose how they communicate, right? So there shouldn't be the pressure that someone has to speak in order to participate in their education. So there's different typing to speech outputs that are out there, different AAC apps. So it's really just figuring out what's best for your child.

SHAUNA: Those are all great tips. Okay, we're going to switch gears for a second and talk about vaccines.

THERESA: Okay.

SHAUNA: There's been a lot of talk about vaccines causing autism. What is the truth about the safety and efficacy of vaccines and their relationship to autism? I feel like this is something that parents should understand.

THERESA: Many things with autism, people are looking for that one answer. Like, what explains all of autism? And there are people who definitely have had reactions to vaccines. There's a vaccine injury program by the United States government that has paid out quite a bit of money to parents whose children were vaccine-injured. So that is certainly something that happens. I don't think there’ll ever be one single thing that explains all of autism. So we know different risk factors. I don't, have not seen a meta-analysis on vaccines that can give a percentage of risk increase for autism based on vaccines, like there is for air pollution. So, there's different amounts of air pollution, and there are studies. And these are agreed-upon studies. Some of these are non-controversial. So when a woman is pregnant in the third trimester, if they're exposed to a certain amount of air pollution, autism risk increases by 30%. Okay. And then, that's well-established fact, right?

SHAUNA: That's a real statistic, that's interesting.

THERESA: That is a real statistic, yes. And then for a child under the age of 2 and under, if they're exposed to that same level of air pollution, their risk for autism, for developing autism, increases by 60%. Yes.

SHAUNA: Fascinating!

THERESA: And there are all these different studies that quantify risks and then the elevation and what that means for a potential autism diagnosis. But I don't think there's going to be one single thing that explains all of autism. So when it comes to vaccines, or when it comes to Tylenol, acetaminophen, the important thing is really to think about your health. And I think this is something that is beneficial to this really controversial area in the sense that we think about our health differently when we're starting to think about, “Okay, so what would be the problem with giving someone a vaccine.” Right? We're activating their immune system. What's wrong with that? Well how is their immune system to begin with? Are they always getting sick? So, should I give my child a vaccine when they're sick? No, right? Because I don't want to overwhelm their immune system. So the conversation of how we think about health and how we make these decisions is changing, I think, for the better. Same thing with acetaminophen, right? So, why is that such a hot topic, right? It's been said, “Okay, acetaminophen causes autism.” What acetaminophen does is it really reduces the amount of glutathione available to a person. And glutathione is your master detoxer, right? So we're in environments where you're eating foods that have different pesticides, we're breathing in air, there's so much toxins that we're exposed to nowadays that you don't really want to walk around with low glutathione, because you need that. Your body needs that for optimal health, not just getting by. But you need it for optimal health. So, there are many different ways of thinking about health that is important now, and that is really what parents need to focus on asking, “Am I optimally healthy? Is there anything that causes my body to not be able to do what I want it to do, whether that's sleep, whether that's not have repetitive thoughts, right? There are so many things that go into that but really thinking about health from a much different perspective is important.

SHAUNA: And I think weighing the risks and benefits of everything, right? Like discuss with your provider the risks and benefits of everything that you do for your child. I think that comes up a lot for us as parents with trans healthcare, weighing the risks and benefits of puberty blockers, weighing the risks and benefits of hormone therapy, things like that. Those are important conversations to have with your doctors, your medical providers, right?

THERESA: Yeah, and it's really important that you work with qualified and very knowledgeable people, because if you don't have someone who's willing to do critical thinking like that with you, you might get in front of a doctor who, the average appointment is 7 minutes. That person literally might want to have that conversation with you but just in that 7 minutes might end up dismissing you, dismissing your concerns, or kind of strong-arming you into doing something, right? Being like, “Well, this is what everyone, this is what the gold standard is to do.” And then, as a parent, you feel like, “Oh, okay, that's what I'm supposed to do. I guess I just do that.” Right? But you didn't have that critical discussion, so really anyone that you’re working with, whether it is related to decisions with anything with puberty blockers, you need to be working with somebody who is willing to have that open conversation with you. And if you don't have that, whether it's vaccines, it doesn't matter, that's not the right person to be working with. And it is scary sometimes to be like, “Okay, I don't know who to work with, right? This person, I don't get a good feeling, but maybe it's the only one,” right? But it's not. And I know we don't need more things to do, but these are really important conversations and discussions to have. So having really good healthcare team around you is one of those really important things, because that can also impact school. Doctors can write certain letters. Doctors are certainly – many times, doctors have opinions on IEPs. Sometimes they want to read the IEP. They want to give input. That's the kind of doctor you want to have on your team for your child.

SHAUNA: Absolutely. Finding a trusted healthcare provider is critical, I think, for parenthood.

THERESA: Yeah. And there's some really great healthcare platforms online because I know geography plays a big role into doctors and things like that. But there are some really great online health portals that have really great doctors who are starting to specialize in different areas. So I definitely would check that out if a parent feels like, oh, there's no one locally. And sometimes you have to drive 2 hours, 3 hours for a good doctor, but it's worth it.

SHAUNA: Agreed. Agreed.

THERESA: Yeah.

SHAUNA: Okay, Nama Dragons has a subgroup, for those listeners who don't know. For moms who have queer kids that have additional needs. Some are on the spectrum or have disabilities or mental health concerns, so if any of the moms listening have autistic kids and haven't found that yet, you can find it on the Mighty platform, our Mama Dragons platform. Are you, Dr. Lyons, aware of any other support groups that parents of autistic and gender-diverse kids should be aware of?

THERESA: I would say Mama Dragons, go check out that subgroup because everyone there is caring and mindful. So that would be my recommendation.

SHAUNA: That is the truth.

THERESA: I'm always hesitant to recommend different Facebook groups and stuff like that, just because they can either go well or not go well. I understand the clawing for information. I just want to learn. I just want to learn. But sometimes those different support groups end up being more harmful than good. If they're not really run well.

SHAUNA: The autism spectrum is really wide. It's a vast spectrum, and so are the needs of both our autistic kids and us as parents. There are also a lot of outdated ideas surrounding autism that have resurfaced in recent years. What do you wish people understood about people on the autism spectrum?

THERESA: There's a lot, definitely. I wish people understood how much an autism person's body gets limited due to health. And most people don't think about that enough. And critically, just because the diagnosis is based on observation. So then there becomes this, what I feel is outdated in the sense that, well, we just don't know what's going on, and it should just be left alone. And if someone can't sleep, “Oh, too bad.” And if their anxiety increases, “Oh, too bad, that's autism.” It just, the diagnosis being made on observation, really prohibits a lot of parents from seeking help in health. And I definitely wish people understood that people with autism are smart but their body limits them in so many different ways. And then in ways they don't want it to. So I think that is something that's really misunderstood, too. Like, when a child has a meltdown, most of the time, they're very remorseful after. Or if they're struggling with communication, and they maybe pinch you, or bite you, or something along those lines that is totally not acceptable, they feel terrible afterwards as well. And if communication is difficult, then they can't even express that they're sorry, right? So, depending on where someone is on the spectrum, just limits what they can communicate. But it doesn't limit what they experience. So I also wish people on the autism spectrum themselves understood their nervous system, and understood trauma and processing trauma. And that it's okay to process that. I would also extend that to the parents. Actually, now that I'm thinking about it, I would extend it to the parents, because another statistic, another research is that parents of kids with autism and emotional dysregulation have an increased risk of 30% of developing PTSD themselves from the experience of raising a child with autism. And I don't say that to blame a child with autism. It is not blame in that way. In many ways, parents take all of that trauma, and they just kind of shove it down as much as possible and think, “Okay, I can handle this.” But it just builds up. And I think it's really important for parents to seek help when needed. And really to build community before even reaching that point. But it is really important to understand that this is a stressful situation and it's not anyone's fault. And really having a level of compassion, but as a parent, it's extremely hard to be patient and have grace and compassion with your child when you're not taking care of yourself and really unwinding from the different experiences that you've had. That's a lot but that would be the most important things.

SHAUNA: I love that, thank you. Okay, our final two questions that we ask all of our guests, the first one, Mama Dragons the name, came out of this idea of fierceness for our children. We would breathe fire to protect and help our children grow up healthy and strong. What are you fierce about?

THERESA: I'm fierce about autism and science, for sure, definitely have fierce about my daughter. Mama Bear, that is me. That's a lot of my life. That's definitely what I'm fierce about. That's what means the most to me right now, is my daughter's health. And I get pretty upset when I see kids who have been suffering through different health issues, just because their parents were told, oh, that's just autism. And that really upsets me. So, for me, I'm as fierce as possible at teaching the science, so parents feel comfortable and feel supported by seeking out, “How can we really help my child's health?” because health just changes so much.

SHAUNA: That is the truth. Okay, and our final question, what is bringing you joy right now? It feels like the world is often very heavy, and unjoyful. What brings you joy?

THERESA: So the sun was out today. So that was really nice. Yes, yes, yes, yes. I try to find – this is something that autism has taught me. So, I try to find joy in even the little things. So it took me a really, really long time to create a habit of being grateful and appreciative. That was something I always had to work at, which kind of annoyed me. But I'm like, “Why can't this just be easier? Why can't I just be grateful? So many people are just walking around, oh, I'm happy for this.” So, probably took at least 5 years of having it be one of my goals for the year of, “Okay, I want to be more appreciative,” and I say all that in the sense of, when I walk around, I try to tune into nature because nature makes me happy easily, because it's just neutral, right? And so, you know, I was walking, and I saw the purple crocuses, and they already bloomed, and they were open! And I just was able to – knelt down toward there was, like, a cluster of them, and I was just looking at them, like. “Ah, it's just so beautiful!” And it was great! Like, it was able to shift me, and I hear the birds chirping. And I got an app on my phone, so now I know, ooh, that's a Blue Jay, now I know what a Blue Jay sounds like, right? And so it's these small things that bring me joy, which then puts me in a good place. So when I'm interacting with my daughter, I'm starting from that joyful place. But it took time and years to cultivate that, but it definitely was worth it. So, joy in the little things or even in the big things. It just feels better when it happens more often.

SHAUNA: That is so true. I love the micro-joys that help us get through the macro hard, right?

THERESA: Yep.

SHAUNA: That's amazing. Dr. Lyons, thank you so much for coming today and sharing all of your wisdom with us, and we are grateful to have you here. Thanks for being In the Den with us today.

THERESA: My pleasure. These were great questions! Loved them!

SHAUNA: Thanks.

SARA: Thank you so much for joining us here In the Den. Did you know that Mama Dragons offers an eLearning program called Parachute? This is an interactive learning platform where you can learn more about how to affirm, support, and celebrate the LGBTQ+ people in your life. Learn more at Mamadragons.org/parachute or find the link in the episode show notes under links.

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