PRG – 1 Identifying Neurodiversity in a Non-Binary Patient with a History of Trauma and Paranoia

Abstract Objective This case highlights a presentation at the intersection of gender dysphoria, autism, trauma, and paranoia, an area with limited clinical literature. Such an understanding is critical and illustrates the need for affirming, trauma-informed assessment. Method Patient is a 10-year-old non-binary individual with a family history of attention deficit hyperactivity disorder, social anxiety, depression, autism, eating disorders, and dyslexia. Patient was born four weeks early during an emergency C-section after their mother experienced autoimmune disorders. Patient’s developmental milestones were met in a typical fashion. At age six, Patient lost all belongings in a house fire, and throughout the pandemic, stressors persisted. Concerns include attention regulation, executive functioning, irritability, suicidal ideation, gender dysphoria, and paranoia. Patient believes there are hidden cameras in house outlets and stuffed animals and worries about being followed to and from school. Furthermore, they avoid physical examinations and showers, and projective measures are consistent with trauma and paranoia. Results From neuropsychological findings, Patient was diagnosed with autism, major depressive disorder, and continued monitoring for attenuating psychosis syndrome. Conclusion Patient’s diagnosis of autism is consistent with existing literature suggesting an elevated prevalence of gender variance and gender dysphoria among autistic youth (Strang et al., 2018; Hisle-Gorman et al., 2019). Furthermore, the complex nature of this case can be contextualized from prior research sharing how non-binary individuals often score higher on paranoia scales, despite not having a psychotic profile (De Sousa et al, 2019). This case study demonstrates the complex co-occurrence of gender identity and neurodevelopmental factors and the need for affirming care.