Navigating Gender Identity for People with Intellectual & Developmental Disabilities (ID/DD)
Practical, rights-based guidance for families, caregivers, and professionals.
Did you know?
Research suggests that gender diversity and gender dysphoria may be more prevalent among people with neurodevelopmental differences, including autism and ID/DD. For example, one review points out that “recent research reports an increase in gender dysphoria in people with neurodevelopmental disabilities including intellectual disability and ASD,” (JAACAP).
People with ID/DD and gender-diverse identities often face intersectional stigma—both from societal ableism and from heteronormativity or cisnormativity. A systematic review found layered stigma in adults with intellectual disabilities who identify as LGBT (PubMed).
Individualized, multidisciplinary care that considers the unique needs of gender-diverse individuals is recommended for supporting anyone on their gender-journey (WPATH).
Guiding principles (short & actionable)
Assume competence, start from respect. Treat the person with ID/DD as the primary source of information about their gender. Use the name and pronouns they ask for—even if communication is non-verbal, use accessible supports (visual aids, social stories, AAC) to understand how they describe themselves (SAGE Journals).
Make information accessible. Provide plain language and easy-read materials about gender, relationships, available supports, and changes in body/social role. People with ID/DD often benefit from visual explanation, repetition, and role-play (PMC).
Prioritize safety and mental health. Gender-diverse people with ID/DD can face high risks of bullying, abuse, mental-health challenges, and lack of access to affirming care. It is essential to build supports around emotional well-being and transitions (PMC).
Work collaboratively—not paternalistically. Involve the person with ID/DD, their trusted advocates, family/supporters, multidisciplinary professionals (psychology, communication, primary care) when needed. Support decision-making rather than override it (PMC).
Document capacity and legal context carefully. For people with ID/DD, decision-making capacity might vary by type of decision (e.g., social change vs medical intervention). Guardianship or supported decision-making frameworks should be considered alongside ethical and legal guidelines (PMC).
Practical steps for families & paid supports
1) Start by listening (use accessible tools)
Ask open, simple questions: “How do you want people to call you?” “How do you feel about your body?” Use yes/no options, picture cards, AAC devices if needed.
Recognize that communication may take time—allow multiple sessions.
Use observation: How does the person express themselves? What clothing, name, pronouns do they lean toward?
Avoid jumping to conclusions (e.g., assuming behavior means “just a phase”). The literature notes caution: “we must also be willing to accept and embrace the idea that someone with an intellectual disability may have a trans identity,” (Intellectual Disability).
2) Provide plain-language education about gender and relationships
Create or source easy-read materials that explain gender identity, pronouns, body changes, relationships (including friendships, romance, consent).
Include examples so the person can reflect: “We can’t really know someone’s gender until they tell us. We can guess based on how someone’s body looks when they are born. Sometimes we guess wrong and that person lets us know,” etc.
Ensure sexual health/relationship education explicitly includes gender diversity — research indicates that people with intellectual disabilities, if they receive sexuality education at all, it often omits LGBTQ+ topics (PMC).
Support regular review — concepts may need to be revisited as the person grows or circumstances change.
3) Build a simple support plan
Key elements can include:
Preferred name/pronouns: Document and agree how staff/family will use them.
Communication supports: How the person will let others know their name/pronouns, what to do if someone uses the old name.
Safety/mental-health plan: Who to call/support when distress arises, what coping strategies work for the individual.
Steps for social transition (if applicable and person-led): Changes in clothing, hairstyle, name change in school/job, restroom access. Make the sequence and pace individualized and gradual.
Regularly review and adjust the plan—needs may change over time.
Recognize that existing models (staffing, behaviour supports) may need adaptation for gender-diverse needs.
4) When medical questions come up, follow multidisciplinary, informed pathways
If the person with ID/DD is considering medical/physical transition (e.g., puberty blockers, hormones, surgeries), then assessment should include: communication capacity, support needs, consent capacity, mental health, medical fitness, family/support context.
Use the WPATH Standards as a broad guide: e.g., capacity to make informed decisions, stable mental health, lived experience in desired gender role prior to irreversible procedures (transhealthcare.org).
For people with ID/DD, adapt these criteria: assess decision-making support, provide accessible information, document the process thoroughly.
Coordinate across specialists: endocrinology, psychology/psychiatry, disability support services, primary care.
Always assume the person with ID/DD has the right to express gender identity — but also recognize the need for tailored supports to safely explore and transition.
5) Respect boundaries, privacy, and dignity
The person’s chosen name/pronouns and gender identity are personal—don’t “out” them without their consent.
Train staff and caregivers in respectful language, confidentiality practices, and inclusive behavior.
Avoid assuming a person with ID/DD cannot understand or express gender identity—this contradicts current evidence which emphasizes autonomy and support (SAGE Journals).
For clinicians & service providers: clinical practice pointers
Assess communication needs first. Many standard questionnaires or assessments assume verbal/receptive language skills; these must be adapted or replaced with accessible versions.
Use supported decision-making where possible. Rather than denying involvement due to presumed incapacity, explore what supports (visual aids, plain language, advocates) enable the person to participate meaningfully in decisions (PMC).
Coordinate care across teams. Inclusive care for people with ID/DD and gender diversity often needs collaboration among disability support, gender-affirming care specialists, speech/language therapy, mental-health professionals, and primary care.
Watch for co-occurring issues. Many people with gender dysphoria also face mental-health challenges or neurodevelopmental conditions; for example, youth with gender dysphoria had higher odds of neurodevelopmental diagnoses such as ASD and ADHD (PMC).
Document thoroughly. Because the evidence base is still emerging, clinicians supporting gender identity in people with ID/DD should document their rationale, consent/adapted consent process, support structures, and ongoing review.
Tailor interventions. One-size-fits-all doesn’t apply: each person’s communication, cognitive, support, and health status must guide planning.
Training and organizational change (what agencies should do)
Develop easy-read intake forms, pronoun/name change protocols, complaints pathways, and staff training on gender-affirming practice and disability-accessible communication.
Provide mandatory training modules that cover intersectionality (gender identity + disability), trauma-informed care, and inclusive practices. The literature emphasises that professionals often lack training at this intersection (DREDF).
Monitor organizational policies to ensure inclusive restroom access, name/pronoun usage, non-discriminatory practice for people with ID/DD who are gender diverse.
Establish peer-support networks or link to community groups for gender-diverse people with ID/DD or those exploring gender identity—peer connection can reduce isolation and stigma.
Collect and review data on inclusion, transition pathways, staff training outcomes, incidents of discrimination/harm, and outcomes for gender-diverse persons with ID/DD.
A short checklist you can use now
Ask and use the person’s chosen name and pronouns.
Provide at least one easy-read explanation about gender and relationships with gender diversity included.
Put a simple safety and mental-health plan in place (supports, crisis contacts, calm strategies).
If medical questions around gender-affirming care arise, refer to a multidisciplinary team knowledgeable about ID/DD and gender identity; document capacity and consent process.
Link to peer support or community resources for gender-diverse people with ID/DD or LGBTQ+ disability networks.
Ensure staff/caregivers receive at least one training session on inclusive gender identity support for people with ID/DD.