Dr. Alexis Bitting discusses gender diversity in the neurodiverse.
(34 minutes) Dr. Alexis Bitting, LMHC is a Licensed Mental Health Counselor and has a Ph.D. in Clinical Sexology. She has specialized experience working with children, teens, and adults with social and developmental delays, including autism spectrum disorders, Asperger’s, ADHD, non-verbal learning, and other challenges. Dr. Bitting utilizes a comprehensive and multi-disciplinary approach when working with clients and their families.
For more about Dr. Bitting: https://www.southfloridatherapists.com/
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Welcoming Dr Alexis Bitting
DR HACKIE REITMAN (HR): Hi, I’m Dr. Hackie Reitman. Welcome to another episode of exploring different brains. And today we have a real expert with us, Dr. Alexis Bitting, who is an expert, not only in autism, but in sexuality and gender differences. Dr. Bitting, welcome.
DR ALEXIS BITTING (AB): Hi, thank you for having me.
HR: Well, tell us how you got into all of this, because here you are, you’re so experienced in autism and you’re so experienced in the sexuality and gender aspects. Tell us how this evolved.
AB: Great question. So, for me, it was the autism came first and then the sexuality component came second. So, I was lucky enough to have a wonderful mentor in college, Dr. Michael Alessandri. Who’s just incredible and very inspiring. And so, kind of got my you know, my brain thinking, wow, this is a very interesting population to work with, and these are fascinating individuals. And so, after college, I ended up working for the center for autism for several years, seven or eight years. And I worked mostly with teens and adults. And with that work, what I noticed was a lot of people tended to shy away from issues regarding sexuality or found it to be a very different type of behavior or very uncomfortable having those conversations, whether it was parents or professionals. And I just never had that discomfort. I actually worked in an HIV STD clinic before I did this work. So, I always had that comfort with that topic. And I really wanted to kind of be more educated in that world so that I could feel helpful to individuals, autistic individuals, and their families in that component, in those areas. So, while I was getting my master’s degree in mental health counseling, I had to focus in on autism and doing good therapy for individuals with autism. And then after that, did my doctorate in clinical sexology to really get the information needed for really specializing and understanding fully the issues that come up with sexuality in general autism or not. And then how that can compound some of the challenges that might have if they have an autism diagnosis. And so that’s been really fun work and very interesting, and, and there’s not a lot of people still talking about it and still having those conversations. And I want to make sure there are resources in the community. So, people can reach out and feel informed and feel understood.
HR: Tell us about the commonality of gender issues and sexuality issues in the autism community.
AB: So, there’s a lot of… To be honest, I was actually doing even some additional research recently. The research is very new and there’s not great research happening right now and there needs to be more. And so, some of the commonalities that tend to come up is there’s a greater incident anecdotally, and some research supports this, a greater incidence of gender differences and in individuals with autism than in the neuro-typical population. And so that would lend itself to, to us thinking, okay, you know, if there’s you know, increased gender dysphoria or gender differences in this Neurodiverse population, we really need to be looking at that and seeing, okay, how can we best support this population with good information, good resources, and really supporting them instead of just, you know, kind of pushing that issue to the side.
HR: You know, members of the older generations like myself, whether gay or straight incidentally are having difficulty understanding all of the new LGBTQ plus community abbreviations, classifications, and thus are inadvertently offending people they don’t mean to offend. Could you enlighten us on some of this?
AB: Sure. Of course, I think an important component for everyone to keep in mind, older generations, younger generations, is that the language for a lot of what we’re talking about now, didn’t really exist up until recently. And if it did, it was in these like smaller groups of people in small populations where they would come up with their own terms or come up with language that really represented who they were, what they felt about themselves. And so, you know, not until recently did we have more widespread terms or, you know, agreement about what some of these terms might be like. You know, we can go more into it, but gender fluid, gender queer, transgender what that really meant. And so, I think without having the language for something you’re just confused, like, you don’t really know what to call it because there’s no language for it. So, I think there’s a beauty in the newer generations, you know, creating this language, having more of this dialogue. But that does leave a lot of people, very, because they’re not used to, they didn’t grow up with this language. It’s all brand new. So, it’s like learning a little bit of like a new language. And so, it’s easy to mess it up or to just not understand or, you know, make mistakes very inadvertently. So, I think on both ends, it’s a little bit of, you know, education and compassion. And truly trying to understand the point of view of the other person, even if I say, you know, why do you need so many words to describe something so similar, if I’m not part of that group, really, I don’t get a say in that, right. So, if I’m a cisgender, so if I’m a woman born as a woman and I identify as a woman, and I’m not part of that population, then I don’t really get a say in the language that, the group uses. And that would be, you know, the opposite as well. And so, I, you know, I think having a lot of respect for one another is really important, and always learning and doing our best to learn and forgiving when there are mistakes
HR: Very well said. Let’s say someone is watching us, and now I’m going to break this down into two questions. One would be the person themselves is having gender and sexuality issues and questions. And for lack of a better term, I might say, confusion, what is the advice you have for them?
AB: So, you’re saying the individual themselves is having some…, Like they are in the question, I like to call it the questioning phase.
AB: Okay. My advice, I think if you’re in the questioning phase is to find some people around you that you can have some of those conversations with that have some of that knowledge and can be objective what I find particularly with youth, but anyone is that the internet is this wonderful place of a lot of information, some of which is good, and some of which is bad. And sometimes it’s hard to parse out what’s good and what’s bad information, or what’s helpful or unhelpful. And it’s easy to go into like a black hole almost so just information. And it can be overwhelming. And I think particularly if you have a Neurodiverse brain that can be even more challenging saying, oh my gosh, it’s easy to get disorganized and overwhelmed.
AB: And so, the first thing I would say is to have a conversation with someone who knows what all these terms mean, can help organize you and say, okay, this is what this means. This is what this means. How do you feel about that? Does this feel like you, does this not feel like you? Because I, you know, for example, I work with a lot of individuals that will come to me and say, maybe something along the lines of I’m transgender. Okay. And so, we talk about what that means, right? What exactly what that means. And does that suit you, does that fit what your brain is saying? Or is it something a little bit different? And it’s okay. Either way. It’s okay. Maybe you are, you have, it is true. You are transgender. And that is, and that is accurately reflecting your feelings and your thoughts, but it may be, you know, I heard transgender and I kind of associate with it, but when you break it down, maybe it’s an individual who is gender fluid and maybe attracted to the same sex and wants to express maybe differently than the social norm.
So, all these things tend to get really confusing. Even for someone who’s really savvy in some of this language. So, I think having someone break down what each of those things mean, work with that person and say, “okay, yes, I identify with this, but not this or somewhat with this”, can be really helpful to organize oneself. And also knowing that for some people it’s very straightforward, they are transgender. For example, they were born a woman, but they are a man. And that’s, you know, simple, you know, I say simple, but it’s not so simple, but simple. For some individuals, it may be a long period of questioning it maybe “I kind of feel like this right now, but maybe six months, a year, two years later, I will, something changed”. So, I may say, “you know what, I’m asexual, I’m aromantic and that’s how I feel, is how I identify and I’m cisgender.” Great Awesome. We figured that out, you feel a little bit better. You feel like you have your identity that feels comfortable, but also being okay with maybe in a year, you know, maybe I identify as a Demi sexual and not asexual, you know, really that’s another term that’s kind of come to light that I think fits a lot of individuals. And that’s okay. So, I think it’s a couple things. A: figuring out what all those words mean and understanding identity, and then also being flexible within that and saying, you know, it’s okay to be able to have a longer period of questioning to make sure this is really what suits me.
HR: And how would you define Demi sexual?
AB: Good Question. So, I think different people describe it somewhat different. So, Demi sexual would be so someone who’s asexual is not sexually, romantically sexually attracted to anyone. Someone who’s demisexual, they’re not necessarily attracted to one gender or another. But really someone’s soul, just one person. They connect with that one person and that’s it. So, they’re not sexually attracted to men or sexually attracted to women or pansexual attracted to everyone. They’re really just attracted to this one specific person for some sort of connection that they made with them.
HR: That’s so interesting. Now let’s switch from the individuals themselves to carrying third parties, such as family and friends say, parents of an adult, female, who is now questioning. What advice do you have for them?
AB: Okay. So, I call…, In the community, they call those “SOFAS”, “significant others, friends, family members, and allies”. So that’s what you’re talking about. Right? So [laughs].
HR: I like that. “sofa”, that makes sense.
AB: So, it’s those people that really care. So, what I would say is, you know, a lot of advice, but what the first thing is to do your best, to respect that person’s wishes, even if you don’t fully understand them. So one of, I think the, I don’t want to say the easiest because it’s very hard for, it can be very hard for parents, is if let’s say you have a child who is a sex assigned at birth as a female, but maybe want to change their pronouns. So as a therapist, when I first meet someone, the first thing I say is, “hi I’m Alexis. I go by the pronouns, she and her, what are your preferred pronouns?” Even if they don’t come in with a Trans or a sexuality related issue, because kids nowadays want that freedom or teens or young adults to be able to, to really kind of come up with that identity and feel understood. So, I would, you know, want to know what that individual, what their pronoun, their preferred pronouns is. It, she/her, they/them, he/him. So, I would start there and then name right for parents, I think are really challenging thing is I have you know, I birthed my sex assigned at birth daughter. Her name is, let’s say Susie, right. I’ve called Susie for 20 years. Right. So, Susie now Susie wants me to call her Matthew and I’m like, I can’t do it. I just, I cannot do it. I can’t, I can’t do it. I can’t have my parents do it. Susie’s grandparents will never call her Matthew. And so just that can be very invalidating to the person that’s doing their best to come out as transgender. They’re not being called…, They’re being called a name that’s very triggering.
So, if I’m a transgender male, right, I want to be called Matthew. Everyone keeps calling me Suzy. Most likely every time I hear the name Suzy or she or her, that’s triggering some of my dysphoric thoughts, those uncomfortable thoughts that I get when my body isn’t matching my gender identity. And so I would say one of the most important things is doing our best to however we can decrease some of that gender dysphoria by listening to the person, my listening to the person’s wishes, what really works for them and, what their desire is. That would be probably one of the first things and one of the most challenging things I see is really, you know, pronouns and name. And then, you know, how, and what are the next steps, you know, what does that person want? Some people only want to, we call socially transition, if they want to transition at all. But that would mean changing how they express themselves on the outside, but maybe not taking hormones, not getting surgery. Some people never want surgery. That doesn’t mean they’re any less transgender than anybody else, or any less valid than anybody else. They just might not want the surgery or might not want to take the hormones or do the voice therapy. Whereas some individuals want to do all of it. They really want to pass as the gender that they feel that they, that they know that they are. And so, I think it’s very complicated per case, but really trying to respect their wishes, even if you don’t fully understand.
HR: One thing the Neurodiverse community has in common with the gender dysphoria community, let’s put it like that, Cause I don’t know the correct terminology, is stigmatization stigma, could you address that a bit?
AB: Yes, that’s a good, actually research I was reading this morning, actually that came up on my feed was about mental health. So, I can even start with just mental health stigmatization. So, there’s a lot of research of increased anxiety and depression for individuals that identify as transgender. And there’s a lot of research that indicates there’s heightened anxiety and depression comorbidity with gender diverse individuals. So, if you combine those two, you often get a lot of increased anxiety and depression, whether it’s clinical or symptomology. And so, I think what can often happen is, again, when you don’t understand someone, you might shy away from them or have judgmental thoughts as humans, we make opinions and judgments of other people for safety reasons, right? So, for protection, right, we make judgements like that’s how cavemen evolved. And in a way it’s very protective, it protects us. We make these opinions and judgment, but socially we’ve evolved to make opinions and judgments that are not for safety. They’re just based on previous experience. Good and bad we stereotype. And I think that often happens with, you know, the transgender population, the autism or Neurodiverse population. And then when you combine the two, it can be even more challenging.
Typically, autistic individuals struggle with the social norms. And really, you know, I think some of our social norms are kind of silly if you think about it, like small talk, right. Really? Why do we need small talk? We kind of don’t really need small talk. And many of the individuals of autism I work with are like, it’s just, I don’t want to do it. And I’m like me neither. Right? So, if you think socially, like there’s not a huge purpose for small talk, it ends up, but you, it starts to build trust. You get to know that person on a very soft level and kind of build information from there, but really a lot of social rules are silly, right? If I like someone, if I’m attracted to someone, why can’t I say, I think you’re attractive. I’d like to go on a date with you. Why not socially? That just says, it’s not how it works. Right? You kind of have to play this cat and mouse game. And so, I think that’s a lot of socialization in a lot of patients, organization of your brain perspective, taking things that can be challenging if you have an autism diagnosis. And so, I think socially, there’s this initially a stigmatization. If you’re Neurodiverse often you may be socially excluded. You may, you know, not be treated very well in school. Many individuals I know have experienced bullying. I would say the majority have experienced some level of bullying or feeling left out growing up or being misunderstood. And then if you’re often, if you fall in somewhere just within the LGBTQ spectrum then there’s also that I’m not fully understood. I might be peer rejected. I may be called names made fun of, so if you combine those two together, it’s a lot of just misunderstanding. And a lot of times it’s, it’s for things that are silly, like that person’s really bad at small talk that doesn’t really make them a good or a bad person. They just don’t like something that most people actually don’t like, they’re just better at faking their way through it.
So, it’s, I think it becomes, you know, a huge challenge and, especially if you’re a gender diverse, there’s so many more social questions that come up that make it even more challenging. What bathroom do you use? How do you, who do you come out with? Who do you trust? How do you build relationships? I’ve had, you know, several individuals identify as even nonbinary, someone who identifies as not, not neither male nor female non-binary doesn’t conform to, you know, those boxes. Came out to who they perceived as a friend, but socially they weren’t quite interpreting that correctly. And that person really wasn’t their friend. So, they come out to this person, they perceive as a friend, then that person goes and tells a bunch of people that this person’s, you know, is that is non-binary. And so that leads to more stigmatization because that person didn’t want to share that information with everyone. Then there’s a judgment that happens and rumors happen at school. And so, it ends up compounding in this way. And often it’s starts off somewhat social and all the stressors that come just compound and compound, it can be really challenging. And I think navigating that is not very easy and having a really solid support system is probably the best thing an individual could ask for. So when you asked that question before about, you know, significant other, you know, family members, I think that’s really that support system, that foundation is key to that individual feeling supported, loved, understood, and being able to manage some of the stigmatization that will happen socially.
HR: Where can our audience learn more about you?
AB: Great question. So, I, currently I’m a therapist at “Pediatric Psychology Associates”. I work out of the South Miami office. Now we have three offices: Western, Aventura, and South Miami. And so, you can always go to our website, it’s www.southfloridatherapists.com. My bio is there. You can always reach out. I’m always happy to chat give a consultation and any advice especially navigating some of these tough times.
HR: Well, I think there’s a great need for the overlap between someone who’s very well trained and has the vast experience you do in autism with the gender diverse issues. It’s where neurodiversity meets gender diversity. And the numbers, as you say, even anecdotally are big, big numbers. And I think if one is going to treat either of these populations, they have to, they have to by definition almost be well-versed in both because, if I were drawing a Venn diagram, there would be a lot of common area in there.
AB: Yeah. Yes. And I think, especially when you’re working with someone who identifies as non-binary or you know, gender diverse or transgender, I think there’s a comfort in the person that you’re talking to. Just I’ll rewind a lot of individuals. I work with say, “I didn’t like my past therapist because I felt like I had to teach them everything about sexuality. I had to teach them what this meant”, and that can be exhausting as a patient. You don’t want as a patient; you want to go to someone who knows what they’re talking about. Right. There was, there was always a, I’m always learning from my patients. I don’t know everything. That’s, that’s a far cry from the truth, but I am always learning, but I try to have as much knowledge as I can in that area that they’re coming to me for. And then they teach me things about like Fortnight or, Minecraft, or anime. And I learned all those other things, but the clinical part, I try to, you know, be well-versed in, because I don’t want my patients having to explain what being demisexual is. Right. I want them to feel comfort in knowing I know what that is. And I accept that I know a pansexual is, or a romantic is, and I know those terms.
Now, there are terms that come out from time to time that are new and it’s okay That I don’t know one or two, but I do know the vast majority. And I think that translates well when you’re having those conversations and in that setting and the same thing with autism, right? Kind of being able to understand some of the basics of what autism is, how it presents, what that person likely went through is very helpful and comforting. Versus, you know, it can be very invalidating to go somewhere and, you know, they don’t quite understand why socially you may have been rejected or why you have challenges communicating with your parents or boss at work. And I think a good example is I had a young man once who he was wonderful at work, great, great worker. He was like the high, one of the highest producing people at his job. But he would come in, people would say hi to him and he would ignore them. So, everyone had a thought about him, and he was really rude. He didn’t like them or, you know, have all these negative thoughts. When I talked to him, he said, you know, I don’t respond back because then they engage in a whole conversation with me and I don’t really want to talk to them for that long. So when, so if he says hi back and say, how are you, how was your weekend? Are you obtaining, he doesn’t want to have that whole conversation. So instead he says nothing.
So, all of these people have been working with him and they just thought he was, you know, maybe non-compliant or rude or, you know, all these other things, but really, he just didn’t want to engage in small talk. And so, when I had that conversation with him, it was like a big light bulb. So, I think knowing the autism piece can help with so many things and then knowing the sexuality piece can help with these other things. And then when you smash them together, it really produces a really great effect and an understanding and support and a caring that can translate to all those people in that person’s life.
HR: What’s the biggest single piece of advice you would give the individual who’s going through some gender confusion. What would be the correct word besides confusion, by the way that I’m trying to say.
AB: I always say they are; you know, it could be the questioning right. If they’re unsure of what that identity is, it sounds like it’s questioning. And if they’re in the midst of going from, you know, their sex assigned at birth to their true gender, you know, their affirmed gender, their, their true gender, and it would be like a transition. So, it sounds like a lot of, you know, the questioning period or that transition period depends on kind of where that person is. If they’re not clear if they’re sure, but they’re just not quite there yet. Or coming out, it could be, you know, especially if you maybe are someone who identifies as gay or lesbian or bisexual, it could be, you know, how to come out to your parents or how to accept that on your own. So, it’s a lot of letters in that and then all these things mean something a little bit different. A piece of advice that’s challenging, I give a lot of advice. I’m trying to think of my population, right? If I’m gender diverse I would say gosh, there’s so many things milling around my head. One piece of advice might be, when you forgive other people, it can help you. And not always then. So sometimes when I work with my gender diverse individuals, “my dad called me this name and it’s the wrong name. And I’m mad at him”. And sometimes forgiveness is not about the other person. It’s not “it’s okay that they did that”, It’s “I’m not going to take on that emotional burden, but I might have a conversation with dad”. Right.
So sometimes a little forgiveness goes a long way. Right. And always knowing, and sometimes it’s, gosh, so many things in my head trying to organize them all is hard. It’s okay to be flexible in your thinking it’s okay for things not to be exactly how you want them to be. But trying to stay hopeful that how you want them to be will happen is key. Right. Kind of having that hopefulness. And so many individuals that come to me are anxious or frustrated. I mean, and that’s very valid. Their experiences would, you know, cause a lot of those uncomfortable emotions. And one of the biggest emotions I try to help, two emotions I try to help work on is how to feel some relief and how to feel some hope. And so how do we get some relief from those emotions? Not to take them away, make them go away. You’re probably still going to be frustrated at XYZ situation or anxious or upset. How do we figure out how to make, cause some relief, create some space for you to feel a little bit better because if you’re very highly, no matter who you are, if you’re highly elevated, you often have a hard time Problem-Solving right. So, if you’re really anxious, really upset, your brain is just not able to problem solve. It’s just having a hard time organizing itself. So, let’s create some relief, right? Let’s use a coping skill. How do we figure out how to, you know, just calm our bodies down? I have many things here in my office, visuals everywhere on different coping skills, because what works for one person doesn’t work for another person. And then let’s figure out how to, how to then problem solve. How do we figure out the very next step and create some hope for the very next step after that? And so that, that would be my advice is to do your best, to find a way to create some relief, a break to cope first, then do the problem solving and create some of that hope that things are going to move in the direction that you want them to be and that you deserve them to be going in.
HR: Well, that’s great stuff. Is there anything we have not covered today that you would like to cover and emphasize?
AB: I guess one thing is, I find a lot of, like, I think I had mentioned a little bit earlier, but a lot of individuals are finding support with online support groups or things like Reddit or Tumblr or going on Instagram or Tiktock. And so, I think some of, it’s providing you a level of support, and it’s helpful, Great. But always looking with information with, kind of a fine-tooth comb and knowing that you don’t have to take all that information as truth. And so many individuals on those chat rooms or forums or social media, they have their own personal experience and it’s going to be very different than your own. And that’s kind of the beauty of it. But that doesn’t necessarily mean it will dictate your experience or that it is your experience or will be anything like yours could be some all most or none, like your experience. And I think being able to look at, you know, information on the internet, dialogue going on the internet, and being really critical about it is so important and making sure you’re getting good information, not just any information
HR: And as in any community or any club you join or any group, there are good people and their bad people. Can be a little bit dangerous in general, not any more so in this crowd and then the other crowd. But sometimes when we join a crowd of like-minded individuals, we can think we’re safer than we are. And there’s a certain amount of “listen, I don’t know if this is true or not. I have to check this out”.
AB: I agree. And you know, One thing I might add to that is I actually think it is a little bit different than other groups, because if I joined a group of people who love soccer, right, we’re talking about soccer or if I joined a group of people who like music, it’s music. But when I’m talking about LGBTQ issues, I’m talking about sex and I’m talking about my body parts and I’m talking about, you know, reproductive organs. And, and I think with that, it becomes a little bit, sometimes a little bit more sexualized and a little bit more romanticized in some ways. And so, I think it does tack on or add this extra layer of emotionality that, you know, my group of people who love soccer, you know, it’s not going to come up in that same way. I’m not talking about, you know, my vagina or my penis. I’m talking about soccer and goalposts and what team I like. And so, I think it tends to sexualize things in a different way whether you’re Neurodiverse or not. And so, I think it is important, you know, to be, to be careful with that information even more so than another group, you know, human behavior. We like to be part of a group, right. That’s human behavior. We feel good. And so particularly if you’ve been socially excluded or had a hard time connecting socially, then you find a group of people that you’re like, Whoa, like we have so much in common. They understand me. You know, we can have these conversations there’s way less judgment. Sometimes it’s so easy to let all your guards down at once. However, you know, it’s really protective and important for us to keep some guards up and to be really cautious and safe with what information we share and what information we take on and absorb
HR: Well, D. Alexis Bitting, it’s been a pleasure to have you here at differentbrains.org, please visit us soon again.
AB: I would love to thank you so much for having me and taking the time.