Tavistock clinic ‘ignored’ link between autism and transgender children

Staff so determined to push pro-trans policy patients were treated as ‘collateral damage’ it is alleged

14 February 2023 12:01am GMT

The Tavistock clinic ignored evidence that 97.5 per cent of children seeking sex changes had autism, depression or other problems that might have explained their unhappiness, a new book claims.

Staff at the NHS facility were so determined to push a pro-transgender policy that children who might not have been trans were treated as “collateral damage” by clinicians who labelled doubters “transphobic”, a whistleblower says.

Seven in ten children had more than five “associated features” such as abuse, anxiety, eating disorders or bullying, and a social worker estimated that as few as 1 in 50 children treated at the clinic would have stayed transgender for life if they had not been given controversial drug therapy.

One clinical psychologist who worked at the Tavistock was “horrified” at the possibility that highly vulnerable children were wrongly being given irreversible drug treatments following referral by the Tavistock, but discussion of the subject was shut down by colleagues, she said.

The claims are made in Time To Think: The Inside Story of the Collapse of the Tavistock’s Gender Service for Children, by Hannah Barnes, a BBC Newsnight journalist, which is published on Feb 23.

The book, which is based on more than 100 hours of interviews with clinicians and patients, paints a picture of a clinic that became overwhelmed by demand and came under the increasing influence of transgender charities.

Children as young as 10 were referred to specialists with a view to them being prescribed puberty-blocking drugs, and others were referred after as little as 20 minutes’ consultation, the book says.

The NHS’s Gender Identity Development Service for children (Gids), which is based at the Tavistock and Portman NHS Foundation Trust in London, will close later this year after it was criticised in an independent review by Dr Hilary Cass. It will be replaced by regional clinics after Dr Cass said that having a single provider of gender identity services was “not a safe or viable long-term option”.

The book discloses that some staff at Gids were concerned about the levels of autism and ADHD in children referred to them, and feared that they might be unnecessarily medicating autistic children.

Autism Spectrum Disorder

Less than two per cent of children in the UK are thought to have an autism spectrum disorder, but according to Gids’s own data, around 35 per cent of its referrals “present with moderate to severe autistic traits”.

In 2000, the only clinical audit of patients ever carried out by Gids found that more than 25 per cent of referrals had spent time in care, compared with 0.67 per cent of the general population. Children referred to Gids were ten times more likely than the national average to have a registered sex offender as a parent, while 42 per cent had lost a parent through death or separation, and 70 per cent had more than five “associated features” such as anxiety, depression, abuse, self-harm, bullying, eating disorders or suicide attempts.

Anna Hutchinson, a former Gids clinician who was interviewed for the book, “feared she may be contributing to a medical scandal, where an NHS service was not stopping to think what else might be going on for so many of these vulnerable children”, the author notes. Only 2.5 per cent of the children seen at the clinic had no associated problems.

The book’s title, Time to Think, refers to the reason given by clinicians for referring children for puberty blockers who identified as transgender. They claimed that by delaying the onset of puberty, the children would have more time to think about what they wanted, and discuss the cause of their unhappiness with professionals, before their bodies went through the changes brought on by puberty.

However, in 2016 it emerged that nearly all of the children referred for assessment for puberty blockers went on to take cross-sex hormones, which would give the children some of the physical characteristics of the opposite sex.

Dr Hutchinson told Ms Barnes that she realised the puberty blockers might have been confirming a trans identity rather than simply pausing puberty, and: “I was horrified because I just suddenly thought, ‘Oh God, Oh God’.” She became concerned that Gids was getting it wrong by referring children for assessment for puberty blockers who were traumatised, abused, autistic or simply gay, but said that the finding on puberty blockers was brushed aside by staff.

Andrea Walker, a former social worker at a Gids satellite clinic in Leeds who spoke under an assumed name, estimated that “only 2 or 3 per cent” of the children seen by staff would have continued to identify as transgender for life if they had not been referred for medical intervention.

Her estimate is broadly in line with the beliefs of Domenico Di Ceglie, who founded Gids in 1989, who said only 5 per cent of patients would transition and 60 to 70 per cent would be gay. Studies elsewhere had shown that for the majority of young people who experienced gender dysphoria as children, their desire to change sex would disappear during puberty.

Some staff at Gids feared that children who would have reconciled themselves with the body they were born with were being denied that chance by the use of drugs.

Dr Hutchinson said: “The ‘non-trans-for-life group’ are just not given a second thought.’ They are treated as ‘collateral damage’.”

Mermaids

Ms Barnes chronicles how the transgender charity Mermaids put huge pressure on the clinic to refer children for drugs at a younger age and to recommend surgery, with one clinician saying they would be “absolutely attacked [by Mermaids] for just trying to stop and think with [children]”.

Ms Walker claimed that a decision by the clinic to scrap its lower age limit of 12 for sending children for assessment for puberty blockers happened because a Dutch clinic had made such a move and because “Mermaids wanted it to happen.”

One former patient, called Harriet, who was interviewed for the book had a mastectomy and then de-transitioned to resume living as a woman. She said she had just needed someone to listen to her teenage problems but instead was quickly put on puberty blockers.

She said: “It does feel a bit like waking up from a nightmare or regaining control of my mind after someone else took over.”

A spokesman for Tavistock said: “Gids works on a case-by-case basis with every young person and their family, working thoughtfully and holistically with them to explore their situation, with no expectation of what the right outcome for them might be.

“Only the minority of young people seen in the service are referred for any physical interventions. At the Tavistock and Portman, we wholeheartedly support our staff to raise concerns, and have recently strengthened our mechanisms for doing so. Concerns relating to young people’s wellbeing are taken seriously and investigated.”

A spokesman for Mermaids said: “While we advocate for the needs of transgender young people, Mermaids’ focus is and always has been supporting our service users who are, at present, struggling with a lack of clarity from NHS England on future specialist gender services for children and young people as well as unacceptable waiting times of more than three years to access life-saving treatment.

“We do not provide clinical advice but rather emotional support and information for those struggling with their gender identity, and do not seek to interfere with private clinical decisions made between a young person and their healthcare professionals, over which we have no influence.”