The role of the physiotherapist is to improve quality of life for all. 

However, it is well known that factors such as the social determinants of health will influence levels of trust and interaction with healthcare and also outcomes for certain population groups.

Intersectionality, a term originated by civil rights advocate, scholar and writer Kimberlé Crenshaw in 1989, is a concept that aims to understand the identities, power dynamics and systemic factors that influence privilege and oppression, including race and ethnicity, disability, religion and sexuality and gender identity.

Viewing healthcare through an intersectional lens allows physiotherapists to guide inclusive and responsive policy and to holistically consider the many factors that have influenced a person’s health outcomes and interactions with the healthcare system.

In recent years, understanding of disability and LGBTQIA+ identities has been examined in literature. 

In particular, diagnoses of a neurodevelopmental and neurodivergent nature, such as autism and ADHD, have been increasingly observed to intersect with gender identity and sexuality (Stein et al 2025).

A study by the University of Cambridge in 2020 found that transgender and gender-diverse adults are three to six times more likely to be diagnosed as autistic than their cisgender counterparts (University of Cambridge 2023). 

A subsequent study also found that autistic individuals were much more likely to identify as LGBTQIA+ than the general population (University of Cambridge 2025).

The interplay between neurodivergent and LGBTQIA+ identities 

Data collection, along with further understanding and acceptance of both population groups, has led to a more accurate estimation of the prevalence of these identities in the Australian population. 

Kate Gello.

It is estimated that 15–20 per cent of the total population is neurodivergent and a 2022 study identified neurodivergence
in 11 per cent of the Australian working population (Australian Disability Network 2024). 

Meanwhile, in 2024 the Australian Bureau of Statistics estimated that 4.5 per cent of Australians over 16 years of age were LGBTQIA+ (AIHW 2024). 

It is highly likely that these numbers are underestimations of the total size of these populations. 

With this in mind, we can expect to treat LGBTQIA+ and neurodivergent individuals in our clinics and healthcare system.

Both populations are considered vulnerable, with unique health needs and characteristics. 

Neurodivergent individuals are more likely to experience poor mental health, chronic pain and barriers to accessing care.

LGBTQIA+-identifying patients are also more likely to experience challenges with mental health and have an additional increased risk of self-injury and suicide and of substance use.

Emerging research has highlighted a potential connection between these intersecting identities and conditions such as postural orthostatic tachycardia syndrome, dysautonomia, mast cell activation syndrome and Ehlers-Danlos syndromes. 

This has significant implications for how we guide practice and treatment for this population group and may require additional screening or assessment in the clinical space.

Supporting LGBTQIA+ neurodivergent individuals

Well-informed and actively accepting physiotherapists provide better care for the LGBTQIA+ population (Ross & Setchell 2019) and a similar effect is seen among those providing neurodivergent-affirming care. 

We want to support patients through a strengths-based lens rather than focusing on deficits. 

Neurodivergent individuals can thrive when practitioners nurture positive self-identity, promote autonomy and validate differences.

This is also true of LGBTQIA+ individuals, with an additional emphasis on community and positive support networks.

In practice, consider the differing sensory needs that these populations may have. 

Patients who are LGBTQIA+ and neurodivergent may want processes explained in detail, especially before disrobing, palpation or treatment. 

Some patients may require exercises to be completed in spaces they feel safe in, such as their bedroom or a quiet area.

Understand who else is involved in a patient’s care and support and liaise with them or refer onwards should you have any concerns about co-occurring conditions such as Ehlers-Danlos syndromes or postural orthostatic tachycardia syndrome.

It is also helpful to know a range of safe and affirming online resources to refer patients to, such as TransHub, ACON or Neurodiversity Hub.

Understanding the role of intersectionality in physiotherapy practice is a crucial skill for improving the health outcomes of LGBTQIA+ and neurodivergent patients. 

With the right knowledge, we are all capable of supporting these patients to achieve their goals and to have positive experiences with physiotherapy.

>> Kate Gallo APAM (she/they) is a queer and neurodivergent physiotherapist working in a private multidisciplinary clinic in Sydney’s Northern Beaches. They are also a member of the APA LGBTQIA+ advisory committee.

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