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Mo K, Anagnostou E, Lerch JP, Taylor MJ, VanderLaan DP, Szatmari P, Crosbie J, Nicolson R, Georgiadis S, Kelley E, Ayub M, Brian J, Lai MC, Palmert MR. Gender diversity is correlated with dimensional neurodivergent traits but not categorical neurodevelopmental diagnoses in children. J Child Psychol Psychiatry 2024; 65:1223-1236. [PMID: 38433429 DOI: 10.1111/jcpp.13965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Gender clinic and single-item questionnaire-based data report increased co-occurrence of gender diversity and neurodevelopmental conditions. The nuances of these associations are under-studied. We used a transdiagnostic approach, combining categorical and dimensional characterization of neurodiversity, to further the understanding of its associations with gender diversity in identity and expression in children. METHODS Data from 291 children (Autism N = 104, ADHD N = 104, Autism + ADHD N = 17, neurotypical N = 66) aged 4-12 years enrolled in the Province of Ontario Neurodevelopmental Network were analyzed. Gender diversity was measured multi-dimensionally using a well-validated parent-report instrument, the Gender Identity Questionnaire for Children (GIQC). We used gamma regression models to determine the significant correlates of gender diversity among age, puberty, sex-assigned-at-birth, categorical neurodevelopmental diagnoses, and dimensional neurodivergent traits (using the Social Communication Questionnaire and the Strengths and Weaknesses of ADHD Symptoms and Normal Behavior Rating Scales). Internalizing and externalizing problems were included as covariates. RESULTS Neither a categorical diagnosis of autism nor ADHD significantly correlated with current GIQC-derived scores. Instead, higher early-childhood dimensional autistic social-communication traits correlated with higher current overall gender incongruence (as defined by GIQC-14 score). This correlation was potentially moderated by sex-assigned-at-birth: greater early-childhood autistic social-communication traits were associated with higher current overall gender incongruence in assigned-males-at-birth, but not assigned-females-at-birth. For fine-grained gender diversity domains, greater autistic restricted-repetitive behavior traits were associated with greater diversity in gender identity across sexes-assigned-at-birth; greater autistic social-communication traits were associated with lower stereotypical male expression across sexes-assigned-at-birth. CONCLUSIONS Dimensional autistic traits, rather than ADHD traits or categorical neurodevelopmental diagnoses, were associated with gender diversity domains across neurodivergent and neurotypical children. The association between early-childhood autistic social-communication traits and overall current gender diversity was most evident in assigned-males-at-birth. Nuanced interrelationships between neurodivergence and gender diversity should be better understood to clarify developmental links and to offer tailored support for neurodivergent and gender-diverse populations.
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Affiliation(s)
- Kelly Mo
- University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Evdokia Anagnostou
- University of Toronto, Toronto, Ontario, Canada
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Jason P Lerch
- University of Toronto, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
- University of Oxford, Oxford, UK
| | - Margot J Taylor
- University of Toronto, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Doug P VanderLaan
- University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Peter Szatmari
- University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jennifer Crosbie
- University of Toronto, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | | - Jessica Brian
- University of Toronto, Toronto, Ontario, Canada
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Meng-Chuan Lai
- University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
- University of Cambridge, Cambridge, UK
- National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Mark R Palmert
- University of Toronto, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
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Özel F, Stratmann M, Papadopoulos FC, Rüegg J, Bornehag CG. Gender-specific play behavior in relation to autistic traits and behavioral difficulties at the age of seven in the SELMA study. PLoS One 2024; 19:e0308605. [PMID: 39196870 DOI: 10.1371/journal.pone.0308605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 07/24/2024] [Indexed: 08/30/2024] Open
Abstract
BACKGROUND Childhood gender nonconformity is related to psychological distress and behavioral difficulties. Similarly, there is evidence for a link between gender nonconformity, or gender dysphoria in some studies, and autism spectrum disorder and related traits. Our knowledge on those associations mostly originates from clinical populations, which might lead to overestimation. Thus, this study aimed to assess associations between gender nonconformity and behavioral difficulties in a population-based study. METHODS In the Swedish Environmental Longitudinal, Mother and Child, Asthma and Allergy (SELMA) study, cross-sectional associations between gender-specific play behavior and behavioral outcomes and autistic traits were investigated among 718 children at 7-years of age. Play behavior was measured using the Preschool Activities Inventory; behavioral outcomes and autistic traits were measured with the Strengths and Difficulties Questionnaire and the Social Responsiveness Scale, respectively. Linear and logistic regression analyses were performed. RESULTS Higher composite play behavior scores (indicating either increased masculine or decreased feminine play behavior) were associated with increased autistic trait scores in girls (β = 0.13; 95% confidence interval [CI] = 0.00, 0.26). Furthermore, higher composite scores were shown to be associated with behavioral difficulties in both girls (β = 0.11; 95% CI = 0.04, 0.18) and boys (β = 0.10; 95% CI = 0.02, 0.19). Additionally, higher feminine scores were related with increased problems in peer relationships in boys (β = 0.04; 95% CI = 0.00, 0.07). CONCLUSIONS This study suggests a link between gender nonconforming play behavior and autistic traits as well as behavioral difficulties among children in a non-clinical population, which calls attention to the necessity of supporting children with gender nonconformity from early ages.
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Affiliation(s)
- Fatih Özel
- Department of Organismal Biology, Uppsala University, Uppsala, Sweden
- Centre for Women's Mental Health during the Reproductive Lifespan-Womher, Uppsala University, Uppsala, Sweden
- Department of Health Sciences, Karlstad University, Karlstad, Sweden
| | - Marlene Stratmann
- Department of Health Sciences, Karlstad University, Karlstad, Sweden
| | | | - Joëlle Rüegg
- Department of Organismal Biology, Uppsala University, Uppsala, Sweden
- Department of Health Sciences, Karlstad University, Karlstad, Sweden
| | - Carl-Gustaf Bornehag
- Department of Health Sciences, Karlstad University, Karlstad, Sweden
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
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de Rooy FBB, Arnoldussen M, van der Miesen AIR, Steensma TD, Kreukels BPC, Popma A, de Vries ALC. Mental Health Evaluation of Younger and Older Adolescents Referred to the Center of Expertise on Gender Dysphoria in Amsterdam, The Netherlands. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:2883-2896. [PMID: 38980647 PMCID: PMC11335953 DOI: 10.1007/s10508-024-02940-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/09/2024] [Accepted: 06/10/2024] [Indexed: 07/10/2024]
Abstract
The present study aimed to investigate whether differences exist between younger and older presenting adolescents at the Center of Expertise on Gender Dysphoria regarding psychological functioning and autistic traits. A total of 1487 consecutively assessed adolescents between 2000 and 2018 were divided in younger presenters (age ≤ 13.9 years) and older presenters (age ≥ 14 years). Of younger presenters, 227 (41.1%) were assigned male at birth and 325 (58.9%) assigned female at birth. In older presenters, 279 (29.8%) were assigned male at birth and 656 (70.2%) assigned female at birth. Behavioral and emotional problems were assessed with the Child Behavior Checklist (CBCL) and the Youth Self-Report (YSR). For autism traits, the Social Responsiveness Scale (SRS) was used. Compared to younger presenters, on both the CBCL and YSR older presenters had higher Total Problem (β = 1.75, p = .005, CI 0.53-2.97, R2 = .04 and β = 4.20, p < .001, CI 2.99-5.40, R2 = .07, respectively) and Internalizing Problem (β = 4.43, p < .001, CI 3.13-5.74, R2 = .06 and β = 6.69, p < .001, CI 5.31-8.07, R2 = .12, respectively) scores. Regarding autistic traits, a higher mean SRS total score was found in older presenting assigned males at birth (β = 4.55, p = .036, CI 0.30-8.81, R2 = .34). In assigned females at birth, no statistically significant difference between older and younger presenters was found in mean SRS total score (β = 1.19, p = .063, CI - 0.07 to 2.45, R2 = .39). Differences in mental health exist between younger and older presenting adolescents and call for an individualized approach in the clinical care of transgender adolescents.
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Affiliation(s)
- Frédérique B B de Rooy
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, Amsterdam, The Netherlands.
- Center of Expertise on Gender Dysphoria, De Boelelaan 1117, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Marijn Arnoldussen
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, Amsterdam, The Netherlands
- Center of Expertise on Gender Dysphoria, De Boelelaan 1117, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Anna I R van der Miesen
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, Amsterdam, The Netherlands
- Center of Expertise on Gender Dysphoria, De Boelelaan 1117, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Thomas D Steensma
- Center of Expertise on Gender Dysphoria, De Boelelaan 1117, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Baudewijntje P C Kreukels
- Center of Expertise on Gender Dysphoria, De Boelelaan 1117, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Arne Popma
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, Amsterdam, The Netherlands
| | - Annelou L C de Vries
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, Amsterdam, The Netherlands
- Center of Expertise on Gender Dysphoria, De Boelelaan 1117, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
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Wong WI, Shi SY, van der Miesen AIR, Ngan CL, Lei HC, VanderLaan DP. Observations on Gender Variance in Chinese Community Children Measured by the Gender Identity Questionnaire for Children. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:2461-2471. [PMID: 38806754 DOI: 10.1007/s10508-024-02889-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 05/30/2024]
Abstract
Few studies have examined how gender variance (GV), broadly defined as gender identity and behaviors (e.g., activities and preferences) that do not correspond with culturally defined gender norms, manifests in community samples, particularly in children and outside Western contexts. We present data based on the Gender Identity Questionnaire for Children (GIQC; Johnson et al., 2004) among 461 Chinese community children (4-12 years old) to gauge how well the GIQC serves as a measure of GV and the prevalence of GV. We examined the descriptive scores of GV, its relationship to a gender-typing measure that has been validated in Chinese children (the Child Play Behavior and Activity Questionnaire, CPBAQ), the scores on the GIQC of children whose gender is incongruent with birth-assigned sex, and the binned category distributions (from gender-variant to gender-conforming) in comparison to a Canadian community sample (van der Miesen et al., 2018). The Chinese children on average scored toward the gender-conforming end and children assigned female at birth showed more GV than children assigned male at birth. More importantly, the GIQC appears to be a reliable and sensitive measure of GV in the Chinese sample. GIQC scores correlated significantly with CPBAQ scores and showed a very similar reliability coefficient, gender difference effect size, and bin distribution pattern as the Canadian reference sample. Also, children reported as gender/sex incongruent had the most gender-variant GIQC scores. Although clinically gender-referred Chinese children are required to establish culturally specific cutoff points, these findings provide initial evidence for the characteristics of GV, the applicability of the GIQC as a measure of GV in Chinese community children, and the comparisons of GIQC categories between Chinese and Canadian community samples.
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Affiliation(s)
- Wang Ivy Wong
- Gender Studies Programme and Department of Psychology, The Chinese University of Hong Kong, 248, 2/F, Sino Building, Shatin, New Territories, Hong Kong.
| | - Sylvia Yun Shi
- Gender Studies Programme and Department of Psychology, The Chinese University of Hong Kong, 248, 2/F, Sino Building, Shatin, New Territories, Hong Kong
| | - Anna I R van der Miesen
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Cho Lam Ngan
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Hoi Ching Lei
- Caritas Medical Centre and Kwai Chung Hospital, Hong Kong Hospital Authority, Ma Tau Wai, Hong Kong
| | - Doug P VanderLaan
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, Canada
- Child and Youth Psychiatry, Centre for Addiction and Mental Health, Toronto, ON, Canada
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Martin CL, Xiao SX, DeLay D, Fabes RA, Hanish LD, Oswalt K. Differing gender diverse children have differing experiences with same- and other-gender peers. BRITISH JOURNAL OF DEVELOPMENTAL PSYCHOLOGY 2024. [PMID: 38770761 DOI: 10.1111/bjdp.12500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 04/29/2024] [Indexed: 05/22/2024]
Abstract
How gender diversity is exhibited varies: some individuals feel similar to the other gender; others experience little similarity to either gender, and some feel similar to both genders. For children, do these variations relate to differing relationships with peers? The goal was to assess whether a community sample of children (884, Mage = 9.04, SD = .90, 51% boys/1 transgender boy; 57% non-Latinx) with differing types of gender diversity have differing relationship experiences and beliefs about same- and other-gender peers. Gender diversity was determined by gender self-concepts (Both-Gender Similar, Cross-Gender Similar, Low-Gender Similar); these were compared among themselves and to gender-typical children (Own-Gender Similar). Results confirmed that children who exhibited differing gender diversity patterns varied in their peer experiences such that gender self-concept matching was found: Children who felt more similar to other-gender peers reported more contact and felt included and efficacious with other-gender peers; children who felt more similar to same-gender peers reported more contact and felt included and efficacious with same-gender peers. These findings suggest that children with two of the atypical patterns (i.e., Cross-Gender and Both-Gender) may experience social benefits that gender typical children do not. These findings illustrate the variability and strengths among gender diverse children.
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Affiliation(s)
- Carol Lynn Martin
- Family and Human Development Program, T. Denny Sanford School of Social and Family Dynamics, Arizona State University, Tempe, Arizona, USA
| | - Sonya Xinyue Xiao
- Department of Psychology, Northern Arizona University, Flagstaff, Arizona, USA
| | - Dawn DeLay
- Family and Human Development Program, T. Denny Sanford School of Social and Family Dynamics, Arizona State University, Tempe, Arizona, USA
| | - Richard A Fabes
- Family and Human Development Program, T. Denny Sanford School of Social and Family Dynamics, Arizona State University, Tempe, Arizona, USA
| | - Laura D Hanish
- Family and Human Development Program, T. Denny Sanford School of Social and Family Dynamics, Arizona State University, Tempe, Arizona, USA
| | - Krista Oswalt
- Family and Human Development Program, T. Denny Sanford School of Social and Family Dynamics, Arizona State University, Tempe, Arizona, USA
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Rawee P, Rosmalen JGM, Kalverdijk L, Burke SM. Development of Gender Non-Contentedness During Adolescence and Early Adulthood. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1813-1825. [PMID: 38413534 PMCID: PMC11106144 DOI: 10.1007/s10508-024-02817-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 01/19/2024] [Accepted: 01/20/2024] [Indexed: 02/29/2024]
Abstract
Adolescence is an important period for the development of gender identity. We studied the development of gender non-contentedness, i.e., unhappiness with being the gender aligned with one's sex, from early adolescence to young adulthood, and its association with self-concept, behavioral and emotional problems, and adult sexual orientation. Participants were 2772 adolescents (53% male) from the Tracking Adolescents' Individual Lives Survey population and clinical cohort. Data from six waves were included (ages 11-26). Gender non-contentedness was assessed with the item "I wish to be of the opposite sex" from the Youth and Adult Self-Report at all six waves. Behavioral and emotional problems were measured by total scores of these scales at all six waves. Self-concept was assessed at age 11 using the Global Self-Worth and Physical Appearance subscales of the Self-Perception Profile for Children. Sexual orientation was assessed at age 22 by self-report. In early adolescence, 11% of participants reported gender non-contentedness. The prevalence decreased with age and was 4% at the last follow-up (around age 26). Three developmental trajectories of gender non-contentedness were identified: no gender non-contentedness (78%), decreasing gender non-contentedness (19%), and increasing gender non-contentedness (2%). Individuals with an increasing gender non-contentedness more often were female and both an increasing and decreasing trajectory were associated with a lower global self-worth, more behavioral and emotional problems, and a non-heterosexual sexual orientation. Gender non-contentedness, while being relatively common during early adolescence, in general decreases with age and appears to be associated with a poorer self-concept and mental health throughout development.
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Affiliation(s)
- Pien Rawee
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Judith G M Rosmalen
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Interdisciplinary Center for Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Luuk Kalverdijk
- Interdisciplinary Center for Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Sarah M Burke
- Interdisciplinary Center for Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
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Mahfouda S, Maybery M, Moore J, Perry Y, Strauss P, Zepf F, Lin A. Gender non-conformity in childhood and adolescence and mental health through to adulthood: a longitudinal cohort study, 1995-2018. Psychol Med 2023; 53:7756-7765. [PMID: 37403583 DOI: 10.1017/s0033291723001721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
BACKGROUND Few studies have examined associations between gender non-conformity (GNC) in childhood or adolescence and mental health outcomes later in life. This study examined associations between (1) GNC and mental health over multiple time points in childhood and adolescence, and (2) GNC in childhood and/or adolescence and mental health in adulthood. METHOD Second generation participants from the Raine Study, a longitudinal cohort from Perth, Western Australia. Data were collected between 1995 and 2018, comprising seven waves: ages 5 (N = 2236), 8 (N = 2140), 10 (N = 2048), 14 (N = 1864), 17 (N = 1726), 22 (N = 1236) and 27 (N = 1190) years. History of GNC, v. absence of this history, was based on responses to item 110 from the Child Behaviour Checklist (CBCL)/Youth Self Report (YSR) ('wishes to be of opposite sex'). The CBCL/YSR were used to measure internalising and externalising symptoms. Items 18 ('deliberate self-harm [DSH] or attempts suicide') and 91 ('talks/thinks about killing self') were used as measures of suicidal ideation (SI) and DSH. For adults, Depression, Anxiety and Stress Subscales and Kessler Psychological Distress Scale assessed mental health. RESULTS Child and adolescent GNC was associated with elevated internalising and externalising behaviours and increased odds of DSH. A history of GNC was also associated with vulnerability for severe psychological distress in adulthood in some symptom scales. CONCLUSION GNC over the child and adolescent period is associated with significant emotional and behavioural difficulties, and psychological distress. A history of GNC in childhood and/or adolescence also predicts poorer mental health in adulthood on multiple symptom domains.
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Affiliation(s)
| | | | - Julia Moore
- Perth Children's Hospital, Nedlands, Australia
| | - Yael Perry
- Telethon Kids Institute, Nedlands, Australia
| | | | - Florian Zepf
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
- German Center for Mental Health (DZPG)
- Center for Intervention and Research on adaptive and maladaptive brain Circuits underlying mental health (C-I-R-C), Jena-Magdeburg-Halle, Germany
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Marino JL, Lin A, Davies C, Kang M, Bista S, Skinner SR. Childhood and Adolescence Gender Role Nonconformity and Gender and Sexuality Diversity in Young Adulthood. JAMA Pediatr 2023; 177:1176-1186. [PMID: 37747725 PMCID: PMC10520839 DOI: 10.1001/jamapediatrics.2023.3873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 08/02/2023] [Indexed: 09/26/2023]
Abstract
Importance Sexuality- and gender-diverse youth experience disproportionate health and social adversity. Accurate early-life indicators are important for development of supportive approaches. Objective To examine whether commonly used items measuring childhood conformity to gender roles are associated with sexual orientation in young adulthood. Design, Setting, and Participants This single-center, prospective cohort study (the Raine Study) assessed 2868 children of 2900 women who were recruited during pregnancy from August 1, 1989, to April 30, 1992, with follow-up ongoing. The Achenbach System of Empirically Based Assessment (ASEBA) Child Behavior Checklist, Teacher Report Form, and Youth Self-Report tools were used to survey parents, teachers, and youths to examine gender diversity among the participating youths. Parents were followed up at years 5, 8, 10, 14, and 17, adolescents at years 14, 17, and 27, and teachers at years 10 and 14. Data were analyzed from August 1, 2020, to July 31, 2023. Exposures Parent and teacher report that a child "behaves like the opposite sex" (gender role behavior), and parent and self-report that a child "wishes to be the opposite sex" (gender role wish), in response to assessment items. Main Outcome Measures Year 27 self-reported sexual identity, attraction, and behavior. Results Of the 2868 children in the original birth cohort, 1154 (40.2%) participated in the year 27 follow-up, of whom 608 (52.7%) were recorded female at birth and 546 (47.3%) were recorded male at birth. Of these, 582 who were recorded female at birth continued to identify as female (cisgender) (95.7%), and 515 recorded male at birth continued to identify as male (cisgender) (94.3%); 47 (4.1%) did not complete the questionnaire. Of cisgender participants, 76 of 605 women (12.6%) and 52 of 540 men (9.6%) had a diverse sexual identity, 204 of 605 women (33.8%) and 77 of 540 men (14.3%) were same-gender attracted, and 100 of 605 women (18.6%) and 39 of 540 men (7.2%) had ever engaged in same-gender sexual behavior. Across all follow-ups, after adjusting for gender, nonconforming gender role behavior was consistently associated with diverse sexual identity and behavior (adjusted odds ratio [aOR] for identity, 2.8; 95% CI, 1.9-4.2; behavior aOR, 2.4; 95% CI, 1.6-3.5). Self-reported gender role wish was consistently associated with diverse sexual orientation (identity aOR, 2.3; 95% CI, 1.4-3.8; attraction aOR, 1.7; 95% CI, 1.1-2.5; behavior aOR, 1.9; 95% CI, 1.2-2.9). Conclusions and Relevance In this cohort study, ASEBA gender role nonconformity was associated with diverse sexual orientation, beginning in early childhood. Findings suggest that the ASEBA measures should not be used to infer sexual orientation or gender diversity in clinical or research settings; asking direct questions may provide more accurate data.
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Affiliation(s)
- Jennifer L. Marino
- Department of Obstetrics and Gynaecology, Royal Women’s Hospital and University of Melbourne, Parkville, Victoria, Australia
- Centre for Adolescent Health, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Ashleigh Lin
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Cristyn Davies
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia
| | - Melissa Kang
- Specialty of General Practice, Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia
| | - Sarita Bista
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia
| | - S. Rachel Skinner
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia
- The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
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Xerxa Y, White T, Busa S, Trasande L, Hillegers MHJ, Jaddoe VW, Castellanos FX, Ghassabian A. Gender Diversity and Brain Morphology Among Adolescents. JAMA Netw Open 2023; 6:e2313139. [PMID: 37171820 PMCID: PMC10182431 DOI: 10.1001/jamanetworkopen.2023.13139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
Importance Gender-diverse youths have higher rates of mental health problems compared with the general population, as shown in both clinical and nonclinical populations. Brain correlates of gender diversity, however, have been reported only among youths with gender dysphoria or in transgender individuals. Objective To examine brain morphologic correlates of gender diversity among adolescents from a general pediatric population who were assigned male or female at birth, separately. Design, Setting, and Participants This cross-sectional study was embedded in Generation R, a multiethnic population-based study conducted in Rotterdam, the Netherlands. Adolescents who were born between April 1, 2002, and January 31, 2006, and had information on self-reported or parent-reported gender diversity and structural neuroimaging at ages 13 to 15 years were included. Data analysis was performed from April 1 to July 31, 2022. Exposures Gender-diverse experiences among adolescents were measured with selected items from the Achenbach System of Empirically Based Assessment forms and the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults, as reported by adolescents and/or their parents. Main Outcomes and Measures High-resolution structural neuroimaging data were collected using a 3-T magnetic resonance imaging scanner (at a single site). We used linear regression models to examine differences in global brain volumetric measures between adolescents who reported gender diversity and those who did not. Results This study included 2165 participants, with a mean (SD) age of 13.8 (0.6) years at scanning. A total of 1159 participants (53.5%) were assigned female at birth and 1006 (46.5%) were assigned male at birth. With regard to maternal country of origin, 1217 mothers (57.6%) were from the Netherlands and 896 (42.4%) were from outside the Netherlands. Adolescents who reported gender diversity did not differ in global brain volumetric measures from adolescents who did not report gender diversity. In whole-brain, vertexwise analyses among adolescents assigned male at birth, thicker cortices in the left inferior temporal gyrus were observed among youths who reported gender diversity compared with those who did not. No associations were observed between gender diversity and surface area in vertexwise analyses. Conclusions and Relevance The findings of this cross-sectional study suggest that global brain volumetric measures did not differ between adolescents who reported gender diversity and those who did not. However, these findings further suggest that gender diversity in the general population correlates with specific brain morphologic features in the inferior temporal gyrus among youths who are assigned male at birth. Replication of these findings is necessary to elucidate the potential neurobiological basis of gender diversity in the general population. Future longitudinal studies should also investigate the directionality of these associations.
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Affiliation(s)
- Yllza Xerxa
- Department of Child and Adolescent Psychiatry, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
- Generation R Study Group, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Tonya White
- Department of Child and Adolescent Psychiatry, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
- Section on Social and Cognitive Developmental Neuroscience, National Institute of Mental Health, Bethesda, Maryland
| | - Samantha Busa
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, New York
| | - Leonardo Trasande
- Department of Pediatrics, New York University Grossman School of Medicine, New York, New York
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
- Department of Environmental Medicine, New York University Grossman School of Medicine, New York, New York
| | - Manon H J Hillegers
- Department of Child and Adolescent Psychiatry, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Vincent W Jaddoe
- Generation R Study Group, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Pediatrics, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Francisco Xavier Castellanos
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, New York
| | - Akhgar Ghassabian
- Department of Pediatrics, New York University Grossman School of Medicine, New York, New York
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
- Department of Environmental Medicine, New York University Grossman School of Medicine, New York, New York
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10
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Morandini JS, Kelly A, de Graaf NM, Malouf P, Guerin E, Dar-Nimrod I, Carmichael P. Is Social Gender Transition Associated with Mental Health Status in Children and Adolescents with Gender Dysphoria? ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:1045-1060. [PMID: 37014582 PMCID: PMC10101898 DOI: 10.1007/s10508-023-02588-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 03/11/2023] [Accepted: 03/13/2023] [Indexed: 05/11/2023]
Abstract
Social gender transition is an increasingly accepted intervention for gender variant children and adolescents. To date, there is scant literature comparing the mental health of children and adolescents diagnosed with gender dysphoria who have socially transitioned versus those who are still living in their birth-assigned gender. We examined the mental health of children and adolescents referred to the Gender Identity Development Service (GIDS), a specialist clinic in London, UK, who had socially transitioned (i.e., were living in their affirmed gender and/or had changed their name) versus those who had not socially transitioned. Referrals to the GIDS were aged 4-17 years. We assessed mental health correlates of living in one's affirmed gender among 288 children and adolescents (208 birth-assigned female; 210 socially transitioned) and of name change in 357 children and adolescents (253 birth-assigned female; 214 name change). The presence or absence of mood and anxiety difficulties and past suicide attempts were clinician rated. Living in role and name change were more prevalent in birth-assigned females versus birth-assigned males. Overall, there were no significant effects of social transition or name change on mental health status. These findings identify the need for more research to understand how social transition influences mental health, including longitudinal studies that allow for more confident inferences to be made regarding the relationship between social transition and mental health in young people with gender dysphoria.
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Affiliation(s)
- James S Morandini
- School of Psychology, The University of Sydney, Sydney, NSW, 2006, Australia.
| | - Aidan Kelly
- Gender Service Organization, Kelly Psychology, London, UK
| | - Nastasja M de Graaf
- Center of Expertise on Gender Dyphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Pia Malouf
- King Street Psychology Clinic, Newtown, Australia
| | - Evan Guerin
- School of Behavioural and Health Sciences, Australian Catholic University, Sydney, Australia
| | - Ilan Dar-Nimrod
- School of Psychology, The University of Sydney, Sydney, NSW, 2006, Australia
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11
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Corbett BA, Muscatello RA, Klemencic ME, West M, Kim A, Strang JF. Greater gender diversity among autistic children by self-report and parent-report. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:158-172. [PMID: 35363085 PMCID: PMC9525458 DOI: 10.1177/13623613221085337] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
LAY ABSTRACT Gender diversity broadly refers to the way in which an individual experiences (expressions and/or identities) their gender distinctly to that which would be expected based upon social norms for their gender assigned at birth. Recent research has shown a higher representation of gender diversity among autistic youth. Previous research in this area has relied on parent-report based on a single question from the Child Behavior Checklist Item-110, asking whether their child "Wishes to be the opposite sex." The Gender Diversity Screening Questionnaire Self-Report and Parent-Report were used to assess the experience of gender diversity in 244 children (140 autism spectrum disorder and 104 typically developing) between 10 and 13 years. The Item-110 was also collected. Results showed that autistic children endorsed much higher rates of Binary Gender Diversity (less identification with their designated sex and more with the other binary sex) and Nonbinary Gender Diversity (identification as neither male nor female) than typically developing children. Similarly, parents of autistic children reported significantly more gender-body incongruence experienced by their child than parents of typically developing children. Specifically, parents of autistic females-assigned-at-birth reported significantly more gender-body incongruence than autistic males-assigned-at-birth. Parent- and self-report measures were largely related. Moreover, statistical comparisons between and within the groups revealed associations between gender profiles and symptoms of anxiety, depression, and suicidality. Results extend previous reports showing increased rates of gender diversity in autistic children, now based on both self-report and parent-report, and highlight the need to better understand and support the unique and complex needs of autistic children who experience gender diversity.
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Affiliation(s)
- Blythe A. Corbett
- Vanderbilt University Medical Center, Department of
Psychiatry and Behavioral Sciences,Vanderbilt Kennedy Center
| | - Rachael A. Muscatello
- Vanderbilt University Medical Center, Department of
Psychiatry and Behavioral Sciences
| | - Mark E. Klemencic
- Vanderbilt University Medical Center, Department of
Psychiatry and Behavioral Sciences
| | - Millicent West
- Vanderbilt University Medical Center, Department of
Psychiatry and Behavioral Sciences
| | - Ahra Kim
- Vanderbilt University Medical Center, Department of
Biostatistics
| | - John F. Strang
- Gender and Autism Program, Children’s National
Hospital,Departments of Pediatrics, Psychiatry, and Behavioral
Science, George Washington University School of Medicine
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12
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Mezzalira S, Scandurra C, Mezza F, Miscioscia M, Innamorati M, Bochicchio V. Gender Felt Pressure, Affective Domains, and Mental Health Outcomes among Transgender and Gender Diverse (TGD) Children and Adolescents: A Systematic Review with Developmental and Clinical Implications. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:ijerph20010785. [PMID: 36613106 PMCID: PMC9819455 DOI: 10.3390/ijerph20010785] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/28/2022] [Accepted: 12/28/2022] [Indexed: 05/04/2023]
Abstract
Although capable of mobilizing significant resilience factors to face stigma and discrimination, transgender and gender diverse (TGD) children and adolescents tend to suffer from more adverse mental health outcomes compared to their cisgender counterparts. The minority stressors that this population faces are mainly due to the gender-based pressure to conform to their assigned gender. This systematic review was aimed at assessing the potential mental health issues that affect the TGD population. The literature search was conducted in three databases; namely, Scopus, PubMed, and Web of Science, based on the PRISMA guidelines. The 33 articles included in the systematic review pointed out how TGD children and adolescents experience high levels of anxiety and depression, as well as other emotional and behavioral problems, such as eating disorders and substance use. Resilience factors have been also pointed out, which aid this population in facing these negative mental health outcomes. The literature review highlighted that, on the one hand, TGD individuals appear to exhibit high levels of resilience; nonetheless, health disparities exist for TGD individuals compared with the general population, which are mainly attributable to the societal gender pressure to conform to their assigned gender. Considerations for research and clinical practice are provided.
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Affiliation(s)
- Selene Mezzalira
- Department of Humanities, University of Calabria, 87036 Rende, Italy
| | - Cristiano Scandurra
- Department of Neuroscience, Reproductive Sciences, and Dentistry, University of Naples Federico II, 80131 Naples, Italy
| | - Fabrizio Mezza
- SInAPSi Center, University of Naples Federico II, 80133 Naples, Italy
| | - Marina Miscioscia
- Department of Developmental Psychology and Socialization, University of Padua, 35131 Padua, Italy
| | - Marco Innamorati
- Department of History, Cultural Heritage, Education, and Society, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Vincenzo Bochicchio
- Department of Humanities, University of Calabria, 87036 Rende, Italy
- Correspondence:
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13
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Ghassabian A, Suleri A, Blok E, Franch B, Hillegers MHJ, White T. Adolescent gender diversity: sociodemographic correlates and mental health outcomes in the general population. J Child Psychol Psychiatry 2022; 63:1415-1422. [PMID: 35147218 DOI: 10.1111/jcpp.13588] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND Gender diversity in young adolescents is understudied outside of referral clinics. We investigated gender diversity in an urban, ethnically diverse sample of adolescents from the general population and examined predictors and associated mental health outcomes. METHODS The study was embedded in Generation R, a population-based cohort of children born between 2002 and 2006 in Rotterdam, the Netherlands (n = 5727). At ages 9-11 and 13-15 years, adolescents and/or their parents responded to two questions addressing children's contentedness with their assigned gender, whether they (a) 'wished to be the opposite sex' and (b) 'would rather be treated as someone from the opposite sex'. We defined 'gender-variant experience' when either the parent or child responded with 'somewhat or sometimes true' or 'very or often true'. Mental health was assessed at 13-15 years, using the Achenbach System of Empirically Based Assessment. RESULTS Less than 1% of the parents reported that their child had gender-variant experience, with poor stability between 9-11 and 13-15 years. In contrast, 4% of children reported gender-variant experience at 13-15 years. Adolescents who were assigned female at birth reported more gender-variant experience than those assigned male. Parents with low/medium educational levels reported more gender-variant experience in their children than those with higher education. There were positive associations between gender-variant experience and symptoms of anxiety, depression, somatic complaints, rule-breaking, and aggressive behavior as well as attention, social, and thought problems. Similar associations were observed for autistic traits, independent of other mental difficulties. These associations did not differ by assigned sex at birth. CONCLUSIONS Within this population-based study, adolescents assigned females were more likely to have gender-variant experience than males. Our data suggest that parents may not be aware of gender diversity feelings in their adolescents. Associations between gender diversity and mental health symptoms were present in adolescents.
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Affiliation(s)
- Akhgar Ghassabian
- Departments of Pediatrics, Population Health, and Environmental Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Anna Suleri
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Elisabet Blok
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands.,The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Berta Franch
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Manon H J Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Tonya White
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
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14
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Berg D, Tellawi G, Anderson SO, Nic Rider G. Beyond diagnosis: Prepubescent gender expansive children on the margins of clinical measures. INFANT AND CHILD DEVELOPMENT 2022. [DOI: 10.1002/icd.2311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Dianne Berg
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health University of Minnesota Medical School Minneapolis Minnesota USA
| | - Ghazel Tellawi
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health University of Minnesota Medical School Minneapolis Minnesota USA
| | - Sloan Okrey Anderson
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health University of Minnesota Medical School Minneapolis Minnesota USA
| | - G. Nic Rider
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health University of Minnesota Medical School Minneapolis Minnesota USA
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15
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Munoz Murakami LY, van der Miesen AIR, Nabbijohn AN, VanderLaan DP. Childhood Gender Variance and the Autism Spectrum: Evidence of an Association Using a Child Behavior Checklist 10-Item Autism Screener. JOURNAL OF SEX & MARITAL THERAPY 2022; 48:645-651. [PMID: 35107047 DOI: 10.1080/0092623x.2022.2035870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Childhood gender variance (GV) is associated with autism spectrum disorder (ASD) diagnosis/traits; however, this association has mainly been investigated in clinical samples. An ASD screening measure based on 10 items from the commonly used Child Behavior Checklist (CBCL) might enable investigation of this association in a wider variety of (non-clinical) populations where the CBCL and a measure of GV are available. We investigated whether GV in 6- to 12-year-olds (N = 1719; 48.8% assigned male at birth) from a community sample showed an association with the CBCL 10-item ASD screener. The Gender Identity Questionnaire for Children measured GV. The CBCL 10-item ASD screener measured ASD traits. The remaining CBCL items provided a measure of children's general emotional and behavioral challenges. Higher GV was associated with higher CBCL ASD screener scores, including when controlling for the remaining CBCL items. The CBCL 10-item ASD screener can be useful for investigating the link between GV and ASD traits in 6- to 12-year-olds. Given that the CBCL is commonly employed, secondary analyses of existing datasets that also included a measure of GV could enable investigation of how widely the association between GV and ASD applies across a variety of populations.
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Affiliation(s)
| | - Anna I R van der Miesen
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Doug P VanderLaan
- Department of Psychology, University of Toronto Mississauga, Mississauga, Canada
- Child and Youth Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada
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16
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MacMullin LN, Bokeloh LM, Nabbijohn AN, Santarossa A, van der Miesen AIR, Peragine DE, VanderLaan DP. Examining the Relation Between Gender Nonconformity and Psychological Well-Being in Children: The Roles of Peers and Parents. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:823-841. [PMID: 33185827 DOI: 10.1007/s10508-020-01832-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 06/18/2020] [Accepted: 09/01/2020] [Indexed: 06/11/2023]
Abstract
No study to date has simultaneously tested how poor peer relations, generic risk factors, and parental attitudes impact the behavioral and emotional challenges of children who vary in their gender expression. In a community sample, the present study investigated various hypothesized psychosocial and generic risk factors regarding the association between childhood gender nonconformity (GNC) and psychological well-being. Canadian parents/guardians reported on their children aged 6-12 years (N = 1719, 48.8% assigned male at birth) regarding their child's GNC, measured by the Gender Identity Questionnaire for Children; behavioral and emotional challenges, measured by the Child Behavior Checklist (CBCL); and peer relations, measured by the CBCL and Strength and Difficulties Questionnaire. Parent/guardian gender-stereotypical attitudes toward child-rearing were assessed using an adapted version of the Child-Rearing Sex Role Attitude Scale, and attachment between the parent/guardian and child was measured with an adapted version of the Child-Rearing Practices Report. Based on regression analyses, GNC was related to elevated behavioral and emotional challenges, and this association was stronger for those who experienced poor peer relations as well as for those whose parents/guardians endorsed gender-stereotyped attitudes and were less willing to serve as a secure base for the child. Recommendations are provided for ways in which social environments can be altered to improve psychological well-being among gender-nonconforming children.
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Affiliation(s)
- Laura N MacMullin
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, L5L 1C6, Canada
| | - Lisa M Bokeloh
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, L5L 1C6, Canada
- Department of Psychology, University of Münster, Münster, Germany
| | - A Natisha Nabbijohn
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, L5L 1C6, Canada
| | - Alanna Santarossa
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, L5L 1C6, Canada
| | - Anna I R van der Miesen
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, L5L 1C6, Canada
- Center of Expertise on Gender Dysphoria, VU Medical Center, Amsterdam, The Netherlands
| | - Diana E Peragine
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, L5L 1C6, Canada
| | - Doug P VanderLaan
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, L5L 1C6, Canada.
- Child and Youth Psychiatry, Centre for Addiction and Mental Health, Toronto, ON, Canada.
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17
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van der Miesen AIR, Raaijmakers D, van de Grift TC. "You Have to Wait a Little Longer": Transgender (Mental) Health at Risk as a Consequence of Deferring Gender-Affirming Treatments During COVID-19. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:1395-1399. [PMID: 32519279 PMCID: PMC7282831 DOI: 10.1007/s10508-020-01754-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 05/10/2023]
Affiliation(s)
- Anna I R van der Miesen
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
- Amsterdam UMC, VU University Medical Center, Center of Expertise on Gender Dysphoria, Amsterdam, The Netherlands
- Department of Plastic, Reconstructive, and Hand Surgery, Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, Amsterdam Public Health Research Institute Amsterdam, PO Box 7057 (ZH 4D120), 1007, MB, Amsterdam, The Netherlands
| | | | - Tim C van de Grift
- Amsterdam UMC, VU University Medical Center, Center of Expertise on Gender Dysphoria, Amsterdam, The Netherlands.
- Department of Plastic, Reconstructive, and Hand Surgery, Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, Amsterdam Public Health Research Institute Amsterdam, PO Box 7057 (ZH 4D120), 1007, MB, Amsterdam, The Netherlands.
- Department of Plastic, Reconstructive, and Hand Surgery, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands.
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18
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Santarossa A, Nabbijohn AN, van der Miesen AIR, Peragine DE, VanderLaan DP. Separation anxiety and gender variance in a community sample of children. Eur Child Adolesc Psychiatry 2019; 28:1629-1643. [PMID: 30993534 DOI: 10.1007/s00787-019-01319-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 03/18/2019] [Indexed: 10/27/2022]
Abstract
In clinical child and retrospective adult samples, childhood gender variance (GV; i.e., cross-gender behaviour) has been associated with separation anxiety (SA; i.e., distress related to separation from attachment figures) in males. This study examined GV and SA in a nonclinical sample of 892 boys and 933 girls aged 6-12 years via parent-reports. Parental factors (i.e., parenting style, parent-child relationship, willingness to serve as an attachment figure, attitudes towards gender stereotypes in children) were examined as potential moderators. GV predicted SA in boys, even when statistically controlling for general psychopathology and demographic variables. Authoritative parenting, closeness in the parent-child relationship, willingness to serve as an attachment figure, and liberal attitudes towards gender stereotypes in children moderated the association between GV and SA in both boys and girls. Thus, SA may be a unique internalizing problem related to GV in boys in nonclinical samples and influenced by a variety of parental factors.
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Affiliation(s)
- Alanna Santarossa
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, L5L 1C6, Canada
| | - A Natisha Nabbijohn
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, L5L 1C6, Canada
| | - Anna I R van der Miesen
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Diana E Peragine
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, L5L 1C6, Canada
| | - Doug P VanderLaan
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, L5L 1C6, Canada. .,Child and Youth Psychiatry, Centre for Addiction and Mental Health, Toronto, ON, Canada.
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19
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Kwan KMW, Shi SY, Nabbijohn AN, MacMullin LN, VanderLaan DP, Wong WI. Children's Appraisals of Gender Nonconformity: Developmental Pattern and Intervention. Child Dev 2019; 91:e780-e798. [PMID: 31646630 DOI: 10.1111/cdev.13316] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Gender-nonconforming (GN) children are often perceived less positively, which may harm their well-being. We examined the development of such perceptions and an intervention to modify them. Chinese children's appraisals were assessed using multiple measures (verbal responses, sharing, and rank order task) after viewing vignettes of gender-conforming (GC) and GN hypothetical peers. In Study 1, children (N = 210; 4-, 5-, 8-, and 9-year-olds) were less positive toward GN than GC peers, especially if they were older or if the peers were boys. In Study 2 (N = 211, 8- and 9-year-olds), showing children exemplars of GN peers who displayed positive and GC characteristics subsequently reduced bias against gender nonconformity. These findings inform strategies aimed at reducing bias against gender nonconformity.
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Affiliation(s)
| | - Sylvia Yun Shi
- University of Hong Kong.,The Chinese University of Hong Kong
| | | | | | | | - Wang Ivy Wong
- University of Hong Kong.,The Chinese University of Hong Kong
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20
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Meyer-Bahlburg HFL. "Diagnosing" Gender? Categorizing Gender-Identity Variants in the Anthropocene. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:2027-2035. [PMID: 30607711 DOI: 10.1007/s10508-018-1349-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/07/2018] [Accepted: 11/08/2018] [Indexed: 05/26/2023]
Abstract
In recent decades, two interrelated major controversies have been unfolding in the area of sex/gender research. (1) Are gender-identity variants to be understood as psychopathology or natural variation? (2) Is gender (and perhaps even sex) better conceptualized as binary or non-binary? The answer depends on the conceptual context and related considerations of utility. In the context of evolutionary biology, marked variants of sex and gender decrease reproductive success and are, thereby, deemed pathologic. In the present era of the anthropocene, however, the material conditions underlying the traditional division of labor between the sexes and the role of reproductive success have dramatically changed. These changes decrease the psychosocial importance of the binary gender distinction, provide more freedom for non-binary gender expression and identity formation, and render the distinction of pathologic and non-pathologic less useful, unless gender dysphoria develops secondary to a psychiatric condition. Although most people state their gender identity in the form of a nominal category, most self-report or interview-based ratings and multi-item scales of gender expression and/or identity show continuous distributions, either unimodal-asymmetric or bimodal, depending on whether they are designed for one or both of the traditional genders. Similarly, the rating scales of androgen-influenced variants of the genitalia-usually designed for one of the traditional sexes-typically represent a unipolar-asymmetric continuum. However, the binary gender system remains the primary framework against which individuals evaluate themselves. For those who develop gender dysphoria, assistance by mental-health service providers continues to be important.
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Affiliation(s)
- Heino F L Meyer-Bahlburg
- Department of Psychiatry, NYS Psychiatric Institute, Vagelos College of Physicians and Surgeons of Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA.
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21
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van der Miesen AIR, Cohen-Kettenis PT, de Vries ALC. Is There a Link Between Gender Dysphoria and Autism Spectrum Disorder? J Am Acad Child Adolesc Psychiatry 2018; 57:884-885. [PMID: 30392630 DOI: 10.1016/j.jaac.2018.04.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/06/2018] [Accepted: 08/28/2018] [Indexed: 10/28/2022]
Abstract
In their Translations article in the January issue of the Journal, Turban and van Schalkwyk provide a critical evaluation of the recently published literature on co-occurring gender dysphoria (GD) and autism spectrum disorder (ASD).1 In addition, they refer to this flux in interest as part of a larger increase in publications on transgender people, which are mostly reviews and do not contain new data. Given the low-grade evidence in this field for most clinical recommendations,2 good-quality research is of great relevance. We support the debate on the GD-ASD literature and acknowledge that translations of the findings to the lay press such as "Do transgender children just have autism?" are not helpful. Also, we agree with many of the limitations brought forward by the authors and acknowledge that, at present, sound underlying evidence for a GD-ASD link is lacking. However, we believe that some nuance in argumentation could help forward the debate of this clinically important topic.
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Affiliation(s)
- Anna I R van der Miesen
- Center of Expertise on Gender Dysphoria at VU University Medical Center, Amsterdam, The Netherlands.
| | - Peggy T Cohen-Kettenis
- Center of Expertise on Gender Dysphoria at VU University Medical Center, Amsterdam, The Netherlands
| | - Annelou L C de Vries
- Center of Expertise on Gender Dysphoria at VU University Medical Center, Amsterdam, The Netherlands
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22
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Coome LA, Skorska MN, van der Miesen AI, Peragine DE, VanderLaan DP. An examination of the biodevelopment of gender expression in children ages 6- to 12-years. CANADIAN JOURNAL OF HUMAN SEXUALITY 2018. [DOI: 10.3138/cjhs.2018-0013] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Lindsay A. Coome
- Department of Psychology, University of Toronto, Mississauga, ON
| | | | - Anna I.R. van der Miesen
- Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Doug P. VanderLaan
- Department of Psychology, University of Toronto, Mississauga, ON
- Child and Youth Psychiatry, Centre for Addiction and Mental Health, Toronto, ON
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Daniolos PT. Identity, Conformity, and Nonconformity: A Closer Look. J Am Acad Child Adolesc Psychiatry 2018; 57:460-461. [PMID: 29960690 DOI: 10.1016/j.jaac.2018.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 05/09/2018] [Indexed: 11/18/2022]
Abstract
As clinicians, we have been vigilant to screen for underlying psychopathology in children and adolescents who meet criteria for gender dysphoria (GD) based on the risk these individuals have for developing externalizing and/or internalizing disorders, likely driven by a stigmatizing society. However, we have not paid careful attention to an often overlooked population, namely gender-nonconforming (GNC) children-especially those in community samples-who do not meet criteria for GD per se but who, according to the well-done and thought-provoking study featured in this issue, van der Miesen et al.'s "Behavioral and Emotional Problems in Gender-Nonconforming Children: A Canadian Community-Based Study,"1 appear to share some similar psychiatric vulnerabilities as their peers with GD, with some unique features noted for natal boys versus natal girls. The few studies that have looked at this group of children have relied on clinical samples, which complicates whether the increased rates of psychopathology are in fact due to GNC-related factors versus inherently higher rates of psychopathology in clinical samples. Because of this, previous studies using clinical samples might overestimate the rates of psychopathology in GNC youths. Van der Miesen et al. smartly attempted to avoid that bias by drawing participants from the community and by excluding participants with any previous mental health diagnoses, including GD.1 This study is a refreshing shift, delving into community samples and using a validated measure, the Gender Identity Questionnaire for Children (GIQC), thus allowing comparisons to be made with prior clinical samples.
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Affiliation(s)
- Peter T Daniolos
- University of Iowa's Stead Family Children's Hospital, Iowa City.
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