Parental Perceptions of Emotional and Behavioral Difficulties Among Prepubertal Gender-Nonconforming Children

Differences in self-perception and social gender status in children with gender incongruence

Background: Gender incongruent children report lower self-perception compared to the norm population. This study explored differences in self-perception between children living in their gender role assigned at birth and children living in their experienced gender role.Method: The self-perception questionnaire was administered to 312 children referred to the Center of Expertise on Gender Dysphoria 'Amsterdam UMC'. Social transition status was determined by parental interviews. 2 (social transition) by 2 (sex assigned at birth) ANCOVA's were conducted.Results: Children living in their assigned gender role reported comparable self-perception to children living in their experienced gender role. Birth assigned girls living in their assigned gender role reported poorer self-perception on 'athletic competence', compared to girls living in their experienced gender role. Birth assigned boys living in their assigned gender role reported poorer on 'scholastic competence' and 'behavioral conduct' compared to boys living in their experienced gender role.Conclusions: Social transition did not show to affect self-perception. Self-perception was poorer for birth assigned boys living in their experienced gender role. For birth assigned girls this was reversed. Future studies should give more insight in the role of social transitions in relation to child development and focus on other aspects related to self-perception.

Longitudinal outcomes of gender identity in children (LOGIC): a study protocol for a prospective longitudinal qualitative study of the experiences and well-being of families referred to the UK Gender Identity Development Service

INTRODUCTION

Gender Identity Development Services (GIDS) worldwide have experienced a significant increase in referrals in recent years. However, little is currently known about the experiences of the children and young people (CYP) and their families attending these services and the influences on their well-being. Most published qualitative studies have explored gender identity and gender questioning CYP from either a parental perspective or in an adolescent sample. Consequently, there is a need for research to explore the voices of younger children and adolescents who are referred to GIDS. This study aims to address current gaps in understanding of the experiences of CYP referred to the UK GIDS, specifically regarding the personal, familial, educational, and social contexts in which CYP and their parents/caregivers are navigating gender identity, social and physical transition, and the healthcare system.

METHODS AND ANALYSIS

A prospective longitudinal qualitative study examining the experiences and well-being of CYP referred to the UK GIDS. A purposive sample of up to 40 families will be recruited. Families will be eligible for the study if the child or young person was aged 3-14 years at the time of referral to the GIDS. Semistructured interviews will be conducted with both the child/young person and their parents/caregivers. Analysis of anonymised interview transcripts will be interpretive and pluralistic, informed by both narrative and thematic approaches. This study forms part of a wider programme of research investigating longitudinal outcomes of gender identity in children (the LOGIC Study).

ETHICS AND DISSEMINATION

The proposed study has been approved by the UK Health Research Authority and London-Hampstead Research Ethics Committee as application 19/LO/0857. The study findings will be published in peer-reviewed journals and presented at both conferences and stakeholder events.

Psychopathological symptom network structure in transgender and gender queer youth reporting parental psychological abuse: a network analysis

BACKGROUND

This is the first study to investigate the effect of parental psychological abuse on potential psychopathological symptoms in gender minority youth subgroups, including transgender women, transgender men, and gender queer individuals.

METHODS

Data was analysed from the Chinese National Transgender Survey in 2017; the survey was distributed through community-based organizations to transgender adolescents and adults residing in China, with representation from all 32 provinces and autonomous regions. A total of 1293 youth that self-identified as transgender or gender queer completed the study. Measures covered psychopathological symptoms including depression, anxiety, risk of suicideand self-harm. Parental psychological abuse was assessed in terms of neglect and avoidance, force to change, and verbal insults. Both the edges and centralities were computed via network analysis, and the network properties were then compared among the three gender minority subgroups. In addition, linear regression was adopted to test the predictive ability of node centrality for low self-esteem.

RESULTS

Descriptive analysis revealed that among the three subgroups, transgender women had more severe psychopathological symptoms and reported the most psychological abuse. Network analysis revealed that the risk of suicide and self-harm was directly connected with one type of parental psychological abuse ("neglect and avoidance"). Node centrality was significantly associated with the predicting value of the nodes on low self-esteem (r² = 0.25, 0.17, 0.31) among all three gender minority subgroups.

CONCLUSIONS

The distinctive core psychopathological symptoms, within the networks of the gender minority subgroups, revealed specific symptoms across each group. The significant association between node centrality and low self-esteem indicated the extent of parental psychological abuse. Parental psychological abuse directed towards gender minority youth should be recognized as a form of family cold violence. It is recommended that schools and local communities should support early intervention to improve psychological well-being.

Is Research on Transgender Children What It Seems? Comments on Recent Research on Transgender Children with High Levels of Parental Support

Recent research on transgender children who have had support from their parents for their transitioning has concluded that their mental health is virtually no different than that of nontransgender children. Such research has been extensively cited, over 370 times in the past three years. Most of the hundreds of reviews received the stated results of the studies with little caution. However, the research featured numerous statistical errors and omissions, the implications of which would likely lead neutral observers to conclude that the mental health of transgender children, even when supported by their parents, was poorer than that of the groups of control children. In particular, levels of anxiety as reported by both parents and their transgender children appear to be significantly higher, and the transgender children's reports of self-worth appear to be significantly lower. Although reports regarding depression are not as significantly different, the effect sizes were generally in a similar direction as the other outcomes, being less favorable for the transgender children. Such issues highlight the need for careful examination of statistical research, even when published in highly regarded medical journals. As with other research, findings from the early stages of controversial research may often be premature. Further research is needed to explore factors underlying these results.

Summary

Some scholars have believed that if transgender children were supported by their parents before the children reached puberty, the generally higher rates of mental illness experienced by many transgender persons might be prevented or alleviated. Dr. Kristina Olson of the Department of Psychology at the University of Seattle was the first scholar to have studied groups of transgender children who were being supported by their parents and to have compared them to a control group of children and to siblings of the same transgender children. Her conclusion was that there were minimal, if any, differences in anxiety, depression, and self-worth among the groups of children; her research has since been cited extensively as having found just that. We reanalyzed her raw data and found that, to the contrary, the transgender children, even when supported by their parents, had significantly lower average scores on anxiety and self-worth. Often, a significantly higher percentage of transgender children, compared to controls, featured preclinical or clinical levels of anxiety. Parental support of transgender children may temporarily reduce levels of poor mental health for some transgender children, but it does not appear to eliminate those problems for all transgender children. Our findings should serve as a warning against accepting research at a surface level, which can lead to acceptance of invalid information and pursuit of ineffective interventions.

Family Discussions of Early Childhood Social Transitions

Objective

An increasing number of children are socially transitioning to live as their identified genders rather than their assigned sexes, yet little empirical work has examined the decision-making process surrounding social transitions. We aimed to understand (1) why parents and their gender nonconforming children do and do not consider social transitions and (2) whether families discuss social transitions both before and after initial social transitions.

Methods

Studies 1 and 2 involved telephone interviews of parents of socially transitioned transgender children (N=60) and gender nonconforming children who were not socially transitioned (N=60), respectively. Study 3 involved an online survey of 266 parents of socially transitioned transgender children.

Results

Parents of socially transitioned transgender children (Study 1) and parents of gender nonconforming children who are not socially transitioned (Study 2) often reported that their children had led the decision to transition or not. Most parents of gender nonconforming children who had not transitioned had discussed transitioning (Study 2) and most parents of socially-transitioned transgender children reported discussing the option of future re-transitions (Study 3).

Conclusions

Parents often report that they and their children are discussing social transitions, a process that children are leading. In contrast to possible concerns about discussing transitions, our results suggest that many families openly discuss the possibility of their children transitioning (or re-transitioning), yet these discussion do not inevitably lead to an imminent transition.

Psychological Functioning, Parenting Stress, and Parental Support among Clinic-Referred Prepubertal Gender Expansive Children

Objective

The purpose of this study is to describe psychological functioning, parenting stress, and parental support of gender expansiveness in prepubertal gender expansive children presenting to a specialized pediatric gender clinic and examine relations between parenting factors and child psychological functioning.

Methods

Standard-of-care questionnaires were completed by parents of all children presenting for services. Data from prepubertal children (i.e., Tanner stage 1 of pubertal development) seen between August 2013 and April 2018 were extracted from patient charts.

Results

Data were analyzed from 71 youth ages three to 11, including 20% (n=14) ages five and younger. Fourteen percent of the sample (n=10) met diagnostic cutoff criteria for Generalized Anxiety Disorder and 20% (n=14) for Oppositional Defiant Disorder. Caregivers reported varying levels of support of their child's gender expansiveness (female caregivers: M=78.85, SD=8.68, range=56-90; male caregivers: M=77.32, SD=10.37, range=53-90), and only 3% (n=2) of caregivers endorsed parenting stress levels in the high range. Parenting stress significantly predicted higher symptom counts across all eight diagnoses. Unexpectedly, higher levels of parental support predicted more symptoms of Major Depressive Disorder and Dysthymia. Parenting stress was a significant moderator of relations between gender-nonconformity and ADHD Hyperactive-Impulsive Type and Conduct Disorder symptoms-higher levels of gender nonconformity was associated with higher symptom counts at moderate and high levels of parenting stress (but not at low levels of parenting stress).

Conclusions

Clinical interventions aimed at reducing parenting stress among caregivers of gender expansive children may have a positive effect on children's psychological functioning.

What about the family in youth gender diversity? A literature review

Background: Previous research has suggested that gender diversity affects everyone in the family, with positive mental health and global outcomes for gender diverse youth reliant on receiving adequate family support and validation. Although the individual mental health, treatment and outcomes for gender diverse youth have received recent research attention, much less is known about a family perspective. Hence, a review of the literature exploring youth gender diversity from a family perspective is warranted. Aims: To systematically identify, appraise and summarize all published literature primarily exploring gender diversity in young people under the age of 18 years, as well as selected literature pertaining to a family understanding. Methods: Six electronic databases (CINAHL, MEDLINE, EMBASE, PsycINFO, SCOPUS, Web of Science) were searched for relevant literature pertaining to youth under the age of 18 years. Results: Research evidence was consistently found to support the beneficial effects of a supportive family system for youth experiencing gender diversity, and a systemic understanding and approach for professionals. Conversely, lack of family support was found to lead to poorer mental health and adverse life outcomes. Few articles explored the experience of siblings under the age of 18 years. Discussion: This literature review is the first to critically evaluate and summarize all published studies which adopted a family understanding of youth gender diversity. The review highlighted a lack of current research and the need for further targeted research, which utilizes a systemic clinical approach to guide support for gender diverse youth and family members.

Experiences of Gender Minority Stress in Cisgender Parents of Transgender/Gender-Expansive Prepubertal Children: A Qualitative Study

Per minority stress theory, sexual and gender minorities are susceptible to bias-related social stressors that can internalize and increase their susceptibility to poor physical and mental health. Parents of transgender/gender-expansive (TGE) children may also encounter a number of stressors on account of their child’s gender experience. No known research had examined how these stressors align within a minority stress framework. This qualitative study examined and characterized minority stress phenomena in a clinically derived sample of English-speaking, cisgender parents of TGE children aged ≤11 years. Study findings included reports of distal and proximal forms of minority stress, with notable impact on health and well-being. Researchers highlight treatment implications and suggest studies continue to examine minority stress in parents of TGE children.