Androgen and the Development of Human Sex-typical Behavior: Rough-and-Tumble Play and Sex of Preferred Playmates in Children with Congenital Adrenal Hyperplasia (CAH)

Lower digit length ratio and aggression in adolescents and young adults with boxer's fracture: A case-control study

Recent evidence shows that a lower second-to-fourth digit ratio (2D:4D), which is a sexually dimorphic trait and the indicator of prenatal testosterone exposure, may be associated with aggressive behaviors. In this cross-sectional, case-control study, we investigated: (1) Are the aggression and impulsivity levels and emotional problems higher? (2) Is the 2D:4D ratio lower in adolescents and young adults who presented with a fifth metacarpal neck fracture (boxer's fracture) compared to controls? (3) Is the digit ratio correlated with aggressive measures in individuals with a fifth metacarpal neck fracture? Seventy-one consecutive patients presented with a fifth metacarpal neck fracture within the age range of 11-25 years old comprised the study group. The control group consisted of 71 age and sex-matched subjects without a history of aggression-related injury. The aggression, impulsiveness, and psychosocial well-being were measured by self-reported questionnaires. 2D:4D was measured by conventional radiography. The 2D:4D ratio was similar between groups, however, when the analyses were conducted separately for sex, females in the study group showed lower 2D:4D than females in the control group (p = 0.001). The aggression level of the study group, measured by the Buss-Perry Aggression Questionnaire was higher than the control group (p = 0.014). The impulsiveness scores on the Barratt Impulsiveness Scale-11 were similar (p = 0.60) and the total difficulty score on the Strengths and Difficulties Questionnaire was higher in the study group (p = 0.009). A lower 2D:4D ratio significantly predicted verbal and total aggression scores (p = 0.036, p = 0.032, respectively). Our findings suggest that females with a history of aggression-related injury have lower 2D:4D, and a lower 2D:4D is correlated with higher aggression levels in both sexes. Understanding and addressing aggression in these patients may help prevent further self-inflicted injuries.

Prenatal testosterone and sexually differentiated childhood play preferences: a meta-analysis of amniotic fluid studies

Sexually differentiated behaviour appears to emerge from a complex interaction of biological and socio-cultural factors, with prenatal exposure to steroid hormones such as testosterone thought to play a key role. Due to large sex differences being present from a very early age, much research has focussed on the influence these hormones may have on play preferences during childhood. We present an overview of the literature and a random-effects meta-analysis linking amniotic testosterone with sexually differentiated play preferences (k = 9, n = 493). The overall effect size estimate was in the theory-consistent direction (i.e., with higher levels of testosterone associated with more male-typical play preferences), though not statistically significant (r = 0.082, p = 0.274). However, after three hypothesised missing studies were imputed via the trim and fill procedure, a significant correlation emerged (r = 0.166, p = 0.014). Nevertheless, one sample was observed to exert a particularly large influence on the outcome of the analysis. Notably this was the second biggest sample and related to the largest effect size estimate. Though far from conclusive, the overall findings are consistent with the idea that individual differences in prenatal testosterone within the typical range predict sexually differentiated play preferences in early life. However, these effects may be small in magnitude and appear to vary considerably across studies.

Evidence and Implications from a Natural Experiment of Prenatal Androgen Effects on Gendered Behavior

Sex and gender are key to people's lives, and are the focus of scientific and popular interest and controversy. Sex-related psychological characteristics reflect more than socialization; they are influenced by sex hormones present during sensitive periods of development, particularly prenatal androgens. Studies of females with congenital adrenal hyperplasia (CAH) show how prenatal androgens affect behavior across the life span, with large effects on gendered activity interests and engagement, moderate effects on spatial abilities, and relatively small (or no) effects on gender identity, gender cognitions, and gendered peer involvement. In addition to showing the complexity of androgen effects on gendered behavior, studies of females with CAH provide an opportunity to test theories of gender development, understand how nature and nurture work together, and examine mechanisms of development. The implications of this work have often been misunderstood, so we consider what it means - and does not mean - for biology to influence gender-related behavior.

Sex Differences in Gender-Diverse Expressions and Identities among Youth with Autism Spectrum Disorder

A growing body of evidence supports a potential link between autism spectrum disorder (ASD) and gender dysphoria, yet few studies have looked at sex differences in the co-occurrence of gender diversity and ASD. The aim of this study was to characterize sex differences in gender-diverse expressions and identities, as well as gender-related concerns, in youth with ASD. Parents of youth with ASD ages 6-21 (n = 163) completed an online questionnaire about their child's gender expression and identity. Sex-typed behaviors during childhood were measured using the Gender Identity Questionnaire (GIQ). Semi-partial Kendall correlations and chi-square tests were used to compare gender non-conformity, gender-diverse identities, and gender-related concerns between sexes. Sex-based differences in mean GIQ score and individual GIQ items were evaluated using a linear regression and semi-partial Kendall correlations, respectively. All regressions and correlations controlled for child age. Parents of girls were more likely to report child appearances and mannerisms that were less concordant with their child's birth sex. Based on parent-report, girls had lower mean GIQ scores, indicating greater cross-gendered/fewer same-gendered behaviors in childhood. Lastly, parents of girls with ASD were more likely to report that their daughters experienced anxiety due to gender-related concerns and discomfort during puberty than parents of boys. These findings suggest that girls with ASD seem more likely have gender-diverse preferences, mannerisms, and appearances that fall outside of traditional gender norms. Gender-related concerns appear to be a source of real distress in girls with ASD, highlighting the need for individualized support, especially during puberty. LAY SUMMARY: Despite evidence of a potential link between autism and gender diversity, few studies have explored differences in gender identity/expression between boys and girls with autism. Based on parent responses, we found that girls with autism are more likely than boys to have appearances and mannerisms, as well as behaviors during childhood, that fall outside of the traditional gender role. The unique profile of girls with autism and their elevated distress over gender-related concerns call for individualized support during adolescence.

Factors affecting infant toy preferences: Age, gender, experience, motor development, and parental attitude

In contrast to the anecdotal claim that "male infants like cars and female infants like dolls," previous studies have reported mixed findings for gender-related toy preferences in infancy. In Experiment 1, we explored the emergence of gender-related preferences using face-car pairs (Experiment 1a, n = 51, 6-20 months) or face-stove pairs (Experiment 1b, n = 54, 6-20 months). In Experiment 2 (n = 42, 14-16 months), we explore the effect of toy properties, infants' past toy exposure, activity levels, and parental attitudes on such preferences using a wider range of toys. For both studies, infants demonstrated a general preference for faced stimuli over other objects, except for male infants who showed no preference between dolls and cars at around 15 months. Infants' prior experience participating in motor-intensive activities, with wheeled toys and parental attitudes appeared to relate to female infants' preferences for dynamic toys. These results indicate a range of factors influence gendered toy preferences and suggest that nurture plays an important role.

Social and Object Attention Is Influenced by Biological Sex and Toy Gender-Congruence in Children With and Without Autism

Emerging research suggests social attention in autism spectrum disorder (ASD) girls is enhanced relative to ASD boys but may also be affected by the type of social and nonsocial content presented. This study examined how biological sex and gender norms interact to influence visual attention in 79 school-aged children observing scenes that included gender-associated toys and actors of both sexes. Attention to social (faces) and object activity (hands with toys) stimuli was measured. Previously described distinctions between social attention in ASD boys and girls were replicated, with ASD girls looking more at faces than ASD boys. Irrespective of diagnosis, males and females attended more to actors that shared their same sex, and attended more to toys with gender-associations that were consistent with their own sex, suggesting that social and object salience increases for children under sex-consistent conditions. Importantly, ASD and typically developing (TD) children increased their gaze to faces when male actors were shown playing with female-associated toys, suggesting that both groups of children are sensitive to societal messages about the acceptability of males playing with female-associated toys. Our findings provide further evidence of heightened attention to faces in ASD girls relative to ASD boys, and indicate that social attention in ASD and TD children is influenced by who (male or female actor) and what (male- or female-associated toy) is being observed. Collectively, these results present a nuanced profile of attention in ASD that adds to a growing body of research indicating subtle phenotypic differences in ASD girls that may impact identification, assessment, and intervention. Autism Res 2020, 13: 763-776.. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Sex differences observed in typical development may also be present in individuals with autism. In this study, we developed an eye-tracking paradigm featuring videos of boys and girls playing with toys that varied in their gender associations. Attention to faces differed between autistic and non-autistic children but was also influenced by the sex of the actor and gender-association of toys. Autistic females demonstrated subtle attention differences that distinguished them from autistic males and may influence referral, diagnosis, and intervention.

Gendered Peer Involvement in Girls with Congenital Adrenal Hyperplasia: Effects of Prenatal Androgens, Gendered Activities, and Gender Cognitions

A key question in understanding gender development concerns the origins of sex segregation. Children's tendencies to interact with same-sex others have been hypothesized to result from gender identity and cognitions, behavioral compatibility, and personal characteristics. We examined whether prenatal androgen exposure was related to time spent with boys and girls, and how that gendered peer involvement was related to sex-typed activities and gender identity and cognitions. We studied 54 girls with congenital adrenal hyperplasia (CAH) aged 10-13 years varying in degree of prenatal androgen exposure: 40 girls with classical CAH (C-CAH) exposed to high prenatal androgens and 14 girls with non-classical CAH (NC-CAH) exposed to low, female-typical, prenatal androgens. Home interviews and questionnaires provided assessments of gendered activity interests and participation, gender identity, and gender cognitions. Daily phone calls over 7 days assessed time spent in gendered activities and with peers. Girls with both C-CAH and NC-CAH interacted more with girls than with boys, with no significant group differences. The groups did not differ significantly in gender identity or gender cognitions, but girls with C-CAH spent more time in male-typed activities and less time in female-typed activities than did girls with NC-CAH. Time spent with girls reflected direct effects of gender identity/cognitions and gender-typed activities, and an indirect effect of prenatal androgens (CAH type) through gender-typed activities. Our results extend findings that prenatal androgens differentially affect gendered characteristics and that gendered peer interactions reflect combined effects of behavioral compatibility and feelings and cognitions about gender. The study also shows the value of natural experiments for testing hypotheses about gender development.

The experience of women living with Congenital Adrenal Hyperplasia: impact of the condition and the care given

CONTEXT

Congenital adrenal hyperplasia (CAH) is caused most often by mutations in the CYP21A2 gene, resulting in cortisol and aldosterone deficiency and increased production of androgens.

OBJECTIVE

To describe how women with CAH experience their condition and the care given.

DESIGN, SETTING AND PARTICIPANTS

Semi-structured interviews with 13 adult Swedish women with CAH were transcribed. Data were analysed by qualitative content analysis to describe the variability in the experiences.

MAIN OUTCOME MEASURES

Qualitative evaluation of the participants' life experiences.

RESULTS

The participants' experiences of having CAH are described in four different categories. 1. Information comprises the experiences of interaction with healthcare providers, knowledge acquisition and information disclosure. 2. Exposure encompasses the experiences of genital examinations, the medical focus on the genitalia and of being photographed repeatedly. 3. Health covers the self-perceived experiences of having a medical condition that requires pharmacological treatment and sometimes surgery. 4. Research comprises the experiences of having a scientifically well-studied condition. Different experiences of shame reoccur in all categories, thus forming the latent theme.

CONCLUSION

The experience of living with congenital adrenal hyperplasia can be facilitated by increased information and by acknowledging that women with CAH are a heterogeneous group with individual needs. Shame may be counterbalanced by increased parental support and increased knowledge among healthcare personnel aimed at providing children with continuous support and coping strategies during their upbringing. Based on the identified themes in this study, there are several research avenues to pursue in the future.