Objective: Gender minority youth (i.e., children/adolescents whose gender identity and/or expression is inconsistent with their birth-assigned sex) experience elevated rates of emotional and behavioral problems relative to cisgender youth (who identify with their birth-assigned sex), which are not intrinsic to gender identity but attributable to unique minority stressors. Although empirically-supported treatments have proven effective in treating these mental health concerns generally, randomized controlled trials have not examined effects for gender minority youth.Method: To address this gap, we pooled data from clinically-referred youth (N = 432; M(SD)age = 10.6(2.2); 55.1% White) assigned to empirically-supported treatment conditions across four previous randomized controlled trials of modular psychotherapy. A proxy indicator of gender identity (i.e., youth's wish to be the opposite sex) was used to classify gender minority (n = 64) and cisgender (n = 368) youth. Youth-and caregiver-reported pretreatment internalizing and externalizing problems, treatment effectiveness on these domains, and treatment acceptability were compared across groups.Results: Gender minority youth reported more severe pretreatment internalizing and externalizing problems compared to cisgender youth; in contrast, their caregivers reported less severe problems. Though treatment was equally effective for both groups on most outcomes, gender minority youth's caregiver-reported externalizing problems improved more slowly and less reliably, and their self-reported internalizing problems were more likely to remain clinically elevated. Further, gender minority youth reported lower treatment satisfaction.Conclusions: While findings suggest that empirically-supported treatments may effectively address many mental health problems for gender minority youth, they also underscore the need for treatment enhancements that improve acceptability and outcomes.Public Significance Statement: This study examined the effectiveness and acceptability of empirically-supported mental health treatments for gender minority youth (who endorsed a wish to be the opposite sex) and cisgender youth. Gender minority youth reported more severe problems before treatment, demonstrated slower improvement in caregiver-reported behavior problems, and endorsed lower treatment satisfaction. Findings support the potential need for provider-focused trainings relevant to gender minority youth.

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We examined whether cultural sexism (county- and state-level sexist attitudes) moderates the efficacy of psychotherapies by re-analyzing data from a previous meta-analysis of randomized controlled trials of youth psychotherapy for the most commonly targeted problems (depression, anxiety, conduct, attention-deficit hyperactivity disorder; 2,698 effect sizes (ESs); 314 studies; N = 19,739; ages 4-18). Higher cultural sexism was associated with lower ESs for studies with ≥50% girls; this association became stronger as the proportion of girls in the samples increased. Cultural sexism was unrelated to ESs for studies with >50% boys. An interaction between state- and county-level sexism revealed that psychotherapies were most beneficial when they were conducted in states and counties with the lowest cultural sexism. Thus, the context in which psychotherapies are delivered is associated with psychotherapy efficacy for girls.

Objective: Gender minority youths (i.e., children/adolescents whose gender identity and/or expression is inconsistent with their birth-assigned sex) experience elevated rates of emotional and behavioral problems relative to their cisgender peers (i.e., youths who identify with their birth-assigned sex). Although empirically-supported treatments have proven effective in treating youth psychopathology generally, randomized controlled trials have not examined effects for gender minority youths.Method: To address this gap, we pooled data from four previously completed randomized controlled trials of a modular empirically-supported treatment with clinically-referred youths (N = 432; M(SD)age = 10.6(2.2); 55.1% White). A proxy indicator of gender identity (i.e., youths’ reports of wishing to be the opposite sex) was used classify gender minority (n = 64) and cisgender (n = 368) youths. Youth- and caregiver-reported pre-treatment internalizing and externalizing problems, treatment effectiveness on these symptom domains, and treatment acceptability (i.e., satisfaction, youth-therapist alliance) were compared across these groups.Results: Gender minority youths reported more severe pre-treatment internalizing and externalizing problems compared to cisgender youths; in contrast, their caregivers reported less severe problems. Though treatment was equally effective for both groups on most outcomes, gender minority youths’ caregiver-reported externalizing problems improved more slowly and less reliably, and their self-reported internalizing problems were more likely to remain clinically elevated at post-treatment. Further, gender minority youths reported lower treatment satisfaction.Conclusions: While findings suggest that empirically-supported treatments may effectively address many mental health problems for gender minority youths, they also underscore the need for treatment enhancements that improve acceptability and outcomes for these youths.