Behavioral and Emotional Problems in Gender-Nonconforming Children: A Canadian Community-Based Study

Miesen, Anna I. R. van der; Nabbijohn, A. Natisha; Santarossa, Alanna; VanderLaan, Doug P.

doi:10.1016/j.jaac.2018.03.015

Cited by 81 publications

(76 citation statements)

References 17 publications

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“…Aitken et al, 2016; Cohen-Kettenis et al, 2003; Steensma et al, 2014). These results are contradicting recent findings from North American studies using community based samples (Durwood et al, 2017; Kuvalanka et al, 2017; Olson et al, 2016), though not all of them (Van der Miesen et al, 2018).…”

Section: Discussioncontrasting

confidence: 99%

“…These clinical studies indicated that children with GD are more likely to experience internalizing problems, such as anxiety and depression, than externalizing problems (Cohen-Kettenis et al, 2003; Steensma et al, 2014). Similarly, a Canadian community-based sample among gender-nonconforming children aged 6–12 years found impaired psychological functioning comparable to the results reported in clinical studies (Van der Miesen et al, 2018).…”

Section: Introductionsupporting

confidence: 82%

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Not social transition status, but peer relations and family functioning predict psychological functioning in a German clinical sample of children with Gender Dysphoria

Sievert

Schweizer

Barkmann

et al. 2020

Clin Child Psychol Psychiatry

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Research provides inconclusive results on whether a social gender transition (e.g. name, pronoun, and clothing changes) benefits transgender children or children with a Gender Dysphoria (GD) diagnosis. This study examined the relationship between social transition status and psychological functioning outcomes in a clinical sample of children with a GD diagnosis. Psychological functioning (Child Behavior Checklist; CBCL), the degree of a social transition, general family functioning (GFF), and poor peer relations (PPR) were assessed via parental reports of 54 children (range 5–11 years) from the Hamburg Gender Identity Service (GIS). A multiple linear regression analysis examined the impact of the social transition status on psychological functioning, controlled for gender, age, socioeconomic status (SES), PPR and GFF. Parents reported significantly higher scores for all CBCL scales in comparison to the German age-equivalent norm population. Peer problems and worse family functioning were significantly associated with impaired psychological functioning, whilst the degree of social transition did not significantly predict the outcome. Therefore, claims that gender affirmation through transitioning socially is beneficial for children with GD could not be supported from the present results. Instead, the study highlights the importance of individual social support provided by peers and family, independent of exploring additional possibilities of gender transition during counseling.

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionsupporting

confidence: 82%

Not social transition status, but peer relations and family functioning predict psychological functioning in a German clinical sample of children with Gender Dysphoria

Sievert

Schweizer

Barkmann

et al. 2020

Clin Child Psychol Psychiatry

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“…Each item on the GIQC is rated on a scale from 1 to 5, where 1 ϭ stereotypically opposite to sex assigned at birth and 5 ϭ stereotypically same as sex assigned at birth (Johnson et al, 2004). In the case that a parent did not answer an item or selected "not applicable," the denominator was adjusted (van der Miesen et al, 2018). The GIQC has minimal age differences and has been reported to be an effective screening measure for GD in children; however, it is not intended as a diagnostic tool and cannot be used to discern whether any of the children in the current sample experienced GD (Johnson et al, 2004).…”

Section: Measures Gender Identity Questionnaire For Children (Giqc)mentioning

confidence: 99%

“…Although research attention toward gender-nonconforming children has historically been rare, it has recently been growing (Turban & Ehrensaft, 2018). Studies have found that between 0.9%–16.3% of children assigned female at birth (AFAB) and 1.0%–7.8% of children assigned male at birth (AMAB) in the community exhibit GNC (Martin, Andrews, England, Zosuls, & Ruble, 2017; van Beijsterveldt, Hudziak, & Boomsma, 2006; van der Miesen, Nabbijohn, Santarossa, & VanderLaan, 2018).…”

mentioning

confidence: 99%

“…Previous studies have used varied measures to assess the prevalence of GNC, and these measures assess different features of GNC (e.g., behaviors, interests, felt pressure to conform to gender norms). For example, van der Miesen et al (2018) used specific cut-off scores on the Gender Identity Questionnaire for Children (GIQC; Johnson et al, 2004), which measures both behavior and identity. Endorsement of Child Behavior Checklist (CBCL) Item 110 (“wishes to be of the opposite sex”) and/or Item 5 (“behaves like the opposite sex”), the latter of which is no longer included in the current CBCL, have also been used to measure GNC (Achenbach & Rescorla, 2001; Strang et al, 2014; van Beijsterveldt et al, 2006; van der Miesen et al, 2018).…”

mentioning

confidence: 99%

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Self-harm and suicidality in gender-nonconforming children: A Canadian community-based parent-report study.

MacMullin¹,

Aitken²,

Nabbijohn³

et al. 2020

Psychology of Sexual Orientation and Gender Diversity

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No study to date has examined self-harm/suicidality in a community sample of children who express gender nonconformity (GNC). This parent-report study (N ϭ 1,923) examined self-harm/suicidality in a nonclinical community sample of 6-to 12-year-old children, including those who express marked GNC but do not have a gender dysphoria (GD) diagnosis. Child Behavior Checklist (CBCL) Items 18 ("Deliberately harms self or attempts suicide") and 91 ("Talks about killing self") measured self-harm/ suicidality. The Gender Identity Questionnaire for Children measured GNC, the CBCL measured peer relations and behavioral and emotional challenges, and the Child-Rearing Sex-Role Attitude Scale measured parents' gender-stereotypical attitudes toward child-rearing. Among children who expressed GNC most markedly, 9.1% had attempted suicide and/or self-harmed and 6.8% had suicidal ideation. These rates parallel those reported for children clinic-referred for GD. Across the sample, suicidal ideation, self-harm/suicide attempt, poor peer relations, and behavioral and emotional challenges were significantly positively correlated. Among children assigned female at birth, self-harm/suicide attempt was negatively correlated with gender-liberal parental attitudes. Binary logistic regressions showed some evidence that children who expressed GNC had higher suicidality/self-harm compared to children who were gender-conforming and did not have a mental health diagnosis; however, group effects were mostly accounted for when controlling for poor peer relations and behavioral and emotional challenges, with the latter being the strongest predictor of suicidal ideation and self-harm/suicide attempt. Thus, self-harm/ suicidality among gender-nonconforming children is likely greater in scope than previously recognized, and parental attitudes, peer relations, and behavioral and emotional challenges are important factors to consider. Public Significance StatementThis study is the first to demonstrate that the issue of suicidality/self-harm among gendernonconforming children from nonclinical, community populations is likely much greater in scope than has been previously recognized. Among children who expressed high levels of gender nonconformity, 9.1% had attempted suicide and/or self-harmed and 6.8% had suicidal ideation, which are similar to rates reported for children clinic-referred for gender dysphoria and highlights a need for awareness of this issue among individuals who regularly interact with children.

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Gender Diversity and Brain Morphology Among Adolescents

et al. 2023

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ImportanceGender-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.ObjectiveTo 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 ParticipantsThis 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.ExposuresGender-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 MeasuresHigh-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.ResultsThis 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 RelevanceThe 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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Behavioral and Emotional Problems in Gender-Nonconforming Children: A Canadian Community-Based Study

Cited by 81 publications

References 17 publications

Not social transition status, but peer relations and family functioning predict psychological functioning in a German clinical sample of children with Gender Dysphoria

Not social transition status, but peer relations and family functioning predict psychological functioning in a German clinical sample of children with Gender Dysphoria

Self-harm and suicidality in gender-nonconforming children: A Canadian community-based parent-report study.

Gender Diversity and Brain Morphology Among Adolescents

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