, Volume 2, Issue 2, pp 99-116

The behavioral treatment of a “transsexual” preadolescent boy

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Abstract

Behavioral treatment procedures were developed to suppress feminine sex-typed behaviors and to increase masculine sex-typed behaviors in an 8-year-old boy with “childhood cross-gender identity.” The boy's clinical history paralleled the retrospective reports of adult transsexuals, including (1) feminine voice inflection and predominantly feminine content in speech, (2) verbal self-reference as “sissy” and “fag” and statements about his preference to be a girl, (3) feminine hand and arm gestures and “swishy” gait, (4) an aversion to masculine play activities, (5) a strong preference for girl playmates and taking a feminine role in play and role-playing, and (6) improvised cross-dressing. With a multiple-baseline intrasubject design across stimulus environments and across behaviors, the subject was treated sequentially in the clinic, at home, and in the school. The boy's mother was trained to administer a token economy program in the home, and the school teacher was taught to apply a response-cost procedure in the classroom. The initial treatment effects were found to be largely response specific and stimulus specific, necessitating treatment for a number of behaviors in the three major environments. Followup data 12 months after treatment termination suggest that the boy's sex-typed behaviors have become essentially normalized. This treatment holds promise for correcting pathological gender identity development in boys and for relieving the associated emotional adjustment problems.

This article is one in a series of publications from Dr. Rekers' and Dr. Lovaas' treatment research program at UCLA on childhood gender problems. The program is supported by United States Public Health Service Research Grants 21803-01Al, 21803-02, and 11440-05 from the National Institute of Mental Health. The authors express their appreciation to Gary Eifer, Dr. Linda Friar, Arana Greenberg, Sandra Kurtzer, Sharon Schwartz, Norman Stone, and Cindy Yates, M.A., for their assistance in data collection. We also thank Dr. Richard Green, UCLA School of Medicine, who referred the first treatment cases to us, and Dr. Alexander C. Rosen, Chief of Psychology at the UCLA Neuropsychiatric Institute, for his consultation on psychological assessment. The essentials of this study were presented in an unpublished paper entitled “Treatment of cross-sex behavior in boys” at the Fourth Annual Meeting of the Society for Psychotherapy Research, June 15, 1973, Philadelphia, Pennsylvania.