Separation anxiety and gender variance in a community sample of children

  • Alanna Santarossa
  • A. Natisha Nabbijohn
  • Anna I. R. van der Miesen
  • Diana E. Peragine
  • Doug P. VanderLaanEmail author
Original Contribution


In clinical child and retrospective adult samples, childhood gender variance (GV; i.e., cross-gender behaviour) has been associated with separation anxiety (SA; i.e., distress related to separation from attachment figures) in males. This study examined GV and SA in a nonclinical sample of 892 boys and 933 girls aged 6–12 years via parent-reports. Parental factors (i.e., parenting style, parent–child relationship, willingness to serve as an attachment figure, attitudes towards gender stereotypes in children) were examined as potential moderators. GV predicted SA in boys, even when statistically controlling for general psychopathology and demographic variables. Authoritative parenting, closeness in the parent–child relationship, willingness to serve as an attachment figure, and liberal attitudes towards gender stereotypes in children moderated the association between GV and SA in both boys and girls. Thus, SA may be a unique internalizing problem related to GV in boys in nonclinical samples and influenced by a variety of parental factors.


Separation anxiety Gender variance Children Parenting styles Parental attitudes Parent–child relationship 



We thank an anonymous reviewer for comments on a prior draft. AS and ANN were supported by Social Sciences and Humanities Research Council (SSHRC) of Canada Undergraduate Research Awards. This research was funded by a University of Toronto Mississauga Research and Scholarly Activity Fund Award and a SSHRC Insight Development Grant to DPV.

Compliance with ethical standards

Conflict of interest

The authors declare they have no conflict of interest.

Research involving human participants

All the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Adelson SL (2012) Practice parameter on gay, lesbian, or bisexual sexual orientation, gender nonconformity, and gender discordance in children and adolescents. J Am Acad Child Adolesc Psychiatry 51:957–974. CrossRefGoogle Scholar
  2. 2.
    Yunger JL, Carver PR, Perry DG (2004) Does gender identity influence children’s psychological well-being? Dev Psychol 40:572–582. CrossRefGoogle Scholar
  3. 3.
    Martin CL, Andrews NC, England DE, Zosuls K, Ruble DN (2017) A dual identity approach for conceptualizing and measuring children’s gender identity. Child Dev 88:167–182. CrossRefGoogle Scholar
  4. 4.
    Achenbach TM (1991) Manual for the child behavior checklist/4–18 and 1991 profile. University of Vermont, Department of Psychiatry, BurlingtonGoogle Scholar
  5. 5.
    Strang JF, Kenworthy L, Dominska A, Sokoloff J, Kenealy LE, Berl M, Walsh K, Menvielle E, Slesaransky-Poe G, Kim KE, Luong-Tran C, Meagher H, Wallace GL (2014) Increased gender variance in autism spectrum disorders and attention deficit hyperactivity disorder. Arch Sex Behav 43:1525–1533. CrossRefGoogle Scholar
  6. 6.
    van Beijsterveldt CEM, Hudziak JJ, Boomsma DI (2006) Genetic and environmental influences on cross-gender behavior and relation to behavior problems: a study of Dutch twins at ages 7 and 10 years. Arch Sex Behav 35:647–658. CrossRefGoogle Scholar
  7. 7.
    van der Miesen AIR, Nabbijohn AN, Santarossa A, VanderLaan DP (2018) Behavioral and emotional problems in gender-nonconforming children: a Canadian community-based study. J Am Acad Child Adolesc Psychiatry 57:491–499. CrossRefGoogle Scholar
  8. 8.
    American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Publishing, ArlingtonCrossRefGoogle Scholar
  9. 9.
    Zucker KJ, Wood H, VanderLaan DP (2014) Models of psychopathology in children and adolescents with gender dysphoria. In: Kreukels BPC, Steensma TD, de Vries ALC (eds) Gender dysphoria and disorders of sex development. Focus on sexuality research. Springer, Boston, pp 171–192CrossRefGoogle Scholar
  10. 10.
    Wallien MSC, Swaab H, Cohen-Kettenis PT (2007) Psychiatric comorbidity among children with gender identity disorder. J Am Acad Child Adolesc Psychiatry 46:1307–1314. CrossRefGoogle Scholar
  11. 11.
    Baams L, Beek T, Hille H, Zevenbergen F, Bos HMW (2013) Gender nonconformity, perceived stigmatization, and psychological well-being in Dutch sexual minority youth and young adults: a mediation analysis. Arch Sex Behav 42:765–773. CrossRefGoogle Scholar
  12. 12.
    Johnson LL, Bradley SJ, Birkenfeld-Adams AS, Kuksis MA, Maing DM, Mitchell JN, Zucker KJ (2004) A parent-report gender identity questionnaire for children. Arch Sex Behav 33:105–116. CrossRefGoogle Scholar
  13. 13.
    Shear K, Jin R, Ruscio AM, Walters EE, Kessler RC (2006) Prevalence and correlates of estimated DSM-IV child and adult separation anxiety disorder in the national comorbidity survey replication. Am J Psychiatry 163:1074–1083. CrossRefGoogle Scholar
  14. 14.
    VanderLaan DP, Santarossa A, Nabbijohn AN, Wood H, Owen-Anderson A, Zucker KJ (2018) Separation anxiety among birth-assigned male children in a specialty gender identity service. Eur Child Adolesc Psychiatry 27:89–98. CrossRefGoogle Scholar
  15. 15.
    Coates S, Person ES (1985) Extreme boyhood femininity: isolated behavior or pervasive disorder? J Am Acad Child Psychiatry 24:702–709. CrossRefGoogle Scholar
  16. 16.
    Zucker KJ, Bradley SJ, Sullivan CBL (1996) Traits of separation anxiety in boys with gender identity disorder. J Am Acad Child Adolesc Psychiatry 35:791–798. CrossRefGoogle Scholar
  17. 17.
    Wallien MSC, Cohen-Kettenis PT (2008) Psychosexual outcome of gender-dysphoric children. J Am Acad Child Adolesc Psychiatry 47:1413–1423. CrossRefGoogle Scholar
  18. 18.
    Li G, Kung KTF, Hines M (2017) Childhood gender-typed behavior and adolescent sexual orientation: a longitudinal population-based study. Dev Psychol 53:764–777. CrossRefGoogle Scholar
  19. 19.
    Steensma TD, van der Ende J, Verhulst FC, Cohen-Kettenis PT (2013) Gender variance in childhood and sexual orientation in adulthood: a prospective study. J Sex Med 10:2723–2733. CrossRefGoogle Scholar
  20. 20.
    Vasey PL, VanderLaan DP, Gothreau LM, Bartlett NH (2011) Traits of separation anxiety in childhood: a retrospective study of Samoan men, women, and fa’afafine. Arch Sex Behav 40:511–517. CrossRefGoogle Scholar
  21. 21.
    Gómez FR, Semenyna SW, Vasey PL (2017) Recalled separation anxiety in childhood in Istmo Zapotec men, women, and muxes. Arch Sex Behav 46:109–117. CrossRefGoogle Scholar
  22. 22.
    VanderLaan DP, Gothreau L, Bartlett NH, Vasey PL (2011) Recalled separation anxiety and gender atypicality in childhood: a study of Canadian heterosexual and homosexual men and women. Arch Sex Behav 40:1233–1240. CrossRefGoogle Scholar
  23. 23.
    Petterson LJ, VanderLaan DP, Vasey PL (2017) Sex, sexual orientation, gender atypicality, and indicators of depression and anxiety in childhood and adulthood. Arch Sex Behav 46:1383–1392. CrossRefGoogle Scholar
  24. 24.
    Bailey JM, Zucker KJ (1995) Childhood sex-typed behavior and sexual orientation: a conceptual analysis and quantitative review. Dev Psychol 31:43–55. CrossRefGoogle Scholar
  25. 25.
    Brassell AA, Rosenberg E, Parent J, Rough JN, Fondacaro K, Seehuus M (2016) Parent’s psychological flexibility: associations with parenting and child psychosocial well-being. J Contextual Behav Sci 5:111–120. CrossRefGoogle Scholar
  26. 26.
    Videon T (2005) Parent-child relations and children’s psychological well-being: do dads matter? J Fam Issues 26:55–78. CrossRefGoogle Scholar
  27. 27.
    McLeod BD, Wood JJ, Weisz JR (2007) Examining the association between parenting and childhood anxiety: a meta-analysis. Clin Psychol Rev 27:155–172. CrossRefGoogle Scholar
  28. 28.
    Suveg C, Aschenbrand SG, Kendall PC (2005) Separation anxiety disorder, panic disorder, and school refusal. Child Adolesc Psychiatr Clin N Am 14:773–795. CrossRefGoogle Scholar
  29. 29.
    Victor AM, Bernstein GA (2009) Anxiety disorders and posttraumatic stress disorder update. Psychiatr Clin N Am 32:57–69. CrossRefGoogle Scholar
  30. 30.
    Wallien MSC, Veenstra R, Kreukels BPC, Cohen-Kettenis PT (2010) Peer group status of gender dysphoric children: a sociometric study. Arch Sex Behav 39:553–560. CrossRefGoogle Scholar
  31. 31.
    Alanko K, Santtila P, Harlaar N, Witting K, Varjonen M, Jern P, Johansson A, von der Pahlen B, Sandnabba NK (2008) The association between childhood gender atypical behavior and adult psychiatric symptoms is moderated by parenting style. Sex Roles 58:837–847. CrossRefGoogle Scholar
  32. 32.
    van Beusekom G, Bos HMW, Overbeek G, Sandfort TGM (2015) Same-sex attraction, gender nonconformity, and mental health: the protective role of parental acceptance. Psychol Sex Orientat Gend Divers 2:307–312. CrossRefGoogle Scholar
  33. 33.
    Rosenberg M, Jellinek MS (2002) Children with gender identity issues and their parents in individual and group treatment. J Am Acad Child Adolesc Psychiatry 41:619–621. CrossRefGoogle Scholar
  34. 34.
    Connors ME (2011) Attachment theory: a “secure base” for psychotherapy integration. J Psychother Integr 21:348–362. CrossRefGoogle Scholar
  35. 35.
    Colonnesi C, Draijer EM, Stams GJJM, van der Bruggen CO, Bögels SM, Noom MJ (2011) The relation between insecure attachment and child anxiety: a meta-analytic review. J Clin Child Adolesc Psychol 40:630–645. CrossRefGoogle Scholar
  36. 36.
    Zeanah CH, Keyes A, Settles L (2003) Attachment relationship experiences and childhood psychopathology. Ann N Y Acad Sci 1008:22–30. CrossRefGoogle Scholar
  37. 37.
    Cooper PJ, Pauletti RE, Tobin DD, Menon M, Menon M, Spatta BC, Hodges EVE, Perry DG (2013) Mother-child attachment and gender identity in preadolescence. Sex Roles 69:618–631. CrossRefGoogle Scholar
  38. 38.
    Bradford AB, Burningham KL, Sandberg JG, Johnson LN (2017) The association between the parent-child relationship and symptoms of anxiety and depression: the roles of attachment and perceived spouse attachment behaviors. J Marital Fam Ther 43:291–307. CrossRefGoogle Scholar
  39. 39.
    Liu R (2005) Parent-youth closeness and youth’s suicidal ideation. Youth Soc 37:145–175. CrossRefGoogle Scholar
  40. 40.
    Matthewson M, Smith RB, Montgomery I (2012) Does the parent-child relationship contribute to children’s and parents’ anxiety? J Relatsh Res 3:1–9. CrossRefGoogle Scholar
  41. 41.
    Davey A, Bouman WP, Arcelus J, Meyer C (2014) Social support and psychological well-being in gender dysphoria: a comparison of patients with matched controls. J Sex Med 11:2976–2985. CrossRefGoogle Scholar
  42. 42.
    Chin E (2016) The role of family therapy in children and adolescents with gender dysphoria and psychiatric problems. J Am Acad Child Adolesc Psychiatry 55:S80. CrossRefGoogle Scholar
  43. 43.
    van den Bergh O, Walentynowicz M (2016) Accuracy and bias in retrospective symptom reporting. Curr Opin Psychiatry 29:302–308. CrossRefGoogle Scholar
  44. 44.
    Driscoll K, Pianta RC (2011) Mothers’ and fathers’ perceptions of conflict and closeness in parent-child relationships during early childhood. J Early Child Infant Psychol 7:1–24Google Scholar
  45. 45.
    Pianta RC (1995) Child-parent relationship scale. University of Virginia Press, CharlottesvilleGoogle Scholar
  46. 46.
    Block JH (1965) The child-rearing practices report: A technique for evaluating parental socialization orientations. University of California, Institute of Human Development, BerkeleyGoogle Scholar
  47. 47.
    Kerns KA, Klepac L, Cole A (1996) Peer relationships and preadolescents’ perceptions of security in the child-mother relationship. Dev Psychol 32:457–466. CrossRefGoogle Scholar
  48. 48.
    Robinson CC, Mandleco B, Olsen SF, Hart CH (1995) Authoritative, authoritarian, and permissive parenting practices: development of a new measure. Psychol Rep 77:819–830. CrossRefGoogle Scholar
  49. 49.
    Freeman NK (2007) Preschoolers' perceptions of gender appropriate toys and their parents' beliefs about genderized behaviors: Miscommunication, mixed messages, or hidden truths? Early Child Educ J 34:357–366. CrossRefGoogle Scholar
  50. 50.
    Achenbach TM, Rescorla LA (2001) Manual for the ASEBA school-age forms and profiles. University of Vermont, Research Center for Children, Youth, and Families. Burlington, VTGoogle Scholar
  51. 51.
    Cohen-Kettenis PT, Owen A, Kaijser VG, Bradley SJ, Zucker KJ (2003) Demographic characteristics, social competence, and behavior problems in children with gender identity disorder: a cross-national, cross-clinic comparative analysis. J Abnorm Child Psychol 31:41–53. CrossRefGoogle Scholar
  52. 52.
    Zahn-Waxler C, Shirtcliff EA, Marceau K (2008) Disorders of childhood and adolescence: gender and psychopathology. Annu Rev Clin Psychol 4:275–303. CrossRefGoogle Scholar
  53. 53.
    Seifer R, Sameroff A, Dickstein S, Schiller M, Hayden LC (2004) Your own children are special: clues to the sources of reporting bias in temperament assessments. Infant Behav Dev 27:323–341. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Alanna Santarossa
    • 1
  • A. Natisha Nabbijohn
    • 1
  • Anna I. R. van der Miesen
    • 2
  • Diana E. Peragine
    • 1
  • Doug P. VanderLaan
    • 1
    • 3
    Email author
  1. 1.Department of PsychologyUniversity of Toronto MississaugaMississaugaCanada
  2. 2.Department of Child and Adolescent Psychiatry, Center of Expertise on Gender DysphoriaVU University Medical CenterAmsterdamThe Netherlands
  3. 3.Child and Youth PsychiatryCentre for Addiction and Mental HealthTorontoCanada

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