Archives of Sexual Behavior

, Volume 47, Issue 4, pp 915–929 | Cite as

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

  • Sheri A. BerenbaumEmail author
  • Adriene M. Beltz
  • Kristina Bryk
  • Susan McHale
Original Paper


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.


Sex segregation Gender cognitions Gender identity Gender-typed activities Prenatal androgens Congenital adrenal hyperplasia 



This research was supported by a grant from the National Institutes of Health, HD057930. We thank the participants; members of the CARES and MAGIC Foundations and pediatric endocrinologists for help in recruiting participants; Diana Crom and Rob Schofield for coordinating data collection and processing; Chun Bun Lam, Elizabeth Beckerman, Timothy Groh, Erin Marshall, Erica Pawlo, and Emily Reitz for assistance with data management, scoring, and analysis.


  1. Alexander, G. M., & Hines, M. (1994). Gender labels and play styles: Their relative contribution to children’s selection of playmates. Child Development, 65, 869–879.CrossRefPubMedGoogle Scholar
  2. Antill, J. K., Cotton, S., Russell, G., & Goodnow, J. J. (1996). Measures of children’s sex-typing in middle childhood II. Australian Journal of Psychology, 48, 35–44.CrossRefGoogle Scholar
  3. Antill, J. K., Russell, G., Goodnow, J. J., & Cotton, S. (1993). Measures of children’s sex typing in middle childhood. Australian Journal of Psychology, 45, 25–33.CrossRefGoogle Scholar
  4. Berenbaum, S. A. (1999). Effects of early androgens on sex-typed activities and interests in adolescents with congenital adrenal hyperplasia. Hormones and Behavior, 35, 102–110. Scholar
  5. Berenbaum, S. A., & Bailey, J. M. (2003). Effects on gender identity of prenatal androgens and genital appearance: Evidence from girls with congenital adrenal hyperplasia. Journal of Clinical Endocrinology and Metabolism, 88, 1102–1106. Scholar
  6. Berenbaum, S. A., & Beltz, A. M. (2011). Sexual differentiation of human behavior: Effects of prenatal and pubertal organizational hormones. Frontiers in Neuroendocrinology, 32, 183–200. Scholar
  7. Berenbaum, S. A., & Beltz, A. M. (2016). How early hormones shape gender development. Current Opinion in Behavioral Sciences, 7, 53–60. Scholar
  8. Berenbaum, S. A., & Hines, M. (1992). Early androgens are related to childhood sex-typed toy preferences. Psychological Science, 3, 203–206.CrossRefGoogle Scholar
  9. Berenbaum, S. A., Martin, C. L., Hanish, L. D., Briggs, P. T., & Fabes, R. A. (2008). Sex differences in children’s play. In J. B. Becker, K. J. Berkley, N. Geary, E. Hampson, J. P. Herman, & E. A. Young (Eds.), Sex differences in the brain: From genes to behavior (pp. 275–290). New York: Oxford University Press.Google Scholar
  10. Berenbaum, S. A., & Snyder, E. (1995). Early hormonal influences on childhood sex-typed activity and playmate preferences: Implications for the development of sexual orientation. Developmental Psychology, 31, 31–42. Scholar
  11. Blakemore, J. E. O., Berenbaum, S. A., & Liben, L. S. (2009). Gender development. New York: Psychology Press/Taylor & Francis.Google Scholar
  12. Crouter, A. C., Whiteman, S. D., McHale, S. M., & Osgood, D. W. (2007). Development of gender attitude traditionality across middle childhood and adolescence. Child Development, 78, 911–926.CrossRefPubMedGoogle Scholar
  13. Dessens, A. B., Slijper, F. M. E., & Drop, S. L. S. (2005). Gender dysphoria and gender change in chromosomal females with congenital adrenal hyperplasia. Archives of Sexual Behavior, 34, 389–397. Scholar
  14. Egan, S. K., & Perry, D. G. (2001). Gender identity: A multidimensional analysis with implications for psychosocial adjustment. Developmental Psychology, 37, 451–463.CrossRefPubMedGoogle Scholar
  15. Ehrhardt, A. A., & Baker, S. W. (1974). Fetal androgens, human central nervous system differentiation and behavior sex differences. In R. C. Friedman, R. M. Richart, & R. L. Vande Wiele (Eds.), Sex differences in behavior (pp. 33–51). New York: Wiley.Google Scholar
  16. Endendijk, J. J., Beltz, A. M., McHale, S. M., Bryk, K., & Berenbaum, S. A. (2016). Linking prenatal androgens to gender-related attitudes, identity, and activities: Evidence from girls with congenital adrenal hyperplasia. Archives of Sexual Behavior, 45, 1807–1815. Scholar
  17. Fabes, R. A., Shepard, A. S., Guthrie, I. K., & Martin, C. L. (1997). Roles of temperamental arousal and gender segregated play in young children’s social adjustment. Developmental Psychology, 33, 693–702.CrossRefPubMedGoogle Scholar
  18. Fridell, S. R., Owen-Anderson, A., Johnson, L. L., Bradley, S. J., & Zucker, K. J. (2006). The Playmate and Play Style Preferences Structured Interview: A comparison of children with gender identity disorder and controls. Archives of Sexual Behavior, 35, 729–737. Scholar
  19. Gasparini, C., Sette, S., Baumgartner, E., Martin, C. L., & Fabes, R. A. (2015). Gender-biased attitudes and attributions among young Italian children: Relation to peer dyadic interaction. Sex Roles, 73, 427–441.CrossRefGoogle Scholar
  20. Hall, C. M., Jones, J. A., Meyer-Bahlburg, H. F. L., Dolezal, C., Coleman, M., Foster, P., … Clayton, P. E. (2004). Behavioral and physical masculinization are related to genotype in girls with congenital adrenal hyperplasia. Journal of Clinical Endocrinology and Metabolism, 89, 419–424.
  21. Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York: Guilford.Google Scholar
  22. Hines, M., & Kaufman, F. (1994). 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). Child Development, 65, 1042–1053. Scholar
  23. Hines, M., Pasterski, V., Spencer, D., Neufeld, S., Patalay, P., Hindmarsh, P. C., … Acerini, C. L. (2016). Prenatal androgen exposure alters girls’ responses to information indicating gender-appropriate behaviour. Philosophical Transactions of the Royal Society of London B, 371, 20150125.
  24. Leaper, C. (1994). Exploring the consequences of gender segregation on social relationships. In C. Leaper (Ed.), Childhood gender segregation: Causes and consequences (pp. 67–86). San Francisco: Jossey-Bass.Google Scholar
  25. Luhtanen, R., & Crocker, J. (1992). A collective self-esteem scale: Self-evaluation of one’s social identity. Personality and Social Psychology Bulletin, 18, 302–318.CrossRefGoogle Scholar
  26. Maccoby, E. E. (1998). The two sexes: Growing up apart, coming together. Cambridge, MA: Harvard University Press.Google Scholar
  27. Maccoby, E. E., & Jacklin, C. N. (1987). Gender segregation in childhood. In H. W. Reese (Ed.), Advances in child development and behavior (Vol. 20, pp. 239–287). New York: Academic Press.Google Scholar
  28. MacKinnon, D. P., & Fairchild, A. J. (2009). Current directions in mediation analysis. Current Directions in Psychological Science, 18, 16–20.CrossRefPubMedPubMedCentralGoogle Scholar
  29. Martin, C. L., & Dinella, L. M. (2012). Congruence between gender stereotypes and activity preference in self-identified tomboys and non-tomboys. Archives of Sexual Behavior, 41, 599–610. Scholar
  30. Martin, C. L., & Fabes, R. A. (2001). The stability and consequences of young children’s same-sex peer interactions. Developmental Psychology, 37, 431–446. Scholar
  31. Martin, C. L., Fabes, R. A., Evans, S. M., & Wyman, H. (1999). Social cognition on the playground: Children’s beliefs about playing with girls versus boys and their relations to sex segregated play. Journal of Social and Personal Relationships, 16, 751–771.CrossRefGoogle Scholar
  32. Martin, C. L., Fabes, R. A., Hanish, L., Leonard, S., & Dinella, L. M. (2011). Experienced and expected similarity to same-gender peers: Moving toward a comprehensive model of gender segregation. Sex Roles, 65, 421–434. Scholar
  33. Martin, C. L., Kornienko, O., Schaefer, D. R., Hanish, L. D., Fabes, R. A., & Goble, P. (2013). The role of sex of peers and gender-typed activities in young children’s peer affiliative networks: A longitudinal analysis of selection and influence. Child Development, 84, 921–937.CrossRefPubMedGoogle Scholar
  34. Martin, C. L., Ruble, D. N., & Szkrybalo, J. (2002). Cognitive theories of early gender development. Psychological Bulletin, 128, 903–933. Scholar
  35. McHale, S. M., Bartko, W. T., Crouter, A. C., & Perry-Jenkins, M. (1990). Children’s housework and their psychosocial functioning: The mediating effects of parents’ sex-role behaviors and attitudes. Child Development, 61, 1413–1426.CrossRefPubMedGoogle Scholar
  36. McHale, S. M., Crouter, A. C., & Tucker, C. J. (1999). Family context and gender role socialization in middle childhood: Comparing girls to boys and sisters to brothers. Child Development, 70, 990–1004. Scholar
  37. McHale, S. M., Kim, J. Y., Dotterer, A. M., Crouter, A. C., & Booth, A. (2009). The development of gendered interests and personality qualities from middle childhood through adolescence: a biosocial analysis. Child Development, 80, 482–495.CrossRefPubMedPubMedCentralGoogle Scholar
  38. McHale, S. M., Kim, J. Y., Whiteman, S., & Crouter, A. C. (2004a). Links between sex-typed time use in middle-childhood and gender development in early adolescence. Developmental Psychology, 40, 868–881. Scholar
  39. McHale, S. M., Shanahan, L., Updegraff, K. A., Crouter, A. C., & Booth, A. (2004b). Developmental and individual differences in girls’ sex-typed activities in middle childhood and adolescence. Child Development, 75, 1575–1593. Scholar
  40. Mehta, C. M., & Strough, J. (2009). Sex segregation in friendships and normative contexts across the life span. Developmental Review, 29, 201–220.CrossRefGoogle Scholar
  41. Merke, D. P., & Bornstein, S. R. (2005). Congenital adrenal hyperplasia. Lancet, 365, 2125–2136. Scholar
  42. Meyer-Bahlburg, H. F. L., Baratz Dalke, K., Berenbaum, S. A., Cohen-Kettenis, P. T., Hines, M., & Schober, J. M. (2016). Gender assignment, reassignment and outcome in disorders of sex development: Update of the 2005 consensus conference. Hormone Research in Paediatrics, 85, 112–118.CrossRefPubMedGoogle Scholar
  43. Meyer-Bahlburg, H. F. L., Dolezal, C., Baker, S., Carlson, A. D., Obeid, J. S., & New, M. I. (2004). Prenatal androgenization affects gender-related behavior but not gender identity in 5-12-year-old girls with congenital adrenal hyperplasia. Archives of Sexual Behavior, 33, 94–104.CrossRefGoogle Scholar
  44. Nordenström, A., Servin, A., Bohlin, G., Larsson, A., & Wedell, A. (2002). Sex-typed toy play behavior correlates with the degree of prenatal androgen exposure assessed by CYP21 genotype in girls with congenital adrenal hyperplasia. Journal of Clinical Endocrinology and Metabolism, 87, 5119–5124. Scholar
  45. Ohannessian, C. M. (2009). Media use and adolescent psychological adjustment: An examination of gender differences. Journal of Child and Family Studies, 18, 582–593. Scholar
  46. Pasterski, V. L., Geffner, M. E., Brain, C., Hindmarsh, P., Brook, C., & Hines, M. (2005). Prenatal hormones and postnatal socialization by parents as determinants of male-typical toy play in girls with congenital adrenal hyperplasia. Child Development, 76, 264–278. Scholar
  47. Pasterski, V., Geffner, M. E., Brain, C., Hindmarsh, P., Brook, C., & Hines, M. (2011). Prenatal hormones and childhood sex segregation: Playmate and play style preferences in girls with congenital adrenal hyperplasia. Hormones and Behavior, 59, 549–555. Scholar
  48. Pasterski, V. L., Hindmarsh, P., Geffner, M., Brook, C., Brain, C., & Hines, M. (2007). Increased aggression and activity level in 3- to 11-year-old girls with congenital adrenal hyperplasia (CAH). Hormones and Behavior, 52, 368–374.CrossRefPubMedPubMedCentralGoogle Scholar
  49. Pasterski, V., Zucker, K. J., Hindmarsh, P. C., Hughes, I. A., Acerini, C. L., Spencer, D., … Hines, M. (2015). Increased cross-gender identification independent of gender role behavior in girls with congenital adrenal hyperplasia: Results from a standardized assessment of 4- to 11-year-old children. Archives of Sexual Behavior, 44, 1363–1375.
  50. Powlishta, K. K., & Maccoby, E. E. (1990). Resource utilization in mixed-sex dyads: The influence of adult presence and task type. Sex Roles, 23, 223–240.CrossRefGoogle Scholar
  51. Rekers, G. A., Sanders, J. A., Rasbury, W. C., Strauss, C. C., & Morey, S. M. (1989). Differentiation of adolescent activity participation. Journal of Genetic Psychology, 150, 323–335. Scholar
  52. Ruble, D. N., Martin, C. L., & Berenbaum, S. A. (2006). Gender development. In N. Eisenberg (Ed.), Handbook of child psychology, Vol. 3: Social, emotional, and personality development (6th ed., pp. 858–932). New York: Wiley.Google Scholar
  53. Ruble, D. N., Taylor, L. J., Cyphers, L., Greulich, F. K., Lurye, L. E., & Shrout, P. E. (2007). The role of gender constancy in early gender development. Child Development, 78, 1121–1136.CrossRefPubMedGoogle Scholar
  54. Servin, A., Nordenström, A., Larsson, A., & Bohlin, G. (2003). Prenatal androgens and gender-typed behavior: A study of girls with mild and severe forms of congenital adrenal hyperplasia. Developmental Psychology, 39, 440–450. Scholar

Copyright information

© Springer Science+Business Media, LLC 2018

Authors and Affiliations

  1. 1.Department of Psychology, 453 Moore BuildingThe Pennsylvania State UniversityUniversity ParkUSA
  2. 2.Department of PediatricsThe Pennsylvania State UniversityUniversity ParkUSA
  3. 3.Department of PsychologyUniversity of MichiganAnn ArborUSA
  4. 4.Department of Human Development and Family StudiesThe Pennsylvania State UniversityUniversity ParkUSA

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