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Assessing Gender Identity Concerns in Children and Adolescents: Evaluation, Treatments, and Outcomes

  • CHILD AND ADOLESCENT DISORDERS (TD BENTON, SECTION EDITOR)
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Abstract

Child and adolescent psychiatrists are increasingly evaluating youth who present with gender-nonconforming behaviors and identities. The lack of discipline-specific guidelines has made assessment and treatment of children and adolescents presenting with these concerns more difficult. Several new guidelines have recently been published, and research efforts are advancing to broaden the scope of understanding of gender identity assessment and treatment in children and adolescents. Familiarity with the latest standards of care, recent research advances, and current knowledge gaps is important to help improve clinical competency in treating mental health issues in this population.

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References

Papers in particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. •• WPATH, Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People, Seventh Edition, 2011. Available at: http://www.wpath.org/publications_standards.cfm. Accessed 12 Feb 2012. These are the latest standards of care put forth by the WPATH; they address the mental health approach to children and adolescents in detail.

  2. Hembree WC, et al. Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2009;94(9):3132–54.

    Article  PubMed  CAS  Google Scholar 

  3. Adelson S. Developing practice parameters for gender-variant children and transgender adolescents. Child Adolesc Psychiatr Clin N Am. 2011;20(4):651–663.

    Google Scholar 

  4. American Psychiatric Association (APA). Diagnostic and statistical manual of mental disorders. 4th edition. Text Revised. Washington (DC): Author; 2000.

  5. Leibowitz S, Spack NP. The development of a gender identity psychosocial clinic: treatment issues, logistical considerations, interdisciplinary cooperation, and future initiatives. Child Adolesc Psychiatr Clin N Am. 2011;20(4):701–724.

    Google Scholar 

  6. • Zucker KJ, Wood H. Assessment of gender variance in children. Child Adolesc Psychiatr Clin N Am. 2011;20(4 (in press)). This paper offers an overview of the assessment of gender variant children by providing details of the psychometric scales that have been developed in the field of gender identity.

  7. Zucker KJ, et al. A gender identity interview for children. J Pers Assess. 1993;61(3):443–56.

    Article  PubMed  CAS  Google Scholar 

  8. Zucker KJ, et al. Human figure drawings of gender-problem children: a comparison to sibling, psychiatric, and normal controls. J Abnorm Child Psychol. 1983;11(2):287–98.

    Article  PubMed  CAS  Google Scholar 

  9. Johnson LL, et al. A parent-report gender identity questionnaire for children. Arch Sex Behav. 2004;33(2):105–16.

    Article  PubMed  Google Scholar 

  10. Delemarre-van de Waal HA, Cohen-Kettenis PT. Clinical management of gender identity disorder in adolescents: a protocol on psychological and paediatric endocrinology aspects. Euro J Endocrinology. 2006;155:S1131–7.

    Google Scholar 

  11. Zucker KJ. On the “natural history” of gender identity disorder in children. J Am Acad Child Adolesc Psychiatry. 2008;47(12):1361–3.

    Article  PubMed  Google Scholar 

  12. Green R. The “Sissy Boy Syndrome” and the development of homosexuality. New Haven (CT): Yale University Press; 1987.

  13. Zucker KJ, Bradley SJ. Gender identity disorder and psychosexual problems in children and adolescents. New York: Guilford Press; 1995.

    Google Scholar 

  14. Drummond KD, et al. A follow-up study of girls with gender identity disorder. Dev Psychol. 2008;44(1):34–45.

    Article  PubMed  Google Scholar 

  15. • Wallien MS, Cohen-Kettenis PT. Psychosexual outcome of gender-dysphoric children. J Am Acad Child Adolesc Psychiatry. 2008;47(12):1413–23. This is the latest published prospective study done on gender dysphoric children. It addresses the degree of gender dysphoria severity as a possible predictor of gender dysphoria persistence into adolescence.

    Article  PubMed  Google Scholar 

  16. de Vries AL, et al. Puberty suppression in adolescents with gender identity disorder: a prospective follow-up study. J Sex Med. 2010.

  17. Zucker KJ. The DSM diagnostic criteria for gender identity disorder in children. Arch Sex Behav. 2010;39(2):477–98.

    Article  PubMed  Google Scholar 

  18. Zucker KJ. Reports from the DSM-V Work Group on sexual and gender identity disorders. Arch Sex Behav. 2010;39(2):217–20.

    Article  PubMed  Google Scholar 

  19. Meyer-Bahlburg HF. From mental disorder to iatrogenic hypogonadism: dilemmas in conceptualizing gender identity variants as psychiatric conditions. Arch Sex Behav. 2010;39(2):461–76.

    Article  PubMed  Google Scholar 

  20. Steensma TD, Cohen-Kettenis PT. Gender transitioning before puberty? Arch Sex Behav. 2011;40(4):649–50.

    Article  PubMed  Google Scholar 

  21. • Steensma TD, et al. Desisting and persisting gender dysphoria after childhood: a qualitative follow-up study. Clin Child Psychol Psychiatry. 2011. This is a qualitative, retrospective study that outlines the different experiences of childhood gender dysphoria when differentiating those whose feelings persisted from those whose desisted.

  22. Pleak RR. Ethical issues in diagnosing and treating gender-dysphoric children and adolescents. In: Rottnek M, editor. Sissies and tomboys: gender nonconformity and homosexual childhood. New York: New York University Press; 1999. p. 34–51.

    Google Scholar 

  23. Rosenberg M. Children with gender identity issues and their parents in individual and group treatment. J Am Acad Child Adolesc Psychiatry. 2002;41(5):619–21.

    Article  PubMed  Google Scholar 

  24. Wallien MS, Swaab H, Cohen-Kettenis PT. Psychiatric comorbidity among children with gender identity disorder. J Am Acad Child Adolesc Psychiatry. 2007;46(10):1307–14.

    Article  PubMed  Google Scholar 

  25. Spack NP, Edwards-Leeper L. Transgendered youth, in Textbook of Adolescent Health Care, e.a. Fisher M, Editor in press, 2011, American Academy of Pediatrics.

  26. de Vries AL, et al. Puberty suppression in adolescents with gender identity disorder: a prospective follow-up study. J Sex Med. 2011;8(8):2276–83.

    Article  PubMed  Google Scholar 

  27. Zucker KJ, Bradley SJ, Owen-Anderson A, Singh D, Blanchard R, Bain J. Puberty-blocking hormonal therapy for adolescents with gender identity disorder: a descriptive clinical study. J Gay Lesbian Ment Health. 2011;15(1):58–82.

    Article  Google Scholar 

  28. Zucker KJ, et al. The recalled gender identity/gender role questionnaire: psychometric properties. Sex Roles. 2006;54:469–83.

    Article  Google Scholar 

  29. Lindgren TW, Pauly IB. A body image scale for evaluating transsexuals. Arch Sex Behav. 1975;4(6):639–56.

    Article  PubMed  CAS  Google Scholar 

  30. Deogracias JJ, et al. The gender identity/gender dysphoria questionnaire for adolescents and adults. J Sex Res. 2007;44(4):370–9.

    Article  PubMed  Google Scholar 

  31. Cohen-Kettenis PT, van Goozen SH. Sex reassignment of adolescent transsexuals: a follow-up study. J Am Acad Child Adolesc Psychiatry. 1997;36(2):263–71.

    Article  PubMed  CAS  Google Scholar 

  32. Achenbach TM. Integrative Guide to the 1991 CBCL/4-18, YSR, and TRF Profiles. Burlington: University of Vermont, Department of Psychology; 1991.

    Google Scholar 

  33. Kovacs M. The Children’s Depression, Inventory (CDI). Psychopharmacol Bull. 1985;21(4):995–8.

    PubMed  CAS  Google Scholar 

  34. Reynolds CR, Richmond BO. Factor structure and construct validity of “what I think and feel”: the revised children’s manifest anxiety scale. J Pers Assess. 1979;43(3):281–3.

    Article  PubMed  CAS  Google Scholar 

  35. Conners CK, Barkley RA. Rating scales and checklists for child psychopharmacology. Psychopharmacol Bull. 1985;21(4):809–43.

    PubMed  CAS  Google Scholar 

  36. Myles BS, Bock SJ, Simpson RL. Asperger syndrome diagnostic scale. Los Angeles: Western Psychological Services; 2001.

    Google Scholar 

  37. de Vries AL, et al. Autism spectrum disorders in gender dysphoric children and adolescents. J Autism Dev Disord. 2010;40(8):930–6.

    Article  PubMed  Google Scholar 

  38. Di Ceglie D, et al. Children and adolescents referred to a specialist gender identity development service: clinical features and demographic characteristics. International Journal of Transgenderism. 2002;Jan–March(6(1)).

  39. Nuttbrock L, et al. Psychiatric impact of gender-related abuse across the life course of male-to-female transgender persons. J Sex Res. 2010;47(1):12–23.

    Article  PubMed  Google Scholar 

  40. Grossman AH, D’Augelli AR. Transgender youth and life-threatening behaviors. Suicide Life Threat Behav. 2007;37(5):527–37.

    Article  PubMed  Google Scholar 

  41. Ryan C, et al. Family rejection as a predictor of negative health outcomes in white and Latino lesbian, gay, and bisexual young adults. Pediatrics. 2009;123(1):346–52.

    Article  PubMed  Google Scholar 

  42. Toomey RB, et al. Gender-nonconforming lesbian, gay, bisexual, and transgender youth: school victimization and young adult psychosocial adjustment. Dev Psychol. 2010;46(6):1580–9.

    Article  PubMed  Google Scholar 

  43. Cohen-Kettenis PT, Delemarre-van de Waal HA, Gooren LJ. The treatment of adolescent transsexuals: changing insights. J Sex Med. 2008;5(8):1892–7.

    Article  PubMed  Google Scholar 

  44. de Vries ALC. Gender dysphoria in adolescents; mental health and treatment evaluation. Amsterdam, the Netherlands: Thesis, VU University Medical Center; 2010.

    Google Scholar 

  45. Lawrence AA. Factors associated with satisfaction or regret following male-to-female sex reassignment surgery. Arch Sex Behav. 2003;32(4):299–315.

    Article  PubMed  Google Scholar 

  46. •• Kreukels BP, Cohen-Kettenis PT. Puberty suppression in gender identity disorder: the Amsterdam experience. Nat Rev Endocrinol. 2011;7(8):466–72. This is a recent review of the development of the medical hormone intervention protocol in the Amsterdam gender identity clinic. The paper offers detailed understanding of how the protocol originated and subsequently evolved.

    Article  PubMed  CAS  Google Scholar 

  47. Adolescent Gender Identity Research Group (AGIR). in International Meeting. 2007. Amsterdam, Netherlands.

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Disclosure

Dr. Leibowitz reported no potential conflicts of interest relevant to this article.

Dr. Telingator reported no potential conflicts of interest relevant to this article.

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Authors and Affiliations

  1. Department of Psychiatry, Children’s Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA

    Scott F. Leibowitz

  2. Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, 1493 Cambridge Street, Cambridge, MA, 02139, USA

    Cynthia Telingator

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  1. Scott F. Leibowitz
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  2. Cynthia Telingator
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Correspondence to Scott F. Leibowitz.

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Leibowitz, S.F., Telingator, C. Assessing Gender Identity Concerns in Children and Adolescents: Evaluation, Treatments, and Outcomes. Curr Psychiatry Rep 14, 111–120 (2012). https://doi.org/10.1007/s11920-012-0259-x

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