Journal of Abnormal Child Psychology

, Volume 31, Issue 1, pp 41–53

Demographic Characteristics, Social Competence, and Behavior Problems in Children with Gender Identity Disorder: A Cross-National, Cross-Clinic Comparative Analysis

  • Peggy T. Cohen-Kettenis
  • Allison Owen
  • Vanessa G. Kaijser
  • Susan J. Bradley
  • Kenneth J. Zucker
Article

Abstract

This study examined demographic characteristics, social competence, and behavior problems in clinic-referred children with gender identity problems in Toronto, Canada (N = 358), and Utrecht, The Netherlands (N = 130). The Toronto sample was, on average, about a year younger than the Utrecht sample at referral, had a higher percentage of boys, had a higher mean IQ, and was less likely to be living with both parents. On the Child Behavior Checklist (CBCL), both groups showed, on average, clinical range scores in both social competence and behavior problems. A CBCL-derived measure of poor peer relations showed that boys in both clinics had worse ratings than did the girls. A multiple regression analysis showed that poor peer relations were the strongest predictor of behavior problems in both samples. This study—the first cross-national, cross-clinic comparative analysis of children with gender identity disorder—found far more similarities than differences in both social competence and behavior problems. The most salient demographic difference was age at referral. Cross-national differences in factors that might influence referral patterns are discussed.

gender identity disorder Child Behavior Checklist behavior problems social competence peer relations 

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References

  1. Achenbach, T. M., & Edelbrock, C. S. (1981). Behavioral problems and competencies reported by parents of normal and disturbed children aged four through sixteen. Monographs of the Society for Research in Child Development, 46(1, Serial No. 188).Google Scholar
  2. Achenbach, T. M., & Edelbrock, C. (1983). Manual for the Child Behavior Checklist and Revised Child Behavior Profile. Burlington: University of Vermont, Department of Psychiatry.Google Scholar
  3. Achenbach, T. M., Edelbrock, C., & Howell, C. T. (1987). Empirically based assessment of the behavioral/emotional problems of 2-and 3-year-old children. Journal of Abnormal Child Psychology, 15, 629-650.PubMedGoogle Scholar
  4. Achenbach, T. M., Verhulst, F. C., Baron, G. D., & Akkerhuis, G. W. (1987). Epidemiological comparisons of American and Dutch children: I. Behavioral/emotional problems and competencies reported by parents for ages 4 to 16. Journal of the American Academy of Child and Adolescent Psychiatry, 26, 317-325.PubMedGoogle Scholar
  5. American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author.Google Scholar
  6. Benziman, H., & Marodes, S. (1997). Indicators of feminine gender identity in latency-aged boys in the Draw a Person and the Rorschach tests. Journal of Clinical Psychology, 53, 143-157.PubMedGoogle Scholar
  7. Bernstein, J., & Zucker, K. J. (2000). [Reasons parents seek out a clinical referral for a child with gender identity disorder: A qualitative analysis]. Unpublished raw data.Google Scholar
  8. Best, D. L. (2001). Gender concepts: Convergence in cross-cultural research and methodologies. Cross-Cultural Research, 35, 23-43.Google Scholar
  9. Boyle, M. H., Offord, D. R., Hofman, H. G., Catlin, G. P., Byles, J. A., Cadman, D. T., et al. (1987). Ontario Child Health Study: I. Methodology. Archives of General Psychiatry, 44, 826-831.PubMedGoogle Scholar
  10. Coates, S., & Person, E. S. (1985). Extreme boyhood femininity: Isolated behavior or pervasive disorder? Journal of the American Academy of Child Psychiatry, 24, 702-709.PubMedGoogle Scholar
  11. Cohen-Kettenis, P. T. (2001). Gender Identity Disorder in DSM? [Letter to the editor]. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 391.PubMedGoogle Scholar
  12. Crijnen, A. A. M., Achenbach, T. M., & Verhulst, F. C. (1999). Problems reported by parents of children in multiple cultures: The Child Behavior Checklist syndrome constructs. American Journal of Psychiatry, 156, 569-574.PubMedGoogle Scholar
  13. DeMaris, A. (1992). Logit modeling: Practical applications. Newbury Park, CA: Sage.Google Scholar
  14. Di Ceglie, D., Freedman, D., McPherson, S., & Richardson, P. (2002). Children and adolescents referred to a specialist gender identity development service: Clinical features and demographic characteristics. International Journal of Transgenderism, 6(1). Retrieved July 9, 2002, from http://www.symposion.com/ijt/ijtvo06no01_01.htmGoogle Scholar
  15. Fagot, B. I. (1977a). Teachers' reinforcement of sex-preferred behaviors in Dutch preschools. Psychological Reports, 41, 1249-1250.PubMedGoogle Scholar
  16. Fagot, B. I. (1977b). Consequences of moderate cross-gender behavior in preschool children. Child Development, 48, 902-907.Google Scholar
  17. Flynn, J. R. (1987). Massive IQ gains in 14 nations: What IQ tests really measure. Psychological Bulletin, 101, 171-191.Google Scholar
  18. Fridell, S. R. (2001). Sex-typed play behavior and peer relations in boys with gender identity disorder. Unpublished doctoral dissertation, University of Toronto.Google Scholar
  19. Green, R. (1976). One-hundred ten feminine and masculine boys: Behavioral contrasts and demographic similarities. Archives of Sexual Behavior, 5, 425-446.PubMedGoogle Scholar
  20. Green, R. (1987). The “sissy boy syndrome” and the development of homosexuality. New Haven, CT: Yale University Press.Google Scholar
  21. Hollingshead, A. B. (1975). Four factor index of social status. Unpublished manuscript, Department of Sociology, Yale University, New Haven, CT.Google Scholar
  22. Kosky, R. J. (1987). Gender-disordered children: Does inpatient treatment help? Medical Journal of Australia, 146, 565-569.PubMedGoogle Scholar
  23. Offord, D. R., Boyle, M. H., Szatmari, P., Rae-Grant, N. I., Links, P. S., Cadman, D. T., et al. (1987). Ontario Child Health Study. II. Six-month prevalence of disorder and rates of service utilization. Archives of General Psychiatry, 44, 832-836.PubMedGoogle Scholar
  24. Rispens, J., Swaab, H., van den Oord, E. J. C. G., Cohen-Kettenis, P., van Engeland, H., & van Yperen, T. (1997). WISC profiles in child psychiatric diagnosis: Sense or nonsense? Journal of the American Academy of Child Psychiatry, 36, 1587-1594.Google Scholar
  25. Sattler, J. M. (2001). Assessment of children: Cognitive applications (4th ed.). San Diego, CA: Jerome M. Sattler.Google Scholar
  26. Schneider, B. H. (2000). Friends and enemies: Peer relations in childhood. London: Arnold.Google Scholar
  27. Tucker, J. B., & Keil, H. H. J. (2001). Can cultural beliefs cause a gender identity disorder? Journal of Psychology and Human Sexuality, 13(2), 21-30.Google Scholar
  28. Van Westerlaak, J. M., Kropman, J. A., & Collaris, J. W. M. (1975). Beroepenklapper. Nijmegen: Instituut voor Toegepaste Sociologie.Google Scholar
  29. Verhulst, F. C., & Achenbach, T. M. (1995). Empirically based assessment and taxonomy of psychopathology: Cross-cultural applications. A review. European Child and Adolescent Psychiatry, 4, 61-76.PubMedGoogle Scholar
  30. Verhulst, F. C., Achenbach, T. M., & Akkerhuis, G. W. (1989). Problems reported for clinically referred American and Dutch children. Journal of the American Academy of Child and Adolescent Psychiatry, 28, 516-524.PubMedGoogle Scholar
  31. Verhulst, F. C., & Koot, H. M. (1992). Child psychiatric epidemiology: Concepts, methods, and findings. Newbury Park, CA: Sage.Google Scholar
  32. Verhulst, F. C., van der Ende, J., & Koot, H. M. (1996). Handleiding voor de CBCL/4-18. Rotterdam, The Netherlands: Afdeling Kinder-en jeugdpsychiatrie, Sophia Kinderziekenuis/Academisch Ziekenhuis Rotterdam/Erasmus Universiteit.Google Scholar
  33. Wechsler, D. (1989). Wechsler Preschool and Primary Scale of Intelligence—Revised Manual. San Antonio, TX: The Psychological Corporation.Google Scholar
  34. Wechsler, D. (1991). Wechsler Intelligence Scale for Children: Manual (3rd ed.). San Antonio, TX: The Psychological Corporation.Google Scholar
  35. Weisz, J. R. (1989). Culture and the development of psychopathology: Lessons from Thailand. In D. Cicchetti (Ed.), The emergence of a discipline: Rochester symposium on developmental psychopathology (Vol. 1, pp. 89-117). Hillsdale, NJ: Erlbaum.Google Scholar
  36. Williams, J. E., Best, D. L., Tilquin, C., Keller, H., Voss, H., Bjerke, T., et al. (1981). Traits associated with men and women: Attributions by young children in France, Germany, Norway, the Netherlands, and Italy. Journal of Cross-Cultural Psychology, 12, 327-346.Google Scholar
  37. Zucker, K. J. (1990). Psychosocial and erotic development in cross-gender identified children. Canadian Journal of Psychiatry, 35, 487-495.Google Scholar
  38. Zucker, K. J. (2000). Gender identity disorder. In A. J. Sameroff, M. Lewis, & S. M. Miller (Eds.), Handbook of developmental psychopathology (2nd ed.), pp. 671-686). New York: Kluwer Academic/Plenum.Google Scholar
  39. Zucker, K. J., & Bradley, S. J. (1995). Gender identity disorder and psychosexual problems in children and adolescents. New York: Guilford Press.Google Scholar
  40. Zucker, K. J., Bradley, S. J., & Sanikhani, M. (1997). Sex differences in referral rates of children with gender identity disorder: Some hypotheses. Journal of Abnormal Child Psychology, 25, 217-227.PubMedGoogle Scholar
  41. Zucker, K. J., Finegan, J. K., Doering, R. W., & Bradley, S. J. (1984). Two subgroups of gender-problem children. Archives of Sexual Behavior, 13, 27-39.PubMedGoogle Scholar
  42. Zucker, K. J., Green, R., Bradley, S. J., Williams, K., Rebach, H. M., & Hood, J. E. (1998). Gender identity disorder of childhood: Diagnostic issues. In T. A. Widiger, A. J. Frances, H. A. Pincus, R. Ross, M. B. First, W. Davis, et al. (Eds.), DSM-IV sourcebook (Vol. 4, pp. 503-512). Washington, DC: American Psychiatric Association.Google Scholar
  43. Zucker, K. J., Owen, A., Bradley, S. J., & Ameeriar, L. (2002). Gender-dysphoric children and adolescents: A comparative analysis of demographic characteristics and behavioral problems. Clinical Child Psychology and Psychiatry, 7, 398-411.Google Scholar

Copyright information

© Plenum Publishing Corporation 2003

Authors and Affiliations

  • Peggy T. Cohen-Kettenis
    • 1
  • Allison Owen
    • 2
  • Vanessa G. Kaijser
    • 1
  • Susan J. Bradley
    • 2
  • Kenneth J. Zucker
    • 2
  1. 1.Gender Clinic, Department of Child and Adolescent PsychiatryUniversity Medical CenterUtrechtThe Netherlands
  2. 2.Child Psychiatry Program, Centre for Addiction and Mental Health – Clarke DivisionChild and Adolescent Gender Identity ClinicTorontoCanada

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