⌚ Gender In Children Literature

Wednesday, July 21, 2021 7:59:07 AM

Gender In Children Literature

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Equality-Time: The Hidden Messages in Children's Stories - Tal Breier Ben Moha - TEDxJaffaWomen

Susan James and Bei Bei Liu offer some critical insights into the evolution of the project, and interrogate some key practices that enabled collaborative thinking and theorising and the co-construction of inquiry based curriculum. Vickie Ren provides insights into what a speech pathologist does and explores how language develops in young children. This episode is an invitation to share a story of an unexpected, co-created project and investigation.

Why are routines and rituals important in our early childhood programs? We are joined by Associate Professor Kylie Smith to explore the topic of gender and play. Kylie shares insight into how young children develop their understanding of gender and the important role early educators have in noticing and challenging gender stereotypes and bias. Hear her talk about why children have the right to an early childhood education that is rich in the joy of art. Amal Nsar and Caitlin Burns from The Joey Club Sydney will reflect upon the Thinking Lens as a protocol for writing and as a generative tool for rich and robust professional conversations.

Ann Pelo illuminates the world of the toddler in the story she shares of time spent with Sam at The Joey Club Sydney, capturing incidental moments that tell rich stories of identity, community connection, thinking and learning. Fran Bastion and Kelly Slip, Director of KU Isobel Pulsford Preschool, consider together the thinking lens as a protocol or discipline that enriches the opportunity for educators to write with care and reverence the stories that matter.

Five of the indicators A2-A6 are readily observable behaviors and preferences such as a strong preference or strong resistance to wearing certain kinds of clothing; a strong preference or strong rejection of specific toys, games and activities; and a strong preference for playmates of the other gender [ 57 ]. The eight indicators were simplified for language and parents were asked to note which, if any, their child had exhibited prior to puberty. The requirement of six-month duration of symptoms was not included. The DSM-5 criteria for gender dysphoria in adolescents and adults consist of six indicators of gender dysphoria [ 57 ].

To meet criteria for diagnosis, an adolescent or adult must manifest at least two of the six indicators. The six indicators were simplified for language, the first indicator was adjusted for a parent to answer about their child, and parents were asked to note which, if any, their child was expressing currently. Survey questions were developed to specifically quantify adolescent behaviors that had been described by parents in online discussions and observed elsewhere.

Statistical analyses of quantitative data were performed using Excel and custom shell scripts Unix. Qualitative data were obtained from open text answers to questions that allowed participants to provide additional information or comments. The types of comments and descriptions were categorized, tallied, and reported numerically. Illustrative respondent quotes and summaries from the qualitative data are used to illustrate the quantitative results and to provide relevant examples.

Two questions were targeted for full qualitative analysis of themes one question on friend group behaviors and one on clinician interactions. For these questions, a second reviewer with expertise in qualitative methods was engaged MM. Both the author LL and reviewer MM independently analyzed the content of the open text answers and identified major themes. Discrepancies were resolved with collaborative discussion and themes were explored and refined until agreement was reached for the final lists of themes. Representative quotes for each theme were selected by LL, reviewed by MM, and agreement was reached. Along with the sudden or rapid onset of gender dysphoria, the AYAs belonged to a friend group where one or multiple friends became gender dysphoric and came out as transgender during a similar time as they did Nearly half Sexual orientation as expressed by the AYA prior to transgender-identification is listed separately for natal females and for natal males Table 2.

It is important to note that none of the AYAs described in this study would have met diagnostic criteria for gender dysphoria in childhood Table 3. In fact, the vast majority Breaking down these results, for readily observable indicators A , Parents responded to the question about which, if any, of the indicators of the DSM criteria for adolescent and adult gender dysphoria their child was experiencing currently. The average number of positive current indicators was 3. Thus, while the focal AYAs did not experience childhood gender dysphoria, the majority of those who were the focus of this study were indeed gender dysphoric at the time of the survey completion.

The AYAs who were the focus of this study had many comorbidities and vulnerabilities predating the onset of their gender dysphoria, including psychiatric disorders, neurodevelopmental disabilities, trauma, non-suicidal self-injury NSSI , and difficulties coping with strong or negative emotions Table 4. The majority Almost half Coping styles for these AYAs included having a poor or extremely poor ability to handle negative emotions productively The majority of respondents The average age of announcement of a transgender-identification was Most of the parents Almost a third of respondents The following quotes capture these top two observations.

The following case summaries were selected to illustrate peer, trauma, and psychiatric contexts that might indicate more complicated clinical pictures. More than a third Two thirds Almost a third More than half of the AYAs While At least two parents relayed that their child discontinued psychiatric care and medications for pre-existing mental health conditions once they identified as transgender. The adolescent and young adult children were, on average, Within friendship groups, the average number of individuals who became transgender-identified was 3.

Parents described intense group dynamics where friend groups praised and supported people who were transgender-identified and ridiculed and maligned non-transgender people. Where popularity status and activities were known, Of the 39 descriptions of responses, 19 of these responses referred to positive benefits the child received after coming out including positive attention, compliments, increased status, increased popularity, increased numbers of online followers, and improved protection from ongoing bullying.

The following are quotes from parents about the perceived benefits of transgender-identification afforded to their child. Being trans is a gold star in the eyes of other teens. Those same friends have dwindled to nothing as he rarely speaks to any of them now. Several AYAs expressed significant concern about the potential repercussions from their friend group when they concluded that they were not transgender after all. There were two unrelated cases with similar trajectories where the AYAs spent some significant time in a different setting, away from their usual friend group, without access to the internet.

Parents described that these AYAs made new friendships, became romantically involved with another person, and during their time away concluded that they were not transgender. In both cases, the adolescents, rather than face their school friends, asked to move and transfer to different high schools. One respondent described that their child expressed relief that medical transition was never started and felt there would have been pressure to move forward had the family not moved away from the peer group. Seven major themes were identified from the comments provided by participants and are described, with representative supporting quotes. Statement of opinions by the evil cis-gendered population are consider phobic and discriminatory and are generally discounted as unenlightened.

The following quotes describe individuals targeted. Parents observed the behaviors both in-person and in online settings, and specifically mentioned seeing posts and conversations on Tumblr, Twitter, Facebook, and Instagram. Participants gave many examples of the observed behaviors that were mocking towards non-transgender people and non-LGB people. Her friends egg her on when she does this. Participants described that their children and friend group seemed to focus on feeling as though they were victims. In the time period just before announcing that they were transgender, AYAs had received online advice including how to tell if they were transgender Two respondents, in answers to other questions, described that their children later told them what they learned from online discussion lists and sites.

Places where teens and other trans people swap info. Like to use [certain, specific] words [with] the therapist when describing your GD, because [they are] code for potentially suicidal and will get you a diagnosis and Rx for hormones. What do you say to that? She learned things to say that would push our buttons and get what she wanted and she has told us now that she learned that from trans discussion sites. Parents identified the sources they thought were most influential for their child becoming gender dysphoric.

The most frequently answered influences were: YouTube transition videos The following quotes illustrate the dominant quantitative findings. Additionally, parents noted worsening of the parent-child relationship and observed that their children had narrowed their interests Table 8. Although small numbers of AYAs had improvement in mental well-being She became more withdrawn. She stopped participating in activities which she previously enjoyed, stopped participating in family activities, and significantly decreased her interaction with friends.

Her symptoms became so severe that she was placed on medication by her physician. A total of There were eight cases of estrangement. Estrangement was child-initiated in six cases where the child ran away, moved out, or otherwise refused contact with parent. AYAs are reported to have exhibited one or more of the following behaviors: expressed distrust of information about gender dysphoria and transgenderism coming from mainstream doctors and psychologists Many AYAs have also: withdrawn from their family There was a subset of eight cases where parents described watching their child have declining mental well-being as they became gender dysphoric and transgender-identified and then had improving mental well-being as they dropped or backed away from a transgender-identification.

One parent described a marked change in her daughter when she was out of school temporarily. She spent all day on the internet, and lost her many school friends—her only friends were on-line and members of the trans community. In three months, my daughter announced she is trans, gender dysphoric, wants binders and top surgery, testosterone shots…she started self-harming. My daughter actually seemed to be looking for a reason for her depression which is now being successfully treated…My daughter is MUCH happier now that she is being treated for her genuine issues.

Coming out as trans made her much worse for a while. The declines were substantial as In most of these cases Of the 23 individuals who had a psychiatric diagnosis made within two years of assuming a transgender-identification, Parents were asked if their child had seen a gender therapist, gone to a gender clinic, or seen a physician for the purpose of beginning transition and 92 respondents Many of the respondents clarified that their child had seen a clinician regarding their gender dysphoria for evaluation only. Although participants were not asked directly what kind of provider their child saw, specialties that were mentioned in answers included: general psychologists, pediatricians, family doctors, social workers, gender therapists, and endocrinologists.

Despite all of the AYAs in this study sample having an atypical presentation of gender dysphoria no gender dysphoria prior to puberty , Three of the content examples would have been challenging to verify as false including: how one was feeling as a child, how one was feeling when a picture was taken, and whether one was from an abusive home. It is unclear whether this process was deliberate or if the individuals were unaware of their actions. The following are quotes describing this phenomenon. This is not the same childhood we have seen as parents.

The open-ended comments from the question about whether the clinician explored mental health, trauma or alternative causes of gender dysphoria before proceeding were selected for qualitative analysis. Nine major themes emerged from the data. Each theme is described in the following paragraphs with supporting quotes from participants. This failure to explore mental health and trauma occurred even when patients had a history of mental health disorder or trauma, were currently being treated for a mental health disorder, or were currently experiencing symptoms. Another theme was insufficient evaluation where parents described evaluations that were too limited or too superficial to explore mental health, trauma or alternative causes of gender dysphoria.

The following are three quotes by three different parents describing insufficient evaluations. She said the half hour diagnosis in her office with him was sufficient, as she considers herself an expert in the field. To question this will only hurt her and prolong her suffering. Parents described that clinicians did not seem interested or willing to explore alternative causes.

One parent described. If our daughter wanted to be male, then that was enough. A few parents had the experience where the clinician either made an appropriate referral for further evaluation or the issues had been addressed previously. Several participants described clinicians who were unwilling to communicate with primary care physicians and mental health professionals even those professionals who were currently treating the patient. She parroted people from the internet. Easiest thing I ever did. Some parents described clinicians who seemed to push the process of transition before the patient asked for it.

Nor did she ask him for this Rx. Parents describe that the clinicians did not take their concerns seriously. I know that in the few contacts I had with the providers, my concerns were discounted. We are left out of everything because of our constant questioning of this being right for our daughter [because of her] trauma and current depression, anxiety and self-esteem problems. Parents expressed doubts about the clinicians regarding their experience, competence or professionalism. I asked the risk manager at [redacted] if they'd considered a personality disorder. The steps taken towards transition during this timeframe are listed in Table At the end of the timeframe, Descriptions of backing away or moving from transgender-identified to not transgender-identified include the following.

She gradually desisted as she developed more insight into who she is. See Table Although the differences in additional isolating and anti-social behaviors did not reach statistical significance, these behaviors trended towards higher rates in the AYAs who were exposed to social influence and may have not reached significant levels due to small numbers. This research describes parental reports about a sample of AYAs who would not have met diagnostic criteria for gender dysphoria during their childhood but developed signs of gender dysphoria during adolescence or young adulthood.

The strongest support for considering that the gender dysphoria was new in adolescence or young adulthood is the parental answers for DSM 5 criteria for childhood gender dysphoria. Not only would none of the sample have met threshold criteria, the vast majority had zero indicators. Although one might argue that three of the indicators could plausibly be missed by a parent A1, A7, and A8 if the child had not expressed these verbally , five of the indicators A are readily observable behaviors and preferences that would be difficult for a parent to miss.

Six indicators including A1 are required for a threshold diagnosis. The nonexistent and low numbers of readily observable indicators reported in the majority of this sample does not support a scenario in which gender dysphoria was always present but was only recently disclosed to the parents. Parents reported that before the onset of their gender dysphoria, many of the AYAs had been diagnosed with at least one mental health disorder or neurodevelopmental disability and many had experienced a traumatic or stressful event.

Experiencing a sex or gender related trauma was not uncommon, nor was experiencing a family stressor such as parental divorce, death of a parent, or a mental health disorder in a sibling or parent. Additionally, nearly half were described as having engaged in self-harm prior to the onset of their gender dysphoria. In other words, many of the AYAs and their families had been navigating multiple challenges and stressors before gender dysphoria and transgender-identification became part of their lives. This context could possibly contribute to friction between parent and child and these complex, overlapping difficulties as well as experiences of same-sex attraction may also be influential in the development of a transgender identification for some of these AYAs.

Care should be taken not to overstate or understate the context of pre-existing diagnoses or trauma in this population as they were absent in approximately one third and present in approximately two thirds of the sample. This research sample of AYAs also differs from the general population in that it is predominantly natal female, white, and has an over-representation of individuals who are academically gifted, non-heterosexual, and are offspring of parents with high educational attainment [ 59 — 61 ].

The sex ratio favoring natal females is consistent with recent changes in the population of individuals seeking care for gender dysphoria. Gender clinics have reported substantial increases in referrals for adolescents with a change in the sex ratio of patients moving from predominantly natal males seeking care for gender dysphoria to predominantly natal females [ 26 — 28 , 62 ]. Although increased visibility of transgender individuals in the media and availability of information online, with a partial reduction of stigma might explain some of the rise in the numbers of adolescents presenting for care [ 27 ], it would not directly explain why the inversion of the sex ratio has occurred for adolescents but not adults or why there is a new phenomenon of natal females experiencing late-onset and adolescent-onset gender dysphoria.

The unexpectedly high rate of academically gifted AYAs may be related to the high educational attainment of the parents and may be a reflection of parents who are online, able to complete online surveys and are able to question and challenge current narratives about gender dysphoria and transition. There may be other unknown variables that render academically gifted AYAs susceptible to adolescent-onset and late-onset gender dysphoria. The potential relationship of experienced homophobia and the development of a rapid onset of gender dysphoria during adolescence or young adulthood as perceived by parents deserves further study. This sample is distinctively different than what is described in previous research about gender dysphoria because of the distribution of cases occurring in friendship groups with multiple individuals identifying as transgender, the preponderance of adolescent natal females, the absence of childhood gender dysphoria, and the perceived suddenness of onset.

Further research is needed to verify these results. There have been anecdotal reports of adolescents who desisted approximately 9—36 months after showing signs of a rapid onset of gender dysphoria, but longitudinal research following AYAs with gender dysphoria would be necessary to study desistance trends. Although it is still unknown whether transition in gender dysphoric individuals decreases, increases, or fails to change the rates of attempted or completed suicides [ 64 ], this study documents AYAs using a suicide narrative as part of their arguments to parents and doctors towards receiving support and transition services. Despite the possibility that the AYAs are using a suicide narrative to manipulate others, it is critical that any suicide threat, ideation or concern is taken seriously and the individual should be evaluated immediately by a mental health professional.

The majority of parents were reasonably sure or certain that their child misrepresented or omitted key parts of their history to their therapists and physicians. For others, the misrepresentation may not be a conscious act. Respondent accounts of clinicians who ignored or disregarded information such as mental health symptoms and diagnoses, medical and trauma histories that did not support the conclusion that the patient was transgender, suggests the possibility of motivated reasoning and confirmatory biases on the part of clinicians. It is unlikely that friends and the internet can make people transgender. The spread of these beliefs could allow vulnerable AYAs to misinterpret their emotions, incorrectly believe themselves to be transgender and in need of transition, and then inappropriately reject all information that is contrary to these beliefs.

One of the most compelling findings supporting a potential role of social and peer contagion in the development or expression of a rapid onset of gender dysphoria is the clusters of transgender-identification occurring within friendship groups. The expected prevalence of transgender young adult individuals is 0. This suggests a localized increase to more than 70 times the expected prevalence rate. This is an observation that demands urgent further investigation. One might argue that high rates of transgender-identified individuals within friend groups may be secondary to the process of friend selection: choosing transgender-identified friends deliberately rather than the result of group dynamics and observed coping styles contributing to multiple individuals, in a similar timeframe, starting to interpret their feelings as consistent with being transgender.

More research will be needed to finely delineate the timing of friend group formation and the timing and pattern of each new declaration of transgender-identification. Although friend selection may play a role in these high percentages of transgender-identifying members in friend groups, the described pattern of multiple friends and often the majority of the friends in the friend group becoming transgender-identified in a similar timeframe suggests that there may be more than just friend selection behind these elevated percentages.

There are many insights from our understanding of peer contagion in eating disorders and anorexia that may apply to the potential role s of peer contagion in the development of gender dysphoria. The descriptions of pro-anorexia subculture group dynamics where the thinnest anorexics are admired while the anorexics who try to recover from anorexia are ridiculed and maligned as outsiders [ 39 — 41 ] resemble the group dynamics in friend groups that validate those who identify as transgender and mock those who do not. And the pro-eating-disorder websites and online communities providing inspiration for weight loss and sharing tricks to help individuals deceive parents and doctors [ 42 — 44 ] may be analogous to the inspirational YouTube transition videos and the shared online advice about manipulating parents and doctors to obtain hormones.

Additionally, per parent report, almost half of the AYAs withdrew from family, It is possible that some of these findings might be secondary to parent-child conflict. To further evaluate these possibilities, future studies should incorporate information about family dynamics, parent-child interactions, parent coping, child coping, and psychiatric trajectories. Future studies should explore these issues as well. Although most parents reported an absence of childhood indicators for gender dysphoria, it is possible that these indicators might have existed for some of the AYAs and that some parents either failed to notice or ignored these indicators when they occurred.

This study did not specifically explore parental approaches to gender dysphoria or parental views on medical or surgical interventions. For some individuals, the drive to transition may represent an ego-syntonic but maladaptive coping mechanism to avoid feeling strong or negative emotions similar to how the drive to extreme weight loss can serve as an ego-syntonic but maladaptive coping mechanism in anorexia nervosa [ 68 — 69 ].

A maladaptive coping mechanism is a response to a stressor that might relieve the symptoms temporarily but does not address the cause of the problem and may cause additional negative outcomes. Examples of maladaptive coping mechanisms include the use of alcohol, drugs, or self-harm to distract oneself from experiencing painful emotions. One reason that the treatment of anorexia nervosa is so challenging is that the drive for extreme weight loss and weight loss activities can become a maladaptive coping mechanism that allows the patient to avoid feeling and dealing with strong emotions [ 69 — 70 ]. In this context, dieting is not felt as distressing to the patient, because it is considered by the patient to be the solution to her problems, and not part of the problems.

In other words, the dieting and weight loss activities are ego-syntonic to the patient. However, distress is felt by the patient when external actors doctors, parents, hospital staff try to interfere with her weight loss activities thus curtailing her maladaptive coping mechanism. The high frequency of parents reporting AYA expectations that transition would solve their problems coupled with the sizable minority who reported AYA unwillingness to work on basic mental health issues before seeking treatment support the concept that the drive to transition might be used to avoid dealing with mental health issues and aversive emotions.

Additional support for this hypothesis is that the sample of AYAs described in this study are predominantly female, were described by parents as beginning to express symptoms during adolescence and contained an overrepresentation of academically gifted students which bears a strong resemblance to populations of individuals diagnosed with anorexia nervosa [ 71 — 75 ]. The risk factors, mechanisms and meanings of anorexia nervosa [ 69 — 70 , 76 ] may ultimately prove to be a valuable template to understand the risk factors, mechanisms, and meanings for some cases of gender dysphoria.

Although trauma and psychiatric disorders are not specific for the development of gender dysphoria, these experiences may leave a person in psychological pain and in search of a coping mechanism. Because maladaptive coping mechanisms do not address the root cause of distress and may cause their own negative consequences, an outcome commonly reported for this sample, AYAs experiencing a decline in their mental well-being after transgender-identification, is consistent with this hypothesis. There was a subset of AYAs for whom parents reported improvement in their mental well-being as they desisted from their transgender-identification which would not be inconsistent with moving from a maladaptive coping mechanism to an adaptive coping mechanism.

In addition to these indirect harms, there is also the possibility that this type of gender dysphoria, with the subsequent drive to transition, may represent a form of intentional self-harm. Promoting the affirmation of a declared gender and recommending transition social, medical, surgical without evaluation may add to the harm for these individuals as it can reinforce the maladaptive coping mechanism, prolong the length of time before the AYA accepts treatment for trauma or mental health issues, and interfere with the development of healthy, adaptive coping mechanisms. It is especially critical to differentiate individuals who would benefit from transition from those who would be harmed by transition before proceeding with treatment.

Clinicians need to be aware of the myriad of barriers that may stand in the way of making accurate diagnoses when an AYA presents with a desire to transition including: the developmental stage of adolescence; the presence of subcultures coaching AYAs to mislead their doctors; and the exclusion of parents from the evaluation. In this study, An AYA telling their clinician that their parents are transphobic and abusive may indeed mean that the parents are transphobic and abusive.

The findings of this study suggest that clinicians need to be cautious before relying solely on self-report when AYAs seek social, medical or surgical transition. Adolescents and young adults are not trained medical professionals. When AYAs diagnose their own symptoms based on what they read on the internet and hear from their friends, it is quite possible for them to reach incorrect conclusions. It is the duty of the clinician, when seeing a new AYA patient seeking transition, to perform their own evaluation and differential diagnosis to determine if the patient is correct or incorrect in their self-assessment of their symptoms and their conviction that they would benefit from transition.

This is not to say that the convictions of the patient should be dismissed or ignored, some may ultimately benefit from transition. However, careful clinical exploration should not be neglected, either. The findings that the majority of clinicians described in this study did not explore trauma or mental health disorders as possible causes of gender dysphoria or request medical records in patients with atypical presentations of gender dysphoria is alarming. It is possible that some teens and young adults may have requested that their discussions with the clinicians addressing gender issues be kept confidential from their parents, as is their right except for information that would put themselves or others at harm.

However, maintaining confidentiality of the patient does not prevent the clinician from listening to the medical and social history of the patient provided by the parent. Because adolescents may not be reliable historians and may have limited awareness and insight about their own emotions and behaviors, the inclusion of information from multiple informants is often recommended when working with or evaluating minors.

One would expect that if a patient refuses the inclusion of information from parents and physicians prior and current , that the clinician would explore this with the patient and encourage them to reconsider. At the very least, if a patient asks that all information from parents and medical sources be disregarded, it should raise the suspicion that what the patient is presenting may be less than forthcoming and the clinician should proceed with caution. The argument to surface from this study is not that the insider perspectives of AYAs presenting with signs of a rapid onset of gender dysphoria should be set aside by clinicians, but that the insights of parents are a pre-requisite for robust triangulation of evidence and fully informed diagnosis.

All parents know their growing children are not always right, particularly in the almost universally tumultuous period of adolescence. Most parents have the awareness and humility to know that even as adults they are not always right themselves. The strengths of this study include that it is the first empirical description of a specific phenomenon that has been observed by parents and clinicians [ 14 ] and that it explores parent observations of the psychosocial context of youth who have recently identified as transgender with a focus on vulnerabilities, co-morbidities, peer group interactions, and social media use.

Additionally, the qualitative analysis of responses about peer group dynamics provides a rich illustration of AYA intra-group and inter-group behaviors as observed and reported by parents. This research also provides a glimpse into parent perceptions of clinician interactions in the evaluation and treatment of AYAs with an adolescent-onset or young adult-onset of gender dysphoria symptoms. The limitations of this study include that it is a descriptive study and thus has the known limitations inherent in all descriptive studies. This is not a prevalence study and does not attempt to evaluate the prevalence of gender dysphoria in adolescents and young adults who had not exhibited childhood symptoms.

Gathering more data on the topics introduced is a key recommendation for further study. It is not uncommon for first, descriptive studies, especially when studying a population or phenomenon where the prevalence is unknown, to use targeted recruiting. To maximize the possibility of finding cases meeting eligibility criteria, recruitment is directed towards communities that are likely to have eligible participants. For example, in the first descriptive study about children who had been socially transitioned, the authors recruited potential subjects from gender expansive camps and gender conferences where parents who supported social transition for young children might be present and the authors did not seek out communities where parents might be less inclined to find social transition for young children appropriate [ 77 ].

In the same way, for the current study, recruitment was targeted primarily to sites where parents had described the phenomenon of a rapid onset of gender dysphoria because those might be communities where such cases could be found. The generalizability of the study must be carefully delineated based on the recruitment methods, and, like all first descriptive studies, additional studies will be needed to replicate the findings.

Three of the sites that posted recruitment information expressed cautious or negative views about medical and surgical interventions for gender dysphoric adolescents and young adults and cautious or negative views about categorizing gender dysphoric youth as transgender. One of the sites that posted recruitment information is perceived to be pro-gender-affirming. Hence, the populations viewing these websites might hold different views or beliefs from each other. And both populations may differ from a broader general population in their attitudes about transgender-identified individuals. Future studies should explore all these issues. This study cannot speak to those details about the participants. All self-reported results have the potential limitation of social desirability bias.

However, comparing this self-report sample to the national self-report sample [ 78 ], the results show similar rates of support. Therefore, there is no evidence that the study sample is appreciably different in their support of the rights of transgender people than the general American population. It is also important to note that recruitment was not limited to the websites where the information about the study was first posted.

Snowball sampling was also used so that any person viewing the recruitment information was encouraged to share the information with any person or community where they thought there could be potentially eligible participants, thus substantially widening the reach of potential respondents. In follow up studies on this topic, an even wider variety of recruitment sources should be attempted. Another limitation of this study is that it included only parental perspective. Ideally, data would be obtained from both the parent and the child and the absence of either perspective paints an incomplete account of events. Input from the youth would have yielded additional information.

Further research that includes data collection from both parent and child is required to fully understand this condition. However, because this research has been produced in a climate where the input from parents is often neglected in the evaluation and treatment of gender dysphoric AYAs, this research supplies a valuable, previously missing piece to the jigsaw puzzle.

If Hypothesis 3 is correct that for some AYAs gender dysphoria represents an ego-syntonic maladaptive coping mechanism, data from parents are especially important because affected AYAs may be so committed to the maladaptive coping mechanism that their ability to assess their own situation may be impaired. There are, however, obvious limitations to relying solely on parent report.

Readers should hold this possibility in mind. Overall, the plus responses appear to have been prepared carefully and were rich in detail, suggesting they were written in good faith and that parents were attentive observers of their children's lives. Although this research adds the necessary component of parent observation to our understanding of gender dysphoric adolescents and young adults, future study in this area should include both parent and child input.

This research does not imply that no AYAs who become transgender-identified during their adolescent or young adult years had earlier symptoms nor does it imply that no AYAs would ultimately benefit from transition. Rather, the findings suggest that not all AYAs presenting at these vulnerable ages are correct in their self-assessment of the cause of their symptoms and some AYAs may be employing a drive to transition as a maladaptive coping mechanism.

Clinicians should carefully explore these options and try to clarify areas of disagreement with confirmation from outside sources such as medical records, psychiatrists, psychologists, primary care physicians, and other third party informants where possible. Further study of maladaptive coping mechanisms, psychiatric conditions and family dynamics in the context of gender dysphoria and mental health would be an especially valuable contribution to better understand how to treat youth with gender dysphoria. Adolescent-onset gender dysphoria is sufficiently different from early-onset of gender dysphoria that persists or worsens at puberty and therefore, the research results from early-onset gender dysphoria should not be considered generalizable to adolescent-onset gender dysphoria.

It is currently unknown whether the gender dysphorias of adolescent-onset gender dysphoria and of late-onset gender dysphoria occurring in young adults are transient, temporary or likely to be long-term. Without the knowledge of whether the gender dysphoria is likely to be temporary, extreme caution should be applied before considering the use of treatments that have permanent effects such as cross-sex hormones and surgery. Research needs to be done to determine if affirming a newly declared gender identity, social transition, puberty suppression and cross-sex hormones can cause an iatrogenic persistence of gender dysphoria in individuals who would have had their gender dysphoria resolve on its own and whether these interventions prolong the duration of time that an individual feels gender dysphoric before desisting.

There is also a need to discover how to diagnose these conditions, how to treat the AYAs affected, and how best to support AYAs and their families. Additionally, analyses of online content for pro-transition sites and social media should be conducted in the same way that content analysis has been performed for pro-eating disorder websites and social media content [ 44 ]. Finally, further exploration is needed for potential contributors to recent demographic changes including the substantial increase in the number of adolescent natal females with gender dysphoria and the new phenomenon of natal females experiencing late-onset or adolescent-onset gender dysphoria.

Collecting data from parents in this descriptive exploratory study has provided valuable, detailed information that allows for the generation of hypotheses about potential factors contributing to the onset and expression of gender dysphoria among AYAs. Emerging hypotheses include the possibility of a potential new subcategory of gender dysphoria referred to as rapid-onset gender dysphoria that has not yet been clinically validated and the possibility of social influences and maladaptive coping mechanisms contributing to the development of gender dysphoria.

Parent-child conflict may also contribute to the course of the dysphoria. I would like to acknowledge Michael L. Littman, PhD, for his assistance in the statistical analysis of quantitative data, Michele Moore, PhD, for her assistance in qualitative data analysis and feedback on an earlier version of the manuscript, Lisa Marchiano, LCSW, for feedback on earlier versions of the manuscript, and four external peer-reviewers, three PLOS ONE staff editors and two Academic Editors for their attention to this research.

Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Correction 19 Mar Littman L Correction: Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria. Abstract Purpose In on-line forums, parents have reported that their children seemed to experience a sudden or rapid onset of gender dysphoria, appearing for the first time during puberty or even after its completion. Methods For this descriptive, exploratory study, recruitment information with a link to a question survey, consisting of multiple-choice, Likert-type and open-ended questions was placed on three websites where parents had reported sudden or rapid onsets of gender dysphoria occurring in their teen or young adult children.

Results There were parent-completed surveys that met study criteria. Funding: The author received no specific funding for this work. Background Gender dysphoria in adolescents Gender dysphoria GD is defined as an individual's persistent discomfort with their biological sex or assigned gender [ 11 ]. Demographic and clinical changes for gender dysphoria Although, by , there was research documenting that a significant number of natal males experienced gender dysphoria that began during or after puberty, there was little information about this type of presentation for natal females [ 5 ].

Download: PPT. Fig 1. Example quotes of online advice from Reddit and Tumblr. Purpose Rapid presentations of adolescent-onset gender dysphoria occurring in clusters of pre-existing friend groups are not consistent with current knowledge about gender dysphoria and have not been described in the scientific literature to date [ 1 — 8 ].

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