Summary

In 2018 the American Academy of Pediatrics (AAP), the main US children's doctors' group, issued a policy backing a "gender-affirming" approach for children and teens. It rejected both conversion therapy and "watchful waiting", meaning supporting a child without pushing either way. James Cantor, a psychologist, read the papers the AAP cited and argued they did not back it. Papers cited about conversion therapy were about sexual orientation, and papers cited to criticise watchful waiting actually recommended it. He also said the AAP left out the follow-up studies of children with gender distress, all of which found most stopped wanting to transition by puberty. The piece became influential. In 2023 the AAP kept its policy but ordered a formal review of the evidence. This is one author checking citations, not new data, and the childhood studies it relies on are themselves disputed.

Key findings

• Der Beitrag prüft die Quellen, die in der Grundsatzerklärung der American Academy of Pediatrics von 2018 zur Versorgung transgender und geschlechtlich diverser Kinder und Jugendlicher zitiert werden (Rafferty et al.).
• Cantor argumentiert, die AAP habe das „achtsame Abwarten“ abgelehnt, den Ansatz, den damals fast alle Kliniken und Fachverbände nutzten, und die Bestätigung als einzig akzeptablen Ansatz unterstützt.
• Er berichtet, dass Arbeiten, die die AAP gegen „Konversions“- oder „reparative“ Therapie anführte, von der sexuellen Orientierung handelten, nicht von der Geschlechtsidentität bei Kindern.
• Er berichtet, dass mehrere Arbeiten, die die AAP zur Kritik am achtsamen Abwarten anführte, es tatsächlich unterstützten.
• Er weist darauf hin, dass die AAP von 11 Nachfolgestudien zu Kindern mit Geschlechtsleidensdruck, die alle fanden, dass die meisten bis zur Pubertät nicht mehr transitionieren wollten, nur eine zitierte (Wallien & Cohen-Kettenis 2008) und nicht erwähnte, was sie fand.
• Im August 2023 bekräftigte die AAP ihre Erklärung von 2018 und ordnete zugleich eine formale Evidenzübersicht an, die eine Aktualisierung leiten soll.

Abstract

The American Academy of Pediatrics (AAP) recently published a policy statement: Ensuring comprehensive care and support for transgender and gender-diverse children and adolescents. Although almost all clinics and professional associations in the world use what's called the watchful waiting approach to helping gender diverse (GD) children, the AAP statement instead rejected that consensus, endorsing gender affirmation as the only acceptable approach. Remarkably, not only did the AAP statement fail to include any of the actual outcomes literature on such cases, but it also misrepresented the contents of its citations, which repeatedly said the very opposite of what AAP attributed to them.

Conclusion

Cantor concludes that the AAP policy statement is not based on the evidence it claims: it omitted the outcomes literature on gender-dysphoric children (every follow-up study finding that most desisted by puberty) and misrepresented its citations, which repeatedly supported watchful waiting rather than the affirmation-only approach the AAP endorsed. The AAP is free to adopt any policy it wishes, he argues, but any assertion that its policy is evidence-based is demonstrably false.