Parent Survey Proposes 'Rapid-Onset Gender Dysphoria' in Teen Peer Groups — A Hypothesis, Not a Validated Diagnosis

Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria

Surveys Mental health & suicide Rising diagnoses & social influence

Authors: Lisa Littman
Journal: PLOS ONE
Year: 2018
Source: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0202330

Summary

Lisa Littman surveyed 256 parents who believed their teenage or young adult child, mostly girls, suddenly developed gender distress around or after puberty. Parents described earlier mental health problems, friend groups where several friends came out as trans together, heavy social media use, and worsening mental health and family relationships. From this, Littman proposed the idea of 'rapid-onset gender dysphoria' (ROGD). Parents were found through three websites sceptical of youth transition, and the young people themselves were never asked. After a second review, the journal republished the paper in 2019 with new wording stressing that ROGD is not a proven diagnosis. Critics (such as Restar 2020) disputed the methods, and a 2022 study of Canadian clinics did not find the links the idea predicts. The paper is best read as an early, disputed idea.

Key findings

256 parents took part. The young people they described were mostly born female (82.8%), with an average age of 16.4, and had announced a transgender identity at about 15 on average.
According to parents, 62.5% had at least one mental health or developmental diagnosis before their gender distress began, and 41% had said they were not straight before that.
In 36.8% of the friend groups described, parents said most friends came out as transgender. 86.7% of parents reported more social media use, a trans-identifying friend group, or both.
After their child came out, parents reported worse mental health in the child (47.2%) and a worse parent-child relationship (57.3%). 49.4% said their child tried to cut themselves off from the family.
76.5% of parents believed their child was wrong to think they were transgender, so most parents who answered were doubtful of their child's identity.
The study puts forward, but does not test, the idea that some gender distress starting in the teen years is socially influenced or an unhealthy way of coping. It collected nothing from the young people or their clinicians.
In March 2019 the journal replaced the original with a corrected version (new title, and rewritten summary, introduction, discussion and conclusion) stressing that ROGD is not a formal diagnosis. The results section was basically unchanged.

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. Parents describe that the onset of gender dysphoria seemed to occur in the context of belonging to a peer group where one, multiple, or even all of the friends have become gender dysphoric and transgender-identified during the same timeframe. Parents also report that their children exhibited an increase in social media/internet use prior to disclosure of a transgender identity. Recently, clinicians have reported that post-puberty presentations of gender dysphoria in natal females that appear to be rapid in onset is a phenomenon that they are seeing more and more in their clinic. Academics have raised questions about the role of social media in the development of gender dysphoria. The purpose of this study was to collect data about parents’ observations, experiences, and perspectives about their adolescent and young adult (AYA) children showing signs of an apparent sudden or rapid onset of gender dysphoria that began during or after puberty, and develop hypotheses about factors that may contribute to the onset and/or expression of gender dysphoria among this demographic group.

Methods: For this descriptive, exploratory study, recruitment information with a link to a 90-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. The study’s eligibility criteria included parental response that their child had a sudden or rapid onset of gender dysphoria and parental indication that their child’s gender dysphoria began during or after puberty. To maximize the chances of finding cases meeting eligibility criteria, the three websites (4thwavenow, transgender trend, and youthtranscriticalprofessionals) were selected for targeted recruitment. Website moderators and potential participants were encouraged to share the recruitment information and link to the survey with any individuals or communities that they thought might include eligible participants to expand the reach of the project through snowball sampling techniques. Data were collected anonymously via SurveyMonkey. Quantitative findings are presented as frequencies, percentages, ranges, means and/or medians. Open-ended responses from two questions were targeted for qualitative analysis of themes.

Results: There were 256 parent-completed surveys that met study criteria. The AYA children described were predominantly natal female (82.8%) with a mean age of 16.4 years at the time of survey completion and a mean age of 15.2 when they announced a transgender-identification. Per parent report, 41% of the AYAs had expressed a non-heterosexual sexual orientation before identifying as transgender. Many (62.5%) of the AYAs had reportedly been diagnosed with at least one mental health disorder or neurodevelopmental disability prior to the onset of their gender dysphoria (range of the number of pre-existing diagnoses 0–7). In 36.8% of the friendship groups described, parent participants indicated that the majority of the members became transgender-identified. Parents reported subjective declines in their AYAs’ mental health (47.2%) and in parent-child relationships (57.3%) since the AYA “came out” and that AYAs expressed a range of behaviors that included: expressing distrust of non-transgender people (22.7%); stopping spending time with non-transgender friends (25.0%); trying to isolate themselves from their families (49.4%), and only trusting information about gender dysphoria from transgender sources (46.6%). Most (86.7%) of the parents reported that, along with the sudden or rapid onset of gender dysphoria, their child either had an increase in their social media/internet use, belonged to a friend group in which one or multiple friends became transgender-identified during a similar timeframe, or both.

Conclusion: This descriptive, exploratory study of parent reports provides valuable detailed information that allows for the generation of hypotheses about factors that may contribute to the onset and/or 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. Parent-child conflict may also explain some of the findings. More research that includes data collection from AYAs, parents, clinicians and third party informants is needed to further explore the roles of social influence, maladaptive coping mechanisms, parental approaches, and family dynamics in the development and duration of gender dysphoria in adolescents and young adults.

Conclusion

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. More research that includes data collection from AYAs, parents, clinicians and third party informants is needed to further explore the roles of social influence, maladaptive coping mechanisms, parental approaches, and family dynamics in the development and duration of gender dysphoria in adolescents and young adults.

Methodological limitations

Parents found through sceptical websites: Survey notices were posted on 4thwavenow, Transgender Trend and Youth Trans Critical Professionals, which the paper itself describes as cautious about or critical of youth transition, then passed on by word of mouth. Parents who share those views are almost certainly over-represented.
Only parents were asked: No teenagers, young adults or clinicians took part, so when the distress started, how the child felt, their mental health and their online life are all parents' impressions. The 2019 correction notes some answers 'might reflect parent perspectives', and critics (Brandelli Costa's formal comment in the journal, 2019, and Restar 2020) point to evidence that parents and children often report things differently.
Most parents disagreed with their child: 76.5% believed their child was wrong to think they were transgender. That raises the risk that parents read events through their own views. For example, they may not have known about earlier distress, or may have seen their child's behaviour as peer influence.
The group was picked for the pattern it describes: To take part, parents had to say the distress started suddenly. The term 'rapid onset gender dysphoria' first appeared on the recruiting sites in the study's own notice, so the sample was chosen for the very pattern it reports.
No comparison group, description only: Without parents of other young people with gender distress, or of young people without it, we can't tell whether earlier diagnoses, social media use or friend groups coming out together are unusual. The correction states no claims about cause can be made.
Home-made questionnaire: The author wrote the 90-question survey herself, with no tested measures of gender distress, mental health or social media use. Critics (Restar 2020) also said some questions were worded in a leading way.
Answers couldn't be checked: Answers were collected anonymously online, with no check of who people were or of the diagnoses reported. Beyond the author's own data cleaning, there was no way to rule out repeat or off-topic answers.
Very similar respondents: 91.7% were mothers, 91.4% White and 71.7% in the US, which limits how far the results apply to others.
Corrected after publication: After a second look by the journal's editors, two academic editors, a statistics reviewer and an outside expert, the paper was republished in March 2019 with a new title and rewritten summary, introduction, discussion, conclusion and conflicts statement. The original claim that ROGD 'appears to represent an entity that is distinct' was replaced with wording stressing it 'has not yet been clinically validated'. The results were basically unchanged.
Published criticism and reply: Restar (Archives of Sexual Behavior, 2020) argued the sampling, survey design and missing youth voices make the findings unreliable. Ashley (Sociological Review, 2020) criticised the idea itself. Littman replied (2020) that her methods match other first descriptive studies in the field, and Hutchinson, Midgen and Spiliadis (2020) argued the idea deserves research.
Later evidence against it: Bauer, Lawson and Metzger (Journal of Pediatrics, 2022) tested links the idea predicts in clinic records of 173 teenagers at 10 Canadian clinics and found no support. Littman (2022) replied that their measure didn't really capture sudden onset, so the question is still disputed.
Not a recognised diagnosis: ROGD is not in the main psychiatric diagnosis manuals (DSM-5-TR and ICD-11). Some professional bodies, such as WPATH in a 2018 statement, have objected to its use, which limits how the term should be applied to individual young people.

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Summary

Key findings

Abstract

Conclusion