63 % des enfants dysphoriques ont désisté à l'adolescence ; intensité et transition sociale prédisaient la persistance

Facteurs associés à l'abandon et à la persistance de la dysphorie de genre chez l'enfant : une étude de suivi quantitative

Études de cohorte & registres Désistance chez l'enfant Santé mentale & suicide

Authors: Thomas D. Steensma, Jenifer K. McGuire, Baudewijntje P.C. Kreukels, Anneke J. Beekman, Peggy T. Cohen-Kettenis
Journal: Journal of the American Academy of Child and Adolescent Psychiatry
Year: 2013
Source: https://pubmed.ncbi.nlm.nih.gov/23702447/

Summary

Dutch clinicians followed 127 children referred to their gender clinic before age 12 and checked who still had gender dysphoria (distress about a body/gender mismatch) in their mid-teens. 37% still had it and sought medical transition. The other 63% did not come back and were counted as desisters (no longer dysphoric); those who answered questionnaires reported little or no distress. Girls persisted more often than boys (50% vs 29%). Children with more intense distress, who said they were (not wished to be) the other sex, who were older when referred, or who had socially transitioned (new name, clothes or pronouns) were more likely to persist. Anxiety, behaviour and friendships did not predict this. An important study, but desistance was assumed for non-returners, all came from one clinic, and the older diagnosis included milder cases.

Key findings

Sur 127 enfants adressés avant 12 ans, 47 (37 %) avaient encore une dysphorie de genre à l'adolescence et 80 (63 %) ont été considérés comme l'ayant dépassée.
Les filles ont persisté plus souvent que les garçons : 24 filles sur 48 (50 %) contre 23 garçons sur 79 (29 %).
L'intensité de la détresse dans l'enfance comptait le plus : 91 à 96 % de ceux qui ont persisté répondaient au diagnostic complet de l'enfance, contre 39 à 58 % de ceux qui n'ont pas persisté.
Les enfants qui disaient être de l'autre sexe persistaient plus souvent que ceux qui disaient souhaiter l'être, ce que les auteurs décrivent comme « être » contre « souhaiter être ».
La transition sociale dans l'enfance était liée à la persistance, avec environ 5 fois plus de probabilités au total et environ 22 fois chez les garçons. Mais les garçons qui avaient fait une transition avaient aussi une détresse plus intense, si bien que l'effet de la transition elle-même n'a pas pu être isolé.
La santé mentale générale et les amitiés des enfants, évaluées par les parents et les enseignants, ne permettaient pas de prédire qui persisterait.
Presque tous ceux qui ont persisté étaient attirés par leur propre sexe de naissance, tandis que la plupart des filles et environ un tiers des garçons qui n'ont pas persisté étaient attirés par le sexe opposé.

Abstract

To examine the factors associated with the persistence of childhood gender dysphoria (GD), and to assess the feelings of GD, body image, and sexual orientation in adolescence. The sample consisted of 127 adolescents (79 boys, 48 girls), who were referred for GD in childhood (<12 years of age) and followed up in adolescence. We examined childhood differences among persisters and desisters in demographics, psychological functioning, quality of peer relations and childhood GD, and adolescent reports of GD, body image, and sexual orientation. We examined contributions of childhood factors on the probability of persistence of GD into adolescence. We found a link between the intensity of GD in childhood and persistence of GD, as well as a higher probability of persistence among natal girls. Psychological functioning and the quality of peer relations did not predict the persistence of childhood GD. Formerly nonsignificant (age at childhood assessment) and unstudied factors (a cognitive and/or affective cross-gender identification and a social role transition) were associated with the persistence of childhood GD, and varied among natal boys and girls.

Conclusion

Intensity of early GD appears to be an important predictor of persistence of GD. Clinical recommendations for the support of children with GD may need to be developed independently for natal boys and for girls, as the presentation of boys and girls with GD is different, and different factors are predictive for the persistence of GD.

Methodological limitations

Growing out of it mostly assumed: The 80 teens who did not return were assumed to have desisted because Amsterdam was the only Dutch teen gender service. 28 of them (35%) never replied, including 12 who could not be found, so some may still have had gender dysphoria or sought care elsewhere or later.
Persisting measured by seeking treatment: Persisters were those who came back, were diagnosed again and judged suitable for puberty blockers. So the result mixes up gender identity with wanting and being able to get medical treatment.
Broad childhood diagnosis: Many who desisted did not fully meet the older diagnosis of the time (61% of boys and 42% of girls who desisted). Among children who fully met it, about 44 of 80 (55%) persisted (worked out from the paper's Table 1). Critics such as Temple Newhook and colleagues (2018) argued that including milder cases inflates the desistance rate; Zucker (2018) published a reply defending these studies.
Short follow-up: Results were checked at age 15 to 19 (on average about 16), so later changes in either direction in adulthood were not captured.
Social transition finding is tangled: Social transition was reported by parents, reduced to a simple yes/no, and closely tied to how intense the distress was. Very few children fully transitioned (3 boys), so the study cannot show whether transition itself makes persisting more likely, as the authors admit.
Shaky numbers in small groups: The separate results for boys and girls were very uncertain (the boys' social transition figure could have been anywhere from about 3 to 187 times higher odds). The way factors were picked also risks finding patterns by chance in a group of only 127.
One specialist clinic: All children came from one Dutch clinic and were referred between 2000 and 2008, before the large rise in teenage girls seeking care. Results may not apply to today's patients or to children never referred to a clinic.
No information on support given: The study does not say what counselling or support children and families received between referral and follow-up, so it cannot say how clinic contact affected the results.
Limited measures: Children's mental health was rated only by parent and teacher checklists, and teen gender questionnaires were filled in only by those who replied, so teen results exist for just 46 of the 80 desisters.
Clinic judging its own work: All authors worked at or with the Amsterdam clinic that created the Dutch treatment approach. They report no financial conflicts of interest.

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Summary

Key findings

Abstract

Conclusion