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

• L'articolo verifica le fonti citate nella politica 2018 dell'American Academy of Pediatrics sull'assistenza a bambini e adolescenti transgender e di genere diverso (Rafferty et al.).
• Cantor sostiene che l'AAP abbia respinto l'«attesa vigile», l'approccio usato allora da quasi tutte le cliniche e dai gruppi professionali, e abbia sostenuto l'affermazione come unico approccio accettabile.
• Riferisce che gli articoli citati dall'AAP contro la terapia «di conversione» o «riparativa» riguardavano l'orientamento sessuale, non l'identità di genere nei bambini.
• Riferisce che diversi articoli citati dall'AAP per criticare l'attesa vigile in realtà la sostenevano.
• Nota che degli 11 studi di follow-up su bambini con disagio di genere, tutti con la conclusione che la maggior parte smetteva di voler fare la transizione entro la pubertà, l'AAP ne ha citato solo uno (Wallien & Cohen-Kettenis 2008) senza menzionarne i risultati.
• Ad agosto 2023 l'AAP ha riaffermato la propria politica del 2018 disponendo al contempo una revisione formale delle prove per guidare un aggiornamento.

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.