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

• この論文は、トランスジェンダーとジェンダーの多様な子どもや10代のケアに関する米国小児科学会の2018年の方針（Raffertyら）が引用した根拠を検証しています。
• Cantorは、AAPが、当時ほぼすべてのクリニックや専門団体が用いていたアプローチである「見守り」を退け、肯定を唯一受け入れられるアプローチとして支持したと主張しています。
• AAPが「転向」療法または「是正的」療法に反対するために引用した論文は、子どもの性自認ではなく、性的指向についてのものだったと報告しています。
• AAPが見守りを批判するために引用した論文のいくつかは、実際にはそれを支持していたと報告しています。
• 性別への苦痛のある子どもの追跡研究11件はすべて、大半が思春期までにトランジションを望まなくなったことを示していましたが、AAPが引用したのは1件（WallienとCohen-Kettenis 2008）だけで、その結果にも触れなかったと指摘しています。
• 2023年8月、AAPは2018年の方針を再確認すると同時に、更新の指針とするためのエビデンスの正式なレビューを命じました。

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.