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

• Het stuk controleert de bronnen die worden aangehaald in het beleid van de American Academy of Pediatrics uit 2018 over de zorg voor transgender en genderdiverse kinderen en tieners (Rafferty et al.).
• Cantor betoogt dat de AAP 'waakzaam afwachten' verwierp, de aanpak die bijna alle klinieken en beroepsgroepen destijds gebruikten, en bevestiging steunde als enige aanvaardbare aanpak.
• Hij meldt dat artikelen die de AAP aanhaalde tegen 'conversie'- of 'reparatieve' therapie gingen over seksuele oriëntatie, niet over genderidentiteit bij kinderen.
• Hij meldt dat verschillende artikelen die de AAP aanhaalde om waakzaam afwachten te bekritiseren dat in feite steunden.
• Hij merkt op dat de AAP van 11 follow-upstudies van kinderen met genderklachten, die allemaal vonden dat de meesten tegen de puberteit niet meer wilden transitioneren, er slechts één aanhaalde (Wallien & Cohen-Kettenis 2008) en niet vermeldde wat die vond.
• In augustus 2023 bevestigde de AAP haar beleid uit 2018 opnieuw, terwijl ze een formele review van het bewijs bestelde om een update te onderbouwen.

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.