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

• 这篇文章核查了美国儿科学会2018年关于照护跨性别和性别多元儿童及青少年的政策（Rafferty等人）中所引用的资料来源。
• Cantor认为，AAP拒绝了当时几乎所有诊所和专业团体所采用的“观察等待”，而将肯定作为唯一可接受的做法。
• 他报告说，AAP引用来反对“转化”或“修复”治疗的论文谈的是性取向，而不是儿童的性别认同。
• 他报告说，AAP引用来批评观察等待的几篇论文实际上是支持它的。
• 他指出，在11项对有性别痛苦儿童的随访研究中，所有研究都发现大多数儿童在青春期前就不再想要过渡，而AAP只引用了其中一项（Wallien和Cohen-Kettenis 2008年），并没有提及其发现。
• 2023年8月，AAP重申了其2018年的政策，同时下令对证据进行正式审查，以指导更新。

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.