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

• 這篇文章檢查了美國小兒科學會 2018 年關於照護跨性別與性別多元兒童及青少年的政策（Rafferty 等人）所引用的來源。
• Cantor 主張，AAP 否定了當時幾乎所有門診和專業團體所採用的「審慎等待」，並支持肯定作為唯一可接受的做法。
• 他報告，AAP 引用來反對「扭轉」或「修復性」治療的論文談的是性傾向，而不是兒童的性別認同。
• 他報告，AAP 引用來批評審慎等待的數篇論文，實際上是支持審慎等待的。
• 他指出，在 11 項對有性別困擾兒童的追蹤研究中，所有研究都發現多數孩子在青春期前就不再想要過渡，AAP 只引用了其中一項（Wallien 和 Cohen-Kettenis 2008），而且沒有提到它的發現。
• 2023 年 8 月，AAP 重申其 2018 年政策，同時下令進行一項正式的證據審查，以引導更新。

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.