Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
Methodological Questions in
Childhood Gender Identity
‘Desistence’ Research
Kelley Winters, Ph.D.
GID Reform Advocates
The...
How pervasive is this axiom about
childhood gender dysphoria?

a  to  nly 
ri in
ho d  or o n.
sp ste d f dre What
dy rsi ...
“Desistence” in the WPATH Standards of
Care, Version 7
“[Gender] dysphoria persisted into 
adulthood for only 6­23% of chi...
“Desistence” in the WPATH Standards of
Care, Version 7

“In most children, gender dysphoria 
will disappear before or earl...
“Desistence” in the DSM-5

5
“Desistence” in the APA Task Force
Report on Treatment of GID.
“the majority [of children with GID] 
will become comfortab...
“Desistence” in the Press
“Actually, no one knows whether Coy 
[Mathis] will continue to feel that she 
is a girl when her...
Consequent Defamation of “Confusion”
“What to do if your child is 
gender­confused. Next, on Dr. Phil"

(McGraw, CBS TV, 2...
“Confusion” in Religious Extremism
“very few children who demonstrate 
gender confused behavior continue to 
do so in thei...
“Confusion” in Political Extremism
“[California] AB 1266 aims to require 
all public schools to allow gender 
confused you...
d 
te
sis r 
er  fo
Is this
 p od
assumption
ria ho  
ho ult  of
actually
sp d
true?
dy o a 23%
Science ?
nt y 6­ .
i l
Op...
A Point of Science:
“the burden of proof in science rests
invariably on the individuals making a
claim, not on the critic....
Three Key Cited Studies from
Toronto and the Netherlands:
Drummond, K. D.; Bradley, S. J.;
Peterson-Badali, M.; Zucker, K....
Concern 1: Fallacy of Conflated Subsets
Are Socially Transitioned Kids, Gender
Dysphoric Kids, Kids Dx with “GID,”
and Non...
Conflated Subsets

(Wallien,

et al. 2008)

“Children diagnosed with 
gender identity disorder 
(GID) have a strong cross­...
Conflated Subsets
In truth,
Socially Transitioned Kids
are a tiny subset of-Gender Dysphoric Kids
are a subset of-Kids Dx ...
Concern 2: Sample Bias in DSM Intake
Criteria

17

“it is conceivable that the childhood 
criteria for GID may “scoop in” ...
Concern 3: Results Skewed by Treatment
“It is beyond the scope of this report 
to describe the types of therapies ... 
rec...
Concern 4: Omitted Long Term
Followup

19

“the median age at which trans 
people first visited their GP to discuss 
their...
Concern 5: Dismissed Retrospective
Evidence

“Age of epiphany... clear spike at age 
5 years, representing the modal 
aver...
Concern 6: Unfounded Assumptions
“...(45.3%) did not 
reapply for 
treatment at the 
Gender Identity 
Clinic during 
adole...
Concern 7: Magic Sticky Flypaper Theory
“[Parents/Caregivers] 
may help the child to 
handle their gender 
variance in a s...
The Magic Sticky Flypaper Theory
The Steensma paper
speculatively disparaged
childhood social transition,
without studying...
Concern 8: The 800 lb. Taboo Question
Does Real Life
Experience in
congruent roles
(including nonbinary
roles) have simila...
A Closer Look at Drummond, et al., 2008
The Claim-- 88% “desistence” of 25
“girls” with full or sub-threshold
childhood GI...
A Closer Look at Wallien, et al., 2008
The Claim-- “27% of our total group of
gender-dysphoric children was still
gender d...
A Closer Look at Steensma, et al., 2011
The Claim-- 55% of 53 children meeting
GIC criteria sought medical transition in
a...
Speaking of Steensma, et al., 2011
The Claim-- “These accounts imply that
the presence of body discomfort may
contribute s...
Summary
(1) Evidence from these studies suggests
that the majority of gender
nonconforming children are not gender
dysphor...
Summary
(3) These studies do acknowledge that
intense anatomic dysphoria in childhood
may be associated with persistent ge...
Summary
(4) Speculation that allowing childhood
social transition traps cisgender youth in
roles that are incongruent with...
References
American Psychiatric Association (2014). Diagnostic and statistical manual of mental disorders (5th ed.). Arlin...
Methodological Questions in
Childhood Gender Identity
‘Desistence’ Research
Kelley Winters, Ph.D.
GID Reform Advocates
The...
Upcoming SlideShare
Loading in …5
×

Methodological Questions in Childhood Gender Identity ‘Desistence’ Research

13,968 views

Published on

A presentation to the 23rd World Professional Association for Transgender Health Biennial Symposium, Feb. 16, 2014, Bangkok, Thailand, by Kelley Winters, Ph.D., of GID Reform Advocates.

It is frequently repeated in mental health literature and popular media that the vast majority of children whose gender identity differs from their assigned birth-sex, or who are severely distressed by their birth-sex, will "desist" in their gender identities and gender dysphoria by adolescence. As a consequence, gender dysphoric children are pressed to remain in their birth-assigned roles throughout the world. But are gender dysphoria and diverse gender identities just a phase?

This presentation reexamines research in Canada and The Netherlands that underlies the "desistence" axiom, with respect to methodological rigor and validity of claims.

Conclusions:

(1) Evidence from these studies suggests that the majority of gender nonconforming children are not gender dysphoric adolescents or adults.

(2) It does not support the stereotype that most children who are actually gender dysphoric will "desist" in their gender identities before adolescence.

(3) These studies do acknowledge that intense anatomic dysphoria in childhood may be associated with persistent gender dysphoria and persistent gender identity through adolescence.

(4) Speculation that allowing childhood social transition traps cisgender youth in roles that are incongruent with their identities is not supported by evidence.

(5) These studies fail to examine the diagnostic value of Real Life Experience in congruent gender roles for gender dysphoric children.

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

Methodological Questions in Childhood Gender Identity ‘Desistence’ Research

  1. 1. Methodological Questions in Childhood Gender Identity ‘Desistence’ Research Kelley Winters, Ph.D. GID Reform Advocates The 23rd WPATH Biennial Symposium Feb. 16, 2013 from Loveland, Colorado, USA (Ver. E, expanded) ©2014 Kelley Winters, www.gidreform.org Photo by Kelley Winters Images Photography
  2. 2. How pervasive is this axiom about childhood gender dysphoria? a  to  nly  ri in ho d  or o n. sp ste d f dre What dy rsi oo il Are e lth f ch p u Its  o Consequences? ad 3% ­2 6 2
  3. 3. “Desistence” in the WPATH Standards of Care, Version 7 “[Gender] dysphoria persisted into  adulthood for only 6­23% of children. ...Newer studies, also including girls,  showed a 12­ 27% persistence rate of  gender dysphoria into adulthood” (p. 11, 2011) Logo ©2014 WPATH 3
  4. 4. “Desistence” in the WPATH Standards of Care, Version 7 “In most children, gender dysphoria  will disappear before or early in  puberty.” (p. 12, 2011) Logo ©2014 WPATH 4
  5. 5. “Desistence” in the DSM-5 5
  6. 6. “Desistence” in the APA Task Force Report on Treatment of GID. “the majority [of children with GID]  will become comfortable with their  natal gender over time (a phenomenon  termed desistence)”  (Byne, et al., 2012) Logo ©2014 WPATH 6
  7. 7. “Desistence” in the Press “Actually, no one knows whether Coy  [Mathis] will continue to feel that she  is a girl when her body develops  further, since most children like her  grow up to be gay, not transgender.” (Drescher,  New York Times,  2013) 7
  8. 8. Consequent Defamation of “Confusion” “What to do if your child is  gender­confused. Next, on Dr. Phil" (McGraw, CBS TV, 2008)   8
  9. 9. “Confusion” in Religious Extremism “very few children who demonstrate  gender confused behavior continue to  do so in their later teen years or early  adulthood” (Stanton, focusonthefamily.com,2009)    9
  10. 10. “Confusion” in Political Extremism “[California] AB 1266 aims to require  all public schools to allow gender  confused youth to use facilities,...  based solely on their perceived  'gender identity' and not their  biological sex.” (Pacific Justice Institute, 2013)   10
  11. 11. d  te sis r  er  fo Is this  p od assumption ria ho   ho ult  of actually sp d true? dy o a 23% Science ? nt y 6­ . i l Opinion? n dren o il Meme? h c Dogma? Given the stakes, 11
  12. 12. A Point of Science: “the burden of proof in science rests invariably on the individuals making a claim, not on the critic.” Lilienfeld, Lynn and Lorh, Science and Pseudoscience in Clinical Psychology, 2004 12
  13. 13. Three Key Cited Studies from Toronto and the Netherlands: Drummond, K. D.; Bradley, S. J.; Peterson-Badali, M.; Zucker, K. J. (2008) Wallien, M.S.C. & Cohen-Kettenis, P.T. (2008) Steensma, T.D.; Biemond, R.; de Boer, F. & Cohen-Kettenis, P.T. (2011) 13
  14. 14. Concern 1: Fallacy of Conflated Subsets Are Socially Transitioned Kids, Gender Dysphoric Kids, Kids Dx with “GID,” and Nonconforming Kids synonymous? 14
  15. 15. Conflated Subsets (Wallien, et al. 2008) “Children diagnosed with  gender identity disorder  (GID) have a strong cross­ gender identification and  a persistent discomfort  with their biological sex  or gender role associated  with that sex (gender  dysphoria)” 15
  16. 16. Conflated Subsets In truth, Socially Transitioned Kids are a tiny subset of-Gender Dysphoric Kids are a subset of-Kids Dx with GIDC/GDC are a small subset of-Gender Nonconforming Kids 16
  17. 17. Concern 2: Sample Bias in DSM Intake Criteria 17 “it is conceivable that the childhood  criteria for GID may “scoop in” girls  who are at relatively low risk for  adolescent/adult gender­dysphoria  that revolves so much around  somatic indicators...” (Drummond, et al., 2008)
  18. 18. Concern 3: Results Skewed by Treatment “It is beyond the scope of this report  to describe the types of therapies ...  received between the assessment in  childhood and follow­up... 13 of the 25 girls had  at least some contact with our clinic ...” (Drummond, et al., 2008) 18  
  19. 19. Concern 4: Omitted Long Term Followup 19 “the median age at which trans  people first visited their GP to discuss  their gender dysphoria has been  rising and is currently 42.” (Reed, et al., 2009)
  20. 20. Concern 5: Dismissed Retrospective Evidence “Age of epiphany... clear spike at age  5 years, representing the modal  average, with a mean average of 7.9  years. ” (Kennedy, et al., 2012) 20
  21. 21. Concern 6: Unfounded Assumptions “...(45.3%) did not  reapply for  treatment at the  Gender Identity  Clinic during  adolescence... we  assumed that their  gender dysphoric  feelings had  (Steensma, et al., 2011) desisted...” 21
  22. 22. Concern 7: Magic Sticky Flypaper Theory “[Parents/Caregivers]  may help the child to  handle their gender  variance in a supportive  way, but without taking  social steps long before  puberty, which are hard  to reverse. ” (Steensma, et al., 2011) 22
  23. 23. The Magic Sticky Flypaper Theory The Steensma paper speculatively disparaged childhood social transition, without studying gender dysphoric children who actually transitioned socially. 23
  24. 24. Concern 8: The 800 lb. Taboo Question Does Real Life Experience in congruent roles (including nonbinary roles) have similar diagnostic value for children as in adults and adolescents? 24
  25. 25. A Closer Look at Drummond, et al., 2008 The Claim-- 88% “desistence” of 25 “girls” with full or sub-threshold childhood GID after age 17. A Clarification-- 59% of a cohort of 37 nonconforming birth-assigned girls reported female identity after age 17; 8% transitioned medically; 32% unknown; none were followed long term. 25
  26. 26. A Closer Look at Wallien, et al., 2008 The Claim-- “27% of our total group of gender-dysphoric children was still gender dysphoric in adolescence.” A Clarification-- 27% of 77 gender nonconforming children transitioned medically after age 16; less than half, 43%, identified with birth-assignment; 30% unknown; none followed long term. 26
  27. 27. A Closer Look at Steensma, et al., 2011 The Claim-- 55% of 53 children meeting GIC criteria sought medical transition in adolescence; nonrespondents, 45%, “desisted” in gender dysphoria. A Clarification—More than half, 55%, of 77 children meeting GID criteria sought medical transition in adolescence; 45% were unknown. 27
  28. 28. Speaking of Steensma, et al., 2011 The Claim-- “These accounts imply that the presence of body discomfort may contribute significantly to persistence or desistence of childhood gender dysphoria .” -- This key finding, persistence of early anatomic dysphoria, has been ignored in much of the literature and press. 28
  29. 29. Summary (1) Evidence from these studies suggests that the majority of gender nonconforming children are not gender dysphoric adolescents or adults. (2) It does not support the stereotype that most children who are actually gender dysphoric will "desist" in their gender identities before adolescence. 29
  30. 30. Summary (3) These studies do acknowledge that intense anatomic dysphoria in childhood may be associated with persistent gender dysphoria and persistent gender identity through adolescence. 30
  31. 31. Summary (4) Speculation that allowing childhood social transition traps cisgender youth in roles that are incongruent with their identities is not supported by evidence. (5) These studies fail to examine the diagnostic value of Real Life Experience in congruent gender roles for gender dysphoric children. 31
  32. 32. References American Psychiatric Association (2014). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. Byne, W., Bradley, S.J., Coleman, E., Eyler, A.E., Green, R., Menvielle, E.J., Meyer-Bahlburg, H.F.L., Pleak, R.R. & Tompkins, D.A. (2012). Report of the American Psychiatric Association Task Force on Treatment of Gender Identity Disorder. Archives of Sexual Behavior, 41(4):759-796. Drescher, J. (2013) "Sunday Dialogue: Our Notions of Gender," New York Times, June 29, http://www.nytimes.com/2013/06/30/opinion/sunday/sunday-dialogue-our-notions-of-gender.html Drummond, Kelley D.; Bradley, Susan J.; Peterson-Badali, Michele; Zucker, Kenneth J. (2008), "A follow-up study of girls with gender identity disorder," Developmental Psychology. Vol 44(1), Jan 2008, 34-45. Kennedy, N. (2012) "Transgender children: more than a theoretical challenge," Goldsmiths College, University of London, http://academia.edu/2760086/ Reed, B., Rhodes, S., Schofield, P., Wylie, K., (2009) "Gender variance in the UK. Prevalence, incidence, growth and geographic distribution," GIRES – the Gender Identity Research and Education Society, http://www.gires.org.uk/assets/MedproAssets/GenderVarianceUK-report.pdf Steensma, T.D., Biemond, R., de Boer, F. & Cohen-Kettenis, P.T. (2011). Desisting and persisting gender dysphoria after childhood: A qualitative follow-up study. Clinical Child Psychology & Psychiatry, 16(4):499-516. Wallien, M.S.C. & Cohen-Kettenis, P.T. (2008). Psychosexual outcome of gender-dysphoric children. J American Academy Child & Adolescent Psychiatry, 47:1413-1423. Winters, K. (2013) Response to Dr. Jack Drescher and the NY Times About Childhood Transition, GID Reform Weblog, July 5, http://gidreform.wordpress.com/category/childhood-social-transition/ World Professional Association for Transgender Health (2011), Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People: Author. 32
  33. 33. Methodological Questions in Childhood Gender Identity ‘Desistence’ Research Kelley Winters, Ph.D. GID Reform Advocates The 23rd WPATH Biennial Symposium Feb. 16, 2013 from Loveland, Colorado, USA (Ver. E, expanded) ©2014 Kelley Winters, www.gidreform.org Photo by Kelley Winters Images Photography

×