Polly Carmichael

Self-Harming Thoughts and Behaviors in a Group of Children and Adolescents with Gender Dysphoria

ABSTRACT This article presents the findings from an audit on self-harm in 125 children and adolescents referred to the Gender Identity Development Service in London. Data concerning self-harming thoughts and behaviors before attending the service were extracted from documents in the patient files and from clinician reports. The findings indicated that suicide attempts and self-harming were more common over the age of 12. Overall, thoughts of self-harm were more common in the natal males whereas actual self-harm was more common in the natal females. The number of suicide attempts did not differ significantly between the two genders. The implications of these findings are discussed. Limitations of the study are also discussed which include that the data was only collected over an 8-month period and that it was extracted from patient files and from clinician reports.

Internalizing and Externalizing Behaviors in a Group of Young People with Gender Dysphoria

ABSTRACT The aim of the current paper was to examine externalizing and internalizing behaviors in adolescents with gender dysphoria. One hundred forty-one young people (84 natal females and 57 natal males, M age = 15.13, SD = 1.70) attending the Gender Identity Development Service in London completed the Youth Self Report form at the end of the assessment period (4 to 6 sessions). The main findings indicated that, overall, the adolescents showed significantly more internalizing than externalizing behaviors. Using cutoff points provided by Achenbach and Rescorla (2001), the mean internalizing score fell within the clinical range and the mean externalizing score within the normal range. There was also a significant positive relationship between these two behaviors both in the natal females and the natal males. The natal males presented with significantly more internalizing behaviors than the natal females; however, no significant difference was observed between the genders in terms of the number of externalizing behaviors and total problems. We discuss the implications of these findings with regard to clinical work.

To treat or not to treat: puberty suppression in childhood-onset gender dysphoria

Puberty suppression using gonadotropin-releasing-hormone analogues (GnRHa) has become increasingly accepted as an intervention during the early stages of puberty (Tanner stage 2–3) in individuals with clear signs of childhood-onset gender dysphoria. However, lowering the age threshold for using medical intervention for children with gender dysphoria is still a matter of contention, and is more controversial than treating the condition in adolescents and adults, as children with gender dysphoria are more likely to express an unstable pattern of gender variance. Furthermore, concerns have been expressed regarding the risks of puberty suppression, which are poorly understood, and the childs ability to make decisions and provide informed consent. However, even if the limited data available mean that it is not possible to make a conclusive treatment recommendation, some safety criteria for puberty suppression can be identified and applied.

Psychological functioning in adolescents referred to specialist gender identity clinics across Europe: a clinical comparison study between four clinics

Adolescents seeking professional help with their gender identity development often present with psychological difficulties. Existing literature on psychological functioning of gender diverse young people is limited and mostly bound to national chart reviews. This study examined the prevalence of psychological functioning and peer relationship problems in adolescents across four European specialist gender services (The Netherlands, Belgium, the UK, and Switzerland), using the Child Behavioural Checklist (CBCL) and the Youth Self-Report (YSR). Differences in psychological functioning and peer relationships were found in gender diverse adolescents across Europe. Overall, emotional and behavioural problems and peer relationship problems were most prevalent in adolescents from the UK, followed by Switzerland and Belgium. The least behavioural and emotional problems and peer relationship problems were reported by adolescents from The Netherlands. Across the four clinics, a similar pattern of gender differences was found. Birth-assigned girls showed more behavioural problems and externalising problems in the clinical range, as reported by their parents. According to self-report, internalising problems in the clinical range were more prevalent in adolescent birth-assigned boys. More research is needed to gain a better understanding of the difference in clinical presentations in gender diverse adolescents and to investigate what contextual factors that may contribute to this.

Seeing the child in context: Supporting gender diverse children and their families in multiple ways – An introduction to this special edition

This Special Issue of Clinical Child Psychology and Psychiatry includes a group of papers that originated in the work of the Gender Identity Development Service (GIDS), which is the nationally designated National Health Service (NHS) in the United Kingdom to work with children and adolescents experiencing significant concern and distress about their gender. This short introduction to those papers aims to set the context and explain why certain areas have been given a focus.

P02 Surveillance Study of Gender Identity Disorder in Children and Adolescents

Aims The incidence of childhood/adolescent Gender Identity Disorder (GID) is unknown. GID is an important condition where gender identity differs from biological sex. It is associated with significant distress, particularly with puberty, with much controversy internationally over the optimal timing of hormonal treatment. We examine the incidence and clinical presentation in UK and Irish children and adolescents. Methods STUDY POPULATION: Children and adolescents aged 4–15.9 years in the UK and Republic of Ireland. DESIGN: Joint British Paediatric Surveillance Unit (BPSU) and Child and Adolescent Psychiatry Surveillance System (CAPSS) study. New cases of GID reported by clinicians over a 19-month reporting period (01-Nov-2011 to 01-June-2013) are validated against the authoritative DSM-IV-TR (2000). Exclusions include disorders of sexual differentiation and major psychosis. PRIMARY OUTCOME: Incidence of childhood/adolescent GID, calculated by dividing the number of validated cases by the base population of children/adolescents aged 4–15.9 years. Sources of denominator data: UK Office of National Statistics and the Central Statistics Office in Ireland. STATISTICAL ANALYSIS: Descriptive statistics and comparisons using two-sample t-tests/Mann-Whitney U tests for continuous data and Chi-squared/Fisher’s exact tests for categorical data. Results Preliminary descriptive data from the first nine months’ surveillance (n = 80 cases, 42 males) indicate that similar numbers of males and females are affected by this condition. There is a lag of several years between median [range] onset of symptoms (6y [1–14y]) and presentation to Paediatricians or Psychiatrists (13y [4–14y]), with high levels of psychiatric co-morbidity at presentation, particularly depression (n = 15, 19%), Asperger Syndrome/autistic spectrum disorder (ASD) (n = 16, 20%) and previous self-harm (n = 24, 30%). There appears to be a relationship between pattern of presentation and co-morbidities observed at diagnosis: nearly half of BPSU cases (5/11) have a co-diagnosis of Asperger Syndrome/ASD at diagnosis compared with 16% of CAPSS cases (11/69). Depression and anxiety have only been reported among CAPSS cases. It is unclear whether these discrepancies reflect referral pathways or different diagnostic approaches. Conclusions We present the first ever population-level data on the clinical features and presentation of childhood/adolescent GID. These data will inform clinical management, including the highly controversial debate around early pubertal suppression in this group.