Behavioral and Emotional Problems on the Teacher’s Report Form: A Cross-National, Cross-Clinic Comparative Analysis of Gender Dysphoric Children and Adolescents

Abstract

For gender dysphoric children and adolescents, the school environment may be challenging due to peer social ostracism and rejection. To date, information on the psychological functioning and the quality of peer relations in gender dysphoric children and adolescents has been studied via parental report, peer sociometric methods, and social interactions in laboratory play groups. The present study was the first cross-national investigation that assessed behavior and emotional problems and the quality of peer relations, both measured by the Teacher's Report Form (TRF), in a sample of 728 gender dysphoric patients (554 children, 174 adolescents), who were referred to specialized gender identity clinics in the Netherlands and Canada. The gender dysphoric adolescents had significantly more teacher-reported emotional and behavioral problems than the gender dysphoric children. In both countries, gender dysphoric natal boys had poorer peer relations and more internalizing than externalizing problems compared to the gender dysphoric natal girls. Furthermore, there were significant between-clinic differences: both the children and the adolescents from Canada had more emotional and behavioral problems and a poorer quality of peer relations than the children and adolescents from the Netherlands. In conclusion, gender dysphoric children and adolescents showed the same pattern of emotional and behavioral problems in both countries. The extent of behavior and emotional problems was, however, higher in Canada than in the Netherlands, which appeared, in part, an effect of a poorer quality of peer relations. Per Bronfenbrenner's (American Psychologist, 32, 513-531, 1977) ecological model of human development and well-being, we consider various interpretations of the cross-national, cross-clinic differences on TRF behavior problems at the level of the family, the peer group, and the culture at large.

Recalled gender-related play behavior and peer-group preferences in childhood and adolescence among adults applying for gender-affirming treatment

“…The results are also in line with previous evidence that indicates a higher proportion of nonconforming gender expression in natal girls diagnosed with a GIDC compared to natal boys diagnosed with a GIDC (e.g. Kane, 2006;Steensma et al, 2013;Wallien et al, 2010). A stronger refusal and social judgment of nonconforming gender expression was reported for boys (Blakemore, 2003;Cohen-Kettenis, et al, 2003).…”

“…In a sociometric study with n D 28 children who have been referred to a gender clinic in the Netherlands, Wallien, Veenstra, Kreukels, and Cohen-Kettenis (2010) found that, compared to their classmates (n D 495), gender-nonconforming boys experienced more negative social consequences than gender-nonconforming girls did. In a recent cross-national, cross-clinic comparative analysis of gender dysphoric children and adolescents (n D 554 children, n D 174 adolescents), Steensma et al (2013) investigated behavioral and emotional problems and the quality of peer relations assessed with the Teacher's Report Form in a sample of n D 728 gender dysphoric patients (554 children, 174 adolescence; n D 219 natal girls, n D 509 natal boys) who were referred to specialized gender identity clinics in the Netherlands and Canada. Gender dysphoric natal boys had poorer peer relations than gender dysphoric natal girls.…”

“…Second, based on previous findings (e.g. Steensma et al, 2013), we assumed more recalled nonconforming gender expression in FtMs compared to MtFs for both EO and LO groups. FtMs are in generally expected to show nonconforming gender expressions in childhood more often compared to MtFs (Wallien et al, 2010;Zucker, 2005).…”

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

“…They found a predominance of internalising problems over externalising problems. On average, emotional and behavioural problems in the clinical range were more prevalent in Canada compared to The Netherlands [11, 17, 18]. …”

How Should Physicians Help Gender-Transitioning Adolescents Consider Potential Iatrogenic Harms of Hormone Therapy?

“…In puberty, the development of the body in an undesired direction is generally distressful. Being a victim of bullying and stigmatization as a consequence of rigid and stereotyped gender norms can have a strong negative effect on the psychological health and quality of life of an adolescent with GD [1]. And, in addition, interventions that can be provided by a (mental) health professional to reduce GD (e.g., hormone therapy) are generally efficient but may have iatrogenic side effects.…”