‘Taking the lid off the box’: The value of extended clinical assessment for adolescents presenting with gender identity difficulties

Clarke, Anna Churcher; Spiliadis, Anastassis

doi:10.1177/1359104518825288

Cited by 34 publications

(18 citation statements)

References 34 publications

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“…In summary, the findings from the current study suggest that gender dysphoria in children arises in association with developmental pathways-reflected in at-risk patterns of attachment and high rates of unresolved loss and trauma-that are shaped by disruptions to family stability and cohesion, ACEs (including maltreatment), and SES (Golden and Oransky, 2019;Meyer-Bahlburg, 2019;Alonso-Zaldivar, 2020). Alongside other studies and perspectives (Bechard et al, 2017;Giovanardi et al, 2018;Churcher Clarke and Spiliadis, 2019;de Graaf and Carmichael, 2019;D'Angelo, 2020), this study confirms the importance of conceptualizing gender dysphoria by using a broad lens that takes into account the multiple factors that contribute to the child's distress, difficulties with adaptation, multimorbidity, and loss of health and well-being. From this broader perspective, neurobiological explanatory models of gender dysphoria must account for the child's lived experience-and that of preceding generations-in shaping brain development and in shaping brain networks involved in "own-body and self " (Altinay and Anand, 2020) experiences.…”

Section: Discussionsupporting

confidence: 83%

Attachment Patterns in Children and Adolescents With Gender Dysphoria

et al. 2021

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The current study examines patterns of attachment/self-protective strategies and rates of unresolved loss/trauma in children and adolescents presenting to a multidisciplinary gender service. Fifty-seven children and adolescents (8.42–15.92 years; 24 birth-assigned males and 33 birth-assigned females) presenting with gender dysphoria participated in structured attachment interviews coded using dynamic-maturational model (DMM) discourse analysis. The children with gender dysphoria were compared to age- and sex-matched children from the community (non-clinical group) and a group of school-age children with mixed psychiatric disorders (mixed psychiatric group). Information about adverse childhood experiences (ACEs), mental health diagnoses, and global level of functioning was also collected. In contrast to children in the non-clinical group, who were classified primarily into the normative attachment patterns (A1-2, B1-5, and C1-2) and who had low rates of unresolved loss/trauma, children with gender dysphoria were mostly classified into the high-risk attachment patterns (A3-4, A5-6, C3-4, C5-6, and A/C) (χ2 = 52.66; p < 0.001) and had a high rate of unresolved loss/trauma (χ2 = 18.64; p < 0.001). Comorbid psychiatric diagnoses (n = 50; 87.7%) and a history of self-harm, suicidal ideation, or symptoms of distress were also common. Global level of functioning was impaired (range 25–95/100; mean = 54.88; SD = 15.40; median = 55.00). There were no differences between children with gender dysphoria and children with mixed psychiatric disorders on attachment patterns (χ2 = 2.43; p = 0.30) and rates of unresolved loss and trauma (χ2 = 0.70; p = 0.40). Post hoc analyses showed that lower SES, family constellation (a non-traditional family unit), ACEs—including maltreatment (physical abuse, sexual abuse, emotional abuse, neglect, and exposure to domestic violence)—increased the likelihood of the child being classified into a high risk attachment pattern. Akin to children with other forms of psychological distress, children with gender dysphoria present in the context of multiple interacting risk factors that include at-risk attachment, unresolved loss/trauma, family conflict and loss of family cohesion, and exposure to multiple ACEs.

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Section: Discussionsupporting

confidence: 83%

Attachment Patterns in Children and Adolescents With Gender Dysphoria

et al. 2021

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“…-though only a very small proportion of people actually do re-transition (Clarke & Spilliadis, 2019) and so the item can be reasonably read as at least somewhat (or perhaps even largely) false. However, additional analyses excluding this item from the conservative pro-science composite yielded nearly identical results to those reported above (see Tables S48-S49).…”

Section: Discussionmentioning

confidence: 99%

Science beliefs, political ideology, and cognitive sophistication

McPhetres¹,

Bagó²,

Pennycook³

2019

Preprint

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Generally, it is assumed that a primary source of contention surrounding science is political and, therefore, that partisan disagreement drives attitudes about various science topics. Other models focus on the roles of basic science knowledge and cognitive sophistication, arguing that these facilitate pro-science beliefs. To test these competing accounts, we identified a range of controversial issues ostensibly subject to ideological disagreement and examined the roles of political ideology, science knowledge, and cognitive sophistication. Results show there is actually very little partisan disagreement on a wide range of contentious scientific issues. We also found very little evidence of motivated reasoning: reasoning ability was instead broadly associated with pro-science beliefs. Finally, one’s level of basic science knowledge was the most consistent predictor of people’s beliefs about science. Results suggest educators and policymakers should focus on increasing basic science literacy and critical thinking rather than the ideologies that purportedly divide people.

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“…Research also informs us that while there are stable young people whose gender incongruence is profound and long-standing, there are also young people now coming forward whose subjective beliefs about their gender identity may be held right now with extreme conviction – including meeting criteria for diagnosis of ‘Gender Dysphoria’ (American Psychiatric Association, 2013) – compared with more fluidity later in life (Churcher-Clarke & Spiliadis, 2019). Although it may be argued that the confident and sure knowledge of the lasting value of physical transition can be established unequivocally in early or mid-childhood, there is as yet little or no research evidence to underpin this claim.…”

Section: Ethics As Relational and Contextualisedmentioning

confidence: 99%

Ethical issues arising in the provision of medical interventions for gender diverse children and adolescents

Wren

2019

Clin Child Psychol Psychiatry

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The care of children and adolescents whose experience of the body is at odds with their gender feelings raises a number of questions that are as much ethical as medical or psychological. In this article I highlight some areas of ethical concern from the point of view of a senior clinician at the nationally commissioned UK Gender Identity Development Service (GIDS). I make the assumption that ethical deliberation is relational and grounded in the natural, social, political and institutional worlds in which the ethical questions arise. I try to show how matters of empirical fact, alongside an appreciation of broad social contexts, and historic and current power relations, provide an essential framework for the ways that ethical choices are framed by key groups of people as they take up different, sometimes opposing, ethical positions. I argue that practising ethically in such a service is not helpfully reduced to a single event, a treatment decision aimed at achieving the morally ‘right’ outcome, but an extended process in time. In the charged debate surrounding the recognition of these young people’s needs, we must do more to promote responsible debate about the scope of sound ethical practice.

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‘Taking the lid off the box’: The value of extended clinical assessment for adolescents presenting with gender identity difficulties

Cited by 34 publications

References 34 publications

Attachment Patterns in Children and Adolescents With Gender Dysphoria

Attachment Patterns in Children and Adolescents With Gender Dysphoria

Science beliefs, political ideology, and cognitive sophistication

Ethical issues arising in the provision of medical interventions for gender diverse children and adolescents

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