An increasing number of youth are identifying themselves as gender variant (e.g., transgender) or nonconforming with culturally defined biological sex-based norms. Children with persistent gender dysphoria (GD) are at risk for psychological distress; subsequently, there has been a rise in the number of families, schools, and health-care providers seeking mental health services and advice regarding medical interventions for youth experiencing significant GD. Pediatric psychologists are well positioned to fulfill this need given their expertise in child development and child emotional and behavioral functioning in addition to their experiences working alongside medical teams and with patients undergoing medical treatments. This article describes the development and implementation of a hospital-based multidisciplinary clinic for gender-variant youth. Particular emphasis is paid to the role of the pediatric psychologist within the clinic. A case example is illustrated. Obstacles and future directions for pediatric psychologists working in this area are highlighted.
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References
1.
American Academy of Pediatrics. (2013). Office-based care for lesbian, gay, bisexual, transgender, and questioning youth. Pediatrics, 132, 198–203. doi:10.1542/peds.2013-1282
2.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., revised). Washington, DC: Author.
3.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
4.
American Psychological Association. Task Force on Gender Identity and Gender Variance. (2009). Report of the task force on gender identity and gender variance (pp. 137–141). Washington, DC: Author.
5.
BurnesT. R.SinghA. A.HarperA. J.HarperB.Maxon-KannW.PickeringD. L., & HoseaJ. (2010). American Counseling Association: Competencies for counseling with transgender clients. Journal of LGBT Issues in Counseling, 4, 135–159.
6.
ByneW.BradleyS. J.ColemanE.EylerA. E.GreenR.MenvielleE. J., . . .TompkinsA. (2012). Report of the American Psychiatric Association task force on treatment of gender identity disorder. Archives of Sexual Behavior, 41, 759–796. doi:10.1007/s10508-012-9975-x
7.
ColemanE.BocktingW.BotzerM.Cohen-KettenisP.DeCuypereG.FeldmanJ., . . .ZuckerK. (2012). Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. International Journal of Transgenderism, 13, 165–232. doi:10.1080/15532739.2011.700873
8.
de VriesA. L. C.DoreleijersT. A. H.SteensmaT. D., & Cohen-KettenisP. T. (2011). Psychiatric comorbidity in gender dysphoric adolescents. Journal of Child Psychology and Psychiatry, 52, 1195–1202. doi:10.1111/j.1469-7610.2011.02426.x
9.
de VriesA. L. C.SteensmaT. D.DoreleijersT. A. H., & Cohen-KettenisP. T. (2010). Puberty suppression in adolescents with gender identity disorder: A prospective follow-up study. The Journal of Sexual Medicine, 8, 2276–2283. doi:10.1111/j.1743-6109.2010.01943.x
10.
DrummondK. D.BradleyS. J.Peterson-BadaliM., & ZuckerK. J. (2008). A follow-up study of girls with gender identity disorder. Developmental Psychology, 44, 34–45. doi:10.1037/0012-1649.44.1.34
11.
Edwards-LeeperL., & SpackN. P. (2012). Psychological evaluation and medical treatment of transgender youth in an interdisciplinary “gender management service”(GeMS) in a major pediatric center. Journal of Homosexuality, 59, 321–336. doi:10.1080/00918369.2012.653302
12.
GoorenL. J.GiltayE. J., & BunckM. C. (2008). Long-term treatment of transsexuals with cross-sex hormones: Extensive personal experience. Journal of Clinical Endocrinology & Metabolism: Clinical and Experimental, 93, 19–25. doi:10.1210/jc.2007-1809
13.
HembreeW. C. (2011). Guidelines for pubertal suspension and gender reassignment for transgender adolescents. Child and Adolescent Psychiatric Clinics of North America, 20, 725–732. doi:10.1016/j.chc.2011.08.004
14.
HembreeW. C.Cohen-KettenisP.Delemarre-van de WaalH. A.GoorenL. J.MeyerW. J.IIISpackN. P., . . .MontoriV. M. (2009). Endocrine treatment of transsexual persons: An Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology & Metabolism: Clinical and Experimental, 94, 3132–3154. doi:10.1210/jc.2009-0345
15.
HughesI. A. (2008). The testes: Disorders of sexual differentiation and puberty in the male. In SperlingM. (Ed.), Pediatric endocrinology (3rd ed., pp. 662–685). Philadelphia, PA: Saunders Elsevier. doi:10.1016/B978-141604090-3.50021-1
16.
Institute of Medicine. (2011). The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Washington, DC: The National Academies Press.
17.
LeeP. A. (1994). Laboratory monitoring of children with precocious puberty. Archives of Pediatrics & Adolescent Medicine, 148, 369–376. doi:10.1001/archpedi.1994.02170040035006
18.
MeyerW.BocktingW. O.Cohen-KettenisP. T.BenjaminH., & International Gender Dysphoria Association. (2011). The Harry Benjamin International Gender Dysphoria Association’s standards of care for gender identity disorders, sixth version [The World Professional Association For Transgender Health Web site]. Retrieved fromhttp://www.wpath.org/Documents2/socv6.pdf
19.
OlsonJ.ForbesC., & BelzerM. (2011). Management of the transgender adolescent. Archives of Pediatrics & Adolescent Medicine, 165, 171–176. doi:10.1001/archpediatrics.2010.275
20.
PerrinE., & StancinT. (2013, September). Children with gender dysphoria. Concurrent session presented at the Annual Meeting of the Society for Developmental and Behavioral Pediatrics, Baltimore, MD.
21.
RosenfieldR. L.CookeD. W., & RadovickS. (2008). Puberty and its disorders in the female. In SperlingM. (Ed.), Pediatric endocrinology (pp. 530–609). Philadelphia, PA: Saunders Elsevier.
22.
SaewycE. M.SkayC. L.PettingellS. L.ReisE. A.BearingerL.ResnickM., . . .CombsL. (2006). Hazards of stigma: The sexual and physical abuse of gay, lesbian, and bisexual adolescents in the United States and Canada. Child Welfare: Journal of Policy, Practice, and Program, 85, 195–213.
23.
SpackN. P.Edwards-LeeperL.FeldmanH. A.LeibowitzS.MandelF.DiamondD. A., & VanceS. R. (2012). Children and adolescents with gender identity disorder referred to a pediatric medical center. Pediatrics, 129, 418–425. doi:10.1542/peds.2011-0907
24.
SteensmaT. D.McGuireJ. K.KreukelsB. P.BeekmanA. J., & Cohen-KettenisP. T. (2013). Factors associated with desistence and persistence of childhood gender dysphoria: A quantitative follow-up study. Journal of the American Academy of Child & Adolescent Psychiatry, 52, 582–590. doi:10.1016/j.jaac.2013.03.016
25.
WallienM. S. C., & Cohen-KettenisP. T. (2008). Psychosexual outcome of gender-dysphoric children. Journal of the American Academy of Child & Adolescent Psychiatry, 47, 1413–1423. doi:10.1097/CHI.0b013e31818956b9
26.
WallienM. S. C.SwaabH., & Cohen-KettenisP. T. (2007). Psychiatric comorbidity among children with gender identity disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 46, 1307–1314. doi:10.1097/chi.0b013e3181373848
27.
WheelerM. D., & StyneD. M. (1991). The treatment of precocious puberty. Endocrinology and Metabolism Clinics of North America, 20, 183–190.
28.
ZuckerK. J., & BradleyS. J. (1995). Gender identity disorder and psychosexual problems in children and adolescents. New York, NY: Guilford Press.
29.
ZuckerK. J.BradleyS. J.Owen-AndersonA.KibblewhiteS. J., & CantorJ. M. (2008). Is gender identity disorder in adolescents coming out of the closet?Journal of Sex & Marital Therapy, 34, 287–290. doi:10.1080/00926230802096192
30.
ZuckerK. J.BradleyS. J.SullivanC. B. L.KuksisM.Birkenfeld-AdamsA., & MitchellJ. N. (1993). A gender identity interview for children. Journal of Personality Assessment, 61, 443–456.
31.
ZuckerK. J., & LawrenceA. A. (2009). Epidemiology of gender identity disorder: Recommendations for the standards of care of The World Professional Association for Transgender Health. International Journal of Transgenderism, 11, 8–18. doi:10.1080/15532730902799946
