Childhood gender identity change: Operant control over sex-typed play and mannerisms

Abstract

To our knowledge this case is the first successful change of childhood gender identity that is documented by pre- and post-diagnostic assessment procedures. Deviant sex-typed behaviors were modified in a 5-yr-old boy judged by an independent clinician to be a high risk for adult transsexualism. In Study 1, the child's mother was trained to reinforce “masculine” play behaviors and to extinguish “feminine” play behaviors in the clinic. This intrasubject study introduced new procedures designed to maximize the generalization of the treatment effect to play in the alone condition. Study 2 was designed to modify the child's cross-gender mannerisms through the use of a response-cost and verbal prompt procedure. The cross-gender mannerism “flexed elbow” decreased as a function of the treatment. At the follow-up 25 months after treatment terminated, the evaluation by an independent clinician indicated the therapeutic change to a male gender identity.