Intense/obsessional interests in children with gender dysphoria: a cross-validation study using the Teacher\u2019s Report Form

Kenneth J Zucker,A Natisha Nabbijohn,Susan J Bradley,Alanna Santarossa,Joanna Matthews,Hayley Wood,Doug P Vanderlaan

doi:10.1186/s13034-017-0189-9

Abstract

ObjectiveThis study assessed whether children clinically referred for gender dysphoria (GD) show symptoms that overlap with Autism Spectrum Disorder (ASD). Circumscribed preoccupations/intense interests and repetitive behaviors were considered as overlapping symptoms expressed in both GD and ASD.MethodsTo assess these constructs, we examined Items 9 and 66 on the Teacher’s Report Form (TRF), which measure obsessions and compulsions, respectively.ResultsFor Item 9, gender-referred children (n = 386) were significantly elevated compared to the referred (n = 965) and non-referred children (n = 965) from the TRF standardization sample. For Item 66, gender-referred children were elevated in comparison to the non-referred children, but not the referred children.ConclusionsThese findings provided cross-validation of a previous study in which the same patterns were found using the Child Behavior Checklist (Vanderlaan et al. in J Sex Res 52:213–19, 2015). We discuss possible developmental pathways between GD and ASD, including a consideration of the principle of equifinality.

Highlights

Children with a Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 diagnosis of gender dysphoria (GD) [Gender Identity Disorder of Childhood in DSM-III and III-R and Gender Identity Disorder (GID) in DSMIV] have a marked incongruence between the gender they have been assigned to at birth and their experienced/expressed gender [1].1 The DSM-5 indicators for the diagnosis, as in DSM-III and DSM-IV, include an array of sex-typed behaviors that often signal a strong identification with the other gender
The main reasons for this were: the parents did not want the teacher to complete the Teacher’s Report Form (TRF); a TRF was mailed to the teacher/school, but it was not returned; the child was too young for the TRF to be administered; the child was being home-schooled; or, the family chose not to complete the assessment so the TRF was not sent to the teacher
Preliminary analyses We first compared the gender-referred children for whom a TRF was completed vs. those for whom it was not

Summary

Introduction

Children with a DSM-5 diagnosis of gender dysphoria (GD) [Gender Identity Disorder of Childhood in DSM-III and III-R and Gender Identity Disorder (GID) in DSMIV] have a marked incongruence between the gender they have been assigned to at birth and their experienced/expressed gender [1].1 The DSM-5 indicators for the diagnosis, as in DSM-III and DSM-IV, include an array of sex-typed behaviors (e.g., toy and activity interests, dress-up play, roles in fantasy play, etc.) that often signal a strong identification with the other gender. One potential explanation for the putative link between GD and ASD is the intense focus on, or an obsessional interest in, specific activities [31, 32]. Such interests relate to the DSM-5 ASD criterion pertaining to highly restricted and fixated interests. In order to appraise these two proposed pathways, the first step would be to determine empirically if, children with GD manifest an elevated pattern of intense interests and obsessions

Methods

Results

Conclusion