Diverse Youth Research Articles

Are middle schoolers with diverse friends liked, disliked, or unnoticed ‐ and by whom?

AbstractHaving cross‐ethnic friends in early adolescence is associated with more positive intergroup attitudes, but little is known about the social signaling function of the diversity of friends. The current study examined how the ethnic diversity of students’ friends in seventh grade is related to their social status (e.g., acceptance, rejection, and social impact) by eighth grade in multi‐ethnic schools. It is hypothesized that friend diversity is (a) related to higher social status among ethnic out‐group peers as it signals inclusiveness, but (b) related to lower in‐group social status as diversity of friends may threaten the ethnic in‐group. Utilizing a longitudinal sample of ethnically diverse youth (n = 4653) from 26 middle schools, the study capitalizes on outgoing friendship nominations in seventh grade and incoming acceptance and rejection nominations in eighth grade, while controlling for overall social status in grade seven. A novel index was used to calculate the diversity of youth's friend groups, and precise coding was done to retain biracial youth in the analytic sample. Results showed that having diverse friends was related to higher visibility (i.e., social impact) and greater acceptance from ethnic out‐group members. In contrast, adolescents with diverse friend groups were less visible and less accepted by their in‐group. Diversity of friends was not associated with out‐group or in‐group rejection. Findings highlight the importance of understanding how the composition of friend groups may signal intergroup attitudes and in‐group solidarity in ways that have social status trade‐offs among out‐ and in‐group members.

Comparison of inpatient psychiatric medication management in gender diverse youth with cisgender peers.

The primary objective was to determine if gender diverse (GD) youth receive different psychotropic prescribing compared with cisgender (CG) peers with the same diagnosis. Secondary objectives include evaluation of readmission rates and the effect of gender-affirming hormone therapy (GAHT) on psychiatric outcomes in transgender (TG) patients. A total of 255 GD youth patients were retrospectively matched to CG controls based on age, primary discharge diagnosis, and year of admission. Data collection included psychotropic medications at admission and discharge, baseline demographics, time to readmission, and total number of readmissions within 6 months. Use of GAHT was also documented. Wilcoxon signed rank test was used for continuous and χ2 for nominal data with an a priori α of 0.05. MDD was the primary discharge diagnosis in 74% of patients. GD youth were more likely to present on antidepressants (P = .031) and antipsychotics (P = .007), and to be discharged with antipsychotics (P = .003). They were additionally more likely to be readmitted within 30 days of discharge (P = .032). TG youth on GAHT (13%) had fewer readmissions (P = .046) than those not on GAHT, but there were no differences in psychotropic prescribing. Higher antipsychotic and antidepressant prescribing were seen in the GD population despite the same mental health diagnosis. Despite higher prescribing in the GD population, patients presented for readmission within 30 days more frequently, which may represent a need for more rigorous transitions-of-care practices in this population.

A participatory approach to iteratively adapting game design workshops to empower autistic youth

IntroductionAutistic people face systemic barriers to fair employment. Informal learning may promote the self-determination transition-age autistic youth need to overcome and/or transform these barriers. This report focuses on the iterative process of developing video game design workshops guided by feedback from autistic students about instructional strategies they found engaging. This study is part of a three-year-long NSF-funded program of research that seeks to empower autistic youth to move toward successful careers by teaching educators how to more effectively guide them.MethodsIn the Summer of 2021, educators at an award-winning NYC-based, not-for-profit, education program, Tech Kids Unlimited (TKU) collaborated with researchers, including autistic students, to iteratively develop and assess two online game design workshops for transition-age autistic youth. Participants selected which workshop they were available for (Workshop 1: n = 18; M age = 16.72 years; Workshop 2: n = 16; M age = 16.56 years). Students in Workshop 2 had more varied support needs and were less motivated to learn video game design than students in Workshop 1. Students completed assessments before and after each workshop and rated their interest in specific workshop activities after each activity. Guided by data from Workshop 1, we revised instructional strategies before conducting Workshop 2.ResultsWe found little evidence for our hypothesis that attentional style would impact educational engagement. However, video game design self-efficacy and self-determination were often positively associated with engagement. Two industry speakers, one of whom was autistic, were among the highest-rated activities. As hypothesized, video game design self-efficacy and self-determination (and unexpectedly) spatial planning improved from pre- to post-test following Workshop 1. Despite our efforts to use what we learned in Workshop 1 to improve in Workshop 2, Workshop 2 did not lead to significant improvements in outcomes. However, students highlighted instructional strategies as a strength of Workshop 2 more often than they had for Workshop 1. Educators highlighted the importance of group “temperature checks,” individualized check-ins, social–emotional support for students and educators, and fostering a positive atmosphere.DiscussionFindings suggest that interactive multimodal activities, stimulating discussions, and opportunities to engage with neurodivergent industry professionals may engage and empower diverse autistic youth.

Experiences of pregnancy prevention among youth experiencing homelessness

Youth experiencing homelessness (YEH) are at high risk for unintended pregnancy and face unique challenges to effectively preventing unintended pregnancy. This qualitative study explored the pregnancy prevention experiences of YEH. A total of 81 diverse youth participated in eight focus group discussions that were conducted to explore their perceptions and experiences related to pregnancy prevention. Youth were recruited from shelters, drop-in centers, and homeless-serving organizations in a large metropolitan area in the southern United States. Thematic content analysis of the data revealed that YEH struggle to engage in sexual and reproductive health services owing, in part, to limited accessibility. Lack of knowledge about contraceptives, perceived adverse side effects of contraceptives, and challenges with adherence to contraceptive methods significantly limited the effective use of contraception among YEH. Youths’ decisions to use contraception were influenced by their relationship status with partners, perceptions about the efficacy and side effects of contraceptives, and the stigma associated with contraceptive use. Providing sexual and reproductive health services to YEH requires a collaborative approach. YEH need comprehensive sexual and reproductive health education and counseling that enables and empowers youth to access, navigate, and utilize such services.

Affirming educational and workplace settings are associated with positive mental health and happiness outcomes for LGBTQA + youth in Australia.

Affirming socio-cultural settings are essential for protecting the mental health and wellbeing of lesbian, bisexual or pansexual, trans and gender diverse, asexual and queer (LGBTQA +) youth. However, limited research has explored the role of affirming educational and workplace settings, as reported by LGBTQA + youth themselves, with respect to their mental health and wellbeing. Moreover, existing research maintains a focus on mitigating poor mental health outcomes, with little attention to positive wellbeing outcomes among LGBTQA + youth. Using data from the largest national survey of LGBTQA + youth aged 14-21 in Australia, multivariable regression analyses were conducted to explore associations between affirming educational and workplace settings and psychological distress and subjective wellbeing among 4,331 cisgender and 1,537 trans and gender diverse youth. Additionally, a series of multivariable regression analyses were conducted to explore individual sociodemographic traits that are associated with reporting affirming educational or workplace settings. Both cisgender and trans or gender diverse participants who reported that their education institution or workplace were affirming of their LGBTQA + identity reported lower levels of psychological distress as well as higher levels of subjective happiness. Additionally, affirming environments were not experienced equally across all subsections of LGBTQA + youth, with reporting of an affirming educational or workplace setting differing most noticeably across gender, type of educational institution and residential location. The findings demonstrate that affirming educational and workplace settings can result not only in better mental health, but also greater levels of subjective happiness among LGBTQA + youth. The outcomes illustrate the importance of ensuring all LGBTQA + youth are afforded the opportunity to thrive in environments where they feel validated and confident to express their identities. The findings further highlight a need to target education institutions and workplaces to ensure the implementation of policies and practices that promote not just inclusion of LGBTQA + youth but affirmation of their identities.

“Our Pain Makes Us Family”: March For Our Lives and the constitutive role of gun violence trauma in youth publics

This essay examines the dynamics of diverse youth public formation through analysis of the 20 student speeches delivered at the 2018 March For Our Lives rally. I argue that the collective identification as youth survivors of gun violence trauma functions to constitute this diverse youth public. I trace how the speakers’ shared gun violence trauma enabled them to form a racially integrated coalition while not discrediting their differently positioned identities and disparate gun violence experiences. In doing so, I forward a conceptualization of how youth publics negotiate gun violence trauma, asserting that youth publics are characterized by both present constraints and a future-oriented agency, members of youth publics must account for tensions across racial differences in their gun violence prevention advocacy, and gun violence trauma functions as a shared basis for political participation. My analysis of the students’ gun violence prevention discourse complicates this framework to reveal how gun violence trauma as a shared basis for youth public membership threatens their source of empowerment: ownership over their futures. Contributing to scholarship on the formation of publics, this essay demonstrates the significance of youth publics at the intersections of race, trauma, and gun violence.

Independent adolescent consent to mental health care: an ethical perspective

ABSTRACT Despite a growing need for mental health services for adolescents, treatment access among adolescents remains poor. Psychologists practicing in the United States are subject to highly variable legal standards for consent and confidentiality of minor clients, which can further suppress treatment accessibility. States permit independent consent for minors according to a wide range of criteria, but whether these criteria are empirically derived remains unknown. Inconsistencies between the law and ethical obligations for psychologists can expose minor clients to harm and force psychologists to make disclosures that violate patients’ rights and ethical standards. These harms may be particularly severe for clients from vulnerable populations such as sexuality and gender diverse youth (SGDY). To prevent ethical dilemmas, psychologists and professional organizations should work toward an empirical understanding of the adolescent capacity to consent to mental health care and use that understanding to promote uniform consent and confidentiality standards.

Patient education and counselling of fertility preservation for transgender and gender diverse people: A scoping review.

To examine patient education, counselling practices, decision aids, and education resources related to fertility preservation for transgender and gender diverse (TGD) youth and young adults. A scoping review was conducted using a comprehensive literature search (Ovid MEDLINE, PubMed Medline, OVID Embase, Ovid PsychoINFO, and Cochrane Central Register of Controlled Trials) conducted from 1806 to October 21, 2022. Inclusion criteria involved abstracts and articles on patient education, counselling, decision aids or education resources regarding fertility preservation for TGD youth and adults. Of 1,228 identified articles and abstracts, only six articles met inclusion criteria. Three key themes were identified: (1) patient education and counselling practices (n = 4), with majority of patients receiving fertility preservation counselling at their respective centres; (2) decision aids and strategies for clinicians on fertility preservation for TGD individuals (n = 2) and; (3) patient education resources (n = 1). There was a paucity of literature on decision aids and patient education resources. This study highlights the need to further develop and evaluate decision aids for healthcare providers and patient education resources, including eLearning modules, around fertility preservation for TGD individuals.

Identifying protective factors for gender diverse adolescents’ mental health

Few studies have disentangled differences in victimization exposures and mental health symptoms among gender diverse subgroups, nor considered the role of potential protective factors in ameliorating the impact of victimization on gender diverse youths’ mental health. Here we report findings from a secondary data analysis, in which we address this gap by analyzing cross-sectional survey data (N = 11,264 in the final analytic sample) from a population-based survey of youth in participating school districts in a large Midwestern U.S. county. Relative to cisgender youth with gender conforming expression, transgender youth and cisgender youth with nonconforming gender expression are more likely to experience victimization and severe mental health concerns. Additionally, school-connectedness moderates the association between bias-based harassment and depression for cisgender youth with gender nonconforming expression, and family support/monitoring buffers the association of peer victimization with suicide attempts among transgender youth. Findings highlight the need to better understand factors which may confer protection among gender diverse adolescents, so that in turn appropriate supports across key contexts can be implemented.

Principles of High-Quality Pediatric Pharmacotherapy

This article highlights the importance of attending to the relational aspects of psychopharmacological work with diverse youth and families. While technical and scientific knowledge remain the focus of medical education, the therapeutic skills known as “nonspecific” treatment factors or “common factors” can also be deconstructed, taught, and examined. [ Psychiatr Ann . 2023;53(7):298–300.]

Testing the minority stress model across gender identity, race, and ethnicity among U.S. gender minority adolescents.

Gender minority (GM) youth are at heightened risk for psychopathology, purportedly due to their experiences of GM stressors. However, few studies have examined how GM stressors are associated with depression and anxiety among GM youth. Furthermore, no prior studies have investigated how experiences of GM stressors differ across gender identity and race/ethnicity within a diverse sample of GM youth. A nationwide online cross-sectional survey of 1,943 fourteen- to 18-year-old GM adolescents (66.91% White, 11.73% multiracial, 8.49% Latinx, 7.10% Black, 3.09% Asian, 1.49% American Indian/Alaskan Native) in the United States assessed GM stressors (prejudice events, expectations of rejection, internalized transnegativity, and concealment) and mental health. Structural equation modeling was used to examine how GM stressors and depressive and anxiety symptoms differ across gender identity and race/ethnicity. Higher levels of each GM stressor were related to higher depressive symptoms. Prejudice events, expectations of rejection, and concealment were related to higher anxiety symptoms. Transmasculine and transfeminine youth reported higher levels of GM prejudice events and expectations of rejection, and higher mental health symptoms, than nonbinary youth. Findings were relatively consistent across racial/ethnic identities, with the exception that Black GM adolescents reported fewer GM prejudice events and expectations of rejection and indirectly exhibited lower mental health symptoms as compared to White GM youth. Researchers and clinicians should be attuned to how intersectional identities are related to stress and mental health among diverse GM youth. Recommendations for individual and structural-level interventions are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

P24-115-23 “Sometimes Your Bones Are Just Bones, They Don't Care What Society Thinks”: A Mixed Methods Study of the Nutrition-Related Experiences of Transgender and Gender Diverse Youth

P24-115-23 “Sometimes Your Bones Are Just Bones, They Don't Care What Society Thinks”: A Mixed Methods Study of the Nutrition-Related Experiences of Transgender and Gender Diverse Youth

Body Mass Index Categories of Transgender and Gender Diverse Youth: Clinical Associations and Predictors.

Background: Transgender/gender diverse (TGD) youth are at risk for weight-related problems. We describe factors associated with their body mass index (BMI) category. Methods: Chart review of 228 TGD patients, 12-20 years (u = 15.7, standard deviation 1.3), 72% female assigned at birth. BMI percentile was calculated using CDC growth charts. We examined bivariate relationships of 18 clinically derived factors, utilizing analysis of variance (ANOVA) for continuous variables and chi-squared/Fisher's exact test for categorical variables. Nonparametric Classification and Regression Tree (CART) analyses were used to predict BMI category. Results: Almost half (49.6%) of TGD youth presenting for their initial visit for pediatric gender-affirming care fell in the healthy weight range, 4.4% in the underweight range, 16.7% in the overweight range, and 29.4% in the obese range. Self-described weight, weight management intentions, unhealthy weight management, prescription of psychiatric medications, and medications associated with weight gain were associated with BMI category. Use of psychiatric medications (54.8%) and medications associated with weight gain (39.5%) was associated with BMI in the overweight/obese categories. Youth with obesity most often reported unhealthy weight management. In CART models, self-described weight was the strongest predictor of BMI category. Conclusion: TGD youth have high rates of underweight and overweight/obesity. Unhealthy BMI should be treated as part of gender-affirming care. Self-described body weight is associated with weight category. More than half of TGD youth were prescribed psychiatric medications; those with overweight and obesity were more likely prescribed psychiatric and medications with associated weight gain. Youth with obesity were most likely to use unhealthy weight management.

Building Equity Into Transition Practice and Service Delivery: A Call for Systemic Changes in the Field of Transition

There is a common narrative in the field of transition: students with disabilities continue to experience poorer post-school outcomes compared with their peers without disabilities. After decades of research and practice, scholars and practitioners have impacted countless numbers of students. However, disparate outcomes for diverse youth still exist. The Division on Career Development and Transition takes the position that if we are to begin reducing persistent differential outcomes for diverse youth, we must examine our current practices and apply anti-oppressive practices to transition planning to ensure we do not continue to perpetuate White cultural norms and ableist approaches to transition. We applied four equity frameworks to transition planning and provided recommendations for transition practice and service delivery.

Community Advisory Boards as a Form of Community-Engaged Research for Gender Diverse Youth.

Gender diverse youth are incredibly resilient but face significant stigma and marginalization. In this article, we argue that in the face of these challenges, researchers must work collaboratively with gender diverse youth and caregivers to identify and address the most important issues affecting them. We use our Navigating Gender Together Project as an example of using community advisory boards in community-engaged research. Although community engagement requires more resources, it overwhelmingly enriches research and increases its relevance for the community. Relevant, evidence-based research is critical in supporting gender diverse youth and their families.

Eating disorder symptoms among transgender and gender diverse youth.

Compared to cisgender peers, transgender and gender diverse (TGD) youth and adults report elevated eating disorder (ED) symptoms likely related to gender dysphoria and attempts to modify their bodies accordingly. Less is known about the impact on gender-affirming care and ED symptoms. This study aimed to expand on extant research and describe ED symptoms in TGD youth seeking gender-affirming care while exploring potential associations between gender-affirming hormone use and ED symptoms. A total of 251 TGD youth completed the Eating Disorders Examination-Questionnaire (EDE-Q) as part of routine clinical care. ANCOVAs and negative binomial regressions examined differences in ED symptoms among transgender females (identifying as female but assigned male at birth) and transgender males (identifying as male but assigned female at birth). ED severity was not significantly different among transgender females versus transgender males, (p = .09), or associated with gender-affirming hormone use (p = .07). Transgender females receiving gender-affirming hormones reported a greater proportion of objective binge eating episodes compared to those who were not (p = .03). Over a quarter of TGD youth reported engagement in ED behaviors suggesting assessment and intervention related to ED behaviors among TGD youth is imperative since adolescence is a particularly vulnerable period for adolescents and engagement in ED behaviors could lead to full ED development and medical risk.

1298-P: Independent Associations of GAD65, IA2, and ZnT8 Autoantibody (Ab) Positivity with C-Peptide (CPep) in a Diverse Cohort of Youth with Diabetes (DM)

The current DM classification does not fully enable precision medicine in DM due to heterogeneity between and within DM types, especially in racially diverse populations. Insulin deficiency (ID) is one of the most clinically actionable DM outcomes and, while its association with islet autoimmunity is known, the influence of Ab type and number after DM onset is uncertain. Thus, we assessed the effect of Ab characteristics on ID (measured as Cpep loss) in youth with established DM. We studied 151 youth with DM (median [IQR] age 15.0 [4.2] yrs, DM duration 5.4 [3.4] yrs), 61% female, 53% Hispanic and 17% non-Hispanic African American. We measured postprandial serum Cpep, glucose and Ab (GAD65, IA2 and ZnT8) and collected clinical/demographic data. Cpep loss was pre-specified as postprandial CPep <0.6 ng/ml. We found 0, 1, 2, or 3 +Ab in 34%, 22%, 31% and 13% of participants, respectively (Figure, left panel). A Breslow-Day statistic suggested homogeneity of the risk ratios across the 3 Ab types for CPep loss (p = 0.42), which were all larger than 1 (Figure, right panel). Cpep loss was significantly associated with ≥1 (vs 0) Ab+ (p < 0.0001) but not with single (vs multiple) Ab+ (p = 0.60). In sum, each of GAD65, IA2 and ZnT8 Ab are significantly associated with ID among diverse youth with DM. This suggests that models predicting ID post-onset should include each of GAD65, IA2 and ZnT8 Ab. Disclosure M.J.Redondo: None. R.A.Oram: Consultant; Janssen Research & Development, LLC, Research Support; Randox R & D. D.Dabelea: None. W.Hagopian: Research Support; Janssen Research & Development, LLC, Provention Bio, Inc., Randox R & D. Discover study group: n/a. K.K.Harrall: None. D.H.Glueck: None. M.Tosur: Advisory Panel; Provention Bio, Inc. S.Uysal: None. A.Muir: None. K.Vehik: None. T.M.Brusko: Consultant; Repertoire Immune Medicines, Quell Therapeutics, Research Support; Immunocore, Ltd., Adaptive Biotechnologies. M.A.Atkinson: None. Funding National Institutes of Health (R01DK124395)

Do linguistically diverse migrants dominate advanced mathematics? Comparing Greater Sydney with the rest of New South Wales

This study uses ethnic capital theory to explore access to secondary mathematics education among linguistically diverse (LD) migrants in metropolitan and regional New South Wales, Australia. Administrative data from over 50,000 students who completed their Higher School Certificate in 2017 were analysed using multilevel logit regressions and marginal effects. The results indicate that, in Greater Sydney, all linguistically diverse first-generation youth took mathematics courses at higher rates than their peers. So did second-generation migrants from Asian backgrounds. Furthermore, considerably larger proportions of students who spoke East Asian, Indo-Aryan, or Arabic languages studied advanced mathematics. Even when only parents spoke these languages at home, their Australian-born children took advanced mathematics more often. Yet, these second-generation students were less overrepresented than those fluent in parental languages. The paper discusses the potential consequences of LD migrant concentration in Greater Sydney, stressing the importance of equitable mathematics education in metropolitan and regional areas.

The importance of youth perspectives in understanding perceptions of safety and outcomes in group homes

Child mental health practitioners and advocates have raised concerns about the use of group homes for youth with mental and behavioral health concerns. However, little is known about what factors contribute to the tremendous variation in youth outcomes following group home care. The current study draws from a large-scale, quasi-experimental, NIMH-funded study of group homes in a southeastern state. This study uses data from interviews with guardians, youth, and group home staff to understand the experiences of 554 diverse youth staying in 44 group homes across 14 agencies. Pre- and post-behavioral and mental health outcomes were measured using the Strengths and Difficulties Questionnaire. Youth were asked to assess staff caring, fairness, pleasantness, and teaching as well as overall group home safety.Youth behavioral and mental health improved between admission and discharge. Most youth felt that staff were certainly fair, caring, pleasant, and teaching them things. A small but meaningful portion of children reported feeling unsafe. Youth perception of the staff as caring and fair and the group home as safe in their first interview significantly predicted improved behavioral and mental health at discharge. To date this is the only study examining youth’s prospective assessment of group home treatment quality on their later treatment outcomes. Along with the broader literature, these findings imply that building trusting, safe relationships with youth should be a top priority and suggests youth perspectives should be a valuable part of staff and safety assessments.

Barriers Pediatric PCP's Identify To Providing Gender-Affirming Care For Adolescents

PurposeBoth affirming environments and access to gender-affirming medical care have a positive impact on the mental health of transgender and gender diverse (TGD) youth, however, many TGD youth experience barriers in accessing this care. Pediatric primary care providers (PCPs) can play an important role in expanding access to gender-affirming care for TGD youth; however, few currently provide this care. The purpose of this study was to explore pediatric PCPs' perspectives regarding barriers they experience to providing gender-affirming care in the primary care setting. MethodsPediatric PCPs who had sought out support from the Seattle Children's Gender Clinic were recruited via email to participate in semistructured, one-hour Zoom interviews. All interviews were transcribed and then subsequently analyzed in Dedoose qualitative analysis software using a reflexive thematic analysis framework. ResultsProvider participants (n = 15) represented a wide range of experiences with respect to years in practice, number of TGD youth seen, and practice location (urban, rural, suburban). PCPs identified both health system and community-level barriers to providing gender-affirming care to TGD youth. Health system-level barriers included: (1) lack of foundational knowledge and skills, (2) limited clinical decision-making support, and (3) health system design limitations. Community-level barriers included (1) community and institutional biases, (2) provider attitudes regarding gender-affirming care provision, and (3) challenges identifying community resources to support TGD youth. DiscussionA multitude of health system and community-level barriers must be overcome in the pediatric primary care setting to ensure that TGD youth receive timely, effective, and more equitable gender-affirming care.