Gender Nonconforming Behaviors Research Articles

Etiology Beliefs About Sexual and Gender Minority Youth (EB-SGM): Validation with College Students, Community Adults, and Pediatric Healthcare Providers

ABSTRACT Sexual and gender minority (SGM) youth are at risk for adverse health outcomes because of stigma and discrimination exposure. Individuals’ beliefs about the biological origin of SGM identity are linked to their negative attitudes and biases against SGM populations, which can also apply to pediatric healthcare providers. The current study outlines validation of the Etiology Beliefs about Sexual and Gender Minority Youth (EB-SGM) scale, a 12-item measure designed to assess adults’ beliefs about youths’ biological versus environmental SGM etiology. College students (N = 285; study 1), community adults (N = 258; study 2), and pediatric providers (N = 104; study 3) completed the EB-SGM and other self-report measures. Exploratory factor analysis (EFA) in study 1 revealed a three-factor structure: beliefs about gender nonconforming behavior, beliefs about gender identity, and beliefs about sexual attraction/behavior. Confirmatory factor analysis (CFA) in study 2 suggested a bi-factor structure, which was replicated in study 3. The EB-SGM demonstrated adequate concurrent and discriminant validity. We also examined bivariate correlations between etiology beliefs and sociodemographic characteristics across samples. Findings indicate that EB-SGM is a psychometrically sound instrument to measure adults’ etiology beliefs. The EB-SGM has the potential to be used as a screening measure to enhance pediatric healthcare providers’ SGM training.

Uncovering associations between gender nonconformity, psychosocial factors, and mental health in adolescents: a birth cohort study.

Little information is available on the association between gender nonconformity during adolescence and subsequent mental health. While the distress related to gender nonconformity may be socially produced rather than attributed to individual-level factors, further research is needed to better understand the role of psychosocial factors in this context. We analyzed data from the Tokyo Teen Cohort, obtained through random sampling of adolescents born between 2002 and 2004. We used inverse probability weighting to examine the association of gender nonconformity at ages 12 and 14 as a time-varying variable with subsequent mental health at age 16, while accounting for time-fixed and time-varying confounders. Furthermore, we used a weighting approach to investigate the mediating role of modifiable psychosocial factors in this association, addressing exposure-mediator and mediator-mediator interactions. A total of 3171 participants were analyzed. Persistent gender nonconforming behavior at ages 12 and 14 was associated with subsequent depression (β = 2.02, 95% confidence interval [CI] 0.85 to 3.19) and psychotic experiences (β = 0.33, 95% CI 0.14 to 0.52) at age 16. The results remained robust in sensitivity analyses. Approximately 30% of the association between gender nonconformity and depression was consistently mediated by a set of psychosocial factors, namely loneliness, bullying victimization, and relationships with mother, father, and friends. Persistent gender nonconformity during adolescence is associated with subsequent mental health. Psychosocial factors play a vital mediating role in this association, highlighting the essential need for social intervention and change to reduce stigmatization and ameliorate mental health challenges.

The Fragile Male: An Experimental Study of Transgender Classification and the Durability of Gender Categories

Is maleness as durable a social classification as femaleness? Theories of gender suggest that men’s dominance in the gender hierarchy affords them greater privileges than women, whereas theories of status predict that men would be subject to greater scrutiny precisely because they occupy a higher-status position. We interrogate the nature of gender categories themselves by examining which theories hold in the context of gender nonconformity. Using a nationally representative survey experiment, we examine how a child’s sex assigned at birth affects their likelihood of being reclassified as transgender for engaging in gender-nonconforming behavior. We find that people are more likely to reclassify boys exhibiting feminine behavior into an alternative identity category (transgender) than girls exhibiting analogous masculine behavior. Thus, membership in the “male” category is more fragile than in the “female” category. These findings suggest that gender nonconformity is itself a gendered process, and that the durability of membership in a social category depends on the status of that social identity. This study provides the first causal evidence of the effect of gender nonconformity on perceptions of both transgender and homosexual identity.

Demographic and Clinical Characteristics of Children with Gender Dysphoria Symptoms: A Turkish Sample

Objective: In this study, we aim to describe the demographic and clinical characteristics and psychological functioning of children with gender dysphoria (GD) symptoms aged between 3-12 years. Material and Methods: The study group included 20 children (17 males, 3 females; mean age 6.63±2.43 years) with GD symptoms. A sociodemographic data form was used to collect data with regards to demographic and clinical characteristics, and pre- peri-and postnatal features. The Child Behavior Checklist (CBCL) is used to assess behavioral and emotional problems in the child. Results: The boy/girl ratio in the study group was 5.66. The mean age at onset of gender-nonconforming behaviors was 2.85±1.17 years and the mean age of admission to our clinic was 5.82±2.27 years. 20% of the mothers reported a preference for an opposite-sex child prior to conception; 20 % of the mothers reported prenatal stress, 20% of the mothers had prenatal and 25% had postnatal depressive symptoms. There was a risk of miscarriage in 10% of children and 25% were born prematurely. 55% of our study sample exceeded the clinical threshold for internalizing problems and 40% exceeded the clinical threshold for externalizing problems in CBCL ratings. Conclusion: There were more prepubertal boys than girls referred for GD symptoms and the age at referral was younger compared to western countries. In addition, findings of this study indicate that children with GD have poorer psychological functioning possibly due to social intolerance for cross-gender behaviors and/or interests alongside the GD per se.

Childhood Gender Nonconformity and Recalled Perceived Parental and Peer Acceptance Thereof, Internalized Homophobia, and Psychological Well-Being Outcomes in Heterosexual and Gay Men from Poland

The link between gender nonconformity and psychopathology may be due in part to negative childhood experiences resulting from other people’s reactions to gender nonconformity. The aim of this study was to test whether recalled perceived levels of parental and peer acceptance of childhood gender nonconforming behaviors and play mediate the relationship of childhood gender nonconformity with depression and social anxiety in adulthood. We also tested whether this relationship was moderated by sexual orientation and, among gay men, whether internalized homophobia was an additional mediator. All variables were measured in a large sample of male participants using self-report (n = 449 gay men, age: M = 27.8 years, SD = 6.69; and n = 296 heterosexual men, age: M = 27.4 years, SD = 6.57) in Poland. Gay men reported more childhood gender nonconformity than heterosexual men. The relationship between gender nonconformity and depressive symptoms as well as social anxiety symptoms was significant in both gay and heterosexual men. Among gay men, this relationship was partially mediated by peer but not parental acceptance of the measured aspects of gender nonconformity and internalized homophobia. Among heterosexual men, recalled perceived parental acceptance of gender nonconformity partially mediated the relationship between gender nonconformity and depressive and social anxiety symptoms. Our findings were partially in line with those found in Western European and North American samples. Although the two groups differed in their recalled perceived gender nonconformity, they did not differ in their depression or social anxiety scores. Nevertheless, childhood gender nonconformity may be an indirect risk associated with mental health symptoms, irrespective of sexual orientation. Its higher prevalence among nonheterosexual individuals makes it a particular risk for this group.

Parents’ Attitudes Predict Adolescent Gender Expression

Parental attitudes and behaviors can influence gender expression in adolescence. In particular, previous work surveying parents of pre-adolescents has suggested that parental attitudes toward gender nonconformity in children correlate with adolescents’ subsequent gender-nonconforming behavior, although this relationship differs based on the sex of the child. However, previous work has not directly measured children’s experiences of their parents’ attitudes and behaviors, nor parents’ current attitudes and behaviors. To address these gaps, the present study surveyed 28 parent-adolescent dyads. In particular, the study assessed parents on four measures: their views on gender roles generally, their own gender conformity, their views on their adolescents’ gender expression, and their responses to their adolescents’ gender nonconformity, as well as assessing adolescents’ experiences and gender expression. In addition to replicating previous findings, the results of this study suggest that adolescent experiences of parental attitudes predict adolescents’ gender expression, with parental responses to gender nonconformity being the strongest predictor. Explanations for these findings as well as future directions for expanding this work across more diverse populations are discussed.

Lesbian, Gay and Bisexual Adults’ Recollections of Others’ Reactions to Their Early Gender Non-Conformity

Globally, gender non-conforming (GNC) behaviors are identified as one of the earliest precursors of non-heterosexual identity. The role of reactions by key persons such as parents, teachers and peers to such behaviors may be important for sexual identity development. In Sri Lanka, there are currently no scholarly data on lesbian, gay and bisexual (LGB) adults’ recollections of their early experiences, particularly those involving how others reacted to their early GNC and gender atypical behaviors. By collecting narratives, this exploratory research paper addresses this gap by examining how 26 LGB adults recalled the manner in which their parents, teachers, and peers responded to their gender-atypical and gender non-conforming behaviors during childhood and adolescence. A participant-focused thematic analysis highlighted the following themes in participants’ recollections: permissiveness of adults towards childhood gender non-conformity for both boys and girls; a shift in adults’ attitudes during adolescence to be more regulatory; and differences between male and female participants in their recollections of peers’ reactions to their GNC behaviors by their peers. These findings suggest the nuances of recollections about growing up as GNC children and adolescents, and the impact these experiences had on later acceptance of a non-heterosexual identity. Future research could begin by observing actual gender nonconformity and gender atypical behaviors in children and adolescence.

Culture influences the development of children's gender-related peer preferences: Evidence from China and Thailand.

Current understanding of how culture relates to the development of children's gender-related peer preferences is limited. To investigate the role of societal acceptance of gender nonconformity, this study compared children from China and Thailand. Unlike China and other cultures where the conceptualization of gender as binary is broadly accepted, individuals who identify as a nonbinary "third" sex/gender have been highly visible and tolerated in Thai society for at least several decades. Chinese and Thai 4- to 9-year-olds (N=458) viewed vignettes of four hypothetical peers who varied on gender (i.e., boy vs. girl) and gender-typed toy play behavior (i.e., masculine vs. feminine), and were asked to give a friendship preference rating for each peer. Chinese, compared with Thai, children evidenced gender-related peer preferences that emerged earlier, remained more stable across age groups, and were relatively more biased against gender-nonconforming behavior. The only cultural similarity was in children's preference for peers who were of the same gender and/or displayed same-gender-typed behavior. Thus, while preference for peers who are of the same gender and/or display same-gender-typed behavior is common among children across cultures, the developmental onset and course of these preferences vary by culture. Moreover, societal acceptance of gender nonconformity might be key to limiting children's bias against gender-nonconforming peers.

Testing the limits of structural thinking about gender.

When seeking to explain social regularities (such as gender differences in the labor market) people often rely on internal features of the targets, frequently neglecting structural and systemic factors external to the targets. For example, people might think women leave the job market after childbirth because they are less competent or are better suited for child-rearing than men, thereby eliding socio-cultural and economic factors that disadvantage women. Across two studies (total N=192) we probe 4- and 5-year-olds and 7- and 8-year-olds' internal versus structural reasoning about gender. We explore the evaluative and behavioral implications of this reasoning process with both novel gendered behaviors that were experimentally created and familiar gendered behaviors that exist outside of a lab context. We show that children generate more structural explanations, evaluate the structural explanation more positively, expect behaviors to be more mutable, and evaluate gender non-conforming behaviors more positively when structural cues are provided. However, we also show that such information may be of limited effectiveness at reducing pre-existing group-based discriminatory behaviors: children continue to report less willingness to affiliate with peers who display non-conforming behaviors even in the presence of structural cues. Taken together, these results provide evidence concerning children's structural reasoning about gender categories and shed new light on how such reasoning might affect social evaluations and behavioral intentions.

“Those Are Typical Tell-Tale Signs of a Lesbian”: LGBQ Young Peoples’ Perceptions of Parental Messaging Surrounding Gender Non-Conforming Behavior

Socialization surrounding gender and sexuality is prominent within the familial context. Gender and sexuality are frequently linked with the assumption that gender-expansive behavior leads to nonheterosexuality. Research has largely focused on parental perspectives, leaving queer youth experiences largely invisible. Utilizing semistructured interviews with 10 queer young adults, this project contributes to the existing discussions regarding gender and sexuality socialization while growing up. First, participants described parents’ seemingly natural ability to correctly categorize youth’s sexual orientation, which is often linked to gender nonconforming behavior. Participants reinforced essentialized ideas of gender and sexuality through their discussion of engagement in expansive gender behavior. Furthermore, women discussed more freedom to engage in diverse gender behavior, while being expected to conform to traditional gender roles. Through elevating youth’s viewpoints on gender and sexuality family dynamics, these findings can assist service providers and parents in supporting queer youth across their gender and sexual development.

Gender Variance in Children and Adolescents with Neurodevelopmental and Psychiatric Conditions from Australia

Gender variance is a broad term used to describe gender non-conforming behaviors. Past studies have used the parental response to Child Behavior Checklist (CBCL) Item 110, which asks whether a child "Wishes to be of opposite sex" as an indicator of gender variance. The population prevalence of gender variance in children and adolescents using this metric was found to be 1.2% in birth-assigned females and 0.4% in birth-assigned males (Achenbach & Rescorla, 2001). However, in those referred for psychiatric evaluation, it was higher (5.4% of birth-assigned females and 2.8% of birth-assigned males) (Achenbach & Rescorla, 2001). The aim of this study was to use the CBCL to estimate the prevalence of gender variance among children and adolescents with neurodevelopmental and psychiatric conditions and assess whether this was higher compared to controls. The response to the CBCL and the child's neurodevelopmental and/or psychiatric diagnosis were extracted from the clinical notes of 1553 children and adolescents referred to an outpatient psychiatry clinic in Australia. This was compared to data from 181 control participants as well as to the CBCL standardization sample of 1605 controls. Of the 1553 young people, whose mean age was 10.9years, gender variance was reported in 3.1% compared to 1.7% in local control participants (p > .05) and 0.7% in the CBCL controls (p < .0001). Rates varied depending upon the underlying diagnosis (ASD 5.2%; ADHD 2.5%, intellectual disability 4.7%; depression 2.6%; and anxiety 4.7%). In this way, our findings support past observations that young people with neurodevelopmental and psychiatric conditions have high rates of gender variance.

Encouraging Gender Conformity or Sanctioning Nonconformity? Felt Pressure from Parents, Peers, and the Self.

Expectations regarding gendered behaviors are understood to emanate from many sources, including parents, peers, and the self but there has been little research directly comparing these three sources of pressure. The present study assessed felt pressure regarding masculine and feminine stereotypic behaviors and compared pressure from parents, peers, and the self and how these sources are associated with self-perceived gender typicality. Participants (N = 275; 53.09% female; grade 7 M = 12.35 years; grade 9 M = 14.3 years; 71% Anglo-Celtic) were recruited from independent schools in Sydney. Felt pressure from the self to engage in masculine behavior was greater than felt pressure from parents or peers. Male adolescents reported higher felt pressure to conform to gender conforming behavior from parents and the self and pressure to avoid gender nonconforming behavior was greatest from peers. Female adolescents reported felt pressure to conform to gender nonconforming behaviors and this pressure was the strongest from the self. Additionally, for both genders, felt pressure from the self was most consistently associated with gender typicality. These findings highlight the importance of self-expectations for gender cognitions relating to both masculine and feminine behaviors.

Is being gender nonconforming distressing? It depends where you live: gender equality across 15 nations predicts how much gender nonconformity is related to self-esteem.

Individuals exhibiting gender nonconforming behaviors experience low self-esteem and a number of other mental health conditions, including elevated suicide risk. Most of the relevant evidence is confined to US studies, however. Adopting a cross-national approach, we examined the pervasiveness of the psychological burden associated with gender nonconformity. Because self-esteem is sensitive to the fulfillment of societal expectations for gender conformity, we reasoned that the relationship between gender conformity and self-esteem ought to decrease as societies become less restrictive in their gender norms. To test this proposition, we conducted two studies including 18 national samples from 15 countries varying in gender equality. Participants responded to an online survey that included measures of gender conformity and self-esteem (N = 4486). Using multilevel analyses and meta-analytic statistics over the samples of both studies, we found that as gender equality increased, the association between gender conformity and self-esteem decreased. The results suggest that rather than being inherently noxious, gender non-conformity becomes detrimental to self-esteem when it clashes with restrictive gender role norms that are enacted by the macrosocial context. We suggest that previous findings on psychological problems related to gender nonconformity be considered within a broader macrosocial context that may constrain people's freedom to move against gender role norms.

Girls and the juvenile justice system: Community stakeholders recognize gender non-conforming behavior as “criminal” for girls

Behaviors that guide girls into the correctional environment often pose little or no threat to public safety (e.g., running away). Deeply rooted gender injustice continues to remain persistent and drives girls deeper into the system. Despite continued discussion on improvement of societal gender norms, girls’ deviant behavior is often considered different from boys. In rural communities, girls’ deviance may be viewed as a threat to societal norms of femininity or a product of poor choices. For girls, these non-violent behaviors pave a way into the system and potentially a life behind bars. The current study serves as a contemporary comparison of qualitative responses outlining differences between perceived deviancy of girls and boys among a sample of community stakeholders in a Midwestern state. Results are consistent—girls continue to be held to different, lesser, standards of “appropriate” conduct than boys, creating a pathway into the juvenile correctional system.

Childhood Maltreatment, Gender Nonconformity, and Adolescent Sexual Orientation: A Prospective Birth Cohort Study.

This study tested whether associations between childhood maltreatment and adolescent sexual orientation were accounted for by childhood gender nonconforming behavior (GNCB) in a prospective birth cohort (N=5,007). Childhood parental maltreatment (physical and emotional) and GNCB were assessed on multiple occasions up to age 6years, and sexual orientation at 15.5years. Boys with a history of maltreatment were significantly more likely to be nonheterosexual. Using propensity score weighting, maltreatment was associated with a 3.5% (p=.03) increase in the prevalence of nonheterosexuality accounting for confounders not including GNCB, and by 2.9% (p=.06) when also accounting for GNCB. These findings suggest that maltreatment is associated with an increased prevalence of nonheterosexuality in boys but may be explained by confounding factors including GNCB.

Overview of care for transgender children and youth

Over the past decade, more and more children and adolescents are identifying as transgender and gender diverse (TGD). Often, they and their parents first turn to their primary care pediatrician for guidance and support. Therefore, in 2018, the American Academy of Pediatrics (AAP) released a policy statement focusing on the health care of TGD youth.4 The AAP acknowledges that many pediatricians have a lack of training in this area and therefore need to increase their knowledge base and expertise in order to provide culturally competent care. While most sexual and gender minority individuals are healthy and well adjusted, some TGD youth are at an increased risk of mental health concerns, including anxiety, depression, substance abuse, eating disorders and suicidality. This is theorized to be due to the experienced or internalized marginalization, stigmatization, victimization, harassment or rejection and not inherent in having gender dysphoria or being transgender. The pediatrician therefore needs to be knowledgeable of, and skilled to screen for, the health disparities that may exist, as well as to be able to support the individual who may disclose their gender identity status during treatment. Parents and guardians may also turn to the pediatrician for guidance when faced with their child who presents with gender non-conforming behaviors or gender dysphoria. Therefore the pediatrician needs to be able to guide the parents as well, as their acceptance and support of their child's journey to gender identity is probably the most important protective factor against health disparities encountered. To deliver optimum care for TGD children and youth, the pediatrician needs to establish an office setting that is inclusive, gender-neutral and TGD friendly. By becoming familiar with the diversity of gender expression and identities, use of gender-appropriate terminology, health disparities often encountered and the importance of providing a safe and welcoming environment, issues that are all covered in this article, the primary care pediatrician will be in position to provide comprehensive health care to this often marginalized population.

Childhood gender-typed behavior and emotional or peer problems: a prospective birth-cohort study.

Retrospective and cross-sectional studies often report associations between childhood gender nonconformity and greater emotional and peer difficulties. This study used the ALSPAC birth cohort to investigate relationships between childhood gender-typed behavior and peer and emotional problems throughout childhood and adolescence. A total of 11,192 participants had at least one measure of parent-rated gender-typed behavior in infancy; 7,049 participants had a measure of child-rated gender-typed behavior at 8.5years. Separate linear mixed regression models were fitted to assess whether parent-rated and child-rated gender-typed behaviors were associated with emotional and peer problems across childhood and adolescence (6-16years old). The effect of adding covariates (self-esteem, abuse, bullying, feeling accepted by peers, and feeling different) on these relationships was assessed. For boys, more gender-nonconforming behavior was associated with greater subsequent emotional and peer problems in childhood and adolescence. Adjusting for self-esteem, relational bullying victimization, feeling different, or feeling accepted by peers reduced some of these associations. In contrast, for girls, more gender-nonconforming behavior was associated with fewer emotional problems in childhood and adolescence. In girls, self-reported gender-nonconforming behavior was also associated with fewer parent-rated peer problems but parent-rated gender-nonconforming behavior was associated with more parent-rated peer problems; this latter association was partly explained by self-esteem, bullying, and abuse victimization. These associations were statistically significant but small. Overall, more female-typical behaviors were generally associated with greater subsequent emotional and peer problems, for both boys and girls. Future studies should investigate factors that reduced these associations, as well as potential negative effects of female-typical behaviors or advantages of male-typical ones. As this was a 14-year longitudinal study, the relationships between gender-role behaviors and emotional/peer problems warrant further research despite the small association sizes.

Does Gender Nonconforming Behavior in Early Childhood Predict Adolescents' Depressive Symptoms?

Gender nonconforming behavior (GNB) is a risk factor for poorer psychological adjustment, but little is known about whether preschool-age children displaying GNB are at risk for depressive symptoms during adolescence. We examined maternal report of GNB at age 4-5 years-old as a predictor of adolescents' depressive symptoms at age 16-17 years-old in a longitudinal study of U.S. children from a predominantly low SES (61% received Aid to Families with Dependent Children) and African American (90%) sample. Youth with GNB in early childhood (n = 10) reported more depressive symptoms during adolescence than did their peers without GNB (n = 115), and this relationship remained after controlling for covariates (environmental risk, prenatal exposure, and neonatal medical problems). Our findings suggest that early GNB may be a risk factor for the development of depressive symptoms in adolescence. Further research is needed to replicate the current findings with a larger sample and to identify the underlying mechanisms by which GNB may increase risk for depressive symptoms. If replicated, the findings further highlight the need for both professionals and parents to become aware of the potential challenges that children with GNB face and to become knowledgeable about ways to facilitate healthy adjustment among gender nonconforming youth.

Young Children With Gender Nonconforming Behaviors and Preferences.

There is growing awareness and exposure in both the medical community and the lay media about the characteristics and complex needs of individuals who believe that their gender identity does not match their birth sex. Despite research and lay publications about teens with gender dysphoria and those who identify as transgender, little guidance is available regarding young (prepubertal) children with questions about their gender identity. Although many terms are used to describe these children, we have chosen to describe them as "gender nonconforming" (GNC). Primary care and developmental-behavioral pediatric providers are often the first professionals with whom young gender nonconforming children and their families discuss their concerns about their emerging gender identity. It is important, therefore, that pediatric providers be knowledgeable about the dilemmas, conflicts, and choices that are typical of these children and their families to guide them appropriately. In this special article, we present observations, informed by clinical experience, an emerging body of research, and a developmental-behavioral pediatric framework, of the complex needs of prepubertal gender nonconforming children and their families and an approach to their care. The article begins by outlining the cognitive and biological bases for gender identity development, as well as the natural history of gender nonconforming preferences and behaviors. It then sets the context for understanding the care of GNC children as an area in which developmentally sophisticated providers can play a crucial role in support of the complex developmental patterns and need for advocacy in multiple settings among these children.

The processing of the Dutch masculine generic zijn 'his' across stereotype contexts: An eye-tracking study.

Language users often infer a person’s gender when it is not explicitly mentioned. This information is included in the mental model of the described situation, giving rise to expectations regarding the continuation of the discourse. Such gender inferences can be based on two types of information: gender stereotypes (e.g., nurses are female) and masculine generics, which are grammatically masculine word forms that are used to refer to all genders in certain contexts (e.g., To each his own). In this eye-tracking experiment (N = 82), which is the first to systematically investigate the online processing of masculine generic pronouns, we tested whether the frequently used Dutch masculine generic zijn ‘his’ leads to a male bias. In addition, we tested the effect of context by introducing male, female, and neutral stereotypes. We found no evidence for the hypothesis that the generically-intended masculine pronoun zijn ‘his’ results in a male bias. However, we found an effect of stereotype context. After introducing a female stereotype, reading about a man led to an increase in processing time. However, the reverse did not hold, which parallels the finding in social psychology that men are penalized more for gender-nonconforming behavior. This suggests that language processing is not only affected by the strength of stereotype contexts; the associated disapproval of violating these gender stereotypes affects language processing, too.