While it has been shown in many studies that transgender youth frequently struggle with significant emotional-behavioral problems, the million dollar question behind this association is the degree to which these symptoms are driven by the intense stigma, lack of acceptance, and
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even outright maltreatment that many of these children and adolescents suffer. This question is relevant not only to point the way for optimal intervention but also for the controversy surrounding the continued inclusion of gender dysphoria, previously known as gender identity disorder, in the DSM5.
To examine this issue further, a group of researchers from the TransYouth Project followed a sample of 73 prepubescent transgender children between the ages of 3 and 12 who had socially transitioned at both home and school. This group was compared cross-sectionally to a sample of nontransgender children as well as a subset of siblings of the trangender children. The main outcome variables were levels of anxiety and depression as measured by the seldom used parent-report questionnaires, the National Institutes of Health Patient Reported Outcomes Measurement Information System. Of note, the transgender children included in this study needed to believe, and not simply wish, that they were actually of the “opposite” gender. Also, none of the subjects, 70% of whom were natal boys who now identified as female, had received any hormonal treatment at the time.
Relative to the control groups or to national norms for the rating scales, the transgender children showed no elevations on depression scores. Some statistically significant differences were found, however, with the transgender group with regard to anxiety, although the mean score for the transgender group (at 54) was not in the clinical (above 63) or even preclinical range (above 60). This finding did not vary according to natal sex.
The authors concluded that their data support the idea that psychiatric symptoms are not inherent in transgender children and that supporting parents and schools in their social transition can result in improved mental health.
While informative, the study does have some limitations. First, one definitely gets that the sense the TransYouth Project was hoping to find the results they did to better advocate for transgender children. While it is probably true that most researchers hope to find a specific result in their studies, this fact probably does have an impact in how the study is interpreted (for example, highlighting the lack of depression rather than the increased anxiety they found). The results also would have been a bit more compelling if the researchers used more widely known rating scales and gathered information from sources other than parents, who might be motivated to demonstrate that their efforts were successful. It would also have been very helpful to present the percentage of children in each group in the clinical and preclinical range for depression and anxiety rather than just the group means.
These problems aside, this study provides some important data, suggesting that transgender children who are provided support and acceptance in their social transition can often be spared much of the anguish that unfortunately befalls many others.
Olson KR, et al. Mental Health of Transgender Children Who Are Supported in Their Identities. Pediatrics 2016, epub ahead of print.