Behavioral and Emotional Problems in Gender-Nonconforming Children: A Canadian Community-Based Study

• Published in: Journal of the American Academy of Child and Adolescent Psychiatry Vol. 57; no. 7; pp. 491 - 499
• Main Authors: van der Miesen, Anna I.R., Nabbijohn, A. Natisha, Santarossa, Alanna, VanderLaan, Doug P.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-07-2018; Elsevier BV
• Subjects: Behavior; Behavior Rating Scales; Bias; Caregivers; Check Lists; Child & adolescent psychiatry; Child Behavior; Child Behavior Checklist; Child psychology; Childhood; Children; Childrens health; Community; Community Relations; community sample; Conformity; Emotional behavior; Emotional disturbances; Emotional Problems; Externalizing problems; Females; Gender dysphoria; Gender identity; Gender nonconforming; gender nonconformity; Girls; Males; Mental depression; Mental disorders; Mental health; Psychological well being; Questionnaires; gender nonconformity; Child Behavior Checklist; community sample; mental health
• ISSN: 0890-8567; 1527-5418
• DOI: 10.1016/j.jaac.2018.03.015

To examine childhood gender nonconformity (GNC) and psychological well-being in a community-based sample using measures that bridge clinical and nonclinical literature.
Caregivers reported on the GNC (Gender Identity Questionnaire for Children [GIQC]) and behavioral and emotional problems (Child Behavior Checklist [CBCL]) of their children aged 6 to 12 years (N = 1719, 48.8% boys). The GIQC was compared to the commonly used single-item proxy, CBCL Item 110 (“wishes to be of the opposite sex”).
Using the GIQC, 2.3% of boys and 2.8% of girls showed GNC levels comparable to those of children referred clinically for gender dysphoria (GD). Item 110 was endorsed for 1.7% of boys and 1.8% of girls. These measures corresponded, but Item 110 endorsement was biased toward more extreme GNC. Among boys, increased GNC on the GIQC, but not Item 110, corresponded with increased clinical-range CBCL problems. Among girls, Item 110 endorsement was associated with increased clinical-range Externalizing problems, whereas the GIQC indicated that intermediate gender expression was associated with fewer externalizing problems. Overall, rates of clinical-range CBCL problems among GNC children were consistent with those reported for GD-referred children.
The scope of mental health risk among community children who exhibit GNC is likely considerably greater than previously recognized. A substantial minority of community children show GNC and mental health risk levels comparable to those seen among GD-referred children. Also, compared to the GIQC, a more comprehensive GNC measure, CBCL Item 110 is likely useful only for detecting extreme manifestations of GNC, which may affect associations with mental health.