A critical commentary on follow-up studies and “desistance” theories about transgender and gender-nonconforming children

ABSTRACT

Background: It has been widely suggested that over 80% of transgender children will come to identify as cisgender (i.e., desist) as they mature, with the assumption that for this 80%, the trans identity was a temporary “phase.” This statistic is used as the scientific rationale for discouraging social transition for pre-pubertal children. This article is a critical commentary on the limitations of this research and a caution against using these studies to develop care recommendations for gender-nonconforming children.

Methods: A critical review methodology is employed to systematically interpret four frequently-cited studies that sought to document identity outcomes for gender-nonconforming children (often referred to as “desistance” research).

Results: Methodological, theoretical, ethical, and interpretive concerns regarding four “desistance” studies are presented. The authors clarify the historical and clinical contexts within which these studies were conducted to deconstruct assumptions in interpretations of the results. The discussion makes distinctions between the specific evidence provided by these studies versus the assumptions that have shaped recommendations for care. The affirmative model is presented as a way to move away from the question of, “How should children's gender identities develop over time?” toward a more useful question: “How should children best be supported as their gender identity develops?”

Conclusion: The tethering of childhood gender diversity to the framework of “desistance” or “persistence” has stifled advancements in our understanding of children's gender in all its complexity. These follow-up studies fall short in helping us understand what children need. As work begins on the 8th version of the Standards of Care by the World Professional Association for Transgender Health, we call for a more inclusive conceptual framework that takes children's voices seriously. Listening to children's experiences will enable a more comprehensive understanding of the needs of gender-nonconforming children and provide guidance to scientific and lay communities.     

Fatigue following Paediatric Acquired Brain Injury and its Impact on Functional Outcomes: A Systematic Review

Fatigue is a commonly reported sequela following an acquired brain injury (ABI), and can have a negative impact on many areas of a child’s life. However, there is minimal research that focuses on fatigue specifically, and so factors such as its occurrence, duration, and impact on functioning remain uncertain. This systematic review aims to provide a comprehensive summary of the research to date, bringing together a number of studies with a focus on paediatric ABI and fatigue. Terms were searched in relevant databases (PsycInfo, Medline, CINAHL), and articles were included or excluded based on specified criteria. Of the 1177 papers identified in the original search, a total of 9 papers met inclusion criteria, and were categorised as traumatic brain injury (TBI; n?=?4), meningitis and meningococcal disease (n?=?2), brain tumours (n?=?2), and mixed ABI group (n?=?1). Key findings suggest that fatigue is a problem encountered by a significant proportion of patients in all the studies reviewed, and often occurred regardless of the cause; fatigue was also associated with poor academic achievement, limited physical activity, and social and emotional problems. Injuries of greater severity were associated with higher levels of fatigue and worse outcomes. Several management options were suggested, though their efficacy was not reported. Future research is required with a suggested focus on using multiple time points to better understand the trajectories of fatigue following childhood ABI, and to build an evidence base to determine which management options are most suitable.     

Negative intergroup contact makes group memberships salient: explaining why intergroup conflict endures

Drawing from the intergroup contact model and self-categorization theory, the authors advanced the novel hypothesis of a valence-salience effect, whereby negative contact causes higher category salience than positive contact. As predicted, in a laboratory experiment of interethnic contact, White Australians (N = 49) made more frequent and earlier reference to ethnicity when describing their ethnic contact partner if she had displayed negative (vs. positive, neutral) nonverbal behavior. In a two-wave experimental study of retrieved intergenerational contact, American young adults (N = 240) reported age to be more salient during negative (vs. positive) contact and negative contact predicted increased episodic and chronic category salience over time. Some evidence for the reverse salience-valence effect was also found. Because category salience facilitates contact generalization, these results suggest that intergroup contact is potentially biased toward worsening intergroup relations; further implications for theory and policy making are discussed.     

Innovative Practice,Clinical Research,and the Ethical Advancement of Medicine

Innovative practice occurs when a clinician provides something new, untested, or nonstandard to a patient in the course of clinical care, rather than as part of a research study. Commentators have noted that patients engaged in innovative practice are at significant risk of suffering harm, exploitation, or autonomy violations. By creating a pathway for harmful or nonbeneficial interventions to spread within medical practice without being subjected to rigorous scientific evaluation, innovative practice poses similar risks to the wider community of patients and society as a whole. Given these concerns, how should we control and oversee innovative practice, and in particular, how should we coordinate innovative practice and clinical research? In this article, I argue that an ethical approach overseeing innovative practice must encourage the early transition to rigorous clinical research without delaying or deferring the development of beneficial innovations or violating the autonomy rights of clinicians and their patients.     

Sad mood,emotion regulation,and response inhibition

ABSTRACT

Affect-as-information models, resource allocation models, and arousal biased competition theory predict different effects of mood on cognition. To test these theories, this study examines the effect of sad mood on response inhibition (RI) and whether emotion dysregulation impacts this potential relationship. Participants were 273 undergraduates who wrote about either a typical day or a sad event from their life. They self-reported mood and emotion regulation difficulties, and RI was a composite score of Colour-Word Stroop, Stop-Signal, and go/no-go computerised tasks. The intensity of self-reported sad mood did not affect RI as predicted, but those who wrote about sad events had worse RI. Worse emotion regulation also predicted worse RI. Cognitive loads, rumination, and mind-wandering are discussed as possible mechanisms. Findings are extended from well-established areas such as working memory to the less-established area of RI.     

The Grandparent–Grandchild Relationship

We report two studies which examine the age stereotypes in interactions model of intergenerational communication. We investigate whether stereotyping processes mediate the effects of various predictors on communication outcomes. Support emerges for the mediating role of stereotyping. The studies also examine relational factors finding support for the argument that relational factors deserve more attention in models of intergenerational communication. Central variables emerging as predictive of intergenerational communication or stereotyping include perceived health of an older adult interlocutor, relational closeness, the nature of the relationship (grandparent versus older adult acquaintance), reciprocal self‐disclosure, and age salience.