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.     

Transient and sustained incentive effects on electrophysiological indices of cognitive control in younger and older adults

Preparing for upcoming events, separating task-relevant from task-irrelevant information and efficiently responding to stimuli all require cognitive control. The adaptive recruitment of cognitive control depends on activity in the dopaminergic reward system as well as the frontoparietal control network. In healthy aging, dopaminergic neuromodulation is reduced, resulting in altered incentive-based recruitment of control mechanisms. In the present study, younger adults (18–28 years) and healthy older adults (66–89 years) completed an incentivized flanker task that included gain, loss, and neutral trials. Event-related potentials (ERPs) were recorded at the time of incentive cue and target presentation. We examined the contingent negative variation (CNV), implicated in stimulus anticipation and response preparation, as well as the P3, which is involved in the evaluation of visual stimuli. Both younger and older adults showed transient incentive-based modulation of CNV. Critically, cue-locked and target-locked P3s were influenced by transient and sustained effects of incentives in younger adults, while such modulation was limited to a sustained effect of gain incentives on cue-P3 in older adults. Overall, these findings are in line with an age-related reduction in the flexible recruitment of preparatory and target-related cognitive control processes in the presence of motivational incentives.     

A longitudinal assessment of the road to mental readiness training among municipal police

Police agencies increasingly implement training programs to protect mental health. The Road to Mental Readiness (R2MR) program was designed by the Canadian military to increase mental health resilience. A version of R2MR was adapted for municipal police by the Mental Health Commission of Canada (MHCC). The current research was designed to assess the R2MR program, as adapted and delivered by the MHCC, in a municipal police sample. Participants were 147 Canadian police agency employees (57% women) who received a single R2MR training session. Participants completed pre- and post-training self-report questionnaires, and follow-ups at 6 and 12 months. The questionnaires assessed mental health symptoms, work engagement, resiliency, mental health knowledge, and stigma. Multilevel modeling analyses assessed for within-participant changes over time. The results were consistent with other single session interventions; specifically, there were no significant changes in mental health symptoms, resilience, or work engagement (p > .05). There were small, but significant (p < .05), reductions in stigma at post-training that may facilitate help-seeking among police; relatedly, in open-ended response fields, participants commonly described the training as helpful for changing attitudes and improving communication. More engagement with the material may produce larger, sustained gains, but more published research is critically needed.     

Auditory attention switching and judgment switching: Exploring multicomponent task representations

An auditory attention-switching paradigm was combined with a judgment-switching paradigm to examine the interaction of a varying auditory attention component and a varying judgment component. Participants heard two dichotically presented stimuli—one spoken by a female speaker and one spoken by a male speaker. In each trial, the stimuli were a spoken letter and a spoken number. A visual explicit cue at the beginning of each trial indicated the auditory attention criterion (speaker sex/ear) to identify the target stimulus (Experiment 1) or the judgment that had to be executed (Experiment 2). Hence, the attentional selection criterion switched independently between speaker sexes (or between ears), while the judgment alternated between letter categorization and number categorization. The data indicate that auditory attention criterion and judgment were not processed independently, regardless of whether the attention criterion or the judgment was cued. The partial repetition benefits of the explicitly cued component suggested a hierarchical organization of the auditory attention component and the judgment component within the task set. We suggest that the hierarchy arises due to the explicit cuing of one component rather than due to a “natural” hierarchy of auditory attention component and judgment component.     

Secret Agent Society: A Randomized Controlled Trial of a Transdiagnostic Youth Social Skills Group Treatment

Group programs are key for targeting social skills (SS) for children with developmental disorders and/or mental illness. Despite promising evidence regarding efficacy of group treatments, there are several limitations to current research regarding generalizability and effectiveness across diagnoses. This randomized control trial assessed whether the Secret Agent Society (SAS) group program was superior to treatment as usual (TAU) in improving social-emotional functioning for children with Attention Deficit-Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), and/or anxiety. Eighty-nine youth (8–12) with ADHD, ASD, and/or an anxiety disorder receiving treatment at hospital-based outpatient clinics were randomized to receive SAS (n?=?47) or TAU (n?=?42) over a three-month period, at which point TAU participants were offered the SAS intervention. Parent report showed significant improvement in Emotion Regulation (ER) and Social Skills (SS) for youth in SAS vs. TAU (Fs?≥?6.79, ps?≤?01). Gains for the SAS condition were maintained at 6-months. Intent-to-treat analysis of teacher report indicated youth in SAS had positive gains in SS (F?=?0.41, p?=?0.475) and ER (F?=?0.99, p?=?0.322), though not significantly better than youth in TAU. Clinically reliable improvement rates were significantly higher for SAS participants than TAU for parent and teacher reported SS and ER. Improvements were significant for youth with single and comorbid diagnoses. Results suggest that SAS was superior to TAU in improving SS and ER for youth aged 8–12 with ADHD, ASD, and/or anxiety. Gains maintained in the medium-term. Trial registration number NCT02574273, registered 10/12/2015.

     

Self-affirmation versus self-consistency: a comparison of two competing self-theories of dissonance phenomena

High or low self-esteem individuals participated in a role-playing paradigm in which a friend stood them up for a dinner date. The participants received either a good explanation from the friend for the missed date (sufficient justification) or a poor explanation (insufficient justification). As predicted by self-affirmation theory (Steele, 1988), but not self-consistency theory (Aronson, 1999), low-esteem participants derogated the friend more than high-esteem participants under both insufficient and sufficient justification. Also supporting self-affirmation theory, sufficient/low-esteem participants reported more offense for being stood-up than sufficient/high-esteem participants. Discussion centers on the role of self-esteem in dissonance processes and on the need for more research that focuses on dissonance/self-threats that result from the behavior of other(s) rather than one’s own behavior.     

The conflicting choices of alternating selves

Participants made choices after the salience of their social identities was manipulated. Choices assimilated to the salient identity, whether that identity stemmed from a person’s role (e.g., student, family member) or culture (e.g., Chinese, American). Thus, the preferences that participants expressed depended on the identity that happened to be salient at the moment of choice, with participants expressing preferences when one identity was salient that conflicted with the preferences they would express were another identity salient. These effects only arose for those who held and identified with the evoked identity. Studies further revealed that such identity-congruent choices influence post-choice satisfaction and regret: participants were less satisfied with their prior choices when the identity salient during post-choice evaluation or consumption was different from the identity salient during choice, compared to when the “choosing” and “consuming” identities were the same. Implications of the findings are discussed.     

Evaluation of a Career Development Skills Intervention With Adolescents Living in an Inner City

The authors evaluated the effectiveness of an intervention with adolescents living in an inner city that was based on the Integrative Contextual Model of Career Development (Lapan, 2004). Adolescent participants reported greater efficacy and positive self‐attributions and greater skills in person‐environment fit; social, prosocial, and work readiness; the garnering of emotional and instrumental support; and self‐regulated learning. Adolescents who participated in a more traditional career counseling model only reported greater emotional support than did adolescents not receiving career counseling.