"He did girls' things!" Hong Kong and Canadian children's reasoning about moral judgments of peers' gendered behaviors.

Children show less positivity toward gender-nonconforming (GN) than gender-conforming (GC) peers. Yet, little is known about children's reasoning about peers of varying gender expressions, including age-, gender-, and culture-related influences. We investigated how children aged 4- to 5- and 8- to 9-years-old in Hong Kong and Canada (N = 678) reason about their moral judgments of GC and GN peers. After viewing vignettes describing GC and GN boys and girls, we asked children whether each target peer's behavior was right or wrong and why they thought so. We coded children's reasoning using a new coding scheme developed via inductive content analysis. Overall, children's most commonly used reasoning styles were global standard, personal choice, gender stereotypes, "don't know," and others' welfare. Children used more gender stereotype-related reasoning when they were older and from Hong Kong, appraising the GN boy, or when they perceived the target's behavior as wrong. In contrast, children reasoned based on personal choice more when they were from Canada or when they perceived the target's behavior as right. These findings inform how age-, gender-, and culture-related factors are associated with children's reasoning about the acceptability or appropriateness of varying kinds of childhood gendered behavior. They provide insights regarding children's appraisals of different gender expressions by illuminating not only how they view GC and GN peers but also, from their own perspectives, why they do so. These insights have implications for strategies aimed at decreasing gender-related biases and increasing children's acceptance of gender diversity. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Children's implicit gender-toy association development varies across cultures.

Gender-stereotyped beliefs develop early in childhood and are thought to increase with age based on prior research that was primarily carried out in Western cultures. Little research, however, has examined cross-cultural (in)consistencies in the developmental trajectory of gender-stereotyped beliefs. The present study examined implicit gender-toy stereotypes among 4- to 9-year-olds (N = 1,013; 49.70% girls) in Canada, China, and Thailand. Children from all three cultures evidenced implicit gender-toy stereotypes over this developmental period, but cultural differences in the developmental pattern and strength of these stereotypes were apparent. Gender-toy stereotypes were relatively strong and stable across age groups among Thai children and relatively weak and stable across age groups among Chinese children. Canadian 4- to 5-year-old children displayed weaker stereotypes, whereas 6- to 9-year-olds displayed stronger stereotypes. These findings highlight the contribution of culture to children's gender stereotype development. Although gender-toy stereotypes were found among 4- to 9-year-olds in all three cultures examined here, the strength of these stereotypes varies by culture. Furthermore, the previously described increase in gender stereotyping over this developmental period appears to not apply across cultures, thus challenging the conventional view on development in this domain based on prior, mainly Western, research. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Gastrointestinal Disorders in Adolescents and Young Adults: Preparing for a Smooth Transition to Adult-Centered Care.

Chronic gastrointestinal disorders are prevalent in youth worldwide. The chronicity of these conditions often results in their persistence into adulthood. Challenges typically faced by young people transitioning to adulthood are often exacerbated in those with chronic gastrointestinal disease. Increased awareness of these challenges among health care professionals and appropriate policies and procedures for health care transition are critical. This article summarizes research on the challenges faced by emerging adults with the gastrointestinal disease during the transition to adult care. Barriers to optimal transitional care and current guidelines are discussed and used to offer practical recommendations for health care professionals working with this population.

Childhood Gender Variance and the Autism Spectrum: Evidence of an Association Using a Child Behavior Checklist 10-Item Autism Screener.

Childhood gender variance (GV) is associated with autism spectrum disorder (ASD) diagnosis/traits; however, this association has mainly been investigated in clinical samples. An ASD screening measure based on 10 items from the commonly used Child Behavior Checklist (CBCL) might enable investigation of this association in a wider variety of (non-clinical) populations where the CBCL and a measure of GV are available. We investigated whether GV in 6- to 12-year-olds (N = 1719; 48.8% assigned male at birth) from a community sample showed an association with the CBCL 10-item ASD screener. The Gender Identity Questionnaire for Children measured GV. The CBCL 10-item ASD screener measured ASD traits. The remaining CBCL items provided a measure of children's general emotional and behavioral challenges. Higher GV was associated with higher CBCL ASD screener scores, including when controlling for the remaining CBCL items. The CBCL 10-item ASD screener can be useful for investigating the link between GV and ASD traits in 6- to 12-year-olds. Given that the CBCL is commonly employed, secondary analyses of existing datasets that also included a measure of GV could enable investigation of how widely the association between GV and ASD applies across a variety of populations.

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.

The Measurement and Conceptualization of Coping Responses in Pediatric Chronic Pain Populations: A Scoping Review.

Background: Pediatric chronic pain is a prevalent condition that requires significant coping to encourage optimal functioning; however, relevant research is vast, heterogeneous, and difficult to interpret. To date, no attempt has been made to map and summarize the measurement and conceptualization of coping responses in the context of pediatric chronic pain. Objectives: A scoping review was conducted to map and summarize the participant characteristics, methodologies, theoretical frameworks, and measures used to assess coping responses in youth with chronic pain. The extent to which authors used definitions and examples of coping responses (conceptual clarity) as well as consistently used measures (measurement consistency) and their corresponding conceptualizations (conceptual consistency) relative to how they were intended to be used were assessed. Methods: Searches were conducted through MEDLINE (PubMed) and PsycINFO. Following title/abstract screening, full-text extractions were performed on 125 English-language publications on coping in youth with chronic pain. Results: Of the 125 studies, only 12.8% used a theoretical framework to explain the coping responses assessed, and even fewer (7.2%) used theory to guide measure selection. Conceptual clarity was rated "low/very low" (i.e., no definitions and/or examples) for 47.2% of studies. The majority of studies were conducted in the United States (67%) and a preponderance of White and female participants was sampled. The research primarily used quantitative methods (85%) and cross-sectional designs (67%). Parent- or self-report questionnaires were the most common methods for assessing coping (86%). Of the 95 studies that utilized one of the 14 questionnaires with known psychometric properties, 33.7 and 55.8% had one or more discrepancies for conceptual and measurement consistency, respectively. Conclusions: This review highlights the lack of clear descriptions and theoretical frameworks of coping responses for pediatric chronic pain. Inconsistencies in the measurement and conceptualization of coping responses limit research and clinical advancements. As a field, we need to strive toward using well-developed theory to create fewer, more well-established standardized measures with clearly defined coping responses. Opportunities for qualitative and observational research in more diverse patient populations should be considered for theory construction and measure validation. Clinical Trial Registration: https://osf.io/xvn2a/?view_only=eff04e0c0b9649be89d403b10e9ff082.

Examining the Relation Between Gender Nonconformity and Psychological Well-Being in Children: The Roles of Peers and Parents.

No study to date has simultaneously tested how poor peer relations, generic risk factors, and parental attitudes impact the behavioral and emotional challenges of children who vary in their gender expression. In a community sample, the present study investigated various hypothesized psychosocial and generic risk factors regarding the association between childhood gender nonconformity (GNC) and psychological well-being. Canadian parents/guardians reported on their children aged 6-12 years (N = 1719, 48.8% assigned male at birth) regarding their child's GNC, measured by the Gender Identity Questionnaire for Children; behavioral and emotional challenges, measured by the Child Behavior Checklist (CBCL); and peer relations, measured by the CBCL and Strength and Difficulties Questionnaire. Parent/guardian gender-stereotypical attitudes toward child-rearing were assessed using an adapted version of the Child-Rearing Sex Role Attitude Scale, and attachment between the parent/guardian and child was measured with an adapted version of the Child-Rearing Practices Report. Based on regression analyses, GNC was related to elevated behavioral and emotional challenges, and this association was stronger for those who experienced poor peer relations as well as for those whose parents/guardians endorsed gender-stereotyped attitudes and were less willing to serve as a secure base for the child. Recommendations are provided for ways in which social environments can be altered to improve psychological well-being among gender-nonconforming children.

Children's bias in appraisals of gender-variant peers.

Past research suggests that children have biased negative appraisals of gender-variant (GV) peers (i.e., peers who display behaviors/interests that do not align with gender stereotypes). In the current study, Canadian cisgender 4- and 5-year-olds and 8- and 9-year-olds (N = 183; 48.6% girls), who were ethnically diverse (36% White European heritage) and from mostly middle- to upper-income families, viewed vignettes depicting boys and girls as either gender-conforming (GC) or GV. Multiple measures gauged children's appraisals in various domains (i.e., friendship/social preference, popularity, happiness, imitation, and moral judgment). Children's bias against GV peers was modest. Children preferred peers who presented as the same gender and/or with same-gender-typed behaviors/interests. Compared with GC peers, GV peers were rated as less happy, and older children rated a GV boy as less popular. When juxtaposed with a previous study of Hong Kong children that used the same study design, there were several parallels in the patterns observed, but Canadian children had a weaker and less consistent pattern of bias against GV peers than children from Hong Kong. In addition, children from these two cultures showed discrepant patterns for certain aspects of appraisals (e.g., happiness, moral judgment). Overall, these findings inform age-, gender-, and cultural-related influences on children's appraisals of GV peers.

Children's Appraisals of Gender Nonconformity: Developmental Pattern and Intervention.

Gender-nonconforming (GN) children are often perceived less positively, which may harm their well-being. We examined the development of such perceptions and an intervention to modify them. Chinese children's appraisals were assessed using multiple measures (verbal responses, sharing, and rank order task) after viewing vignettes of gender-conforming (GC) and GN hypothetical peers. In Study 1, children (N = 210; 4-, 5-, 8-, and 9-year-olds) were less positive toward GN than GC peers, especially if they were older or if the peers were boys. In Study 2 (N = 211, 8- and 9-year-olds), showing children exemplars of GN peers who displayed positive and GC characteristics subsequently reduced bias against gender nonconformity. These findings inform strategies aimed at reducing bias against gender nonconformity.

Separation anxiety and gender variance in a community sample of children.

In clinical child and retrospective adult samples, childhood gender variance (GV; i.e., cross-gender behaviour) has been associated with separation anxiety (SA; i.e., distress related to separation from attachment figures) in males. This study examined GV and SA in a nonclinical sample of 892 boys and 933 girls aged 6-12 years via parent-reports. Parental factors (i.e., parenting style, parent-child relationship, willingness to serve as an attachment figure, attitudes towards gender stereotypes in children) were examined as potential moderators. GV predicted SA in boys, even when statistically controlling for general psychopathology and demographic variables. Authoritative parenting, closeness in the parent-child relationship, willingness to serve as an attachment figure, and liberal attitudes towards gender stereotypes in children moderated the association between GV and SA in both boys and girls. Thus, SA may be a unique internalizing problem related to GV in boys in nonclinical samples and influenced by a variety of parental factors.

Gender Variance and the Autism Spectrum: An Examination of Children Ages 6-12 Years.

Gender variance (GV) and autism spectrum disorder (ASD) frequently co-occur in clinical populations. We investigated GV in association with ASD characteristics in nonclinical children and in children with developmental/mental health diagnoses. In 6-12-year-olds (N = 2445; 51% birth-assigned boys), the Gender Identity Questionnaire for Children measured GV and the Children's Social Behavior Questionnaire measured six subdomains of ASD characteristics. Among nonclinical children, GV was associated with parent-reported difficulties orienting socially and stereotyped behaviors. GV was also associated with parent-reported clinical diagnoses of ASD, sensory processing disorder, and oppositional defiant disorder. These findings suggest associations between specific ASD characteristics and GV in nonclinical children. Also, childhood GV should be further examined in a range of clinical populations, including ASD individuals.

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

OBJECTIVE: To examine childhood gender nonconformity (GNC) and psychological well-being in a community-based sample using measures that bridge clinical and nonclinical literature. METHOD: 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"). RESULTS: 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. CONCLUSION: 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.

Separation anxiety among birth-assigned male children in a specialty gender identity service.

Previous research suggested that separation anxiety disorder (SAD) is overrepresented among birth-assigned male children clinic-referred for gender dysphoria (GD). The present study examined maternally reported separation anxiety of birth-assigned male children assessed in a specialty gender identity service (N = 360). SAD was determined in relation to DSM-III and DSM-IV criteria, respectively. A dimensional metric of separation anxiety was examined in relation to several additional factors: age, ethnicity, parental marital status and social class, IQ, gender nonconformity, behavioral and emotional problems, and poor peer relations. When defined in a liberal fashion, 55.8% were classified as having SAD. When using a more conservative criterion, 5.3% were classified as having SAD, which was significantly greater than the estimated general population prevalence for boys, but not for girls. Dimensionally, separation anxiety was associated with having parents who were not married or cohabitating as well as with elevations in gender nonconformity; however, the association with gender nonconformity was no longer significant when statistically controlling for internalizing problems. Thus, SAD appears to be common among birth-assigned males clinic-referred for GD when defined in a liberal fashion, and more common than in boys, but not girls, from the general population even when more stringent criteria were applied. Also, the degree of separation anxiety appears to be linked to generic risk factors (i.e., parental marital status, internalizing problems). As such, although separation anxiety is common among birth-assigned male children clinic-referred for GD, it seems unlikely to hold unique significance for this population based on the current data.

Intense/obsessional interests in children with gender dysphoria: a cross-validation study using the Teacher's Report Form.

OBJECTIVE: This study assessed whether children clinically referred for gender dysphoria (GD) show symptoms that overlap with Autism Spectrum Disorder (ASD). Circumscribed preoccupations/intense interests and repetitive behaviors were considered as overlapping symptoms expressed in both GD and ASD. METHODS: To assess these constructs, we examined Items 9 and 66 on the Teacher's Report Form (TRF), which measure obsessions and compulsions, respectively. RESULTS: For Item 9, gender-referred children (n = 386) were significantly elevated compared to the referred (n = 965) and non-referred children (n = 965) from the TRF standardization sample. For Item 66, gender-referred children were elevated in comparison to the non-referred children, but not the referred children. CONCLUSIONS: These findings provided cross-validation of a previous study in which the same patterns were found using the Child Behavior Checklist (Vanderlaan et al. in J Sex Res 52:213-19, 2015). We discuss possible developmental pathways between GD and ASD, including a consideration of the principle of equifinality.