Gender-inclusive clinical screeners: Using CBCLs and YSRs in a clinic-based sample of transgender/gender-diverse youth.

This study examines differences in score profiles on the Child Behavior Checklist (CBCL) and Youth Self-Report (YSR) for transgender and gender-diverse (TGD) youth in a clinical setting. Data were collected from youth receiving services at a gender care clinic in the Midwestern United States. Inclusion criteria were youth that identify as transgender, nonbinary, or another gender-diverse identity label between the ages of 6 and 18 and received services between October 2017 and November 2021. The analytic sample (N = 177) included 51.4% transmasculine, 17.5% transfeminine, 22.6% nonbinary/gender-expansive, and 8.5% questioning youth. 88.1% of youth were White. Wilcoxon signed-rank tests compared differences in mean T scores when using male versus female scoring templates for YSR and CBCL separately. Statistically significant differences were found on the majority of scales, particularly for TGD adolescents. For example, significant differences were found on the YSR for 10 of 11 scales for transmasculine and transfeminine youth ages 11-18 and 9 of 11 scales for nonbinary/gender-expansive youth. McNemar's test revealed significant differences in the number of clinical range scores for transmasculine YSR respondents on Anxious/Depressed, Somatic Complaints, Thought Problems, and Internalizing scales. For CBCL comparison of clinical significance, significant differences were found for Anxious/Depressed, Attention Problems, and Total Problems scales for transmasculine youth ages 12-18. Selecting a scoring template is contextually relevant; however, template selection appears to matter less when examining clinical relevance. Results suggest that clinicians using the CBCL and YSR with TGD youth have flexibility in scoring template selection. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The gender-affirmative life span approach: A developmental model for clinical work with transgender and gender-diverse children, adolescents, and adults.

The gender-affirmative life span approach (GALA) is an innovative therapeutic framework for promoting the mental health of transgender and gender-diverse (TGD) clients of all ages. Based in interdisciplinary philosophical foundations, GALA proposes that TGD clients can be supported in psychotherapy through (a) developing gender literacy, (b) building resiliency, (c) moving beyond the binary, (d) exploring pleasure-oriented sexuality, and (e) making connections to medical interventions. Psychotherapy incorporating these 5 core components is developmentally tailored for children, adolescents, young adults, or older adults. Developing gender literacy is the process of understanding how sex assigned at birth, gender identity, gender expression, and sexual orientation are distinct but interconnected concepts, as well as learning to identify oppressive practices in TGD people's lives. Building resiliency involves learning how to overcome adversity and effectively cope with challenging situations in life. Resiliency-building also involves having social support networks to share these difficulties and gain support. Gender and sexual binaries pathologize nonconformity and limit the full range of healthy gender and sexual expression. Moving beyond the binary to a spectrum approach allows for the inclusion and affirmation of all gender identities and expressions. Unfortunately, research and practice have largely focused on negative sexual outcomes for TGD people. Thus, age-appropriate psychotherapy aimed at developing sex-positive pleasure and satisfaction is critical. Lastly, gender-competent mental health practitioners need to have knowledge about, and skills to refer for, medical interventions, when appropriate. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Utrecht Gender Dysphoria Scale - Gender Spectrum (UGDS-GS): Construct validity among transgender, nonbinary, and LGBQ samples.

Background: Researchers combined both versions of the original Utrecht Gender Dysphoria Scale (UGDS) to create a single gender spectrum version (UGDS-GS) which measures dissatisfaction with gender identity and expression over time as well as comfort with affirmed gender identity. Aim: This study examined the construct validity of the newly revised, UGDS-GS. Method: Tests of measurement invariance were conducted in stages to assess measurement invariance of the UGDS-GS across three groups: cisgender, binary transgender, and nonbinary/genderqueer. Results: Findings indicate that the UGDS-GS functions acceptably in all three gender groups (configural and metric invariance). Also, across binary transgender and nonbinary/genderqueer groups, the measure functions very similarly with all four types of invariance. Item level findings highlight the specificity of the measure to distinguish experiences of binary transgender and nonbinary/genderqueer persons differently from cisgender LGBQ individuals. Conclusions: The UGDS-GS demonstrates a large degree of invariance across binary transgender, nonbinary/genderqueer, and cisgender LGBQ subgroups; and therefore, findings indicate this revision to be a substantial improvement. This 18-item self-report, Likert-type scale measure is a) inclusive of all gender identities and expressions (e.g., transfeminine spectrum, transmasculine spectrum, genderqueer, nonbinary, cisgender); b) appropriate for use longitudinally from adolescence to adulthood; and c) administered at any point in the social or medical transition process, if applicable, or in community-based research focused on gender dysphoria that examines cisgender and transgender persons.

Creating gender: A thematic analysis of genderqueer narratives.

Background and Aims: Increasingly, research is emerging on the subjective experience of genderqueer people. This study explored how genderqueer identities are understood and managed in both personal and social domains. Method: Interview data from 25 genderqueer-identified American adolescents and emerging adults, aged 15 to 26 (M = 21.28, SD = 3.20), were pulled from a larger study of 90 transgender and genderqueer participants. The 90-minute semi-structured interviews included questions about gender identity, the developmental pathway of participants, and relationships with others regarding gender. Results: Participants described "genderqueer" as a sufficiently broad category to capture their diverse experiences, and descriptions of genderqueer identities were heterogeneous, directly contradicting binary understandings of gender identity. A thematic analysis of interview transcripts resulted in three themes: intrapsychic experience, descriptions of master narratives about gender identity, and the co-construction of identities. Discussion: Participants described navigating a series of master and alternative narratives, such that all transgender people transgress a cisnormative master narrative, but genderqueer people further transgress normative understandings of a medicalized, binary transgender identity. The experience of co-creating identities was the process by which participants actively navigated constraints of the master narrative experience. Participants described the integral role of language in crafting new narratives to legitimize genderqueer experiences, as well as the subsequent intragroup conflict resulting from conflicting relationships to narratives in the transgender community. This study highlights genderqueer identities as a source of strength and positivity, and the importance of expanding beyond the hegemonic gender binary within research and clinical practice.

The gender affirmative lifespan approach (GALA): A framework for competent clinical care with nonbinary clients.

Background: The limited research on nonbinary individuals suggests that this community experiences significant health disparities. Compared to binary transgender individuals, research suggests that nonbinary individuals are at elevated risk for discrimination and negative mental health outcomes, including depression, anxiety, traumatic stress, and suicidality. Even mental health providers who work with binary transgender individuals often lack knowledge of and training to work competently with nonbinary individuals. Methods: The authors of this conceptual article present the Gender Affirmative Lifespan Approach (GALA), a psychotherapy framework based in health disparities theory and research, which asserts that therapeutic interventions combating internalized oppression have the potential to improve mental health symptomatology resulting in improved overall health and well-being for gender diverse clients. GALA's therapeutic interventions are designed to promote positive gender identity development through five core components: (1) building resiliency; (2) developing gender literacy; (3) moving beyond the binary; 4) promoting positive sexuality; and (5) facilitating empowering connections to medical interventions (if desired). Results: The core components of the GALA model are individualized to each client's unique needs, while taking into consideration age and acknowledging developmental shifts in, or fluidity of, gender across the lifespan. This model represents an inclusive, trans-affirmative approach to competent clinical care with nonbinary individuals. Discussion: Application of the GALA model with nonbinary clients is discussed, including one clinical case vignette.

Predictive validity of the genderqueer identity scale (GQI): differences between genderqueer, transgender and cisgender sexual minority individuals.

Introduction: The Genderqueer Identity Scale (GQI; McGuire et al., this issue) - a newly developed and validated measure - assesses genderqueer identity via four subscales: challenging the gender binary, the extent to which participants actively work to dismantle gender binaries in identity and expression); social construction of gender, or the degree to which participants interpret their gender identity as something that develops versus an innate essentialist phenomenon; theoretical awareness of gender, the degree of social and political intention attached to gender identity; and gender fluidity, or repeated shifting of gender expression across periods of time. Aim: This descriptive study examined the predictive validity of the GQI and group differences in genderqueer identity with a sample of transgender, genderqueer and nonbinary spectrum, and cisgender sexual minority adults (N = 510). Methods: We hypothesized that Genderqueer Non-binary (GQNB) participants would score higher on GQI subscale scores compared to transgender participants who identify within the gender binary. Results: Results from ANOVA models indicated a statistically significant difference in intrapersonal subscales across sexual minority and transgender binary or genderqueer groups. For the interpersonal subscales there were differences across all three groups. Cisgender sexual minority participants reported the lowest levels on all scales, while genderqueer participants reported the highest, and transgender binary were in-between. Discussion: The GQI demonstrates strong predictive validity in distinguishing binary transpersons from GQNB and cisgender sexual minority persons. Findings reveal that these three subgroups who might otherwise be similarly categorized (i.e., LGBTQ) show significant differences on challenging the binary, social construction, theoretical awareness, and gender fluidity constructs.

Revisiting the Link: Evidence of the Rates of Autism in Studies of Gender Diverse Individuals.

Turban and van Schalkwyk assert in their Translations article, "'Gender Dysphoria' and Autism Spectrum Disorder: Is the Link Real?" that an over-representation of autism spectrum disorder (ASD) in gender dysphoria is unsupported based on current evidence. Turban and van Schalkwyk discuss 7 of the currently 19 available empirical studies (excluding reviews and case reports) of the over-occurrence of ASD and/or autism traits with gender dysphoria/diversity. They are correct to note that some ASD screeners may lack specificity; that is, a clinical-range total score could indicate non-ASD-related mental health conditions or other developmental difference. However, they do not account for the 7 available studies which specifically report rates of clinical diagnoses of ASD among unselected gender-diverse samples. We suggest also that many of the studies that assess ASD-symptoms in gender-diverse groups are more convincing than suggested by Turban and van Schalkwyk because they employ measures assessing the multi-dimensionality of ASD symptoms and report significant elevations not only for socially-related symptoms but also for the various components of restricted and repetitive behaviors and interests (RRBI) core to ASD. We come together to write this response as gender clinicians and researchers, autism clinicians and researchers, and key stakeholders, including autistic and autistic transgender self-advocates. We work and live with the co-occurrence of autism and gender diversity on a daily basis, and we are concerned that perpetuating misunderstanding about the co-occurrence places individuals at risk.

Anxious Attachment, Social Isolation, and Indicators of Sex Drive and Compulsivity: Predictors of Child Sexual Abuse Perpetration in Adolescent Males?

It has been suggested that child sexual abuse is related to poor attachment to parents, which is associated with an inability to form intimate relationships. Seto and Lalumière indicated that there were too few studies of adolescent males to determine whether poor attachment was associated with perpetration. This study was designed to follow up on a previous study and further explored the association between insecure attachment to parents, social isolation, and interpersonal adequacy to child sexual abuse perpetration in adolescents. We compared two samples of adolescent males who had committed sexual offenses, those who committed offenses against children (n = 140) and those who committed offenses against peer or adults (n = 92), with a sample of similarly aged males in treatment for mental health or substance use issues (n = 93). Data were collected using a semi-structured interview and computer-administered questionnaire. We found an indirect association between anxious attachment and sexual offenses against child victims, which was accounted for by measures of social involvement and social isolation. These involvement and isolation measures also did not have a direct association with sexual offenses against child victims, in that their contribution was accounted for by a measure of Masculine Adequacy. This Masculine Adequacy, combined with decreased levels of Sexual Preoccupation and Hypersexuality and increased Sexual Compulsivity, was associated with commission of child sexual abuse. The interpersonal variables did not enter a model predicting sexual offending against peers/adults, which seemed solely associated with the interaction between Sexual Compulsivity and Hypersexuality.

Predicting reoffense for community-based sexual offenders: an analysis of 30 years of data.

This study contributes to the area of risk prediction by exploring whether the Static-99R is useful for predicting reoffense in community-based samples, and for noncontact offenders with and without identified victims. A total of 744 participants drawn from an outpatient sex offender treatment program in a large metropolitan area were followed for a period of up to 30 years. Multiple Cox Regressions were run; covariates included length of treatment, status in treatment, Static-99R items, and number of technical probation violations. Overall, reoffending was an infrequent occurrence in this sample regardless of how it was defined, with sexual reoffenses identified in 13% of the sample and any criminal reoffense identified in 20% of the sample. Consistent with previous research, the Static-99R was a better predictor of sex-related reoffenses than of nonsexual reoffenses. However, in no case were more than a couple of the items significantly related to reoffending and these items differed depending on reoffense definition.

Understanding sexual perpetration against children: effects of attachment style, interpersonal involvement, and hypersexuality.

This study explores in an adolescent sample hypotheses about child sexual abuse perpetration drawn from contemporary theories that implicate insecure attachment and adolescent social development. Specifically, three 13- to 18-year-old adolescent male samples (sex offenders with child victims, sex offenders with peer/adult victims, and nonsex delinquent youth) were compared in a cross-sectional design. Participants completed a computer-administered self-report questionnaire and a semistructured attachment style interview. Attachment style was coded by two independent raters blind to study hypotheses and group membership. The results indicated an indirect effect for attachment style. Attachment anxiety affected involvement with peers and interpersonal adequacy. Feelings of interpersonal inadequacy, combined with oversexualization and positive attitudes toward others distinguished sex offenders with child victims from nonsex delinquents and from sex offenders with peer/adult victims. These data provide a preliminary model of sexual abuse perpetration consistent with contemporary theories. Attachment anxiety with a lack of misanthropic attitudes toward others appears to lead to isolation from peers and feelings of interpersonal inadequacy. Individuals with this constellation of factors may turn to children to meet their intimacy and sexual needs, both of which seem to be exaggerated compared with other troubled youth.