Cinsiyet Hoşnutsuzluğu Belirtileri Gösteren Çocuklarda Demografik ve Klinik Özellikler: Bir Türkiye Örneklemi

Year 2023, Volume: 17 Issue: 2, 133 - 138, 22.03.2023

Hatice Güneş , M. Levent Kayaalp

https://doi.org/10.12956/tchd.1142786

Cited By: 1

Abstract

Amaç: Bu araştırmada cinsiyet hoşnutsuzluğu (CH) belirtileri gösteren 3-12 yaş aralığındaki çocuklarda demografik ve klinik özelliklerin tanımlanması amaçlanmıştır.

Gereç ve Yöntemler: Araştırmaya CH belirtileri gösteren 20 çocuk dahil edilmiştir (17 erkek, 3 kız; ortalama yaş 6.63±2.43 yıl). Araştırmada demografik ve klinik veriler ile pre-peri- ve postnatal özelliklerin kaydedilmesi amacıyla sosyodemografik veri formu; davranışsal ve duygusal sorunların değerlendirilmesi amacıyla ise Çocukluk Çağı Davranış Değerlendirme Ölçeği (ÇÇDDÖ) kullanılmıştır.

Bulgular: Araştırmamız örnekleminde erkek/ kız oranı 5.66’dır. CH belirtilerinin ortaya çıkma yaşı ortalama 2.85±1.17 yıldır. Ortalama başvuru yaşı ise 5.82±2.27 yıl bulunmuştur. Annelerin %20’si gebelik öncesinde karşı cinsiyetten bir çocuk tercihi olduğunu belirtmiş; %20’si prenatal dönemde stres, %20’si prenatal, %25’i ise postnatal dönemde depresif belirtiler bildirmiştir. Katılımcıların %10’unda düşük riski öyküsü mevcuttur ve %25’i prematüredir. Katılımcıların %55’nin ÇÇDDÖ içe yönelim sorun davranış puanları; %40’nın ise dışa yönelim sorun davranış puanları klinik eşiğin üzerinde yer almıştır.

Sonuç: Ergenlik öncesi dönemde, kız çocuklarına kıyasla daha fazla erkek çocuğu CH belirtileri ile kliniğimize yönlendirilmiştir. Ülkemizde CH belirtileri ile ilk başvuru yaşı batı ülkelerinde göre daha düşük bulunmuştur. CH olan çocuklarda ruhsal işlevsellik düşük bulunmuştur. CH olan çocuklarda yaşanan ruhsal sorunların CH’nun kendisinin yanı sıra karşı cinsiyet ilgileri ve davranışlarına karşı toplumsal tutumların da etkili olduğu düşünülmüştür. 

Keywords

cinsiyet hoşnutsuzluğu, cinsiyet kimliği, çocuk

Demographic and Clinical Characteristics of Children with Gender Dysphoria Symptoms: A Turkish Sample

Abstract

Objective: In this study, we aim to describe the demographic and clinical characteristics and psychological functioning of children with gender dysphoria (GD) symptoms aged between 3-12 years.

Material and Methods: The study group included 20 children (17 males, 3 females; mean age 6.63±2.43 years) with GD symptoms. A sociodemographic data form was used to collect data with regards to demographic and clinical characteristics, and pre- peri-and postnatal features. The Child Behavior Checklist (CBCL) is used to assess behavioral and emotional problems in the child.

Results: The boy/girl ratio in the study group was 5.66. The mean age at onset of gender-nonconforming behaviors was 2.85±1.17 years and the mean age of admission to our clinic was 5.82±2.27 years. 20% of the mothers reported a preference for an opposite-sex child prior to conception; 20 % of the mothers reported prenatal stress, 20% of the mothers had prenatal and 25% had postnatal depressive symptoms. There was a risk of miscarriage in 10% of children and 25% were born prematurely. 55% of our study sample exceeded the clinical threshold for internalizing problems and 40% exceeded the clinical threshold for externalizing problems in CBCL ratings.

Conclusion: There were more prepubertal boys than girls referred for GD symptoms and the age at referral was younger compared to western countries. In addition, findings of this study indicate that children with GD have poorer psychological functioning possibly due to social intolerance for cross-gender behaviors and/or interests alongside the GD per se. 

Keywords

gender dysphoria, gender identity, child, prepubertal

References

• 1. d’Abrera JC, D’Angelo R, Halasz G, Prager S, Morris P. Informed consent and childhood gender dysphoria: emerging complexities in diagnosis and treatment. Australas Psychiatry 2020;28:536–8.
• 2. Becker I, Ravens-Sieberer U, Ottová-Jordan V, Schulte-Markwort M. Prevalence of adolescent gender experiences and gender expression in Germany. J Adolesc Heal 2017;61:83–90.
• 3. Bonifacio JH, Maser C, Stadelman K, Palmert M. Management of gender dysphoria in adolescents in primary care. CMAJ 2019;191:E69–75. Available from: URL:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6336471/pdf/1910e69.pdf. Accessed: 16 September 2022.
• 4. American Psychiatric Association. Diagnostic and statistical manual of mental disorders-Text Review: DSM-4-TR. Washington, DC: American Psychiatric Association, 2000.
• 5. American Psychiatric Association. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association, 2013.
• 6. Akgül GY, Ayaz AB. Gender dysphoria in children and adolescents/Çocuk ve ergenlerde cinsiyet hoşnutsuzluğu. J Ist Faculty Med 2021;84:S4–10.
• 7. Zucker KJ. Epidemiology of gender dysphoria and transgender identity. Sex Health 2017;14:404–11.
• 8. Van Beijsterveldt CEM, Hudziak JJ, Boomsma DI. Genetic and environmental influences on cross-gender behavior and relation to behavior problems: A study of Dutch twins at ages 7 and 10 years. Arch Sex Behav 2006;35:647–58.
• 9. Coleman E, Bockting W, Botzer M, Cohen-Kettenis P, De-Cuypere G, Feldman J, et al. Standards of care for the health of transsexual, transgender and gender nonconforming people, version 7. Int J Transgenderism 2012;13:165–232. 10. Frew T, Watsford C, Walker I. Gender dysphoria and psychiatric comorbidities in childhood: a systematic review. Aust J Psychol 2021;73:255–71.
• 11. Akgül GY, Ayaz AB, Yildirim B, Fis NP. Autistic traits and executive functions in children and adolescents with gender dysphoria. J Sex Marital Ther 2018;44:619–26.
• 12. Akgül GY, Budak BY, Ayaz AB, Fiş NP. Psychiatric Follow-up of Adolescents with Gender Dysphoria: Marmara University Faculty of Medicine Child Psychiatry Clinic Experience/Cinsiyet Hosnutsuzlugu Olan Ergenlerin Psikiyatrik Izlemleri: Marmara Universitesi Tip Fakultesi Cocuk Psikiyatri Klinigi. Turkish J Child Adolesc Ment Heal 2020;27:156–62.
• 13. Yildirim B, Fis NP, Akgul GY, Ayaz AB. Gender dysphoria and attention problems: Possible clue for biological underpinnings. Psychiatry Clin Psychopharmacol 2017;27:283–90.
• 14. Achenbach T. Manual for Child Behavior Checklist/ 4-18 and 1991 Profile. Burlington: University of Vermont, Department of Psychiatry, 1991.
• 15. Erol N, Arslan B, Akçakın M. The adaptation and standardization of the Child Behavior Checklist among 6-18 years old Turkish Children. In: Sergeant J (ed). Eunethydis: European Approaches to Hyperkinetic Disorder. Zürih: Fotorotar, 1995:97–113.
• 16. Erol N, Şimsek Z. Çocuk ve gençlerde ruh sağlığı: yeterlik alanları, davranış ve duygusal sorunların dağılımı. In: Erol N, Kılıç C, Ulusoy M, Keçeci M, Şimşek Z (eds). Türkiye Ruh Sağlığı Profili Raporu. Ankara: Eksen Yayıncılık, 1998.
• 17. World Medical Association. World Medical Association Declaration of Helsinki. Ethical principles for medical research involving human subjects. Bull World Health Organ 2001;79:373-4.
• 18. de Vries ALC, Cohen-Kettenis PT. Clinical management of gender dysphoria in children and adolescents: The Dutch approach. J Homosex 2012;59:301–20.
• 19. Singh D, Bradley SJ, Zucker KJ. A Follow-Up Study of Boys With Gender Identity Disorder. Front Psychiatry 2021;12:632784. Available from: URL:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8039393/pdf/fpsyt-12-632784.pdf. Accessed: 1 July 2022.
• 20. Cohen-Kettenis PT, Owen A, Kaijser VG, Bradley SJ, Zucker KJ. Demographic characteristics, social competence, and problem behavior in children with gender identity disorder: A cross-national, cross-clinic comparative analysis. J Abnorm Child Psychol 2003;31:41–53.
• 21. Di Ceglie D, Freedman D, McPherson S, Richardson P. Children and adolescents referred to a specialist Gender Identity Development Service: Clinical features and demographic characteristics. Int J Transgenderism 2002;6:97-103.
• 22. Wood H, Sasaki S, Bradley SJ, Singh D, Fantus S, Owen-Anderson A, et al. Patterns of referral to a gender identity service for children and adolescents (1976-2011): Age, sex ratio, and sexual orientation. J Sex Marital Ther 2013;39:1–6.
• 23. Steensma TD. From gender variance to gender dysphoria: Psychosexual development of gender atypical children and adolescents. (Doctoral dissertation). Amsterdam:Vrije Universiteit, 2013.
• 24. de Graaf NM, Carmichael P, Steensma TD, Zucker KJ. Evidence for a Change in the Sex Ratio of Children Referred for Gender Dysphoria: Data From the Gender Identity Development Service in London (2000–2017). J Sex Med 2018;15:1381–3.
• 25. Skordis N, Kyriakou A, Dror S, Mushailov A, Nicolaides CN. Gender dysphoria in children and adolescents: an overview. Hormones 2020;19:267–76.
• 26. Turban JL, Ehrensaft D. Research Review: Gender identity in youth: treatment paradigms and controversies. J Child Psychol Psychiatry 2018;59:1228–43.
• 27. Martinerie L, Condat A, Bargiacchi A, Bremont-Weill C, De Vries MC, Hannema SE. Management of endocrine disease: Approach to the management of children and adolescents with Gender Dysphoria. Eur J Endocrinol 2018;179:R219–37.
• 28. Claahsen - van der Grinten H, Verhaak C, Steensma T, Middelberg T, Roeffen J, Klink D. Gender incongruence and gender dysphoria in childhood and adolescence—current insights in diagnostics, management, and follow-up. Eur J Pediatr 2021;180:1349–57.
• 29. Hilton MN, Boulton KA, Kozlowska K, McClure G, Guastella AJ. The co-occurrence of neurodevelopmental disorders in gender dysphoria: Characteristics within a paediatric treatment-seeking cohort and factors that predict distress pertaining to gender. J Psychiatr Res 2022;149:281–6.
• 30. Øien RA, Cicchetti DV, Nordahl-Hansen A. Gender Dysphoria, Sexuality and Autism Spectrum Disorders: A Systematic Map Review. J Autism Dev Disord 2018;48:4028–37.
• 31. Thrower E, Bretherton I, Pang KC, Zajac JD, Cheung AS. Prevalence of Autism Spectrum Disorder and Attention-Deficit Hyperactivity Disorder Amongst Individuals with Gender Dysphoria: A Systematic Review. J Autism Dev Disord 2020;50:695–706.
• 32. Wang C, Geng H, Liu W, Zhang G. Prenatal, perinatal, and postnatal factors associated with autism: A meta-analysis. Medicine (Baltimore) 2017;96:e6696. Available from: URL:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5419910/pdf/medi-96-e6696.pdf Accessed: 20 June 2022.
• 33. Chen LC, Chen MH, Hsu JW, Huang KL, Bai YM, Chen TJ, et al. Association of parental depression with offspring attention deficit hyperactivity disorder and autism spectrum disorder: A nationwide birth cohort study. J Affect Disord 2020;277:109–14.
• 34. Manzari N, Matvienko-Sikar K, Baldoni F, O’Keeffe GW, Khashan AS. Prenatal maternal stress and risk of neurodevelopmental disorders in the offspring: a systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol 2019;54:1299–309.
• 35. Kian N, Samieefar N, Rezaei N. Prenatal risk factors and genetic causes of ADHD in children. World J Pediatr 2022;18:308–19.
• 36. Reilly M, Desousa V, Garza-Flores A, Perrin EC. Young Children With Gender Nonconforming Behaviors and Preferences. J Dev Behav Pediatr 2019;40:60–71.
• 37. Dora M, Grabski B, Dobroczyński B. Gender dysphoria, gender incongruence and gender nonconformity in adolescence – Changes and challenges in diagnosis. Psychiatr Pol 2021;55:23–37.
• 38. Erol N, Simsek ZT. Mental Health of Turkish Children: Behavioral and Emotional Problems Reported By Parents, Teachers, and Adolescents. In: International perspectives on child and adolescent mental health. Vol 1. Elsevier, 2000:223–47. 39. Cartaya J, Lopez X. Gender dysphoria in youth: A review of recent literature. Curr Opin Endocrinol Diabetes Obes 2018;25:44–8. 40. Kyriakou A, Nicolaides CN, Skordis N. Current approach to the clinical care of adolescents with gender dysphoria. Acta Biomed 2020;91:165–75.