Clinician Judgment in the Diagnosis of Gender Identity Disorder in Children

Abstract

Clinician judgment methodology was used to explore the influence of gender nonconformity and gender dysphoria on the diagnosis of children with Gender Identity Disorder (GID). A convenience sample of 73 licensed psychologists randomly received a vignette to diagnose. Vignettes varied across sex of child, gender conforming behavior, and gender dysphoria (including all possible permutations). Eight percent of respondents given a vignette involving a child who met purely behavioral criteria for GID diagnosed the child with GID. When additional information was provided, which in addition to gender nonconforming behavior the child also self-reported a cross-gender identity, this increased to 27% (significant at 5%).

We acknowledge Scott Pytluck, PhD, and Richard Carroll, PhD, who served as members of the first author's Clinical Research Project committee. We thank Bruce Center, PhD, for providing advice on the analysis and presentation of the data; and Heather Haley, MS, and Anne Marie Weber-Main, PhD, for their critical review and editing of manuscript drafts.

Notes

¹For diagnosis, clients must meet criteria A, B, C, and D.

¹Vignettes were purposefully constructed so that for all gender role conforming children, the described behaviors did not meet any DSM-IV GID criteria; for all moderately nonconforming children, only two of five Category A criteria were met, and the child should not be diagnosed with GID according to DSM-IV criteria; and for all most nonconforming children, behaviors met four of five Category A criteria, and the child should be diagnosed with GID according to DSM IV criteria.

¹In round 3, clinicians were presented with the information that the child stated a persistent desire to be the other gender, displaying gender dysphoria.

²Other includes no diagnosis, V-code, and other diagnoses.