Current Problems in Pediatric and Adolescent Health Care
Volume 39, Issue 5 , Pages 117-143 , May 2009

Gender Identity Disorder in Children and Adolescents

  • Birgit Möller, PhD

      Affiliations

    • Department of Child and Adolescent Psychiatry and Psychotherapy, University Clinical Center Hamburg, Hamburg, Germany
    • ,
  • Herbert Schreier, MD

      Affiliations

    • Child Psychiatry, Children's Hospital and Research Center Oakland, Oakland, California
    • ,
  • Alice Li, MD

      Affiliations

    • Child Psychiatry, Children's Hospital and Research Center Oakland, Oakland, California
    • ,
  • Georg Romer, MD

      Affiliations

    • Department of Child and Adolescent Psychiatry and Psychotherapy, University Clinical Center Hamburg, Hamburg, Germany

References 

  1. Cloud J. His name is Aurora. (News) Time Sept 25, 2000;156:90-1.
  2. Brown PL. Supporting boys or girls when the line isn't clear. New York Times. 2006;Dec 2
  3. Rosenberg D. (Rethinking) gender. Newsweek. 2007;149:50–51May 21, 53-7
  4. Walters B. Living as and with a transgender kid, on ABC news “20/20.” Friday, April 27 2008.
  5. Rosin H. A boy's life. The Atlantic. 2008;November
  6. Spiegel A. Two families grapple with sons' gender preferences. All Things Considered, National Public Radio. 2008;May 7
  7. Stein MT, Zucker KJ, Dixon SD. Sammy: gender identity concerns in a six-year-old boy. Pediatrics. 2001;107:850–854
  8. Zucker KJ, Bradley SJ, Owen-Anderson A, Kibblewhite SJ, Cantor JM. Is gender identity disorder in adolescents coming out of the closet?. J Sex Marital Ther. 2008;34:287–290
  9. DSM-VI-TR (4th Edition, text revision). Washington, DC: American Psychiatric Association; 2000;
  10. Stein MT, Zucker KJ, Dixon SD. Sammy: gender identity concerns in a six-year-old boy. Pediatrics. 2001;107:850–854
  11. Zucker KJ, Cohen-Kettenis PT. Gender identity disorder in children and adolescents. In:  Rowland DL,  Incrocci L editor. Handbook of sexual and gender identity disorders. New York: Wiley, Sons; 2008;
  12. Perrin EC, Cohen KM, Gold M, Ryan C, Savin-Williams RC, Schorzman CM. Gay and lesbian issues in pediatric health care. Curr Prob Pediatr Health Care. 2004;34:355–398
  13. Menvielle EJ, Tuerk C, Perrin EC. To the beat of a different drummer: the gender-variant child. Contemp Pediatr. 2005;22:38–39
  14. Wallien MSC. Gender dysphoria in children. Causes and consequences. Amsterdam: Ponsen & Looien; 2008;
  15. Coolidge FL, Thede LL, Young SE. The heritability of gender identity disorder in a child and adolescent twin sample. Behav Gen. 2002;32:251–257
  16. Achenbach TM, Edelbrock C. Manual for the child behavior checklist and. revised child behavior profile. Burlington, VT: Queen City Printers; 1983;
  17. Cohen-Kettenis PT, Pfäfflin F. Transgenderism and intersexuality in childhood and adolescence: making choices. Thousand Oaks, London, New Dehli: Sage Pubn Inc; 2003;
  18. Zucker K, Bradley S. Gender identity disorder and psychosexual problems in children and adolescents. New York: Guilford; 1995;
  19. Achenbach TM, Edelbrock CS. Behavioral problems and competencies reported by parents of normal and disturbed children aged four through sixteen. Monogr Soci Res Child Dev. 1981;46:1–82
  20. Zucker KJ, Bradley SJ, Sanikhani M. Sex differences in referral rates of children with gender identity disorder: some hypotheses. J Abnorm Child Psychol. 1997;25:217–227
  21. Verhulst FC, van der Ende J, Koot HM. Dutch manual for the CBCL/4-18, Afdeling Kinder- en Jeugdpsychiatrie. Rotterdam: AZ/Erasmus Universiteit; 1996;
  22. Von Beijsterveldt CE, Hudziak JJ, Boomsma DI. Genetic and environmental influences on cross-gender behavior and relations to behavior problems: a study of Dutch twins at ages 7 and 10 years. Arch Sex Behav. 2006;35:647–658
  23. Fagot B. Consequences of moderate cross-gender behavior in pre-school children. Child Dev. 1977;48:902–907
  24. Bakker A, Van Kesteren PM, Gooren LJ, Bezemer PD. The prevalence of transsexualism in the Netherlands. Acta Psychiatr Scand. 1993;87:237–238
  25. Tsoi WF. The prevalence of transsexualism in Singapore. Acta Psychiatr Scand. 1988;78:501
  26. Bailey JM, Zucker KJ. Childhood sex-typed behavior and sexual orientation: a conceptual analysis and quantitative review. Dev Psychol. 1995;31:43–55
  27. Green R. The “Sissy Boy Syndrome” and the Development of Homosexuality. New Haven: Yale University Press; 1987;
  28. Green R. Gender identity in childhood and later sexual orientation: follow-up of 78 males. Am J Psychiatry. 1985;142:339–341
  29. Zucker KJ. Gender identity disorder in children and adolescents. Annu Rev Clin Psychol. 2005;1:467–492
  30. Rieger G, Linsenmeier JA, Gygax L, Bailey JM. Sexual orientation and childhood gender nonconformity: evidence from home videos. Dev Psychol. 2008;44:46–58
  31. Von Beijsterveldt CE, Hudziak JJ, Boomsma DI. Genetic and environmental influences on cross-gender behavior and relations to behavior problems: a study of Dutch twins at ages 7 and 10 years. Arch Sex Behav. 2006;35:647–658
  32. Drummond KD, Bradley SJ, Peterson-Badali M, Zucker KJ. A follow-up study of girls with gender identity disorder. Dev Psychol. 2008;44:34–45
  33. Wallien MS, Cohen-Kettenis PT. Psychosexual outcome of gender-dysphoric children. J Am Acad Child Adolesc Psychiatry. 2008;47:1413–1423
  34. Knafo A, Iervolino AC, Plomin R. Masculine girls and feminine boys: genetic and environmental contributions to atypical gender development in early childhood. J Pers Soc Psychology. 2005;88:400–412
  35. Cohen-Kettenis PT, Delemarre-van de Waal HA, Gooren LJ. The treatment of adolescent transsexuals: changing insights. J Sex Med. 2008;5:1892–1897
  36. Di Ceglie D, Freeman D, McPherson S, Richardson P. Children and adolescents referred to a specialist gender identity development service: clinical features and demographic characteristics. Available at: http://www.symposion.com/ijt/ijtvo06no0101.htm). Accessed 2002.
  37. Cohen-Kettenis PT, Wallien M, Johnson LL, Owen-Anderson AF, Bradley SJ, Zucker KJ. A parent-report gender identity questionnaire for children: a cross-national. Clin Child Psychol Psychiatry. 2006;11:397–405
  38. Von Beijsterveldt CE, Hudziak JJ, Boomsma DI. Genetic and environmental influences on cross-gender behavior and relations to behavior problems: a study of Dutch twins at ages 7 and 10 years. Arch Sex Behav. 2006;35:647–658
  39. Saghir M, Robins E. Male and female homosexuality: a comprehensive investigation. Baltimore (MD): Williams, Wilkins; 1973;
  40. Zuger B. Early effeminate behavior in boys: outcome and significance for homosexuality. J Nerv Ment Dis. 1984;172:90–97
  41. Zucker KJ, Bradley SJ. Gender identity disorder and psychosexual problems in children and adolescents. New York: Guilford Press; 1995;
  42. Drummond KD, Bradley SJ, Peterson-Badali M, Zucker KJ. A follow-up study of girls with gender identity disorder. Dev Psychol. 2008;44:34–45
  43. Cohen-Kettenis PT. Gender identity disorder in DSM?. J Am Acad Child Adolesc Psychiatry. 2001;40:391;[Letter to the editor]
  44. Meyenburg B. Indication and clinical experience with early hormone treatment of transsexuals adolescents. Oral presentation at the congress of the German Academy of Psychiatry, Psychotherapy, and Neurology. 2008;
  45. Meyenburg B. Gender identity disorder in adolescence: outcomes of psychotherapy. Adolescence. 1999;34:305–313
  46. Coates S, Friedman RC, Wolfe S. The etiology of boyhood gender identity disorder: a model for integrating temperament, development, and psychodynamics. Psychoanal Dialog. 1991;1:481–523
  47. Di Ceglie D. Management and therapeutic aims in working with children andadolescents with gender identity disorders, and their families. In:  Di Ceglie D,  Freedman D editor. A stranger in my own body (Atypical gender identity development and mental health). London: Karnac Books; 1998;p. 185–197
  48. Stoller RJ. Boyhood gender aberrations: treatment issues. J Am Psychoanal Assoc. 1978;26:541–558
  49. Meyer JK, Dupkin C. Gender disturbance in children: an interim clinical report. Bull Menninger Clin. 1985;49:236
  50. Haber CH. The psychoanalytic treatment of a preschool boy with a gender identity disorder. J Am Psychoanal Assoc. 1991;39:107–129
  51. Loeb L, Shane M. The resolution of a transsexual wish in a five-year-old boy. J Am Psychoanal Assoc. 1982;30:419–434
  52. Stoller RJ. Boyhood gender aberrations: treatment issues. J Am Psychoanal Assoc. 1978;26:541–558
  53. Chiland C. Transsexualism: illusion and reality. London: Continuum; 2003;
  54. Meyer JK, Dupkin C. Gender disturbance in children: an interim clinical report. Bull Menninger Clin. 1985;49:236–269
  55. Chiland C. Enfance et transsexualisme. Psychiatr Enfant. 1988;31:313–373
  56. Volkan V, Berent S. Psychiatric aspects of surgical treatment for problems of sexual identification (transsexualism). In:  Howells JG editors. Modern perspectives in the psychiatric aspects of surgery. New York: Bruner/Mazel; 1976;p. 447–467
  57. Person E, Ovensey L. The transsexual syndrome in males I: primary transsexualism. Am J Psychother. 1974;28:4–20
  58. Coates S. Developmental research on childhood identity disorder. In:  Fonagy P,  Drause R,  Leuzinger-Bohleber M editor. Identity, gender and sexuality 150 years after Freud controversies in psychoanalysis series. London: International Psychoanalytical Association; 2006;p. 103–131
  59. Chiland C. Exploring transsexualism. London: Karnac Books; 2005;p. 67
  60. Coates S. Extreme boyhood femininity: overview and new reasearch findings. In:  De Freis Z,  Friedman RC,  Corn R editor. Sexuality: new perspectives. Westport: Greenwood; 1985;p. 101–204
  61. Coates S, Friedman RC, Wolfe S. The etiology of boyhood gender identity disorder: a model for integrating temperament, development, and psychodynamics. Psychoanalyt Dialog. 1991;1:481–523
  62. Zucker KJ. Children with gender identity disorder: is there a best practice?. Neuropsychiatr Enfance Adolesc. 2008;(in press)
  63. Wallien MSC, Swaab H, Cohen-Kettenis PT. Psychiatric comorbidity among children with gender identity disorder. J Am Acad Child Adolesc Psychiatry. 2007;46(10):1307
  64. Coolidge FL, Thede LL, Young SE. The heritability of gender identity disorder in a child and adolescent twin sample. Behav Gen. 2002;32:251–257
  65. Verhulst FC, Ende J, van der Koot HM. Handleiding voor de CBCL/4-18. Rotterdam: Afd. Kinder-en Jeugdpsychiatrie, AZ/Erasmus Universiteit.
  66. Wallien MSC, Swaab H, Cohen-Kettenis PT. Psychiatric comorbidity among children with gender identity disorder. J Am Acad Child Adolesc Psychiatry. 2007;46(10):1307–1314
  67. Cohen-Kettenis P, van Goozen SHM, Snoeck I. Internalizing disorders in prepubertal children with gender identity disorder. Poster presented at the 26th annual meetin of the International Acedemy of Sex Research, Paris, France, 2000.
  68. Wallien MSC, Swaab H, Cohen-Kettenis PT. Psychiatric comorbidity among children with gender identity disorder. J Am Acad Child Adolesc Psychiatry. 2007;46:1307–1314
  69. Zucker K. Associated psychopathology in chidren and adolescents with gender identity disorder. Oral presentation at the 55th annual meeting of the American Academy of Child and Adolescent Psychiatry. 2008;October 28-November 2
  70. Roberts CW, Green R, Williams K, Goodman M. Boyhood gender identity development: a statistical contrast between two family groups. Dev Psychol. 1987;23:544–557
  71. Bates JE, Bentler PM, Thompson SK. Gender-deviant boys compared with normal clinical control boys. J Abnorm Child Psychol. 1979;7:243–259
  72. Zucker KJ. Children with gender identity disorder: is there a best practice?. Neuropsychiatr Enfance Adolesc. 2008;4;(in press)
  73. Coates SW. Ontogenesis of boyhood gender identity disorder. J Am Acad Psychoanal. 1990;18:414–438
  74. Zucker K. Associated psychopathology in chidren and adolescents with gender identity disorder. 2008;Oral presentation at the 55th annual meeting of the American Academy of Child and Adolescent Psychiatry, October 28-November 2
  75. Menville E. Gender variance and psychopathology: does parental support count. 2008;Oral presentation at the 55th annual meeting of the American Academy of Child and Adolescent Psychiatry, October 28-November 2
  76. Swidey N. What makes people gay. Boston Globe Magazine August 14. 2005;117
  77. Kraemer B, Noll T, Delsignore A, Milos G, Schnyder U, Hepp U. Finger length ratio (2D:4D) in adults with gender identity disorder. Arch Sex Behav. 2007;
  78. McIntyre MH. The use of digit ratios as markers for perinatal androgen action. Reprod Biol Endocrin. 2006;4:10
  79. Wallien MS, Zucker KJ, Steensma TD, Cohen-Kettenis PT. 2D:4D finger-length ratios in children and adults with gender identity disorder. Horm Behav. 2008;
  80. Schneider HJ, Pickel J, Stalla GK. Typical female 2nd-4th finger length (2D:4D) ratios in male-to-female transsexuals-possible implications for prenatal androgen exposure. Psychoneuroendocrinology. 2006;31:265–269
  81. Berglund H, Lindstrom P, Chehne-Helmy C, Savic I. Male to female transsexual show sex atypical hypthalamaus activation when smelling odorous steroids. Cereb Cortex. 2007;18:1900–1908
  82. Hare L, Bernard P, Sanchez FJ, Baird PN, Vilain E, Kennedy T, et al. Androgen receptor repeat length polymorphism associated with male-to-female transsexualism. Biol Psych. 2008;[Epub ahead of print]
  83. Miller A. Neurocognitive and bran findings in variants of gender identity. Oral presentation at the 55th annual meeting of the American Academy of Child and Adolescent Psychiatry, October 28-November 2, 2008.
  84. Coolidge FL, Thede LL, Young SE. The heritability of gender identity disorder in a child and adolescent twin sample. Behav Genet. 2002;32:251–257
  85. Knafo A, Iervolino AC, Plomin R. Masculine girls and feminine boys: genetic and environmental contributions to atypical gender development in early childhood. J Pers Soc Psychol. 2005;88:400–412
  86. Iervolino AC, Hines M, Golombok SE, Rust J, Plomin R. Genetic and environmental influences on sex-typed behavior during the preschool years. Child Dev. 2005;76:826–840
  87. Van Beijsterveldt CE, 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;35:647–658
  88. Cohen-Kettenis PT, van Goozen SHM, van Trotsenburg MAA. Das transsexuelle Gehirn. In:  Lautenbacher S,  Güntürkün O,  Hausmann M editor. Gehirn und Geschlecht. Berlin: Springer; 2007;p. 125–141
  89. Ruble DN, Martin CL, Berenbaum SA. Gender development. In:  Damon W,  Lerner RM,  Eisenberg N editor. Handbook of child psychology. 6th Edition. Social, emotional and personality development. Vol. 3:New York: pWiley; 2006;p. 858–932
  90. Connellan J, Baron-Cohen S, Wheelwright S, Batki A, Ahluwalia J. Sex differences in human neonatal social perception. Infant Behav Dev. 2000;23:113–118885, 866, 912, 913
  91. Meyer-Bahlburg HF. Gender identity outcome in female-raised 46,XY persons with penile agenesis, cloacal exstrophy of the bladder, or penile ablation. Arch Sex Behav. 2005;34:423–438[Review].
  92. Meyer-Bahlburg HFL, Dolezal C, Baker SW, New MI. Sexual orientation in women with classical or non-classical congenital adrenal hyperplasia as a function of degree of prenatal androgen excess. Arch Sex Behav. 2008;37:85–99
  93. van Goozen SH, Slabbekoorn D, Gooren LJ, Sanders G, Cohen-Kettenis PT. Organizing and activating effects of sex hormones in homosexual transsexuals. Behav Neurosci. 2002;116:982–988
  94. Wallen K, Baum MJ. Masculinization and defeminization in altricial and precocial mammals: comparative aspects of steroid hormone action. In:  Pfaff DW,  Arnold AP,  Etgen AM, et al. editor. Hormones brain behavior. Amsterdam Academic Press; 2002;p. 385–423
  95. Meyer-Bahlburg HF. Gender identity outcome in female-raised 46,XY persons with penile agenesis, cloacal exstrophy of the bladder, or penile ablation. Arch Sex Behav. 2005;34:423–438(Review).
  96. Rekers GA, Lovaas OI. Behavioral treatment of deviant sex-role behaviors in a male child. J Appl Behav Anal. 1974;7:173–190
  97. Rekers GA. Assessment and treatment of childhood gender problems. In:  Lahey BB,  Kazdin AE editor. Advances in clinical child psychology. Vol. 1:New York: Plenum Press; 1977;p. 267
  98. Rekers GA, Lovaas OI. Behavioral treatment of deviant sex-role behaviors in a male child. J Appl Behav Anal. 1974;7:173–190
  99. Rekers GA. Sex-role behavior change: intrasubject studies of boyhood gender disturbance. J Psychol. 1979;103:255–269
  100. Lev AI. Disordering gender identity: gender identity disorder in the DSM-IV-TR. Sexual and gender diagnoses of the diagnostic and statistical manual (DSM). Karasic D, Drescher J, editors. Haworth Press; co-published in J Psychol Human Sexual 2005;17:35-69.
  101. Coates S, Friedman RC, Wolfe S. The etiology of boyhood gender identity disorder: a model for integrating temperament, development, and psychodynamics. Psychoanal Dialog. 1991;1:481–523
  102. Di Ceglie D. Management and therapeutic aims in working with children and adolescents with gender identity disorders, and their families. In:  Di Ceglie D,  Freedman D editor. A stranger in my own body (Atypical gender identity development and mental health). London: Karnac Books; 1998;p. 185–197
  103. Stoller RJ. Boyhood gender aberrations: treatment issues. J Am Psychoanal Assoc. 1978;26:541–558
  104. Haber CH. The psychoanalytic treatment of a preschool boy with a gender identity disorder. J Am Psychoanal Assoc. 1991;39:107–129
  105. Loeb L, Shane M. The resolution of a transsexual wish in a five-year-old boy. J Am Psychoanal Assoc. 1982;30:419–434
  106. Stoller RJ. Boyhood gender aberrations: treatment issues. J Am Psychoanal Assoc. 1978;26:541–558
  107. Chiland C. Transsexualism: illusion and reality. London: Continuum; 2003;
  108. Meyer JK, Dupkin C. Gender disturbance in children: an interim clinical report. Bull Menninger Clin. 1985;49:236–269
  109. Stoller RJ. The mother's contribution to infantile transvestic behaviour. J Psychoanal. 1966;47:384–395
  110. Haber CH. The psychoanalytic treatment of a preschool boy with a gender identity disorder. J Am Psychoanal Assoc. 1991;39:107–129
  111. Stoller R. Male childhood transsexualism. J Am Acad Child Adolesc Psychiatry. 1968;7:193–201
  112. Bleiberg E, Jackson L, Ross JL. Gender identity disorder and object loss. J Am Acad Child Adolesc Psychiatry. 1986;25:58–67
  113. Isay R. Becoming gay: the journey to self-acceptance. New York: Pantheon; 1996;
  114. Meyer-Bahlburg HFL. Gender identity disorder in young boys: a parent- and peer-based treatment protocol. Clin Child Psychol Psychiatry. 2002;7:360–376
  115. Menvielle EJ, Tuerk C. A support group for parents of gender-nonconforming boys. J Am Acad Child Adolesc Psychiatry. 2002;41:1010–1013
  116. Rosenberg M. Children with gender identity issues and their parents in individual and group treatment. J Am Acad Child Adolesc Psychiatry. 2002;41:619–621
  117. Di Ceglie D, Coates Thümmel E. An experience of group work with parents of children and adolescents with gender identity disorder. Clin Child Psychol Psychiatry. 2006;11:387–396
  118. Menvielle EJ, Tuerk C. A support group for parents of gender non-conforming boys. J Am Acad Child Adolesc Psychiatry. 2002;41:1010–1013
  119. Brill S, Pepper R. The transgender child. San Francisco (CA): Cleis Press; 2008;
  120. Green R, Fuller M. Group therapy with feminine boys and their families. Int J Group Psychother. 1973;23:54–68
  121. Green R. The “sissy boy syndrome” and the development of homosexuality. New Haven (CT): Yale University Press; 1987;p. 319
  122. Di Ceglie D. Management and therapeutic aims in working with children and adolescents with gender identity disorders, and their families. In:  Di Ceglie D,  Freedman D editor. A stranger in my own body—atypical gender identity development and mental health. London: Karnac Books; 1998;p. 185–197
  123. Di Ceglie D. Gender identity disorder in young people. Adv Psychiatr Treat. 2000;6:458–466
  124. The World Association of Transgender Health Standards of Care for Gender Identity Disorders. 6th version, 2001. Available at: www.wpath.org/Documents2/socv6.pdf+gender+identity+disorder+educate&hl=de&ct=clnk&cd=7&gl=de.
  125. Zucker K. Children with gender identity disorder: is there a best practice?. Neuropsychiatr Enfance Adolesc. 2008;(in press)
  126. Zucker KJ. Gender identity disorder. In:  Martin A,  Volkmar FR editor. Lewis's child and adolescent psychiatry: a comprehensive textbook. 4th Edition. Baltimore (MD): Lippincott Williams, Wilkins; 2007;p. 669–680
  127. Bradley SJ, Zucker KJ. Gender identity disorder: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry. 1997;36:872–880
  128. Spack N. An endocrine perspective on the care of transgender adolescents. Oral presentation at the 55th annual meeting of the American Academy of Child and Adolescent Psychiatry, October 28-November 2, 2008.
  129. Cohen-Kettenis P, Gooren L. The influence of hormone treatment on psychological functioning of transsexual. J Psychol Human Sex. 1992;5:55–67
  130. Cohen-Kettenis PT, van Goozen SH. Sex reassignment of adolescent transsexuals: a follow-up study. J Am Acad Child Adolesc. 1997;36:263–271
  131. Smith YL, van Goozen SH, Cohen-Kettenis PT. Adolescents with gender identity disorder who were accepted or rejected for sex reassignment surgery: a prospective follow-up study. J Am Acad Child Adolesc Psychiatry. 2001;40:472–481
  132. Smith YL, van Goozen SH, Kuiper AJ, Cohen-Kettenis PT. Sex reassignment: outcomes and predictors of treatment for adolescent and adult transsexuals. Psychol Med. 2005;35:89–99
  133. Cohen-Kettenis PT, Delemarre-van de Waal HA, Gooren LJ. The treatment of adolescent transsexuals: changing insights. J Sex Med 2008 Jun 17 [Epub ahead of print].
  134. Korte A, Goecker D, Krude H, Lehmkuhl U, Grüters-Kieslich A, Beier KM. Geschlechtsidentitätsstörungen im Kindes- und Jugendalter. Dt. Aerzteblatt, Jg. 2008;105:(in press)
  135. Meyenburg B. Geschlechtsidentitätsstörungen im Kindes- und Jugendalter. In:  Sigusch V editors. Sexuelle Störungen und ihre Behandlung. Stuttgart: Thieme; 2006;p. 337–344
  136. Meyenburg B. Gender identity disorder in adolescence: outcomes of psychotherapy. Adolescence. 1999;134(34):305–313
  137. Plöderl M, Fartacek R. Childhood gender nonconformity and harassment as predictors of suicidality among gay, lesbian, bisexual, and heterosexual Austrians. Arch Sex Behav. 2007;
  138. Landolt MA, Bartholomew K, Saffrey C, Oram D, Perlman D. Gender nonconformity, childhood rejection, and adult attachment: a study of gay men. Arch Sex Behav. 2004;33:117–128
  139. Alanko K, Santtila P, Harlaar N, Witting K, Varjonen M, Jern P, et al The association between childhood gender atypical behavior and adult psychiatric symptoms is moderated by parenting style. Sex Roles. 2008;58:837–847
  140. Becker S. Transsexuelle Entwicklungen. Psychother Dialog. 2008;(in press)
  141. Becker S. Transsexuelle Entwicklungen. Psychother Dialog 2008 (in press).
  142. Cohen-Kettenis PT, Gooren LJG. Transsexualism: a review of etiology, diagnosis and treatment. J Psychosom Res. 1999;46:315–333
  143. Cohen-Kettenis PT, Delemarre-van de Waal HA, Gooren LJ. The treatment of adolescent transsexuals: changing insights. J Sex Med. 2008;5(8):1892–1897[Epub 2008 Jun 28].
  144. Menvielle E. Raising girlyboys. 2004. p. 3.
  145. Bartlett NH, Vasey PL, Bukowski WM. Is gender identity disorder in children a mental disorder? (Sex roles). A J Res. 2000;43(11/12):753–785
  146. Gender Specturm Education and Training. Available at: http://www.genderspectrum.org/ or Family Acceptance Project: http://familyproject.sfsu.edu/.
  147. Groneberg M. Mythen und Wissen zur Intersexualität. In:  Groneberg M,  Zehnder K editor. Intersex Geschlechtsanpassung zum Wohl des Kindes?. Fribourg: Academic Press Fribourg; 2008;p. 83–145
  148. Hirschauer S. The Medicalization of Gender Migration. Vol. 1, Number 1, July-September 1997. http://www.symposion.com/ijt/ijtc0104.htm.
  149. Money J. The concept of gender identity disorder in childhood and adolescence after 39 years. J Sex Marital Ther. 1994;20:163–177
  150. Golombok S, Rust J. The Pre-school Activities Inventory: a standardized assessment of gender roles in children. Psychol Assess. 1993;5:131–136

PII: S1538-5442(09)00016-9

doi: 10.1016/j.cppeds.2009.02.001

Current Problems in Pediatric and Adolescent Health Care
Volume 39, Issue 5 , Pages 117-143 , May 2009

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