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Behavioral and Emotional Problems on the Teacher’s Report Form: A Cross-National, Cross-Clinic Comparative Analysis of Gender Dysphoric Children and Adolescents

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Abstract

For gender dysphoric children and adolescents, the school environment may be challenging due to peer social ostracism and rejection. To date, information on the psychological functioning and the quality of peer relations in gender dysphoric children and adolescents has been studied via parental report, peer sociometric methods, and social interactions in laboratory play groups. The present study was the first cross-national investigation that assessed behavior and emotional problems and the quality of peer relations, both measured by the Teacher’s Report Form (TRF), in a sample of 728 gender dysphoric patients (554 children, 174 adolescents), who were referred to specialized gender identity clinics in the Netherlands and Canada. The gender dysphoric adolescents had significantly more teacher-reported emotional and behavioral problems than the gender dysphoric children. In both countries, gender dysphoric natal boys had poorer peer relations and more internalizing than externalizing problems compared to the gender dysphoric natal girls. Furthermore, there were significant between-clinic differences: both the children and the adolescents from Canada had more emotional and behavioral problems and a poorer quality of peer relations than the children and adolescents from the Netherlands. In conclusion, gender dysphoric children and adolescents showed the same pattern of emotional and behavioral problems in both countries. The extent of behavior and emotional problems was, however, higher in Canada than in the Netherlands, which appeared, in part, an effect of a poorer quality of peer relations. Per Bronfenbrenner’s (American Psychologist, 32, 513–531, 1977) ecological model of human development and well-being, we consider various interpretations of the cross-national, cross-clinic differences on TRF behavior problems at the level of the family, the peer group, and the culture at large.

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Notes

  1. The Amsterdam clinic was established in 1988 at the University Medical Center Utrecht in Utrecht. It moved to the VU Medical Centre in Amsterdam in 2002. The Toronto clinic was established in 1975 at the Clarke Institute of Psychiatry (now the Centre for Addiction and Mental Health).

  2. Internalizing and Externalizing T scores were calculated using the Dutch norms for both clinics. We arbitrarily used the Dutch norms rather than American norms. The factor structure of the TRF is reasonably similar in the two countries (de Groot et al. 1996) and there are only very slight differences in number of behavior problems in the standardization samples (Achenbach et al. 1987b; Verhulst and Akkerhuis 1986, pp. 48–50).

  3. The TRF also contains an item assessing “how well” the teacher knows the child or adolescent. This item yielded similar results as for “how long” the child or adolescent was known and was, therefore, not incorporated in the analyses.

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Authors and Affiliations

  1. Department of Medical Psychology and Medical Social Work, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands

    Thomas D. Steensma, Baudewijntje P. C. Kreukels & Peggy T. Cohen-Kettenis

  2. Gender Identity Service, Child, Youth, and Family Services, Underserved Populations Program, Centre for Addiction and Mental Health, Toronto, Canada

    Kenneth J. Zucker, Doug P. VanderLaan, Hayley Wood & Amanda Fuentes

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  1. Thomas D. Steensma
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  2. Kenneth J. Zucker
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  3. Baudewijntje P. C. Kreukels
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Correspondence to Thomas D. Steensma.

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Steensma, T.D., Zucker, K.J., Kreukels, B.P.C. et al. Behavioral and Emotional Problems on the Teacher’s Report Form: A Cross-National, Cross-Clinic Comparative Analysis of Gender Dysphoric Children and Adolescents. J Abnorm Child Psychol 42, 635–647 (2014). https://doi.org/10.1007/s10802-013-9804-2

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