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A Gender Identity Interview for Children

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Abstract

A 12-item gender identity interview schedule was administered to 85 children referred for concerns regarding their gender identity development and 98 clinical and normal control children. Factor analysis identified two factors, which were labeled Affective Gender Confusion and Cognitive Gender Confusion. The gender-referred group gave significantly more deviant responses than did the controls on both factors. Results were discussed with regard to several diagnostic and assessment issues pertaining to children with gender identity disorder.
... The majority of the tools conceptualised gender as binary, including DAP, 30 FPT, 18 Rorschach, 31 GIIC, 38 RCGI, 35 PPPSI, 39 GBIB, 21 Revised Gender Behaviour Inventory for Boys, 24 Games Inventory, 20 Gender-Preference and Gender-Identity IAT, 27 Explicit Gender Peer Preferences, 27 Brown IT Scale for Children, 42 MAPS, 43 GIQC, 44 PGQ, 20 and PECB. 46 GDQ 37 was the only tool identified that deliberately provided for non-binary and agender identities and that has been used with adolescents. ...
... 15 tools have been used with preschool-aged children across 18 studies. [16][17][18][19]22,23,25,26,38,44,48,49,[51][52][53]55,56,59 All three types of measures (behaviour or task observation, child self-reported tools, and parent-reported tools) were used for the preschool-age group; however, behaviour or task observation and parent-reported assessments were most common. For children, 17 tools have been used across 28 studies, with all three types of measures also being used across this age group. ...
... For children, 17 tools have been used across 28 studies, with all three types of measures also being used across this age group. [15][16][17][18][19][20][21][22][23][24][25][26][27]29,38,40,44,48,49,[51][52][53][54][55][56][57][58][59] All but one test was used with the adolescent age group across 36 studies. [15][16][17][19][20][21][22][23]25,27,29,34,35,37,38,40,44,[48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66] The DAP test was the most used test in preschool-aged children, 17,19,22,25,48,49,[51][52][53] children, 15,17,19,22,25,48,49,[51][52][53] and adolescents. ...
Article
Increasing numbers of children and adolescents are being referred to gender services for gender-related concerns. Various instruments are used with these patients in clinical care, but their clinical validity, strengths, and limitations have not been systematically reviewed. In this systematic review, we searched MEDLINE, PubMed, and PsycINFO databases for available tools that assess gender identity, gender expression, or gender dysphoria in transgender and gender-diverse (TGD) children and adolescents. We included studies published before Jan 20, 2020, that used tools to assess gender identity, expression, or dysphoria in TGD individuals younger than 18 years. Data were extracted from eligible studies using a standardised form. We found 39 studies that met the inclusion criteria, from which we identified 24 tools. The nature of tools varied considerably and included direct observation, child and adolescent self-report, and parent-report tools. Many methods have only been used with small samples, include outdated content, and lack evaluation of psychometric properties. In summary, a paucity of studies in this area, along with sparse reporting of psychometric properties, made it difficult to compare the relative use of tools, and current tools have substantial limitations. Future research is required to validate existing measures and create more relevant, culturally appropriate tools.
... To measure the intensity of experienced gender incongruence the Gender Identity Interview (GII) was used. The original interview instrument was developed and validated by Zucker et al. (1993). For the purpose of this study the validated Dutch version of the GII was used (GII-C; Wallien et al., 2009). ...
... The available instruments have substantial limitations (Bloom et al., 2021). Although the GII, the Dutch version of the GIIC for instance, has adequate psychometric properties (Zucker et al., 1993;Walien et al., 2009) and is widely used across all age groups, it has not been revised since it's been developed. Therefore, the terminology used is nonaffirming and outdated (Bloom et al., 2021). ...
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Background: Gender incongruent children report lower self-perception compared to the norm population. This study explored differences in self-perception between children living in their gender role assigned at birth and children living in their experienced gender role. Method: The self-perception questionnaire was administered to 312 children referred to the Center of Expertise on Gender Dysphoria ‘Amsterdam UMC’. Social transition status was determined by parental interviews. 2 (social transition) by 2 (sex assigned at birth) ANCOVA’s were conducted. Results: Children living in their assigned gender role reported comparable self-perception to children living in their experienced gender role. Birth assigned girls living in their assigned gender role reported poorer self-perception on ‘athletic competence’, compared to girls living in their experienced gender role. Birth assigned boys living in their assigned gender role reported poorer on ‘scholastic competence’ and ‘behavioral conduct’ compared to boys living in their experienced gender role. Conclusions: Social transition did not show to affect self-perception. Self-perception was poorer for birth assigned boys living in their experienced gender role. For birth assigned girls this was reversed. Future studies should give more insight in the role of social transitions in relation to child development and focus on other aspects related to self-perception.
... Very few measures are designed specifically for assessment with TGE children. Two more commonly known measures, the Gender Identity Interview (GII; Zucker et al., 1993) and the Gender Preference Interview (GPI; Cohen- Kettenis & Pfäfflin, 2003) have been critiqued as being based on outdated, cis-centric gender development theory (Berg & Edwards-Leeper, 2018). In other words, the underlying assumption built into these measures is that the gender development of cisgender people is normal and even preferable. ...
... 2.2.1 | Gender identity interview (GII; Zucker et al., 1993) The GII is a 12-item semi-structured interview between a clinician and child. The measure was designed as an attempt to help clinicians understand a client's gender identity. ...
Article
Few clinical measures are available for use with transgender and gender‐expansive (TGE) prepubescent children. This qualitative study includes 65 TGE children, ages 4–12, with 21 identifying as boys, 34 as girls, and 10 as nonbinary. Race/ethnicity reported by parents: 72.3% White, 7.7% Asian, 6.2% Hispanic/Latinx, 4.6% multiple races, 3.1% Black/African American, 1.5% American Indian or Alaskan Native, and 4.6% were missing race/ethnicity data. Children’s responses to clinical measures identified these themes: dysphoria, identity statements, gender statements, contentment with self, and anticipatory statements. Findings highlight the need to develop clinical measures that center children’s voices, are inclusive of all gender identities, and go beyond diagnostic criteria to better reflect and understand the meaning children make of gender‐related experiences.
... Affective gender confusion is the child's desire to be a member of the other sex. Cognitive gender confusion is when a child mislabels his or her gender, or shows a lack of cognitive gender constancy over time (Zucker et al., 1993). The GII consists of 12 questions which are scored on a 3-point scale ranging from 0 to 2. A 0 was assigned if the child answered a factual question correctly or gave a stereotypic response. ...
... Children who gave more answers in line with their desired gender identity have a higher score. This correlates to more GI (Zucker et al., 1993). The Dutch translation of the GII was used, which was validated by Wallien et al. (2009). ...
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Article
Background In the DSM-5 diagnosis of childhood Gender Dysphoria, two of the eight criteria focus on body satisfaction of the child. Nevertheless, this subject is understudied. This study aims to describe the body image of children with gender incongruence (GI) in relation to birth assigned sex and the intensity of GI. Method Self-report and parent-report measures on body satisfaction and gender incongruence were obtained from 207 children (<12 years) who were referred to the Center of Expertise on Gender Dysphoria at the Amsterdam University Medical Centers, location VUmc, between 2010 and 2016. First, a general description of body satisfaction in children who took part in this study is provided. Secondly, body image of birth assigned boys and girls are compared using chi-square tests and univariate ANCOVA’s. Thirdly, the association between intensity of GI and body image is examined using multiple linear regression analyses. Results Of the 207 children with GI, 50% reported dissatisfaction with their gender-specific characteristics. Overall, children were less dissatisfied with their neutral body characteristics. Birth assigned girls report greater dissatisfaction with their body characteristics than birth assigned boys. Intensity of GI was significantly related to satisfaction with gender specific body characteristics where a greater intensity of GI relates to more body dissatisfaction. Conclusion Mental health practitioners should be aware of the diversity in body dissatisfaction in this group. Furthermore, evaluation of body image should be an important topic in the counseling of these children. Future research should focus on the relation of body dissatisfaction and the development of gender incongruent feelings in children with GI.
... Interpretation of those results, and especially comparison to the present work is difficult for several reasons. First, in past studies, when asked "are you a boy or a girl?" about 90% of the children supplied answers that aligned with their sex at birth 18 , leading some to question whether or not the majority of those children were the equivalent of transgender children today or not [19][20][21] . Second, participants in those studies were children between the 1960's and the 1990's, and many features of society have changed since then, including greater rates of acceptance and acknowledgement of transgender identities. ...
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Article
BACKGROUND AND OBJECTIVES Concerns about early childhood social transitions amongst transgender youth include that these youth may later change their gender identification (i.e., retransition), a process that could be distressing. The present study aimed to provide the first estimate of retransitioning and to report the current gender identities of youth an average of 5 years after their initial social transitions. METHODS The present study examined the rate of retransition and current gender identities of 317 initially-transgender youth (208 transgender girls, 109 transgender boys; M=8.1 years at start of study) participating in a longitudinal study, the Trans Youth Project. Data were reported by youth and their parents through in-person or online visits or via email or phone correspondence. RESULTS We found that an average of 5 years after their initial social transition, 7.3% of youth had retransitioned at least once. At the end of this period, most youth identified as binary transgender youth (94%), including 1.3% who retransitioned to another identity before returning to their binary transgender identity. 2.5% of youth identified as cisgender and 3.5% as nonbinary. Later cisgender identities were more common amongst youth whose initial social transition occurred before age 6 years; the retransition often occurred before age 10. CONCLUSIONS These results suggest that retransitions are infrequent. More commonly, transgender youth who socially transitioned at early ages continued to identify that way. Nonetheless, understanding retransitions is crucial for clinicians and families to help make them as smooth as possible for youth.
... In studies whose sample was recruited from consecutive clinical patients who received childhood diagnoses of GID (Drummond et al., 2008;Steensma, et al., 2013;Wallien & Cohen-Kettenis, 2008), the continued experience of GD or discomfort over time was assessed using measures such as the Utrecht Gender Dysphoria Scale (UGDS; Doorn et al., 1996), the Gender Identity Interview for Adolescents and Adults (GIIAA; Zucker et al., 1993) and the Gender Identity Interview for Children (GIIC; Deogracias et al., 2007). The Body Image Scale (BIS; Lindgren & Pauly, 1975) was used in four studies to assess satisfaction with primary and secondary sex characteristics. ...
Article
Background Children are presenting in greater numbers to gender clinics around the world. Prospective longitudinal research is important to better understand outcomes and trajectories for these children. This systematic review aims to identify, describe and critically evaluate longitudinal studies in the field. Method Five electronic databases were systematically searched from January 2000 to February 2020. Peer-reviewed articles assessing gender identity and psychosocial outcomes for children and young people (<18 years) with gender diverse identification were included. Results Nine articles from seven longitudinal studies were identified. The majority were assessed as being of moderate quality. Four studies were undertaken in the Netherlands, two in North America and one in the UK. The majority of studies had small samples, with only two studies including more than 100 participants and attrition was moderate to high, due to participants lost to follow-up. Outcomes of interest focused predominantly on gender identity over time and emotional and behavioural functioning. Conclusions Larger scale and higher quality longitudinal research on gender identity development in children is needed. Some externally funded longitudinal studies are currently in progress internationally. Findings from these studies will enhance understanding of outcomes over time in relation to gender identity development in children and young people.
... Only the scores that were assessed by both the 1.5-5 and the 6-18 scales were selected in our study and compared. (3) For gender identity, we used the Gender Identity Interview for Children (GIIC) [25]. The GIIC includes 12 questions scored using a 3-item Likert scale which assess affective and cognitive gender confusion within the child. ...
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Article
Medical advances in assisted reproductive technology have created new ways for transgender persons to become parents outside the context of adoption. The limited empirical data does not support the idea that trans-parenthood negatively impacts children’s development. However, the question has led to lively societal debates making the need for evidence-based studies urgent. We aimed to compare cognitive development, mental health, gender identity, quality of life and family dynamics using standardized instruments and experimental protocols in 32 children who were conceived by donor sperm insemination (DSI) in French couples with a cisgender woman and a transgender man, the transition occurring before conception. We constituted two control groups matched for age, gender and family status. We found no significant difference between groups regarding cognitive development, mental health, and gender identity, meaning that neither the transgender fatherhood nor the use of DSI had any impact on these characteristics. The results of the descriptive analysis showed positive psycho-emotional development. Additionally, when we asked raters to differentiate the family drawings of the group of children of trans-fathers from those who were naturally conceived, no rater was able to differentiate the groups above chance levels, meaning that what children expressed through family drawing did not indicate cues related to trans-fatherhood. However, when we assessed mothers and fathers with the Five-Minute Speech Sample, we found that the emotions expressed by transgender fathers were higher than those of cisgender fathers who conceived by sex or by DSI. We conclude that the first empirical data regarding child development in the context of trans-parenthood are reassuring. We believe that this research will also improve transgender couple care and that of their children in a society where access to care remains difficult in this population. However, further research is needed with adolescents and young adults.
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This study reports follow-up data on the largest sample to date of boys clinic-referred for gender dysphoria ( n = 139) with regard to gender identity and sexual orientation. In childhood, the boys were assessed at a mean age of 7.49 years (range, 3.33–12.99) at a mean year of 1989 and followed-up at a mean age of 20.58 years (range, 13.07–39.15) at a mean year of 2002. In childhood, 88 (63.3%) of the boys met the DSM-III, III-R, or IV criteria for gender identity disorder; the remaining 51 (36.7%) boys were subthreshold for the criteria. At follow-up, gender identity/dysphoria was assessed via multiple methods and the participants were classified as either persisters or desisters. Sexual orientation was ascertained for both fantasy and behavior and then dichotomized as either biphilic/androphilic or gynephilic. Of the 139 participants, 17 (12.2%) were classified as persisters and the remaining 122 (87.8%) were classified as desisters. Data on sexual orientation in fantasy were available for 129 participants: 82 (63.6%) were classified as biphilic/androphilic, 43 (33.3%) were classified as gynephilic, and 4 (3.1%) reported no sexual fantasies. For sexual orientation in behavior, data were available for 108 participants: 51 (47.2%) were classified as biphilic/androphilic, 29 (26.9%) were classified as gynephilic, and 28 (25.9%) reported no sexual behaviors. Multinomial logistic regression examined predictors of outcome for the biphilic/androphilic persisters and the gynephilic desisters, with the biphilic/androphilic desisters as the reference group. Compared to the reference group, the biphilic/androphilic persisters tended to be older at the time of the assessment in childhood, were from a lower social class background, and, on a dimensional composite of sex-typed behavior in childhood were more gender-variant. The biphilic/androphilic desisters were more gender-variant compared to the gynephilic desisters. Boys clinic-referred for gender identity concerns in childhood had a high rate of desistance and a high rate of a biphilic/androphilic sexual orientation. The implications of the data for current models of care for the treatment of gender dysphoria in children are discussed.
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A coding system was developed to measure sex-typed responses in the Rorschach protocols of children with gender identity disorder (n = 79). Their responses were compared to that of sibling (n = 25), psychiatric (n = 26), and normal (n = 28) controls. Results show that children with gender identity disorder gave significantly more cross-sex responses than same-sex responses, whereas the psychiatric and normal controls gave significantly more same-sex responses than cross-sex responses. The siblings did not differ in the number of same-sex and cross-sex responses. Results are discussed with regard to various assessment issues in the study of children with gender identity disorder.
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Clinical data from two cases of male transsexualism, a child and an adult, illustrate the nature of the bisexuality typical of such patients. The first, an 8-year-old boy whose desire to be a girl is seen in his constant dressing and acting like a girl, confirms in play therapy, story telling, and drawings his fantasies of being a female. However, these fantasies are never free of the knowledge that he has a penis and a male identity as well. That this bisexuality persists into the transsexual's adulthood is exemplified in the fantasy life of the second case, a 30-year-old operated male transsexual. The memory, "I was once a boy" never quite fades away; no matter how successfully the passing as a woman is managed, she cannot rid herself of the secret maleness. The belief in such patients that they are fundamentally female though possessed of an anatomically normal male body will persist through adulthood, unaltered by "sex change," by hormonal or surgical procedures, or by living successfully for years as a woman. This bisexuality is conscious, painful, and not assuaged by symptom formation, forgetting, or other defenses that would remove the conscious sense of having two sexes. In the child the unwanted sense of belonging to the male sex, which causes a disquieting undercurrent, can be used as the base upon which a more solid sense of masculinity can be built. Unfortunately, for the adult transsexual the balance of the "two-sexed" awareness cannot be tipped to a willingness to live as a man; despite treatment aimed at making them more manly, adult transsexuals retain their wish to be female-and their secret knowledge that, after all the operations and female hormones, a male part remains untouched within.
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Development through a sequence of gender understanding was thought to be asynchronous, with a given level of attainment achieved first when self was the referent, second when a same-sex other was the referent, and last when an opposite-sex other was the referent. 204 preschool children completed 3 gender-understanding questionnaires differing in the referent depicted. Components of gender understanding were assessed on the basis of judgments and, in the case of pseudo- versus true constancy attainment, on the basis of judgments plus explanations. Sex of examiner, sex of child, and test-retest effects did not influence attainment, and longitudinal change over an 8-month interval was observed in the children's responses to the self-referent. The predicted referent-related asynchrony was observed for the judgment-based components, for which understanding appears to follow an orderly sequence with attainment at each step occurring in a self, same-sex, opposite-sex order. No referent-related asynchrony was apparent in the transition from pseudoconstancy to true constancy.
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The Rorschachs of 14 feminine boys were intensively studied. Relative to the records of normal subjects, feminine boys displayed an inordinate investment in quasi-human at the expense of fully human responses. When percepts had individuals in interaction, the preponderance of these interactions were malevolent. Boundary disturbances, as indicated by lapses of thought organization, were commonplace. Females were frequently represented in idealized, stereotypical, or caricatured ways. Lastly, overt gender confusion was seen in single percepts of humans. It is proposed that these results provide evidence of severely disturbed internalized object representations. As such, boyhood femininity is inextricably linked to psychopathology and not a secondary consequence of peer rejection, as has been argued by others. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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The chief purpose of this study was to examine the development of stable concepts of "boy" and "girl" (gender identity constancy) in kindergartners and first and second graders. Gender constancy was explored in relation to cognitive level (assessed both by grade and conservation measures); whether the concept was applied to the subject himself or to another child; whether the concept was applied to live children or pictorial representations; and sex role preferences (games, television characters, peer preferences). In support of a cognitive-developmental position, gender constancy was found to be related to cognitive level, and most children conformed to a developmental sequence (Guttman scalogram) in which conservation preceded gender constancy. Gender constancy performance was better when the concept was applied to the self versus another child and when applied to pictorial representations versus live forms. Gender constancy was not related to sex role preferences.
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4 developmental levels of gender constancy were identified in 55 preschool-age children on the basis of a reproducible Guttman scale of answers to sets of questions pertaining to gender identity, gender stability over time, and gender consistency across situations. Children's developmental level of gender constancy was predictive of the amount and the proportion of time they attended to an adult male and an adult female film model. As boys developed gender constancy, their relative preference for watching the male model increased significantly; as girls developed gender constancy, their relative preference for watching the female model increased, though not significantly. At the more advanced levels of gender constancy, boys watched the male model more than did girls. It was suggested that same-sex social learning may develop as a function of children's cognitive understanding of gender as an identifiable, stable and consistent human attribute.
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