Brown University and PLOS ONE: Defend academic freedom and scientific inquiry

We are urging Brown University and the editors of the peer-reviewed journal PLOS ONE to continue to support the research of Dr. Lisa Littman. Her recently published paper, “Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports,” explores the possibility that social contagion may cause some teens and young adults to incorrectly conclude they are transgender, and thereby undertake irreversible medical interventions that they may eventually regret.

Since its publication, there has been a concerted effort to suppress Dr. Littman’s groundbreaking study. Complete details can be found below. Readers who share our concern about this activist-driven attack on scientific inquiry and academic freedom are strongly encouraged to sign the petition at this link.

In addition,  please consider telephoning and/or writing a personal letter to the following individuals at Brown University and PLOS ONE. What’s at stake: The future of research into the unexplained increase in young people, particularly girls, presenting to gender clinics.

Bess Marcus, Dean of School of Public Health, bess_marcus@brown.edu, 401-863-9858

Christopher Kahler, Chair of Behavioral and Social Sciences, christopher_kahler@brown.edu, 401-863-6651

Brian Clark, Director of News and Editorial Development, brian_clark@brown.edu, 401-863-1638

Joerg Heber, PLOS ONE Editor-in-Chief, jheber@plos.org, 415-624-1200


Petition text

We, the undersigned, are writing in support of Dr. Lisa Littman of Brown University and her study on the topic of rapid onset gender dysphoria (ROGD).

Many of us are parents of teens and young adults who, having never expressed discomfort with their sex during childhood, experienced a sudden onset of gender dysphoria after exposure to the concept through peers and/or websites promoting transition. Some of the signatories to this petition are parents who completed Dr. Littman’s survey. The results of the study support the possibility that social contagion, rather than an innate, immutable sense of incongruence between body and mind, may be at work in some of these cases.

We are grateful that Dr. Littman’s research has been published and that this issue is finally beginning to get the attention it deserves. Although an abrupt adolescent onset of dysphoria has been mentioned previously in the scientific literature[1] , Dr. Littman’s study is the first to explore and document the phenomenon in detail. It describes what appears to be happening to many young people today.

We must be very clear: the parental reports in this study offer important and much-needed preliminary information about a cohort of adolescents, mostly girls, who with no prior history of dysphoria, are requesting irreversible medical interventions, including the potential to impair fertility and future sexual function. In any other group of children, these grave consequences would be seen as human rights violations unless there was significant and overwhelming evidence these procedures would be beneficial long-term.

Across the world in the last few years, researchers and clinicians have noted a sharp uptick in the number of young people, primarily females, who are requesting medical transition services. For example, in the United Kingdom gender clinic referrals have quadruped in the last five years. This constitutes an epidemic. As a leader in public health research, it is incumbent upon Brown University to investigate the causes and conditions leading to this sharp increase, as well as the long term outcomes.

Tavistock-referrals-of-boys-vs-girls-

Referral data from Tavistock GIDS: http://gids.nhs.uk/number-referrals

We are disheartened to see that Brown University has already removed a news release announcing the study from its website and replaced it with a letter to their community that states: “There is an added obligation for vigilance in research design and analysis any time there are implications for the health of the communities at the center of research and study.”

We, the undersigned, many of whom are parents who participated in Littman’s survey, agree wholeheartedly that the “scientific community holds an obligation for vigilance in research design and methodology.” There has yet to be a study that includes a cohort of youth offered mental health care in place of affirmation therapy. The glaring absence of a control group of youth who are supported by their families in their gender exploration but who are not affirmed in “wrong body” beliefs is a failure of the scientific community. As the number of girls and young women who desist from their trans identification grows, we must demand recognition for this cohort as members of the “communities at the center of research and study.”

The university has effectively caved to pressure from activists who claim that Dr. Littman recruited participants from “anti-trans” or “far right” hate sites. Similarly, the moderator of the PLOS One Twitter site promised to “investigate” the published study after trans activists mobbed their account. Trans activists  claim the parents who completed the survey were too transphobic to accept that their children were trans and too disconnected to have noticed that they had been suffering from dysphoria since childhood.

These claims are false in every respect. The three websites referenced are available for all to view, but the vast majority of contributors are secular, engaged, open-minded, mostly liberal-leaning parents.

These sites point to the probability that many kids who are today identifying as trans are in fact experiencing internalized homophobia. In other words, the contributors to these sites are concerned about the wellbeing of gay and lesbian kids, and they want to ensure that their children are not transitioning simply because they are ashamed of their sexual orientation.

Consider the study results:

  • 85.9% support same-sex marriage.
  • 88.2% believe trans people deserve the same rights and protections as everyone else.

Clearly, those who claim the respondents are from the far right are either misinformed or disingenuous.

And what of the claim that the parents were “unsupportive” or too disconnected from their children to recognize they had felt dysphoric during childhood? Dr. Littman acknowledges this possibility in her paper. However, she also notes that “the 200 plus responses appear to have been prepared carefully and were rich in detail, suggesting they were written in good faith and that parents were attentive observers of their children’s lives.”

Littman’s study offers, for the first time, a glimpse into families who hold space for their dysphoric children while also seeking out mental health care that focuses on underlying conditions. Consider some of her findings:

  • 204 out of 256 youth reported on in the study claimed alternative sexualities to their parents prior to coming out as transgender
  • Over 200 youth were supported in changing their presentation in terms of hairstyle and dress
  • 188 had changed their names
  • 175 had changed their pronouns
  • 111 youth told their parents they wanted to see a gender therapist; 92 were taken to see one

Moreover, of Dr. Littman’s respondents, there were only eight cases of estrangement: six by the youths themselves and two “where the estrangement was initiated by the parent because the AYA’s outbursts were affecting younger siblings or there was a threat of violence made by the AYA to the parent.” [AYA = “adolescent or young adult.”]

These are clearly parents who supported their children in their distress and through exploration of identity. Littman’s study also found that 119 youth requested medical interventions at the same time they announced their new gender identity or within the first month of their announcement. Remember, 100% of the youth discussed in her survey did not qualify for a diagnosis of gender dysphoria at any point in their childhood or  prior to coming out. Yet, 17 youth were offered an Rx on their first visit with a clinician. Perhaps even more concerning, “For parents who knew the content of their child’s evaluation, 71.6% reported that the clinician did not explore issues of mental health, previous trauma, or any alternative causes of gender dysphoria before proceeding and 70.0% report that the clinician did not request any medical records before proceeding.” This is in a cohort of young people of whom 62.5% had been diagnosed with at least one mental health or neurodevelopmental disability prior to the onset of gender dysphoria, which mirrors data from other affirmation-focused clinics.[2]

Another notable criticism of the study is that Dr. Littman sought input only from parents, not from their children. Here again she acknowledges the limitation: “Although this research adds the necessary component of parent observation to our understanding of gender dysphoric adolescents and young adults, future study in this area should include both parent and child input.” We understand that Dr. Littman plans future surveys specifically for dysphoric youth and we cannot emphasize enough how important this research will be for this particular group of young people and their families.

We, the signatories to this letter, overwhelmingly support the rights of transgender people, but we want better diagnostic and mental health care for youth who suddenly demand serious medical interventions, particularly in the absence of a history of dysphoria.  We believe that medical interventions that may benefit some individuals may not help, and may even harm, others, as already evidenced by the growing number of desisters and detransitioners, many of whom have already suffered from irreversible side effects of their earlier medical transition . We support more research to help distinguish between the two groups, and Dr. Littman’s study is an important first step.

We strongly urge Brown University and PLOS ONE to resist ideologically-based attempts to squelch controversial research evidence. Please stand firm for academic freedom and scientific inquiry.  We urge you to support Dr. Littman in this important line of research.


[1] See, for example, Bonfatto, M. & Crasnow, E. (2018) Gender/ed identities: an overview of our current work as child psychotherapists in the Gender Identity Development Service, Journal of Child Psychotherapy, 44:1, 29-46, DOI: 10.1080/0075417X.2018.1443150. Also see Byne, W., Bradley, S. J., Coleman, E., Eyler, A. E., Green, R., Menvielle, E. J., . . . Tompkins, D. A. (2012). Report of the American Psychiatric Association Task Force on Treatment of Gender Identity Disorder. Archives of Sexual Behavior, 41(4), 759-796. doi:10.1007/s10508-012-9975-x.

[2] “In all diagnostic [mental health] categories, prevalence was severalfold higher among TGNC youth than in matched reference groups.” http://pediatrics.aappublications.org/content/early/2018/04/12/peds.2017-3845

 

 

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First peer-reviewed study of rapid onset gender dysphoria released today

The research, conducted by Dr. Lisa Littman, examines parent reports of the heretofore little-studied phenomenon of rapid onset of gender dysphoria in adolescence, also called ROGD.

The full paper can be accessed here (open access):

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0202330

Stay tuned for an interview with Dr. Littman here on 4thWaveNow within the next few days.

Research evidence: Gender-atypical tots likely to become gay or lesbian

by Michael Biggs

Michael Biggs is Associate Professor of Sociology at the University of Oxford and Fellow of St Cross College. He researches social movements and collective protest.


Transgender activists insist that children who behave in ways more typical of the opposite sex—a boy who likes dressing up as a fairy princess, a girl who enjoys rough-and-tumble play—are ‘transgender’. Such kids, they argue, must be subjected to medical interventions to make them superficially resemble the opposite sex, and these interventions must take place as soon as possible. The British National Health Service gives puberty-blocking hormones to children as young as 10, while in the United States some surgeons will amputate the breasts of 13-year-old girls.

Many of the kids labelled ‘transgender’ would—if left alone—grow up to be lesbian or gay. This observation has been made by many parents, and sometimes their children who desisted or detransitioned, whose stories are gathered on this website. It is also supported by a growing body of scientific research. Developmental Psychology published an important article last year (Li, Kung, and Hines 2017), which 4thWaveNow has previously highlighted. Thanks to the generosity of Gu Li in sharing some of the data, I will try to explicate the results for the general reader.

The article exploits a survey of exceptional quality, from a well-defined population: mothers giving birth in a county in southwestern England in 1991–2. Therefore it avoids the problem of haphazard sampling which undermines so many surveys of sexuality. The survey is large, so the article analyzes 4,597 children. Because they are tracked over time, we can see how the children behaved just before starting school (at 4 years and 9 months), and then how they turned out by the age of 15.

Gendered behavior

The survey asked mothers (or other caregivers) about their children’s behavior. We are interested in the questions on gender which comprise the Preschool Activities Inventory (Golombok and Rust 1993). This is a standard list of two dozen questions covering toys, activities, and characteristics. For example, the interviewer asks how often the child played with toy guns in the last month, from “never” to “very often.” All these questions are condensed into a single scale, so that the child can be placed somewhere on a spectrum from most ‘feminine’ to most ‘masculine’.

The Preschool Activities Inventory predates the emergence of transgenderism as a phenomenon. Yet the questions bear a striking resemblance to the reasons given by parents for diagnosing their kids as transgender, as catalogued by Lily Maynard. Thus, femininity is elicited by questions about playing with dolls, dressing in girls’ clothes, and pretending to be a female character like a princess; masculinity by playing with cars, or joining ball games. Today’s trans kids, in other words, would be drawn from those on the extremes of the Inventory.

Biggs image 1

The first graph plots gendered activities of the children in the survey. The horizontal axis is derived from the Preschool Activities Inventory, ranging from most ‘masculine’ to most ‘feminine’. Clearly there is a large difference, on average, between boys and girls. But there is also a wide variation within each sex. Indeed, the two distributions overlap at the edges. The mid point between the typical (median) girl and the typical boy is indicated by a vertical line. About 6% of girls behaved in ways more typical of boys than of girls, and vice versa for 3% of boys. A few of these kids were extremely atypical for their sex: girls, for example, who preferred even more ‘masculine’ activities than those chosen by the typical boy.

These atypical kids, incidentally, demonstrate the limits of socialization as the sole explanation for gendered behavior. Parents were not encouraging them to deviate from gender norms, and yet this subset of children were becoming more gender-divergent as they grew up (activities were also measured earlier, at the ages of 2½ and 3½) while most of their peers were gravitating towards behavior more typical for their sex. In fact, analysis of this same population shows that the mothers with higher levels of testosterone gave birth to girls who chose more ‘masculine’ activities, though there was no effect on boys (Hines et al. 2002). As the authors note in the abstract, “nonheterosexual individuals appear to diverge from gender norms regardless of social encouragement to conform to gender roles.”

Sexual orientation

Now fast forward ten years to the children at 15 (in 2006–07). They were asked about their sexual orientation, recording their answer confidentially on a computer. For simplicity we will divide orientation into two groups: on one hand, heterosexuals (“100%” or “mainly”) and on the other, homosexuals (“100%” or “mainly” gay or lesbian). A small number of teens identified as bisexual or asexual; they are excluded from the total.

Only 1.1% of boys identified as gay rather than heterosexual, and 0.7% of girls identified as lesbian. These proportions roughly match the total British population, but younger cohorts—like the millennials in this survey—are more likely to call themselves gay or lesbian than older generations. Therefore one suspects that some of those who called themselves heterosexual at 15 would subsequently come out as gay or lesbian in their late teens or early twenties.

Biggs image 2

The second graph uses gendered behavior to predict subsequent sexual orientation for girls. The horizontal axis is the same as in the first graph. The curve shows how girls who had preferred more ‘masculine’ activities were far more likely to identify as lesbians. As the curve extends further to the right, it is based on fewer individuals (shown as points), and so estimation becomes less certain. We can, however, be confident in the following comparison. A girl who was average in gendered activities has a 0.5% chance of becoming lesbian. For a girl who was midway between average girl and average boy, the probability triples to 1.7%.

biggs image 3

The third graph is the equivalent for boys. A boy who was at the average in gendered activities has a 0.6% chance of becoming gay. For a boy who was halfway between the average boy and the average girl, the probability multiplies eight-fold to 4.9%. Again, we cannot give too much credence to the extreme left of the curve, as it derives from only a few individuals. One final point needs emphasis. While kids who behaved in ways more typical of the opposite sex were far more likely to identify as homosexual than those who conformed, nevertheless the majority of them were heterosexual. As noted already, some of them would come out as gay or lesbian later on. Nevertheless, the majority of gender-nonconforming kids are heterosexual.

In sum, then, girls and boys growing up in England in the early 1990s preferred different toys and activities. To what extent this reflected socialization from parents and television, as feminists emphasize, and to what extent innate sexual differences, remains an open question.

It’s crucial is to appreciate variation and overlap as well as differences. Just as some women are naturally taller than some men, so some girls prefer more ‘masculine’ activities than some boys do. Such girls were far more likely to turn out as lesbian. That was the case, at least, in this survey of children coming of age in a society that was relatively tolerant of homosexuality—and before transgender identities were ascendant in social media and schools. We can only speculate how the cohort born ten years later would identify. But we must realize that the characteristics that now diagnose a ‘transgender child’ are the same characteristics that increase the chances of a teenager becoming gay or lesbian.

Note

Predicted probabilities are estimated from logistic regression. Adding a quadratic term or log transforming the Preschool Activities Inventory does not improve the model’s fit. N = 2,382 boys and 2,141 girls. Data kindly supplied by Gu Li.


References

Golombok, Susan, and John Rust. 1993. “The Pre-School Activities Inventory: A Standardized Assessment of Gender Role in Children.” Psychological Assessment, vol. 5, pp. 131–136.

Hines Melissa, Susan Golombok, John Rust, Katie J. Johnston, Jean Golding, and Avon Longitudinal Study of Parents and Children Study Team. 2002. “Testosterone During Pregnancy and Gender Role Behavior of Preschool Children: A Longitudinal, Population Study.” Child Development, vol. 73, pp. 1678–87.

Li, Gu, Karson T. F. Kung, and Melissa Hines. 2017. “Childhood Gender-Typed Behavior and Adolescent Sexual Orientation: A Longitudinal Population-Based Study.” Developmental Psychology, vol. 53, pp. 764–77.