September 25, 2016
By Dr. Kelly Winters, Ph.D., member of the International Advisory Panel for the World Professional Association for Transgender Health (WPATH) Standards of Care:
WPATH: clarify and correct the childhood “desistance” myth statement in the SOC7
WPATH: Issue a public policy statement discrediting the practice of gender-conversion psychotherapies that is consistent with the SOC7
APA: clarify and correct the childhood “desistance” myth statement in the DSM-5
APA: remove “Transvestic Disorder” category from the DSM-5
WHO: initiate substantive conversation on converging the Adult/Adolescent Gender Incongruence categories in the proposed ICD-11 with the childhood category to refute the historical stereotype of childhood gender “confusion” and practice of gender conversion psychotherapies
US Dept. of HHS: align transition related categories in ICD-10-CM to ICD-11 in 2018
US Dept. of HHS/CMS: issue a National Coverage Determination for surgical transition care that is recognized as medically necessary by US and international medical authorities
From here: https://gidreform.wordpress.com/2016/09/19/gender-madness-in-psycho-politics-transgender-children-under-fire/
July 6, 2012
Excerpts From the APA Task Force on GID report issued this week:
Edgardo J. Menvielle, M.D., M.S.H.S. and Richard R. Pleak, M.D.
The optimal approach to treating pre-pubertal children with GV, including DSM-defined GID, is much more controversial than treating these phenomena in adolescents and adults for several reasons. Intervention, or the lack thereof, in childhood as opposed to later may have a greater impact on long range outcome (Crouch, Liao, Woodhouse, Conway, & Creighton, 2008); however, consensus is lacking regarding the definition of desirable outcomes. Further, children have limited capacity to participate in decision making regarding their own treatment and must rely on caregivers to make treatment decisions on their behalf. An additional obstacle to consensus is the lack of randomized controlled treatment outcome studies of children with GID or with any degree of GV (Zucker, 2008b). In the absence of such studies, the highest level of evidence currently available for treatment recommendations for these children can best be characterized as expert opinion. Such opinions do not occur in a complete vacuum of relevant data, but are enlightened by a body of literature (mostly APA level C and lower), including systematic experimental single-case trials as well as both uncontrolled and inadequately controlled treatment studies, longitudinal studies without intervention, and clinical case reports.
Opinions vary widely among experts depending on a host of factors, including their theoretical orientation as well as their assumptions and beliefs (including religious) relating to the origins, meanings, and fixity/malleability of gender identity. For example, do gender variations represent natural variations, not assimilated into the social matrix, or pathological mental processes? Even among secular practitioners there is a lack of consensus regarding some of the most fundamental issues: What are indications for treatment? What outcomes with respect to gender identity, gender role behaviors, and sexual orientation are desirable? Is the likelihood of a particular outcome altered by intervention? What constitutes ethical treatment aimed at bringing about the desired changes/outcomes? Adding to this complexity, service seekers as well as providers differ in their religious and cultural beliefs as well as in their world-views regarding gender identity, appropriate gender role behaviors, and sexual orientation. Primary caregivers may, therefore, seek out providers for their children who mirror their own world views, believing that goals consistent with their views are in the best interest of their children.
We begin by examining the natural history of GID as defined by outcome without treatment. We then discuss the goals of interventions in treating these children and the factors that influence clinicians in goal selection. Next, we describe various interventions that have been proposed. The empirical data available to inform the selection of goals and interventions are then reviewed and an opinion is offered regarding the status of current credible evidence upon which treatment recommendations could be based.
The following are the proposed revisions to the diagnostic criteria for children exhibiting sex-role incongruence. If approved, they will be used to diagnose sex-role noncompliant children to be treated with medical “puberty suppression”, sterilization and extensive plastic surgery to change the child’s body to a newly dysfunctional but superficially rough visual approximation of the other sex. The APA’s position is that social sex-roles are biologically created, possibly by brain neurology which although incredibly plastic in every other instance, for some reason in terms of sex roles is unchangeable. They advocate sterilization and lifetime cross-sex hormone treatments for children that are unable or unwilling to adhere to sex-based gender stereotypes and traditions.
P 00 Gender Dysphoria in Children
Updated May 4, 2011
Gender Dysphoria (in Children)** 
A. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months duration, as manifested by at least 6* of the following indicators (including A1): [2, 3, 4]
1. a strong desire to be of the other gender or an insistence that he or she is the other gender (or some alternative gender different from one’s assigned gender) 
2. in boys, a strong preference for cross-dressing or simulating female attire; in girls, a strong preference for wearing only typical masculine clothing and a strong resistance to the wearing of typical feminine clothing 
3. a strong preference for cross-gender roles in make-believe or fantasy play 
4. a strong preference for the toys, games, or activities typical of the other gender 
5. a strong preference for playmates of the other gender 
6. in boys, a strong rejection of typically masculine toys, games, and activities and a strong avoidance of rough-and-tumble play; in girls, a strong rejection of typically feminine toys, games, and activities 
7. a strong dislike of one’s sexual anatomy 
8. a strong desire for the primary and/or secondary sex characteristics that match one’s experienced gender 
B. The condition is associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning, or with a significantly increased risk of suffering, such as distress or disability.**
The proposed revisions rename the childhood diagnosis from the DSM4’s previous “Gender Identity Disorder” (GID) to the revised name “Gender Dysphoria”(GD).
Gender = Sex Role. Dysphoria = Distress.
The previous APA revisions proposed to re-name the diagnosis “Gender Incongruence” (GI) :
“In response to criticisms that the term was stigmatizing, we originally proposed to replace the term “Gender Identity Disorder” with Gender Incongruence. This was accompanied by a re-definition of the condition, revised criteria, eliminating the previous subtype pertaining to sexual attraction, and introducing a new subtype categorization that does not exclude individuals with a somatic disorder of sex development (DSD). We chose the new term, Gender Incongruence, as descriptive and to avoid a presupposition of the presence of a clinically significant acute distress in all cases as a requirement for the diagnosis. In part, this was based on more general discussions in the DSM-5 Task Force on separating out the distress/impairment criterion and evaluating these parameters as a separate dimensions.
We also debated and discussed the merit of placing this condition in a special category apart from (formerly Axis-I) psychiatric diagnoses to reflect its unusual status as a mental condition treated with cross-sex hormones, gender reassignment surgery, and social and legal transition to the desired gender (particularly with regard to adolescents and adults). We chose not to make any decision between its categorization as a psychiatric or a medical condition and wished to avoid jeopardizing either insurance coverage or treatment access”
Also reinstated at the behest of transgenderists is the severity scale, which trans-activists feel assists with the authorization of sterilization and medicalization of children who experience distress conforming to sex-roles.
“This revised proposal also re-introduces a clinical significance criterion, B, which clarifies that diagnosis requires distress or impairment that meets a clinical threshold. This criterion is present in the DSM-IV but was removed from the first DSM–5 proposal. Parents of affirmed/transitioned youth and care providers have raised concerns that removal of the clinical significance criterion would further obscure the medical necessity of puberty delaying medications as well as hormonal and surgical transition care.”
Here is the APA’s clinical significance survey. Each question must be answered as shown:
- Very Strong
“Dimensional Assessment for Gender Dysphoria in Children
Questions A1-A8 are the dimensional metrics for the corresponding categorical criteria.
Instructions: Please circle the letter next to the statement that applies to your child the best.
For Male Children (Parent-Report)
A1. Over the past 6 months, how intense was your son’s desire to be a girl or insistence he is a girl?
A2. Over the past 6 months, how intense was your son’s preference to wear girls’ or women’s clothing during dress-up play or activities (e.g., during dress-up play or at other times)?
A3. Over the past 6 months, how intense was your son’s preference for female roles in fantasy or pretend play?
A4. Over the past 6 months, how intense was your son’s preference for the toys, games, and activities typical of girls?
A5. Over the past 6 months, how intense was your son’s preference for girl playmates?
A6a. Over the past 6 months, how intense was your son’s rejection of typically masculine toys, games, and activities?
A6b. Over the past 6 months, how intense was your son’s avoidance of rough-and-tumble play?
A7. Over the past 6 months, how intense was your son’s dislike of his sexual anatomy (e.g., that he dislikes or hates his penis or testes)?
A8. Over the past 6 months, how intense was your son’s desire for the sexual anatomy of a girl (e.g., sits to urinate, pretends to have breasts, would like to have a vagina)?
For Female Children (Parent-Report)
A1. Over the past 6 months, how intense was your daughter’s desire to be a boy or insistence she is a boy?
A2a. Over the past 6 months, how intense was your daughter’s preference for wearing only typical masculine clothing?
A2b. Over the past 6 months, how intense was your daughter’s resistance to the wearing of typical feminine clothing?
A3. Over the past 6 months, how intense was your daughter’s preference for male roles in fantasy or pretend play?
A4. Over the past 6 months, how intense was your daughter’s preference for the toys, games, and activities typical of boys?
A5. Over the past 6 months, how intense was your daughter’s preference for boy playmates?
A6. Over the past 6 months, how intense was your daughter’s rejection of typically feminine toys, games, and activities?
A7. Over the past 6 months, how intense was your daughter’s dislike of her sexual anatomy (e.g., dislikes the prospects of breast development or that she has a vagina)?
A8. Over the past 6 months, how intense was your daughter’s desire for the sexual anatomy of a boy (e.g., that she would like to have a penis or to grow one; stands to urinate)?
Should religious or other parents be permitted to subject their children to “treatments” which prevent them from going through puberty and subsequent surgical sterilization because they exhibit distress about complying with sex-roles? Because they do not want to treated in the way boys and girls are treated – very differently according to sex- and reject the roles expected of them, and enforced on them, even by violence, or medical violence in the case of the sterilization advocated by transgenderists and the APA? Should children distressed by sex-roles be diagnosed with a mental illness or “medical” condition even though they are perfectly healthy in every way prior to “treatment”, but not after, because the “treatment” is permanently disabling? Is it child abuse? Is it a human rights crime? We KNOW WITHOUT A DOUBT that the vast majority of these kids will acquire the ability to cope with their sex-role distress after going though natural puberty, without further need for psychiatric support, whether by finding social support among other sex-role rejecting people, or by fighting the nature of sex-roles and rejecting the roles entirely. We KNOW that MOST of these kids, left alone, grow up to be GAY, and well-adjusted in their communities. Should psychiatrists be “correcting” gender-nonconforming children? Should they be slating these kids for irreversible sterilization and profound surgical genital mutilation? Should boys that want to have long hair and play with girls and hate sports and like dolls be pathologized? Should girls that don’t want to be treated as girls be “treated” with lifetime cross-hormones so they can look like boys? Or should the APA develop “treatments” that are non-invasive and that support children who reject the gender roles imposed on them? Should the APA fight sex-role conformity rather than promote it by pathologizing children?
The American Psychiatric Association requests public feedback on these proposed revisions. Deadline is June 12, 2011.