Psychosocial development in gender nonconforming children

Gender expression refers to the way that children experience and express themselves in a masculine or feminine way, through their interests, friendships and clothing choices (Collaer & Hines, 1995). Those who do not follow the social norms expected for their biological sex are referred to as 'gender nonconforming'. Recalled experience of childhood gender nonconformity (CGN) has been associated with a number of negative outcomes, including poorer mental health (Alanko et al., 2009; Roberts, Rosario, Corliss, Koenen & Austin, 2012; Roberts, Rosario, Slopen, Calzo & Austin, 2013), poorer relationships with parents (Alanko et al., 2009), and poorer relationships with peers (Roberts et al., 2013).

While these studies have helped to develop understanding of the consequences of CGN later in life, they are limited by the fact that their measures of CGN are all retrospective. This means that these could be affected by recall bias. Memories of childhood behaviours and experiences may be changed to better fit with the identity that is currently experienced (Alanko et al., 2009). To resolve the causal direction of this relationship, longitudinal data is needed, including CGN measured in childhood. There are currently no prospective studies investigating the role of childhood reported CGN on mental health and wellbeing in adolescence and adulthood.

Data from a birth cohort study, the Avon Longitudinal Study of Parents and Children (ALSPAC), will be used in the proposed research to assess the prospective relationship between CGN as reported in childhood with a number of these outcomes. This will confirm the direction of causation of the relationships described above. CGN was reported by mothers when children were aged 30 months, 42 months and 57 months, and by children at 8 years. Psychiatric diagnoses were measured at ages 7, 10, 13, 16 and 17, and educational outcomes at GCSE level.

With regard to potential mediators, the parent-child relationship was reported by parents at age 6 and 16, and by children at age 9 and 14. Children's reports of friends and peersat ages 8, 10, 12, and 17. Self-esteem was measured at ages 11 and 17.

Given previous findings suggesting a possible mediation of the relationship between CGN and poorer health or educational outcomes by factors such as bullying (Roberts et al., 2013) or low self-esteem, mediation models will be analysed using the ALSPAC data. These will be assessed using mediational analysis based on path and structural equation modelling (SEM). This will help to understand the longitudinal relationship between the different variables being studied. Due to the nature of longitudinal data sets, participant drop-out and missing data is common. Multiple imputation techniques will be applied to resolve this issue.

In addition to the quantitative analysis of the ALSPAC data, qualitative data will be collected to investigate in more depth the associations between CGN and distress. Collecting qualitative data from those with CGN will help to develop a more nuanced understanding of how parents and peers reacted to the CGN, and whether this contributed to any distress or mental health outcomes in participants. In addition to conducting interviews with the children with CGN, interviews will also be performed with parents to assess their perspective on the CGN. This will not only add further information, but will help to highlight whether there are discrepancies between how the children and their parents feel about the gender nonconformity.

These findings, together with the quantitative analysis, will help to develop an understanding of how and when CGN leads to negative outcomes in mental health and relationships. This will have important implications for those who work with children, such as teachers, social workers and healthcare providers. If the triggers of these negative outcomes can be identified early on, this may reduce the later impact on mental health and poor relationships.