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The paper's two unstated assumptions

Posted by bhall on 04 Nov 2018 at 02:35 GMT

This paper depends on the following two implicit assumptions:
-- Gender dysphoria is never a part of a child’s hidden inner life; something compels a child to confess their dysphoria to a parent at roughly the onset of dysphoria. There are no factors that would prevent a child from confessing their dysphoria at the time they become aware of it.
-- Parents accurately report the time at which a child comes out as transgender or begins to show signs of dysphoria.

The survey responses indicated that 80.9% of the announcements of being transgender “out of the blue without significant prior evidence of gender dysphoria”. The maximum reported time between a parent noticing signs of gender dysphoria and the child’s announcement of being transgender was three months. None of the parents observed signs of gender dysphoria in their children during earlier childhood. The paper states that the onset of gender dysphoria occurred in cluster outbreaks in friendship groups and that the onset was sudden.

Obviously, these results depend on the implicit assumptions stated above. In defense of the results, the paper states 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.” But this is a non sequitur. Parents can write descriptions of a child’s history, rich in detail, derived from attentive observation, while being in denial about a particular aspect of the child’s life and either leaving out significant details or misrepresenting them. In fact, the paper brings up the possibility of a mismatch between description and reality:

“The patient’s history being significantly different than their parents’ account of the child’s history should serve as a red flag that a more thorough evaluation is needed and that as much as possible about the patient’s history should be verified by other sources.”

Either parent or child, or both, may be motivated to give an inaccurate account of the child’s history. Since the survey only collected responses from parents, there’s no way of confirming the presence or absence of red flags, and therefore no way of evaluating whether the results described above are an accurate aggregate representation of the onset of gender dysphoria and the timing of coming out as transgender. Again, the paper brings up the possibility of motivated accounts:

“Because adolescents may not be reliable historians and may have limited awareness and insight about their own emotions and behaviors, the inclusion of information from multiple informants is often recommended when working with or evaluating minors.”

The same may be said of parents with regard to their children’s emotions and behaviors.

In regard to the assumptions above, I searched in the r/ftm discussion group at Reddit. The paper focuses on teenage girls with gender dysphoria, and “ftm” stands for “female to male”, or people assigned female at birth who are transitioning to male. My search keywords were “parent come out”. I selected the first hits that came up, eliminating people who said they had socially conservative parents, or parents who were homophobic or transphobic, so as to match the children of the parents who responded to the survey as closely as possible. I made no effort to cherry pick the data.

From this post and its comments:
https://old.reddit.com/r/...

“I'm a 21 year old… I recognized my feelings as dysphoria from about 15 onwards… My original plan was to tell my parents that I'm trans after that appointment was over, but I decided that I want to do it before then… they believe in evolution, climate change, and didn't disown me when I told them I was gay. I've watched videos or TV shows with trans characters with both of them, and their reaction is nothing to write home about: it's very bland and neutral.”

“I did [came out] when I was 19 (I am 29 now… It really didn't go well at first. My mom didn't understand… My dad was pissed. He didn't get it, and said I just thought I was this way because I saw it on the internet.”

“When I told them, my dad didn't speak to me for two weeks… Both of them are fairly liberal, probably socialist by American standards… Honestly, I prefer my family at arm's length anyway. I'm 30… My coworkers, by contrast, have been lovely.”

https://old.reddit.com/r/...

“How can I come out to my parents? Does anyone have any advice? I have no clue how to go about it.”

https://old.reddit.com/r/...

“Im 18 and i just started T 2.5 months ago via informed consent. My parents don't know that I'm pn T or even that I'm trans.”

https://old.reddit.com/r/...

“I'm 16, ftm, and dependent on my parents. I'm coming out to them at the end of this week, after my birthday. I don't think they will reject me, but they don't know much about trans people. I've typed up a letter with definitions and resources since I'd rather not say it face to face. I'm staying with a friend the night of (my parents don't know the address), and I'm planning to email the letter to my parents while I'm gone. Then I kind of want to tell them, "I'm turning off my phone until tomorrow morning… This would give them time to talk to my siblings, who already know… I also get called my name and pronouns at work, but nowhere else.”

The people who have already come out describe conflict with their parents. One person waited 6 years after recognizing their gender dysphoria before coming out to their parents. One person is coming out via email and turning off the phone in order to avoid conflict with their parents. Where siblings and coworkers are mentioned, they know before the parents and seem to have been more supportive than the parents. One parent decided that the child had been influenced by the Internet (the child came out 10 years ago and is still trans.) In general, these people find it difficult to communicate with their parents about this. The parents seem to be oblivious to their children’s gender identities, and among family and coworkers they are the last to know.

Another commenter on this paper wrote here:
https://journals.plos.org...

“... those of us with significant experience working with this population (and contrary to the article, very much in alignment with the current literature out there on gender dysphoria et. al.) know that often parents describe their child's disclosure after puberty as coming completely out of the blue, influenced by social media, etc. This has even been described by parents of one kid who literally came out as transgender at age 6, again at age 9 and again at age 13. "this came out of nowhere!" they said.”

My sample is no more random that the survey sample, and much smaller. Also, both the papers sample and my sample came from websites where participants tend to have a particular viewpoint on trans issues. Nonetheless, I haven’t found any support for the paper’s implicit assumptions, and in fact the evidence I found contradicts the assumptions. It seems to be the case that parents are often not aware of their children’s gender dysphoria, even with children who have been experiencing it for years. Children are frequently afraid to discuss it with their parents, even when their parents don’t seem to be homophobic or transphobic, and in fact the children may concoct elaborate plans to avoid telling their parents face to face. At a minimum, children may not tell their parents because they don’t know how to tell them. And when parents are told, they may refuse to acknowledge it and claim that later announcements of being transgender have come out of the blue, sometimes years after first being told.

In light of this, the paper’s survey results may be an accurate representation of the parent respondents’ perceptions, but it cannot be taken as a reliable representation of the children’s behavior.

No competing interests declared.

RE: The paper's two unstated assumptions: Misread table

bhall replied to bhall on 04 Nov 2018 at 15:03 GMT

I have trouble reading Plos-One’s tables on my computer system. The maximum reported time between a parent noticing signs of gender dysphoria and the child’s announcement of being transgender was not three months, and the sentence stating that it was should be disregarded. It plays no part in my argument.

No competing interests declared.