Steensma 2013 — desistance in children

Steensma and colleagues followed a cohort of children with gender dysphoria in Amsterdam and published their findings in 2013 in the Journal of the American Academy of Child and Adolescent Psychiatry on factors that predict whether dysphoria persists (persistence) or disappears (desistance) between childhood and adolescence.

The main article on this subject is Desistance.

Research

Steensma and colleagues followed a cohort of children with gender dysphoria in Amsterdam and published their findings in 2013 in the Journal of the American Academy of Child and Adolescent Psychiatry on factors that predict whether dysphoria persists (persistence) or disappears (desistance) between childhood and adolescence.

Key findings

For a majority of the children studied, the dysphoria disappeared around the start of puberty. Factors associated with persistence included the intensity of the dysphoria, social transition in childhood, age at first presentation, and cognitive and affective cross-gender identification.

Policy implications

The study is frequently cited in policy discussions about gender care for young people, including in the Cass Review. It highlights the importance of carefully differentiating which children might benefit from medical intervention under the Dutch Protocol. The steps parents and young people can take before a medical pathway begins are outlined in the step-by-step plan from transkompas.nl.

Figures

The researchers followed 127 young people who had been referred to the Amsterdam gender clinic before the age of twelve. In 47 of them, the gender dysphoria persisted into adolescence; they returned to the clinic for treatment. The other 80 did not, and were counted as desisters. Earlier studies from the Netherlands and Canada found similar or higher proportions of children whose dysphoria disappeared. Recent German insurance data likewise point to low diagnostic stability among young people.

Criticism of the counting method

A group of researchers led by Julia Temple Newhook criticized the desistance studies in 2018. Children who did not return to the clinic were counted as desisters, even though it was not known how all of them were doing. The diagnostic criteria were also broader in those years than they are today. Kenneth Zucker responded that the overall picture remains intact even if only the children whose outcome is known are counted. See also watchful waiting.

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