Affirmative Mental Health Care for Transgender and Gender Diverse Youth : A Clinical Guide

This unique resource offers an in-depth, comprehensive look at different types of mental health needs of transgender and gender diverse youth, how these intersect with gender identity, gender expression, and sexual orientation, and provides practical information on how to ethically, responsibly, and sensitively care for these patients. __Affirmative Mental Health Care for Transgender and Gender Diverse Youth: A Clinical Guide__ begins with three introductory chapters which contain practical information regarding assessment, psychological interventions, and the potential medical and surgical interventions that are indicated for youth with gender identity concerns. The remaining chapters are illustrated by multiple cases build around overarching chapter themes. Each case chapter opens with broad questions applicable to clinical practices, while the cases themselves focus on a particular co-occuring mental health condition. The case chapters are structured with intersectionality in mind, including elements of ethnic, racial, and cultural diversity, and the patients range over the full developmental spectrum, from pre-pubertal children to older adolescents. Chapter cases range in complexity as well, to provide readers with the tools they need to evaluate patients, and to assist in the decision of which presenting factors to prioritize in treatment at which time. Ending each chapter are clinical take-home messages, closing with additional practical knowledge that can be applied to other cases providers may see in their own practices. Written by expert clinicians in the field, __Affirmative Mental Health Care for Transgender and Gender Diverse Youth: A Clinical Guide__ is an ideal resource not only for child and adolescent psychiatrists, but for clinicians across all mental health disciplines working with gender non-conforming youth, and who are interested in providing informed, affirmative, and intersectional care. Foreword 6 Preface 12 Contents 15 Contributors 17 Chapter 1: Affirming and Gender-Informed Assessment of Gender Diverse and/or Transgender Youth Across Development 19 Introduction 19 Framing the Gender-Informed Assessment 20 Terminology 22 Role of the Mental Health Provider in Gender-Informed Assessment 23 Diagnostic Criteria 24 Psychopathology in Youth Presenting with Gender-Related Concerns 26 Structure of the Assessment 28 Length 28 Developmental Considerations 29 Collateral Information 30 Documentation 31 Interviewing About Gender Identity 31 Questions for the Prepubertal Child 32 Questions for the Adolescent 32 Assessment Constructs 33 Pronoun and Name Use 34 Gender Identity, Gender Expression, and Sexual Orientation 36 Family Dynamics 38 Coping Strategies 38 Psychosocial and Community Factors 40 Psychometric Instruments 41 Psychometric Instruments for Children 42 Psychometric Instruments for Adolescents 42 Assessing for Appropriateness for Hormonal and/or Surgical Interventions 42 Conclusion 45 References 46 Chapter 2: Social Gender Transition and the Psychological Interventions 48 Introduction 48 Gender Development 49 Social Gender Transition 51 Defining Social Gender Transition 51 Historical Approaches to Prepubertal Gender Diverse Children 53 Social Gender Transition in Prepubertal Children 55 Social Gender Transition in Adolescents 58 Other Psychological Interventions 61 Supportive Psychotherapy 61 Psychopharmacology 62 Nonphysiological Transition Interventions with Psychological Benefit 63 Conclusion 63 References 63 Chapter 3: Transgender Adolescents and the Gender-­Affirming Interventions: Pubertal Suppression, Hormones, Surgery, and Other Pharmacological Interventions 65 Introduction 65 Pubertal Stages, Physical Changes, and Hormonal Changes 66 Medical Interventions 68 Puberty Suppression 69 Reversible Androgen Blocking and Menstrual Suppression 72 Gender-Affirming Sex Hormone Therapy 73 Surgery 75 Conclusion 77 References 77 Chapter 4: Gender Dysphoria and Family Dynamics and Culture: A Case Composite 79 Introduction 79 Clinical Relevance 80 Brief Literature Review 80 Diagnosis and Assessment 82 History of Presenting Concerns 82 Relevant Psychiatric History 82 Gender Development History 83 Psychosocial Factors 83 Mental Status 84 DSM 5 Diagnosis 84 Preliminary Biopsychosocial Formulation 84 Management 85 Treatment Course 85 Clinical Pearls and Pitfalls 87 Conclusion 89 References 89 Chapter 5: The Gender Nonbinary Adolescent 91 Introduction 91 Gender Nonbinary Identities and Gender Dysphoria in Youth 92 Case Report: Kay 93 Diagnosis and Assessment 94 Management 97 Case Report: Tonia 98 Diagnosis and Assessment 98 Management 103 Clinical Pearls/Pitfalls 104 Conclusion 105 References 106 Chapter 6: “I’m Here to Get Taller and Because I Want to Be a Boy”: A Case of Down-­Turner Mosaicism in a Prepubescent Gender-Nonconforming Child 107 Introduction 107 Case Report 109 Diagnosis and Assessment 110 Management 113 Brief Literature Review 115 Clinical Pearls/Pitfalls 116 References 118 Chapter 7: Prepubertal Children with Gender Dysphoria: A Case to Illustrate the Management of Co-occurring Attention Deficit Hyperactivity Disorder and Disruptive Behavior Disorders 121 Introduction 121 Summary of Key Clinical Questions 122 Co-occurring Attention Deficit Hyperactivity Disorder and/or Disruptive Behavior Disorders in Prepubertal Gender Dysphoric Children 122 Case Report 124 Diagnosis and Assessment 124 Psychiatric History 125 Gender Development History 126 Psychosocial Factors 127 Mental Status Exam 128 Formulation 128 Management 129 Clinical Pearls/Pitfalls 131 Conclusion 134 References 135 Chapter 8: Gender Dysphoria and Autism Spectrum Disorders 136 Introduction 136 Brief Literature Review 137 Diagnosis and Assessment 138 Management 139 Clinical Pearls and Pitfalls 140 Conclusion 143 References 143 Chapter 9: Anxiety and Gender Dysphoria 144 Case Introduction 144 Presenting Concern 144 Clinical Relevance 144 Literature Review 145 Case Report 146 History of Presenting Concern 146 Relevant Psychiatric History 147 Relevant Gender Development History 147 Psychosocial Factors 149 Mental Status Exam 150 DSM Diagnoses 151 Preliminary Biopsychosocial Formulation 151 Treatment Course 153 Case Discussion 155 Conclusion 157 References 157 Chapter 10: Trauma Stabilization and Recovery in a Transgender Latina: A Retrospective Case Example 159 Introduction 159 Case Report 161 Diagnosis and Assessment 161 Management 163 Mid-Treatment (Sessions 4–12) 164 Termination/Closure (Sessions 14–18) 166 Clinical Pearls/Pitfalls 167 Conclusion 168 References 168 Chapter 11: Depression and Gender Dysphoria 171 Introduction 171 Summary of Key Clinical Questions 172 Co-occurring Depression and Self-Directed Violence in Gender Dysphoric Youth 172 Case Reports 175 Case 1: Margarita 175 Diagnosis and Assessment: Case 1 176 Management: Case 1 177 Case 2: Sally 178 Diagnosis and Assessment: Case 2 178 Management: Case 2 178 Case 3: Burt 181 Diagnosis and Assessment: Case 3 181 Management: Case 3 185 Clinical Pearls/Pitfalls 186 Why Is Gender Such a Big Deal? 186 Promoting Resiliency and Healing for Transgender Youth and Families: Concluding Thoughts 189 References 191 Chapter 12: Gender Dysphoria and Psychotic Spectrum Disorders 194 Introduction 194 Brief Literature Review 194 Case Report 196 Case Discussion 199 Conclusion 200 References 201 Chapter 13: Gender Dysphoria and Multiple Co-occurring Psychiatric Issues: Compare and Contrast 202 Introduction 202 Brief Literature Review 203 Case 1: Sam 204 Psychiatric History 205 Gender Development History 205 Psychosocial Factors 206 Mental Status Exam 207 DSM Diagnoses 207 Biopsychosocial Formulation 208 Treatment Course 209 Case 2: Cody 211 Psychiatric History 211 Gender Development History 211 Psychosocial and Legal Factors 212 Mental Status Exam 213 DSM Diagnoses 214 Biopsychosocial Formulation 214 Treatment Course 215 Case Discussion 216 Conclusion 219 References 220 Index 221 Front Matter ....Pages i-xviii Affirming and Gender-Informed Assessment of Gender Diverse and/or Transgender Youth Across Development (Scott Leibowitz, Aron Janssen)....Pages 1-29 Social Gender Transition and the Psychological Interventions (Scott Leibowitz)....Pages 31-47 Transgender Adolescents and the Gender-Affirming Interventions: Pubertal Suppression, Hormones, Surgery, and Other Pharmacological Interventions (Samantha M. Busa, Scott Leibowitz, Aron Janssen)....Pages 49-62 Gender Dysphoria and Family Dynamics and Culture: A Case Composite (Melissa MacNish)....Pages 63-74 The Gender Nonbinary Adolescent (Valerie Tobin, Shane W. Gahn)....Pages 75-90 “I’m Here to Get Taller and Because I Want to Be a Boy”: A Case of Down-Turner Mosaicism in a Prepubescent Gender-Nonconforming Child (Diane Chen, Courtney A. Finlayson, Elizabeth Leeth, Elizabeth B. Yerkes, Emilie K. Johnson)....Pages 91-104 Prepubertal Children with Gender Dysphoria: A Case to Illustrate the Management of Co-occurring Attention Deficit Hyperactivity Disorder and Disruptive Behavior Disorders (David Call)....Pages 105-119 Gender Dysphoria and Autism Spectrum Disorders (Aron Janssen)....Pages 121-128 Anxiety and Gender Dysphoria (Laura Edwards-Leeper)....Pages 129-143 Trauma Stabilization and Recovery in a Transgender Latina: A Retrospective Case Example (Marco A. Hidalgo)....Pages 145-156 Depression and Gender Dysphoria (Eric N. Boyum, Peter Daniolos)....Pages 157-179 Gender Dysphoria and Psychotic Spectrum Disorders (Aron Janssen, Brandon S. Ito)....Pages 181-188 Gender Dysphoria and Multiple Co-occurring Psychiatric Issues: Compare and Contrast (Rebecca A. Hopkinson, Nathaniel G. Sharon)....Pages 189-207 Back Matter ....Pages 209-214