Just Read: They’re not pretending: Gender Cognition in Transgender Children

The KPLantern team is now engaged in “synthesis,” which currently looks like a secure room with a lot of post-it notes (photo below) and as part of that we are reviewing relevant science.

This paper describes a clever study designed to look at how transgender children’s unconscious brains work. When challenged subliminally do they really identify with their lived gender or the sex they were assigned at birth?

The tool used is the Implicit Association Test, which has been validated and used in children as young as 3 years old, in various forms tailored to their verbal and visual abilities. I was excited to read this study (h/t Vivienne Ming, PhD @neuraltheory) because it builds upon what I learned when reading Blindspot and the formation of a child’s identity (see blog post: Just Read: Blindspot: Hidden Biases that shape, and could fix, society ).

The researchers recruited trans* children who are living in their identified gender aged 5-12, AND matched cisgender children as well as siblings (where available) as controls.

In the study they looked at several implicit (unconscious) associations: preference for gender (male/female = good,bad), gender identity (“me” and male or female). They also looked at explicit (conscious) associations: preference for gender (male or female), object preferences (photo of a gendered child and ambiguously named object), gender peer preferences (who do you prefer to be friends with – boy/girl).

The results are striking.

Remember that they had age matched controls + siblings. In every measure, the transgender children’s brains computed gender as their lived identity, not as their natal sex, unconsciously and consciously, and responded the same as cisgender children with the same identification. In other words, a transgender boy and a cisgender boy were indistinguishable in terms of how they responded to the stimuli presented to them around how they see themselves. Check out figure 1 in the paper, you’ll see.

Wouldn’t live as a boy again – not at 18, 40, 50 or even a 100

In parallel to receiving this study, I was also sent this piece (h/t Gail Knudson, MD @Gail_Knudson) produced by the BBC: The story of two transgender children – BBC News, with the quote above from one of the children profiled, Jessica.

As the paper referenced here points out, no one knows for sure if the identities studied are stable over time. However it’s very unlikely that children in this situation are imagining, pretending, being oppositional, confused, delayed, or faking.

Further, and addressing the broader concern about transgender individuals’ mere existence raised at the outset of this article, the data reported here should serve as evidence that transgender children do indeed exist and that their identity is a deeply held one.

Synthesis and KPLantern

As I mentioned above, we are beginning the synthesis phase of KPLantern, led by the IDEO-trained Kaiser Permanente Innovation Consultancy (@KPInnovation).

KPLantern Synthesis 54117
KPLantern Synthesis (View on Flickr.com)

Here’s what it looks like. I’ve blurred the text and we are also using pseudonyms throughout to protect the information being reviewed. Doctors and health professionals don’t usually put this much care and effort into understanding the lives and health of the people they serve. Here they do.

It’s the way of the design thinker. I’ll keep posting on the experience as we continue.

In the meantime, I’m just delighted that there’s a community of people, experts, scientists, around us who are helping us understand health better 🙂 .

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