This study explored how transgender (trans) youth and parents of trans youth made decisions around hormone therapy initiation as well as trans youth experiences of barriers to care.
Participants ...included 21 trans youth (ages 14–18) and 15 parents of trans youth who resided in British Columbia, Canada. Data for this grounded theory research consisted of transcripts and lifeline drawings collected through semi-structured interviews conducted August 2016 through February 2017.
The decision-making processes of youth and of parents are illustrated in three-phase temporal models, starting with discovery, leading to (inter)action while seeking care, and reflection after hormone therapy initiation. Youth who sought hormone therapy were clear about their decision to access this care. Throughout these processes, youth experienced numerous parent- and system-related barriers to care. Youth with the lowest levels of parent support experienced more system barriers, with non-binary/genderfluid youth experiencing greater barriers and less support for hormone therapy than youth with binary genders. A new barrier identified in this study was health care provider imposed requirements for parental involvement and/or approval, which rendered some youth unable access to hormone therapy.
Health care providers should be aware of the deliberation and information-seeking in which youth engage prior to seeking care as well as the temporally misaligned decision-making processes of youth and parents. Understanding the challenges trans youth experience due to insufficient parental support and system barriers can provide important context for health care providers striving to provide accessible, gender-affirming care and decision-making support for trans youth.
Depressive symptoms and non-suicidal self-injury not only increase in prevalence during adolescence, but they can also occur together. Both psychological problems seem to have similar precipitating ...conditions, suggesting they have transdiagnostic conditions—personal or contextual characteristics that contribute to co-occurrence. We sought to understand when these two problems co-occur and what is related to their co-occurrence.
Using a pattern-centered approach and two waves of longitudinal data collected annually, we examined latent profiles of depressive symptoms and self-injury among a Swedish sample of adolescents aged 12 to 16 (MageT1 = 13.65 years, SD = 0.64), 53.7% boys and 47.3% girls. Most of the adolescents were Swedish (89%), with parents who were married or cohabitating (68%). We also examined the transitions between profiles over time.
Our results suggest that during this time frame, depressive symptoms and self-injury tend to emerge and stabilize or abate together. We also examined a broad array of predictors, including individual characteristics, emotion dysregulation, experiences with friends, parents' negative reactions to behavior, and school stress. The significant unique predictors suggest that adolescents who reported being subjected to relational aggression, having negative experiences while drinking, and low self-esteem had a greater probability of moving from moderate to high levels or maintaining high levels of depressive symptoms and self-injury, compared to adolescents classified in the other statuses.
Focusing on negative interpersonal experiences and selfesteem as transdiagnostic conditions may guide research and aid clinicians in supporting adolescents who feel depressed and engage in self-injury.
Purpose of Review
This scoping review includes recent literature on eating disorder diagnoses and evaluation of eating disorder symptom presentation among transgender youth (ages 8–25).
Recent ...Findings
A total of 20 publications from the previous 5 years were identified, including case reports, retrospective chart reviews, and surveys. Significantly higher rates of eating disorder symptoms were documented in transgender youth compared to cisgender youth. Similarly, some studies reported transgender youth were more likely to be diagnosed with an eating disorder than cisgender youth, though the proportion of youth with eating disorder diagnoses varied across studies. A consistent theme across case studies was engagement in food restriction and/or compensatory eating behaviors to prevent puberty onset or progression, suggesting that for some transgender youth, these behaviors may be understood as a means of coping with gender-related distress.
Summary
Clinical care could be enhanced through establishment of best practices for screening in settings offering eating disorder treatment and gender-affirming care, as well as greater collaboration among these programs. Research is needed to validate eating disorder measures for use with transgender youth and evaluate the effects of eating disorder treatment and gender-affirming medical interventions on the well-being of transgender youth.
Adolescents' prospection is often assessed as individual differences; however, adolescents likely share anticipated events with adults in their lives. To understand how prospection is shared between ...adolescents and parents, this study examined conversations about the upcoming transition to high school for the types of prospective content emerging in conversations, whether dyads engaged collaboratively in prospective content, how emergent patterns of prospective content in conversations were organized regarding familial roles, and whether participants' prospective content is shifted, maintained, or augmented. Participants were 27 parent-adolescent dyads; 15 adolescents were girls, 12 were boys. Content analysis was used to examine four types of prospection: episodic memory of the past, simulation, reasoning about counterfactuals, and constructing multiple possible futures. In most conversations, a partner extended prospective content. Dyads maintained the prospective content, however there was also evidence of dyad partners shifting or augmenting content. The findings point to the shared construction of prospection
Abstract
Information is lacking on the role shared decision making plays in the care of transgender (trans) youth. This qualitative, descriptive study explored how trans youth, parents and health ...care providers engaged or did not engage in shared decision-making practices around hormone therapy initiation and what conditions supported shared decision-making approaches in clinical practice. Semi-structured interviews were conducted with 47 participants in British Columbia, Canada, and analyzed using a constructivist grounded theory approach. While formal shared decision-making models were not used in practice, many participants described elements of such approaches when asked about their health care decision-making processes. Others described health care interactions that were not conducive to a shared decision-making approach. The key finding that emerged through this analysis was a set of five conditions for supporting shared decision making when making decisions surrounding initiation of hormone therapy with trans youth. Both supportive relationships and open communication were necessary among participants to support shared decision making. All parties needed to agree regarding what decisions were to be made and what role each person would play in the process. Finally, adequate time was needed for decision-making processes to unfold. When stakeholders meet these five conditions, a gender-affirming and culturally safer shared decision-making approach may be used to support decision making about gender-affirming care. Implications for clinical practice and future research are discussed.
Previous research has shown a consistent positive association between non-suicidal self-injury and depressive symptoms. However, the direction of the effects has not been examined. To understand ...whether non-suicidal self-injury predicts depressive symptoms or vice versa, we examined the relations between non-suicidal self-injury and depressive symptoms across three waves of self-report data collected 1 year apart from 506 Swedish adolescents (47 % girls;
M
age = 13.21; SD = .57) who were attending 7th grade at the onset of the study. The results suggest that depressive symptoms predict increases in non-suicidal self-injury 1 year later between the first and second waves of the study. Between the second and third waves of the study depressive symptoms and non-suicidal self-injury were significantly correlated indicating co-occurrence with no direction of effect rather than depressive symptoms predicting non-suicidal self-injury or vice versa. Group comparisons revealed no differences for boys and girls. The findings help clarify the relationships between non-suicidal self-injury and depressive symptoms during middle adolescence.
Mattering is the tendency to view the self as significant to other people. Theoretically, mattering has been proposed to promote psychosocial well-being. Although prior research has found positive ...associations between mattering to parents and psychosocial well-being among adolescents, extant studies have not clarified whether perceptions of mattering predict psychosocial well-being or the other way around. Thus, the direction of the association needs verification. The purpose of this study was to examine the direction of associations between adolescents’ mattering to parents and friends and adolescents’ depressive symptoms and problem behaviors using cross-lag models. A two-wave annual survey assessed mattering to family and friends, depressive symptoms, and problem behaviors of students in grades 6 to 9 (N = 164; 56.1% girls) in a school district in western Canada (Time 1 age range = 11 to 15 years; mean age = 12.23; standard deviation = 1.07). Structural equation modeling was used to assess concurrent, auto-regressive, and cross-lagged associations between mattering and psychosocial well-being. Mattering to mother, father, and friends was assessed in separate models. Significant lags were found only between mattering to friends and depressive symptoms and problem behaviors, with positive associations suggesting a form of socialization through mattering. With one exception, mattering to parents was not directly associated with psychosocial well-being over time. However, gender moderated the association between mattering to mother (Time 1), depressive symptoms (Time 2), problem behaviors (Time 1), and mattering to mother (Time 2). Taken together, these results suggest that mattering may not be as strongly protective of adolescent well-being as previously suggested.
Goal attainment scaling (GAS) is an internationally recognized measure that is widely used in educational, counseling, and clinical settings to identify and evaluate relevant goals for an individual. ...The GAS is an unusual measure because its content, which consists of goals, is formed by the respondent and/or users in the process of completing the GAS. Using the unified view of validity as a guiding framework, this systematic review examines validation practices and how goals are represented in this measure. This review demonstrates that validation practices tend to focus on aspects that do not support the overall construct validity of the measure, as well as reference to the GAS measure or GAS scores as a property. Several gaps in validity evidence and the various ways goals are conceptualized are described and discussed. The varying ways goals are considered suggest clarity is needed to enhance explanations and score meaning. This review urges researchers to consider ways validity and validation evidence can help verify the many claims that are made about this measure. Future validity research needs to consider application of a theoretical framework and response processes as key aspects of substantiating the construct measured by the GAS.
•The application of action-project method to observe foster parents’ coparenting expanded current structural approaches.•Internal processes are observed through video recall interviews.•Coparenting ...and integration of children into the foster family.
Despite evidence from studies of other types of families that higher quality coparenting likely contributes to positive socioemotional development and adjustment of children, little attention has been paid to foster coparenting. This investigation applied contextual action theory and action-project method to the study of foster coparenting and the integration of children into the family. Four long-term foster parent couples participated in video-recorded conversations and video recall interviews. The illustrative findings hold the potential to add to the foster parent training literature by demonstrating how this approach to studying coparenting expands structural approaches. The action project method assists in accessing coparents’ internal processes that steer their actions and joint actions and the social meaning of their actions in relation to the social context of foster parenting.
