Psychosocial development in gender nonconforming children

性别表达是指儿童通过他们的兴趣、友谊和服装选择，以男性或女性的方式体验和表达自己的方式(Collaer&Hines，1995)。那些不遵守其生物性别预期的社会规范的人被称为“性别不一致”。回忆起童年时期的性别不一致(CGN)与许多负面后果有关，包括较差的心理健康(Alanko等人，2009；Roberts，Rosario，Corliss，Koenen&Austin，2012；Roberts，Rosario，Slopen，Calzo&Austin，2013)，与父母关系较差(Alanko等人，2009)，以及与同伴关系较差(Roberts等人，2013)。虽然这些研究有助于加深对CGN在以后生活中的后果的理解，但它们都受到一个事实的限制，即他们对CGN的测量都是有追溯性的。这意味着这些可能会受到回忆偏见的影响。对童年行为和经历的记忆可能会被改变，以更好地适应当前经历的身份(Alanko等人，2009年)。为了解决这种关系的因果关系，需要纵向数据，包括儿童时期测量的CGN。目前还没有关于儿童时期报告的CGN在青春期和成年期间对心理健康和幸福感的作用的前瞻性研究。出生队列研究-雅芳亲子纵向研究(ALSPAC)的数据将被用于拟议的研究，以评估儿童时期报告的CGN与许多这些结果之间的潜在关系。这将确认上述关系的因果关系的方向。母亲在孩子30个月、42个月和57个月时报告了CGN，孩子在8岁时报告了CGN。精神病学诊断在7岁、10岁、13岁、16岁和17岁时进行测量，教育结果在GCSE水平上进行评估。对于潜在的中介因素，父母在6岁和16岁时报告亲子关系，孩子在8岁、10岁、12岁和17岁时报告朋友和同伴关系。自尊在11岁和17岁时进行测量。鉴于先前的发现表明，通过欺凌(Roberts et al.，2013)或低自尊等因素可能中介了CGN与较差的健康或教育结果之间的关系，将使用ALSPAC数据分析中介模型。将使用基于路径和结构方程模型(SEM)的中介分析来评估这些因素。这将有助于理解所研究的不同变量之间的纵向关系。由于纵向数据集的性质，参与者丢失和丢失数据是很常见的。除了对ALSPAC数据进行定量分析外，还将收集定性数据，以更深入地研究CGN与痛苦之间的关联。从CGN患者那里收集定性数据将有助于更细致地了解父母和同龄人对CGN的反应，以及这是否导致参与者的任何痛苦或心理健康结果。除了与中广核的孩子进行访谈外，还将与家长进行访谈，以评估他们对中广核的看法。这不仅将增加更多的信息，还将有助于突出孩子和他们的父母对性别不一致的感受是否存在差异。这些发现，与量化分析一起，将有助于理解CGN如何以及何时导致心理健康和人际关系的负面结果。这将对那些从事儿童工作的人产生重要影响，如教师、社会工作者和医疗保健提供者。如果这些负面结果的诱因能够在早期被识别出来，这可能会减少后来对心理健康和糟糕的人际关系的影响。

Gender expression refers to the way that children experience and express themselves in a masculine or feminine way, through their interests, friendships and clothing choices (Collaer & Hines, 1995). Those who do not follow the social norms expected for their biological sex are referred to as 'gender nonconforming'. Recalled experience of childhood gender nonconformity (CGN) has been associated with a number of negative outcomes, including poorer mental health (Alanko et al., 2009; Roberts, Rosario, Corliss, Koenen & Austin, 2012; Roberts, Rosario, Slopen, Calzo & Austin, 2013), poorer relationships with parents (Alanko et al., 2009), and poorer relationships with peers (Roberts et al., 2013).While these studies have helped to develop understanding of the consequences of CGN later in life, they are limited by the fact that their measures of CGN are all retrospective. This means that these could be affected by recall bias. Memories of childhood behaviours and experiences may be changed to better fit with the identity that is currently experienced (Alanko et al., 2009). To resolve the causal direction of this relationship, longitudinal data is needed, including CGN measured in childhood. There are currently no prospective studies investigating the role of childhood reported CGN on mental health and wellbeing in adolescence and adulthood.Data from a birth cohort study, the Avon Longitudinal Study of Parents and Children (ALSPAC), will be used in the proposed research to assess the prospective relationship between CGN as reported in childhood with a number of these outcomes. This will confirm the direction of causation of the relationships described above. CGN was reported by mothers when children were aged 30 months, 42 months and 57 months, and by children at 8 years. Psychiatric diagnoses were measured at ages 7, 10, 13, 16 and 17, and educational outcomes at GCSE level.With regard to potential mediators, the parent-child relationship was reported by parents at age 6 and 16, and by children at age 9 and 14. Children's reports of friends and peersat ages 8, 10, 12, and 17. Self-esteem was measured at ages 11 and 17.Given previous findings suggesting a possible mediation of the relationship between CGN and poorer health or educational outcomes by factors such as bullying (Roberts et al., 2013) or low self-esteem, mediation models will be analysed using the ALSPAC data. These will be assessed using mediational analysis based on path and structural equation modelling (SEM). This will help to understand the longitudinal relationship between the different variables being studied. Due to the nature of longitudinal data sets, participant drop-out and missing data is common. Multiple imputation techniques will be applied to resolve this issue.In addition to the quantitative analysis of the ALSPAC data, qualitative data will be collected to investigate in more depth the associations between CGN and distress. Collecting qualitative data from those with CGN will help to develop a more nuanced understanding of how parents and peers reacted to the CGN, and whether this contributed to any distress or mental health outcomes in participants. In addition to conducting interviews with the children with CGN, interviews will also be performed with parents to assess their perspective on the CGN. This will not only add further information, but will help to highlight whether there are discrepancies between how the children and their parents feel about the gender nonconformity. These findings, together with the quantitative analysis, will help to develop an understanding of how and when CGN leads to negative outcomes in mental health and relationships. This will have important implications for those who work with children, such as teachers, social workers and healthcare providers. If the triggers of these negative outcomes can be identified early on, this may reduce the later impact on mental health and poor relationships.