P02 Surveillance Study of Gender Identity Disorder in Children and Adolescents

Abstract

The incidence of childhood/adolescent Gender Identity Dis- order (GID) is unknown. GID is an important condition where Abstracts gender identity differs from biological sex. It is associated with sig- nificant distress, particularly with puberty, with much controversy internationally over the optimal timing of hormonal treatment. We examine the incidence and clinical presentation in UK and Irish chil- dren and adolescents. Methods STUDY POPULATION: Children and adolescents aged 4–15.9 years in the UK and Republic of Ireland. DESIGN: Joint British Paediatric Surveillance Unit (BPSU) and Child and Adoles- cent Psychiatry Surveillance System (CAPSS) study. New cases of GID reported by clinicians over a 19-month reporting period (01-Nov-2011 to 01-June-2013) are validated against the authorita- tive DSM-IV-TR (2000). Exclusions include disorders of sexual dif- ferentiation and major psychosis. PRIMARY OUTCOME: Incidence of childhood/adolescent GID, calculated by dividing the number of validated cases by the base population of children/adolescents aged 4–15.9 years. Sources of denominator data: UK Office of National Statistics and the Central Statistics Office in Ireland. STATISTICAL ANALYSIS: Descriptive statistics and comparisons using two- sample t-tests/Mann-Whitney U tests for continuous data and Chi-squared/Fisher’s exact tests for categorical data. Results Preliminary descriptive data from the first nine months’ surveillance (n = 80 cases, 42 males) indicate that similar numbers of males and females are affected by this condition. There is a lag of several years between median [range] onset of symptoms (6y [1–14y]) and presentation to Paediatricians or Psychiatrists (13y [4–14y]), with high levels of psychiatric co-morbidity at presenta- tion, particularly depression (n = 15, 19%), Asperger Syndrome/ autistic spectrum disorder (ASD) (n = 16, 20%) and previous self- harm (n = 24, 30%). There appears to be a relationship between pattern of presenta- tion and co-morbidities observed at diagnosis: nearly half of BPSU cases (5/11) have a co-diagnosis of Asperger Syndrome/ASD at diag- nosis compared with 16% of CAPSS cases (11/69). Depression and anxiety have only been reported among CAPSS cases. It is unclear whether these discrepancies reflect referral pathways or different diagnostic approaches. Conclusions We present the first ever population-level data on the clinical features and presentation of childhood/adolescent GID. These data will inform clinical management, including the highly controversial debate around early pubertal suppression in this group.