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Transgender Youth Executive Functioning: Relationships with Anxiety Symptoms, Autism Spectrum Disorder, and Gender-Affirming Medical Treatment Status

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Abstract

Executive function (EF) underlies broad health and adaptive outcomes. For transgender youth, navigating gender discernment and gender affirmation demand EF. Yet, factors associated with transgender youth EF are unknown. We investigate hypothesized predictors of EF: over-represented conditions among transgender youth (anxiety and depression symptoms, autism spectrum disorder [ASD]) and gender-affirming care. One-hundred twenty-four transgender 11−21-year-olds participated. Parents/caregivers completed EF and mental health report measures. ASD diagnostics and gender-affirming medication histories were collected. 21 % of non-autistic and 69 % of autistic transgender youth had clinically elevated EF problems. Membership in the gender-affirming hormone treatment group was associated with better EF. ASD, anxiety symptoms, and membership in the long-duration pubertal suppression group were associated with poorer EF. Given the importance of EF skills for multiple outcomes, and the unique and additional EF demands specific to transgender youths’ experiences, EF skill monitoring—and when appropriate, supports—should be considered for transgender youth.

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Notes

  1. This manuscript uses “Autism Spectrum Disorder” (“ASD”) to describe the clinical diagnosis of autism. When referring to people, identity-first language (i.e., “autistic youth”) is used in accordance with calls from autistic self-advocacy organizations [33, 34] and to reflect the understanding of autism as a component of human neurodiversity [35].

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Funding

This work was supported by the CTSI-CN [UL1TR001876] and NIH CTSA [KL2TR001877].

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Authors and Affiliations

  1. Division of Neuropsychology, Children’s National Hospital, Washington, DC, USA

    John F. Strang, Ayesha Khawaja & Tekla Maisashvili

  2. Gender Development Program, Children’s National Hospital, Washington, DC, USA

    John F. Strang, Amber Song, Shane Henise, Ayesha Khawaja & Tekla Maisashvili

  3. Center for Neuroscience, Children’s National Hospital, Washington, DC, USA

    John F. Strang, Amber Song, Cara Pugliese, Ayesha Khawaja, Tekla Maisashvili & Lauren Kenworthy

  4. George Washington University School of Medicine, Washington, DC, USA

    John F. Strang & Lauren Kenworthy

  5. Gender & Sex Development Program, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA

    Diane Chen

  6. Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA

    Diane Chen

  7. Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA

    Diane Chen

  8. Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Diane Chen

  9. Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Diane Chen

  10. Center for Biobehavioral Health, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH, USA

    Eric Nelson, Leena Nahata & Connor Grannis

  11. Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA

    Eric Nelson & Leena Nahata

  12. Division of Psychiatry, Nationwide Children’s Hospital, Columbus, OH, USA

    Scott F. Leibowitz

  13. Department of Psychiatry, The Ohio State University College of Medicine, Columbus, OH, USA

    Scott F. Leibowitz

  14. Division of Endocrinology, The Ohio State University College of Medicine, Columbus, OH, USA

    Leena Nahata

  15. Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA

    Laura G. Anthony

  16. Pediatric Mental Health Institute, Children’s Hospital of Colorado, Aurora, CO, USA

    Laura G. Anthony

  17. Center for Autism Spectrum Disorders, Division of Neuropsychology, Children’s National Hospital, Washington, DC, USA

    Amber Song, Cara Pugliese & Lauren Kenworthy

  18. The Arc of the United States National Council of Self-Advocates, Washington, DC, USA

    Elizabeth Graham

  19. Adolescent and Young Adult Medicine, Youth Pride Clinic, Children’s National Hospital, Washington, DC, USA

    Shane Henise & Michael Mancilla

  20. Center for Genetic Medicine Research, Youth Pride Clinic, Children’s National Hospital, Washington, DC, USA

    Eric Vilain

  21. Department of Genomics and Precision Medicine, George Washington University, Washington, DC, USA

    Eric Vilain

  22. Epigenetics, Data, & Politics at Centre National de la Recherche Scientifique, Paris, France

    Eric Vilain

  23. Curry School of Education, University of Virginia, Charlottesville, VA, USA

    Eleonora Sadikova

  24. Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, USA

    Andrew Freeman

  25. State of Nevada, Division of Child and Family Services, Las Vegas, NV, USA

    Andrew Freeman

  26. Division of Neuropsychology, Children’s National Hospital, 15245 Shady Grove Road, Suite 350, Rockville, MD, 20850, USA

    John F. Strang

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Corresponding author

Correspondence to John F. Strang.

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Conflict of interest

Lauren Kenworthy is a co-author of the Behavioral Rating Inventory of Executive Fuction-2 (BRIEF-2), one of the standardized measures employed in this study. She receives financial compensation from the sale of the BRIEF-2. The other authors have no conflicts of interest to disclose.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual caregivers of participants younger than 18 years old, and from participants who were 18 years old or older. Assent was obtained from all participants.

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Strang, J.F., Chen, D., Nelson, E. et al. Transgender Youth Executive Functioning: Relationships with Anxiety Symptoms, Autism Spectrum Disorder, and Gender-Affirming Medical Treatment Status. Child Psychiatry Hum Dev 53, 1252–1265 (2022). https://doi.org/10.1007/s10578-021-01195-6

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