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Psychologically aggressive parenting (PAP) exposure negatively affects children's development of aggression. Nevertheless, not all children exposed to PAP display aggressive behaviors. Sympathetic nervous system (SNS) activity may influence the impact of early adversity on aggression. This study examines whether SNS reactivity and sex moderate the link between psychologically aggressive parenting (PAP) during childhood and later aggression. Emerging adults (N = 182, mean age = 19.03 years, 53 % female) retrospectively reported on their childhood PAP and current aggression. Salivary alpha-amylase (sAA) collected from a social stress task indexed SNS reactivity to stress. Childhood PAP was associated with emerging adulthood anger, hostility, physical, and verbal aggression. Moreover, males were more likely to exhibit anger, verbal, and physical aggression and had higher levels of sAA reactivity than females. A significant three-way interaction between childhood PAP, sAA reactivity, and sex accounted for participants' current verbal aggression. The link between childhood PAP and later verbal aggression was stronger for males at higher levels of sAA reactivity. Females with higher levels of sAA reactivity displayed lower levels of verbal aggression regardless of PAP exposure. Males and females with lower levels of sAA reactivity were at elevated risk for verbal aggression regardless of PAP exposure. Moreover, we found a significant two-way interaction between PAP and sex on anger, such that higher levels of PAP exposure were associated with more anger among males, but not females. These findings highlight the importance of examining interactions between biological and environmental factors and sex in accounting for later aggression.

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Purpose: This study surveyed a national sample of inpatient pediatric behavioral health facilities on policies related to care for transgender and gender-expansive (TGE) youth to assess adherence to best practices. Methods: Staff/providers at youth inpatient psychiatric facilities were recruited by phone or email. Participants completed an electronic survey on facilities' training policies, staff comfort related to gender diversity, and other policies related to caring for TGE youth. Results: Of 479 potential participating facilities, 124 surveys were initiated and 59 were completed. Measures to ensure accessibility to TGE patients are present in many facilities surveyed, with most reporting that their facility had nondiscrimination policies in place (86.2%) and required training on working with TGE patients (52.5%). A minority of participants (12.1%) reported that their facility roomed TGE youth based on sex assigned at birth, although only a small portion roomed based on gender identity alone (19.0%). Slightly more than two-thirds stated that their facility had individual restrooms available. Most participants (74.6%) stated that facility staff were comfortable discussing gender diversity in general, although this was less common for other topics related to TGE patient care. Conclusion: Our survey highlights efforts made by inpatient behavioral health facilities to ensure accessibility of services to TGE youth, although our results showed notable differences across facilities. Given inconsistent federal protections for TGE patients, there remains a need for efforts to ensure that TGE youth are receiving all possible support in these treatment settings, such as accessible restrooms and bedroom assignments, as well as the opportunity to room with peers.

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Scientific disinformation is false and misleading information that is used intentionally by legal and political actors to sway public opinion and oppose facts. In recent years, disinformation has become a tool for authorities to limit gender-affirming health care (GAC) for transgender and gender-expansive youth who experience gender dysphoria. Existing modes of expert intervention in health policy may not be sufficient to match the pace of these quickly unfolding health care bans. A cross-disciplinary team of academics in medicine, psychology, and law assembled to challenge scientific disinformation on GAC with 2 rapid-response rebuttal reports. Reports were produced in 3 to 10 weeks after the passage of GAC bans in Texas, Alabama, and Florida in 2022. They were posted online to facilitate dissemination and engage litigators, judges, policy experts, advocates, parents, and others. The team's efforts complemented public statements by medical societies and lawsuits brought by national LGBTQ litigators. The team's reports were cited in legal challenges to GAC bans in Texas, Alabama, and Florida. The team also filed amicus briefs for direct consideration by the courts and public comments to health care agencies in Florida. The reports received coverage in local and national media outlets in broadcast and print media. This advocacy case study describes the process used to challenge disinformation about GAC with rapid-response rebuttal reports, as well as the impact of this work and associated challenges. In an increasingly polarized political climate, this process may be adapted to other areas of health policy in which scientific disinformation takes root.

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Purpose: This study sought to replicate and expand a previous pilot investigation of reproductive knowledge, attitudes toward fertility and parenthood, and sources of information on these topics among transgender and gender-expansive (TGE) youth. Methods: The Yale Pediatric Gender Program (YPGP) Reproductive Knowledge and Experiences Survey (YPGP-RKES) was administered to 70 TGE adolescents receiving care at an interdisciplinary clinic providing gender-affirming health care at an academic medical center. Data gathered included sources of information on reproduction and fertility, concerns about future parenthood and reproduction, and interest in different types of parenthood. Results: Over a third (39.1%) of participants reported it was important to them to have a child one day, while only a small proportion (23.2%) reported an interest in biological parenthood. A plurality of participants (37.3%) reported at least one concern about future fertility. The number of reproductive concerns did not differ by age or treatment (puberty blockers or gender-affirming hormones vs. no treatment) status. With respect to needs for more information and sources of information, most (56.5%) participants received information about fertility issues before this study, with the most cited source of information being online research. Conclusions: The current study replicated and extended previous findings on the reproductive attitudes and knowledge of TGE adolescents. Understanding the informational needs and priorities of adolescent TGE patients presenting for medical treatment will allow providers to give more robust patient education. This will, in turn, facilitate patients' ability to provide fully informed consent for treatment that aligns with their fertility and reproductive priorities and goals.

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An increasing number of transgender and gender nonconforming (TGNC) youth are seeking gender-affirming medical treatments and affirmative mental health supports. The field currently lacks guidelines or recommendations for the integration of spirituality and religion into such care. Providers must consider spirituality and religion when working with this population because it may reduce the burden of adversity and may also improve the likelihood of positive outcomes among this population. Informed by an adapted version of the Minority Stress Model and the cultural humility framework, our manuscript details recommendations for interdisciplinary care with TGNC youth and families in the following areas: functional assessment of spirituality and religion as they relate to gender identity, parental support, medical decision making, coping; religious/spiritual referral; psychotherapy referral; and community advocacy. Recommendations offer providers in interdisciplinary settings applicable frameworks and guidelines for integrating spirituality and religion into care with TGNC youth and families.

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BACKGROUND: In collaboration with members of the transgender and gender diverse (TGD) community, we created a didactic resource about the unique needs of TGD youth. METHODS: We developed teaching materials enhanced by video clips of two TGD adolescents openly sharing aspects of their lived experience. We compared the video and no video conditions in a randomized controlled trial (RCT) in which participants were assigned to one of four parallel conditions: 1) a transgender [TgV] or 2) a cisgender [CgV] woman presenting with videos embedded into the presentation, 3) the same cisgender woman presenting without the videos [CgN], or 4) a no intervention control [NiC]. Our primary outcome was change in the total score of the Transgender Knowledge, Attitudes, and Beliefs Scale (T-KAB). RESULTS: We recruited and proportionally randomized 467 individuals, 200 of whom completed ratings before and after the intervention: TgV (n = 46), CgV (N = 46), CgN (n = 44), and NiC (n = 64). Mean scores on all measures of TGD acceptance increased in the video group, compared to the no video group. Improvements persisted after 30 days (p < 0.01), except on perceptions about TGD family members. The three active intervention groups did not differ in efficacy. CONCLUSIONS: These findings provide empirical evidence that a well-informed presenter, regardless of their gender, can achieve similar improvements in perceptions and knowledge about TGD youth when using a resource that can be disseminated free of cost.

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There are growing concerns regarding the referral of children and youth with mental health conditions to emergency departments (EDs). These focus on upward trends in utilization, uncertainty about benefits and negative effects of ED visits, and inequities surrounding this form of care. A review was conducted to identify and describe available types of data on ED use. The authors' interpretation of the literature is that it offers compelling evidence that children and youth in the U.S. are being sent to EDs for mental health conditions at increasing rates for reasons frequently judged as clinically inappropriate. As a major health inequity, it is infrequent that such children and youth are seen in EDs by a behavioral health professional or receive evidence-based assessment or treatment, even though they are kept in EDs far longer than those seen for reasons unrelated to mental health. The rate of increase in these referrals to EDs appears much greater for African American and Latinx children and youth than White children and is increasing for the publicly insured and uninsured while decreasing for the privately insured. A comprehensive set of strategies are recommended for improving healthcare quality and health equity. A fact sheet is provided for use by advocates in pressing this agenda.

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Psychological and psychosocial functioning of binary transgender and nonbinary youth has been understudied in settings treating individuals at risk for psychiatric hospitalization. Further, little is currently known about potential differences in baseline levels of psychiatric distress and adaptive functioning across gender-diverse youth and their psychiatrically distressed cisgender counterparts. Key differences may elucidate avenues for adapted treatment and protocols among youth presenting for psychiatric care. Archival data of 426 youth (Mage = 14.94, SD = 1.5 years) referred to a psychiatric Intensive Outpatient Program (IOP) were used to examine differences in self-reported domains of psychological (e.g., depression, anxiety, Posttraumatic Stress Disorder [PTSD], emotion dysregulation) and psychosocial (e.g., parental and interpersonal relations) functioning across gender. The group included N = 272 cisfemale (64.1%), N = 137 cismale (32.2%), N = 10 transgender (2.3%) and N = 7 nonbinary (1.6%) self-identified youth. Cismales reported the lowest levels of distress and highest levels of adaptive functioning as compared to the other groups, whereas binary transgender and cisfemale youth did not significantly differ across any measured domain. Nonbinary youth reported higher levels of anxiety, hyperactivity, psychological inflexibility, and inadequacy than cisfemales, but largely did not differ from binary transgender youth. Beyond statistical comparisons, nonbinary youth demonstrated globally elevated levels of psychiatric distress and compromised adaptive functioning, with most ratings falling in the clinically significant and/or at-risk ranges. Results highlight the need for clinicians to carefully attend to unique needs of nonbinary youth and for future research to expand upon our preliminary findings. Clinical implications are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

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OBJECTIVE: To provide a topical review of the literature on the use of medical-legal partnerships (MLPs) to address social determinants of health (SDH) needs as a means to reduce health disparities, and to make recommendations for the implementation of MLPs within pediatric psychologists' clinical work, research, and training. METHODS: We conducted a topical review of the research on the intersection of MLPs, SDH needs, and health disparities among pediatric populations. Given the scarcity of literature available, both empirical and theoretical articles were included in the review. RESULTS: Though limited, the extant literature suggests that use of MLPs may help address the SDH needs that perpetuate disparities among pediatric populations. To date, MLPs are not as frequently incorporated in the training and work of pediatric psychologists as they may be in other related fields (e.g., medicine). CONCLUSIONS: MLPs provide an opportunity for psychologists to broaden their interdisciplinary collaborations, to more aptly meet the social and legal needs of their patients to assist in reducing inequities among underserved pediatric populations. The systematic incorporation of MLPs into pediatric psychology training may help to increase the utilization of these services moving forward.

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As with male populations more generally, eating disorder symptom expression among trans-masculine youth is understudied. Gender minority individuals are at increased risk for eating disorders; however, culturally responsive and developmentally tailored research is limited. Although all gender minority individuals may experience elevated risk for developing eating disorders, the focus of this article is trans-masculine youth. We provide a theoretical conceptualization of eating disorder symptom expression among this understudied group, and propose novel directions for research, particularly for youth at pubertal onset. Adolescence as a critical developmental period for intervention is highlighted.

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As the need for comprehensive, affirmative health care for transgender and gender nonconforming youth has increased in recent years, clinical practice has struggled to catch up with evolving standards of care. The Yale Gender Center is an example of an interdisciplinary model of care that addresses not only clinical needs, but also ancillary needs for patients and training opportunities for students across several health disciplines. In this article, we discuss our clinical and training models, lessons learned, and our proposed directions to expand care. It is our hope to not only offer a model for interdisciplinary care among other health care centers, but to be able to learn from missteps and potentially collaborate with other centers in the future.

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The present study examines the impact of the parasympathetic nervous system (PNS), as measured by respiratory sinus arrhythmia (RSA), on the link between family aggression experienced during adolescence and posttraumatic stress symptoms during young adulthood. Participants completed retrospective self-report measures of interparental aggression and harsh parenting exposure during adolescence and measures of current posttraumatic stress symptoms. RSA indexed PNS activity. Among females, the three-way interaction between harsh parenting, interparental aggression, and resting RSA was significant in accounting for young adulthood PTSD symptoms. At higher values of resting RSA and higher levels of interparental aggression exposure, harsh parenting experienced during adolescence was positively associated with adulthood PTSD symptoms. Among males, adolescent aggression exposure and resting RSA did not significantly account for variation in adulthood PTSD symptoms. Thus, this study suggests that resting PNS activity may play an important role in the relationship between stressors during adolescence and later PTSD in females.

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OBJECTIVE: The goal of this study was to examine respiratory sinus arrhythmia (RSA), an indicator of parasympathetic nervous system-linked cardiac activity, and skin conductance level (SCL), a sympathetic indicator, as moderators of the link between child maltreatment and adolescent aggression. METHOD: Participants were 234 maltreated (48.3% male) and 128 (57.8% male) comparison youth aged 9-16 years participating in wave 2 of a longitudinal study. RESULTS: Regression analyses suggest that among boys, high RSA may be protective against the effects of maltreatment on aggressive behavior. Among girls, the moderating effect of RSA was further moderated by SCL reactivity such that low levels of both baseline RSA and SCL reactivity, or conversely high levels of both baseline RSA and SCL reactivity, exacerbated the link between maltreatment and aggression. CONCLUSIONS: High RSA may protect against the effects of maltreatment on aggressive behavior, though this effect may be moderated by SCL reactivity among girls.

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