Reactive Aggression and Suicidal Behaviors in Children Receiving Outpatient Psychological Services: The Moderating Role of Hyperactivity and Inattention.

The current study examines associations between reactive and proactive aggression and suicidal thoughts and behaviors among youth (N = 115, 62% male), ranging from 6 to 12 years, seeking services in an outpatient psychological clinic. Symptoms of hyperactivity/impulsivity and inattention were evaluated as potential moderators of this link. Children and a caregiver completed self- and parent-report questionnaires on aggression, suicidal behaviors, depressive symptoms, and ADHD-related behaviors during intake. Reactive aggression was more strongly linked to suicidal thoughts and behaviors than proactive aggression. Further, hyperactivity/impulsivity, but not inattention, moderated the association between reactive aggression and suicidal thoughts and behaviors, such that reactive aggression was only associated with suicidal behaviors at high levels of hyperactivity/impulsivity. These findings were evident for reactive, not proactive, aggression and when accounting for the variance associated with depressive symptoms, age, and gender. Hyperactivity/impulsivity is discussed as a potentially important target among reactively aggressive youth for prevention of suicidal behaviors.

Supporting Pride, Activism, Resiliency, and Community: A Telemedicine-Based Group for Youth with Intersecting Gender and Racial Minority Identities.

Transgender and nonbinary (TNB) people who also identify as black, indigenous, and/or people of color (BIPOC) may experience compounding stress related to their racial and gender minority identities. This case study describes supporting pride, activism, resiliency, and community (SPARC), a brief five-session telemedicine-based process group for TNB BIPOC adolescents and young adults (AYA). Five AYA participated and all attended at least one session. Acceptability and satisfaction were assessed through survey and open-ended feedback. Results suggest that SPARC was acceptable and satisfactory. SPARC may be considered a promising group to provide an affirming and supportive space for TNB BIPOC AYA.

Preliminary Factor Structure of the Parental Attitudes of Gender Expansiveness Scale for Parents (PAGES-P).

Objective: Parental acceptance and support are associated with positive psychosocial outcomes among transgender and gender expansive (TGE) adolescents. Understanding the degree of parental acceptance and support of gender identity and expression is an important component of gender affirmative pediatric assessment and can inform intervention. Although there are reliable measures assessing general family support, there are no existing parent self-report measures assessing acceptance and support of their gender expansive children. The present study examines the factor structure of the Parental Attitudes of Gender Expansiveness Scale for Parents (PAGES-P). Methods: Participants included 739 parents who completed the PAGES-P as standard-of-care during their child's gender health clinic visit within a children's hospital in the Midwestern United States. Principal Component Analysis (PCA) was used to identify subscales reflected in the PAGES-P. Results: PCA yielded four subscales reflecting the following domains: (1) support and affirmation, (2) guilt and loss, (3) gender concealment, and (4) pride. Conclusions: This study provides preliminary evidence of the factor structure of the PAGES-P. The resulting subscales lend insight into the thoughts and behaviors of parents of TGE youth and can inform clinical practice to facilitate parental support and promote overall well-being in TGE youth.

Demographic Differences in Youth Perceptions of Staff: A National Evaluation of Adjudicated Youth.

Despite the large societal and personal cost associated with the detainment of juvenile offenders in residential facilities, little is known about the factors that contribute to youth behavior while incarcerated. One factor that may be of importance to maintaining security within facilities and improving rehabilitation efforts is youth's perceptions of correctional staff, namely, youth's perceptions of positive staff characteristics (e.g., friendliness; helpfulness) and staff behavior toward youth (e.g., fair punishments). Accordingly, the current study used the National Survey of Youth in Custody across two cohorts to better understand youth perceptions about staff by examining rates of these perceptions within juvenile detention centers nationwide. Furthermore, given the overrepresentation of marginalized groups in the justice system, systematic differences in youth's perceptions about staff were evaluated based on demographic characteristics, including age, race, sex, and sexual orientation, to better understand how these characteristics influence youth perceptions. Results suggested several significant differences based on demographic characteristics, with the most prominent and consistent differences associated with race and age, with Black youth and older youth having the least positive views of staff. Interestingly, non-heterosexual youth were more likely to view staff characteristics as positive than heterosexual youth. Implications of findings are discussed.

Comparison of Gender Minority Stress and Resilience Among Transmasculine, Transfeminine, and Nonbinary Adolescents and Young Adults.

PURPOSE: This study examined whether transmasculine, transfeminine, and nonbinary adolescents and young adults (AYA) experience different levels of gender minority stress and resilience. METHODS: Demographic and clinical information were abstracted from medical charts from AYA initiating gender-affirming care. Group comparisons between transgender and nonbinary groups were examined using one-way analyses of variance and Tukey's honestly significant difference post hoc tests. RESULTS: Participants were 638 transgender and nonbinary AYA (65.5% transmasculine, 24.6% transfeminine, and 9.9% nonbinary). Transmasculine and transfeminine AYA reported more discrimination (ps = .008 and .006, respectively) compared to non-binary AYA. Transfeminine and nonbinary AYA reported more negative future expectations (ps = .006 and .016, respectively) and pride (ps ≤ .001 and .032, respectively) than transmasculine AYA. CONCLUSIONS: Findings suggest that transmasculine, transfeminine, and nonbinary AYA experience different levels of gender minority stress and resilience. Future research is warranted to further examine between-group differences and differential impact on mental health outcomes.

Fertility Discussions: Perspectives of Adolescents and Young Adults With Differences of Sex Development.

Objective: Fertility-related health care and decision-making needs for youth with differences of sex development (DSD) are complex and vary by condition and the values and preferences of each individual and their partner and/or family. Discussing fertility implications can be a challenging aspect of clinician and family communication about a DSD diagnosis. This qualitative study assesses fertility-related communication experiences of adolescents and young adults (AYA) with DSD. Method: Participants included 97 AYA with DSD ages 12-26 years (M = 18.5, SD = 3.9) who completed questionnaires on demographic and medical information and patient-clinician communication. A subsample of 33 AYA also completed semistructured interviews about experiences with fertility discussions. Results: Two major themes, each with subthemes, were identified: (1) understanding of fertility related to (1a) one's own fertility status, (1b) reproductive and parenting options, and (1c) emotional reactions to one's own fertility status and (2) conversations about fertility related to (2a) reflections on conversations, (2b) barriers, and (2c) advice. Conclusions: AYA perspectives in this study provide important information about how youth with DSD learn about their fertility status, the impact their fertility status has on them, and the fertility-related conversations they have with their providers and families. Specific recommendations for providers and parents or caregivers include the following: inform youth of their fertility status as early as possible; be direct but patient in delivering information; begin by giving basic information and provide more detail as the conversation unfolds; revisit the conversation over time to allow for further discussion or information-seeking; offer additional information or resources, including behavioral health resources.