Self-Reported Sexual Behavior of Transgender Youth.

INTRODUCTION: Research indicates that transgender/gender diverse (TGD) youth are more likely to engage in sexual behavior, have more sexual partners, and initiate sexual behavior earlier than their cisgender peers. However, no gender-inclusive self-report survey questionnaires (ie, those that do not assume the gender of sexual partners or body parts used for sex) exist to assess the sexual behavior of TGD youth. The current study illustrates a questionnaire with nuanced wording to more accurately portray the sexual behavior of TGD youth presenting for gender-affirming medical care compared with national adolescent norms. METHODS: A retrospective chart review was conducted of 323 youth, ages 13-18, presenting to a pediatric gender clinic between 2015 and 2021. The youth self-reported their gender identity (ie, masculine, feminine, gender queer, questioning/unsure), sexual behaviors, and partners via a REDCAP survey. RESULTS: Rates of dating among TGD youth were significantly lower than national norms (33.7% vs 68.3%; χ2= 172.644, P < .0001), as was sexual behavior (14.9% vs. 39.5% χ2= 80.419, P < .0001). Rates of self-reported involuntary sexual activity among TGD youth did not differ significantly from national norms (7.1% vs. 6.9%, ns). The body parts used for sex, the number of sexual partners, and the gender identity of sexual partners are reported. DISCUSSION: The results suggest that rates of dating and sexual behavior among TGD youth are significantly lower than national norms, supporting a need for screening of sexual health among TGD youth utilizing gender-inclusive measures. A standardized gender-inclusive questionnaire of sexual behavior is needed to improve data accuracy and help develop inclusive programs to address the sexual health needs of TGD youth.

Body Mass Index Categories of Transgender and Gender Diverse Youth: Clinical Associations and Predictors.

Background: Transgender/gender diverse (TGD) youth are at risk for weight-related problems. We describe factors associated with their body mass index (BMI) category. Methods: Chart review of 228 TGD patients, 12-20 years (u = 15.7, standard deviation 1.3), 72% female assigned at birth. BMI percentile was calculated using CDC growth charts. We examined bivariate relationships of 18 clinically derived factors, utilizing analysis of variance (ANOVA) for continuous variables and chi-squared/Fisher's exact test for categorical variables. Nonparametric Classification and Regression Tree (CART) analyses were used to predict BMI category. Results: Almost half (49.6%) of TGD youth presenting for their initial visit for pediatric gender-affirming care fell in the healthy weight range, 4.4% in the underweight range, 16.7% in the overweight range, and 29.4% in the obese range. Self-described weight, weight management intentions, unhealthy weight management, prescription of psychiatric medications, and medications associated with weight gain were associated with BMI category. Use of psychiatric medications (54.8%) and medications associated with weight gain (39.5%) was associated with BMI in the overweight/obese categories. Youth with obesity most often reported unhealthy weight management. In CART models, self-described weight was the strongest predictor of BMI category. Conclusion: TGD youth have high rates of underweight and overweight/obesity. Unhealthy BMI should be treated as part of gender-affirming care. Self-described body weight is associated with weight category. More than half of TGD youth were prescribed psychiatric medications; those with overweight and obesity were more likely prescribed psychiatric and medications with associated weight gain. Youth with obesity were most likely to use unhealthy weight management.

Emotional Well-Being of Pediatric Brain Tumor Survivors and Comparison Peers: Perspectives From Children and Their Parents.

OBJECTIVE: The aim of this study was to examine the emotional well-being of pediatric brain tumor survivors (PBTS) from the perspective of children's self-reports and parents' reports relative to matched comparison peers (COMP) and their parents. It was hypothesized that PBTS would self-report more depression symptoms, loneliness, and lower self-concept than COMP. We also hypothesized that mothers and fathers of PBTS would report more internalizing symptoms and lower total competence for their children. Age and sex effects were examined in exploratory analyses. METHODS: Families of 187 PBTS and 186 COMP participated across 5 sites. Eligible children in the PBTS group were 8-15 years of age and 1-5 years post-treatment for a primary intracranial tumor without progressive disease. COMP were classmates matched for sex, race, and age. RESULTS: PBTS self-reported lower scholastic, athletic, and social competence, but not more depression, loneliness, or lower global self-worth than COMP. Parents of PBTS reported more internalizing symptoms and lower total competence than parents of COMP. With few exceptions, group differences did not vary as a function of child age and sex. CONCLUSION: PBTS reported diminished self-concept in scholastic, athletic, and social domains, while their parents reported broader challenges with internalizing symptoms and total competence. Discrepancies between self-report and parent report require further study to inform targeted interventions for PBTS. Screening survivors for emotional challenges in follow-up clinic or in school setting may help with the allocation of psychosocial support and services for PBTS and their families.

Psychosocial functioning of caregivers of pediatric brain tumor survivors.

BACKGROUND: Assessment of caregiver needs is a recommended standard of care in pediatric oncology. Caregivers of pediatric brain tumor survivors (PBTS) are a subgroup that may be at highest psychosocial risk. This study examined psychosocial functioning of caregivers of PBTS in comparison to caregivers of youth without cancer history. We hypothesized that caregivers of PBTS would exhibit more psychological symptoms, higher caregiver burden, and lower perceptions of social support than caregivers of comparison youth. PROCEDURE: As part of a five-site study, we utilized a matched sample design to evaluate psychosocial functioning of 301 caregivers of 189 PBTS (ages 8-15) who were 1-5 years post treatment, and 286 caregivers of 187 comparison youth matched for sex, race, and age. Caregivers completed measures of psychological symptoms, caregiver burden, and perceptions of social support. Repeated measures mixed models compared outcomes between groups and examined differences based on caregiver sex. Socioeconomic status (SES) was examined as a moderator of significant main effects. RESULTS: Caregivers of PBTS reported similar levels of psychological symptoms to caregivers of comparison youth. Mothers of PBTS mothers reported higher caregiver burden and lower perceptions of social support than mothers of comparison youth. Low SES exacerbated group differences in caregiver burden. CONCLUSIONS: Mothers of PBTS may have more caregiving responsibilities and perceive less social support, but reported similar levels of psychological symptoms to comparison mothers; fathers of PBTS were similar to comparison fathers. The mechanisms involved in this complex psychosocial dynamic require further investigation.

Weight Status, Medication Use, and Recreational Activities of Treatment-Naïve Transgender Youth.

Background: Studies of transgender/gender diverse (TGD) youth indicate a high prevalence of overweight/obesity and concern for unhealthy weight management behavior. This study describes the association of weight status with medication use and recreational activities among treatment-naïve, pediatric TGD patients. Methods: This study is a chart review of 277 patients [aged 9-18 years, 79.1% female sex assigned at birth (SAB), and 86.3% white] seen at a medical center from 2017 to 2020. BMI was calculated by age and SAB using CDC growth charts. BMI percentile (BMI%) and BMI z-score (BMIz) were used to define weight status. Results: By BMI% category, 3.6% patients were in the underweight range (BMI <5%); 50.5% had BMI >85%; and 30.3% had BMI >95%. Overweight and obesity rates were higher than national norms (χ2 = 15.152, p < 0.01). Female SAB participants had higher BMIz values than male SAB participants. Youth who reported watching/listening to media (t = 3.50, p < 0.01) and parent-reported creative arts involvement (t = 1.97, p = 0.05) were associated with higher BMIz values. Conversely, spending time with friends and family was associated with a lower BMIz. Over half of the patients were prescribed medications, and those patients taking medications had higher BMIz values than those not taking medications (t = -1.96, p < 0.05). Female SAB, involvement in sedentary recreational activities, and taking medications to treat gastrointestinal conditions were associated with elevated BMIz. Conclusions: Overweight/obesity is a common problem among TGD youth. TGD youth should be considered a high-risk group and targeted in obesity prevention and treatment efforts. Interventions to decrease sedentary activities and improve connections with friends and family are promising strategies to address overweight and obesity among TGD youth.

A controlled study of internalizing symptoms in older adolescents with sickle cell disease.

BACKGROUND: Due to the ongoing medical challenges we hypothesized that older adolescents with sickle cell disease (SCD) would report greater rates of internalizing symptoms and diagnoses. This study is a follow-up to a previous study [1] that found few differences between the emotional well-being of children ages 8-15 with SCD and comparison peers. Our aim is to re-assess internalizing symptoms of youth with SCD and comparison peers at age 18. PROCEDURE: At follow-up, trained staff members administered semi-structured psychiatric interviews and widely use behavioral health questionnaires to adolescents with SCD (n = 48), their comparison peers (COMP; n = 51) and a caregiver. Mood, internalizing symptoms and diagnoses, were evaluated cross-sectionally at the follow-up (age 18). RESULTS: Psychiatric interview data showed that COMP reported more phobias relative to adolescents with SCD; no significant differences were reported for any other current symptoms (depression, anxiety, or mania). Questionnaire data showed all scores in the normal range with two significant differences: older adolescents with SCD reported more symptoms of tension-anxiety and fatigue-inertia. Both groups reported significant rates of internalizing disorders with 31% of youth with SCD and 35% of COMP having a DSM-IV diagnosis. CONCLUSIONS: Psychiatric interview data for both groups of older adolescents suggested considerable psychopathology; questionnaire data for both groups were in the normal range. We report few significant differences-more phobias in comparisons peers; more tension-anxiety and fatigue-inertia reported by youth with SCD. The overall findings suggest considerable resilience for youth with SCD, but both groups of adolescents report significant rates of psychopathology similar to national rates.

Obesity in young children with autism spectrum disorders: prevalence and associated factors.

BACKGROUND: The purpose of this study was to identify rates of overweight and obesity in young children with autism spectrum disorders (ASD) and factors related to overweight. METHODS: Retrospective chart reviews were conducted for 273 children with ASD [i.e., autistic disorder, Asperger's disorder, pervasive developmental disorder not otherwise specified (PDD-NOS)] after receiving outpatient services with a developmental pediatrician or the developmental team at a children's hospital. Information on child demographics, height and weight, medications prescribed, and adaptive functioning was collected from charts. RESULTS: Rates of overweight and obesity in children with ASD were found to be above nationally representative prevalence estimates for children. Among children with autistic disorder, 17.16% had a body mass index (BMI) percentile in the overweight range and 21.89% had a BMI percentile in the obese range. For children with Asperger's disorder/PDD-NOS, 12.50% were considered overweight and 10.58% were considered obese. Neither psychotropic medications prescribed nor adaptive functioning was found to be related to whether the child was overweight or obese. CONCLUSIONS: Children with ASD are at risk for overweight and obesity, and children with autistic disorder are at greater risk for weight problems than children with Asperger's disorder/PDD-NOS. Further research is needed to identify factors related to overweight in children with ASD.

Health-related quality of life, depression, and metabolic parameters in overweight insulin-resistant adolescents.

INTRODUCTION: The purpose of this study was to examine the incidence and severity of depression and health-related quality of life (HRQoL) in youth with insulin resistance (IR) who are overweight/obese and to examine the impact on making lifestyle changes. METHOD: New patients presenting for treatment in an IR clinic were screened for depression and HRQoL and reassessed twice during a 1-year treatment period. Metabolic and growth parameters were obtained for each participant. RESULTS: Elevated symptoms of depression were reported in 51% of the sample, and these symptoms were stable over time. Approximately 10% of these youth reported moderate or severe symptoms of depression. HRQoL scores indicated a good quality of life overall with slight improvement in some areas over time. Depression scores were not associated with demographic variables or metabolic parameters. DISCUSSION: More than 50% of adolescents with IR and obesity reported elevated symptoms of depression. These results provide sufficient evidence for the need to conduct routine screening of depression for all youth with IR so that appropriate mental health referrals can be made.

Nutrition, physical activity, and bone mineral density in youth with autistic spectrum disorders.

OBJECTIVE: Fractures and pain, secondary to low bone mineral density (BMD), have been reported in pediatric patients with autistic spectrum disorders (ASD). The purpose of this study was to assess the BMD of a clinical sample of 10- to 18-year olds with ASD, and the nutrition and physical activity correlates of skeletal health in this population. METHODS: Twenty-six patients with ASD were recruited from an outpatient multidisciplinary child-development clinic. Lumbar bone density was measured using dual-energy x-ray absorptiometry. Data collection included anthropometries, serum nutrient levels, parent interview, and 72-hour diet, screen-time, and physical activity records. RESULTS: Four patients (15%) met criteria for pediatric low BMD with z scores less than or equal to -2.0; another 4 were at risk with z scores less than or equal to -1.0. Approximately 54% of participants had insufficient serum 25-hydroxy vitamin D. Mean electronic media use was 251 minutes/day; mean physical activity 69 minutes/day. Fewer than 50% of participants met daily reference intake of vitamins A, B3, D, E, K, zinc, calcium, folate, potassium, and fiber. Bone density correlated positively with body mass (r = .47), calcium intake (r = .46), and calorie intake (r = .58). CONCLUSIONS: Children aged 10 to 18 years old with ASD are at risk for occult low bone density. In this study, those with low body mass index and insufficient calcium and calorie intake were at greater risk. Other unhealthy behaviors in this population included a high screen-time to physical activity ratio and multiple nutrient deficiencies.