An exploration of the lived experiences of non-binary individuals who have presented at a gender identity clinic in the United Kingdom.

Background: Despite an increased awareness of non-binary identity in the current social landscape, the experiences and needs of this heterogeneous community are poorly understood and represented in the research literature. Evidence indicates that social exclusion is not uncommon for individuals expressing a non-binary gender identity, with reflections in the literature that this may in turn have an impact on their psychological wellbeing. Aim: As non-binary individuals are increasingly presenting at UK gender identity clinics and requesting medical interventions, the aim of this study was to better understand their experiences and needs. Method: Two focus groups were run consisting of eight service users of a National Health Service (NHS) gender identity clinic in the United Kingdom. The transcripts of these focus groups were analysed using thematic analysis. Results: Five themes were identified: Invisibility, Managing non-binary gender identity in a binary world, Individuality, Gender dysphoria and Seeking interventions. Discussion: Clinical implications are discussed, with the recommendation for an affirmative approach that offers space for the non-binary individual to articulate their desires and come to terms with their identity. This exploration must take into consideration the person's place within a social world that can be transphobic and limited in terms of potential medical interventions. Further research is needed to better understand this marginalised community.

Motor excitability is reduced prior to voluntary movements in children and adolescents with Tourette syndrome.

Tourette syndrome (TS) is a neuro-developmental disorder characterized by the occurrence of motor and vocal tics: involuntary, repetitive, stereotyped behaviours that occur with a limited duration, often typically many times in a single day. Previous studies suggest that children and adolescents with TS may undergo compensatory, neuroplastic changes in brain structure and function that help them gain control over their tics. In the current study we used single-pulse and dual-site paired-pulse transcranial magnetic stimulation (TMS), in conjunction with a manual choice reaction time task that induces high levels of inter-manual conflict, to investigate this conjecture in a group of children and adolescents with TS, but without co-morbid Attention Deficit Hyperactivity Disorder (ADHD). We found that performance on the behavioural response-conflict task did not differ between the adolescents with TS and a group of age-matched typically developing individuals. By contrast, our study demonstrated that cortical excitability, as measured by TMS-induced motor-evoked potentials (MEPs), was significantly reduced in the TS group in the period immediately preceding a finger movement. This effect is interpreted as consistent with previous suggestions that the cortical hyper-excitability that may give rise to tics in TS is actively suppressed by cognitive control mechanisms. Finally, we found no reliable evidence for altered patterns of functional inter-hemispheric connectivity in TS. These results provide evidence for compensatory brain reorganization that may underlie the increased self-regulation mechanisms that have been hypothesized to bring about the control of tics during adolescence.