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The behavioral treatment of a “transsexual” preadolescent boy

Abstract

Behavioral treatment procedures were developed to suppress feminine sex-typed behaviors and to increase masculine sex-typed behaviors in an 8-year-old boy with “childhood cross-gender identity.” The boy's clinical history paralleled the retrospective reports of adult transsexuals, including (1) feminine voice inflection and predominantly feminine content in speech, (2) verbal self-reference as “sissy” and “fag” and statements about his preference to be a girl, (3) feminine hand and arm gestures and “swishy” gait, (4) an aversion to masculine play activities, (5) a strong preference for girl playmates and taking a feminine role in play and role-playing, and (6) improvised cross-dressing. With a multiple-baseline intrasubject design across stimulus environments and across behaviors, the subject was treated sequentially in the clinic, at home, and in the school. The boy's mother was trained to administer a token economy program in the home, and the school teacher was taught to apply a response-cost procedure in the classroom. The initial treatment effects were found to be largely response specific and stimulus specific, necessitating treatment for a number of behaviors in the three major environments. Followup data 12 months after treatment termination suggest that the boy's sex-typed behaviors have become essentially normalized. This treatment holds promise for correcting pathological gender identity development in boys and for relieving the associated emotional adjustment problems.

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References

  1. Barlow, D. H., Reynolds, E. J., & Agras, W. S. Gender identity change in a transsexual.Archives of General Psychiatry, 1973,28, 569–576.

  2. Bates, J. E., Skilbeck, W. M., Smith, V. R., & Bentler, P. M. Gender role abnormalities in boys: An analysis of clinical ratings.Journal of Abnormal Child Psychology, 1974,2, 1–16.

  3. Bentler, P. M. A note on the treatment of adolescent sex problems.Journal of Child Psychology and Psychiatry, 1968,9, 125–129.

  4. Green, R. Childhood cross-gender identification.Journal of Nervous and Mental Disease, 1968,147(5), 500–509.

  5. Green, R.Sexual identity conflict in children and adults. New York: Basic Books, 1974.

  6. Green, R., & Money, J.Transsexualism and sex reassignment. Baltimore: The Johns Hopkins Press, 1969.

  7. Green, R., Newman, L. E., & Stoller, R. J. Treatment of boyhood transsexualism.Archives of General Psychiatry, 1972,26, 213–217.

  8. Lovaas, O. I., Freitag, G., Gold, V. J., & Kassorla, I. C. Recording apparatus and procedure for observation of behaviors of children in free play settings.Journal of Experimental Child Psychology, 1965,2, 108–120.

  9. Mussen, P. H. Early sex-role development. In D. A. Goslin (Ed.),Handbook of socialization theory and research. Chicago: Rand McNally, 1969.

  10. Myrick, R. D. The counselor-consultant and the effeminate boy.Personnel and Guidance Journal, 1970,48(5), 355–361.

  11. Patterson, G. R., & Gullion, M. E.Living with children: New methods for parents and teachers. Champaign, Illinois: Research Press, 1968.

  12. Rekers, G. A.Pathological sex-role development in boys: Behavioral treatment and assessment. (Doctoral dissertation, University of California at Los Angeles) Ann Arbor, Michigan: University Microfilms, 1972, No. 72-33, 978.

  13. Rekers, G. A. Shaping athletic behaviors in effeminate boys. Unpublished manuscript, University of California, Los Angeles, 1973.

  14. Rekers, G. A. Stimulus control over sex-typed play in cross-gender identified boys.Journal of Experimental Child Psychology, 1974, in press.

  15. Rekers, G. A., & Lovaas, O. I. Behavioral treatment of deviant sex-role behaviors in a male child.Journal of Applied Behavior Analysis, 1974,7, 134–151.

  16. Sherman, J. A., & Baer, D. M. Appraisal of operant therapy techniques with children and adults. In C. M. Franks (Ed.),Behavior therapy: Appraisal and status. New York: McGraw-Hill, 1969.

  17. Stoller, R. J.Sex and gender: The development of masculinity and femininity. New York: Science House, 1968.

  18. Stoller, R. J. Psychotherapy of extremely feminine boys.International Journal of Psychiatry, 1970,9, 278–282.

  19. Wahler, R. G. Setting generality: Some specific and general effects of child behavior therapy.Journal of Applied Behavior Analysis, 1969,2(4), 239–246.

  20. Zuger, B. Feminine-like behavior in boys present from early childhood.Journal of Pediatrics, 1966,69, 1098–1107.

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Author information

Correspondence to Dr. George A. Rekers.

Additional information

This article is one in a series of publications from Dr. Rekers' and Dr. Lovaas' treatment research program at UCLA on childhood gender problems. The program is supported by United States Public Health Service Research Grants 21803-01Al, 21803-02, and 11440-05 from the National Institute of Mental Health. The authors express their appreciation to Gary Eifer, Dr. Linda Friar, Arana Greenberg, Sandra Kurtzer, Sharon Schwartz, Norman Stone, and Cindy Yates, M.A., for their assistance in data collection. We also thank Dr. Richard Green, UCLA School of Medicine, who referred the first treatment cases to us, and Dr. Alexander C. Rosen, Chief of Psychology at the UCLA Neuropsychiatric Institute, for his consultation on psychological assessment. The essentials of this study were presented in an unpublished paper entitled “Treatment of cross-sex behavior in boys” at the Fourth Annual Meeting of the Society for Psychotherapy Research, June 15, 1973, Philadelphia, Pennsylvania.

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Rekers, G.A., Lovaas, O.I. & Low, B. The behavioral treatment of a “transsexual” preadolescent boy. J Abnorm Child Psychol 2, 99–116 (1974). https://doi.org/10.1007/BF00919093

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Keywords

  • Behavioral Treatment
  • Gender Identity
  • Identity Development
  • Adjustment Problem
  • Emotional Adjustment