1448 The quotation from Joseph Califano (“Treatment and accountability . . .”) occurs on page 9 of the Columbia University National Center on Addiction and Substance Abuse report Criminal Neglect: Substance Abuse, Juvenile Justice and the Children Left Behind (2004).
1449 The positive impact of family-based intervention is explored in William Shadish et al., “Effects of family and marital psychotherapies: A meta-analysis,” Journal of Consulting & Clinical Psychology 61, no. 6 (December 1993).
1450 The quotation about the effectiveness of family and group interventions occurs on page 255 of Susan R. Woolfenden, Katrina Williams, and Jennifer K. Peat, “Family and parenting interventions for conduct disorder and delinquency: A meta-analysis of randomized controlled trials,” Archives of Disease in Childhood 86, no. 4 (April 2002).
1451 The effectiveness of prenatal home visits in reducing juvenile crime is discussed on page 90 of the US surgeon general’s report Youth Violence (2001). For more information on preventive programs, see Peter W. Greenwood et al., Diverting Children from a Life of Crime: Measuring Costs and Benefit (1996).
1452 Delinquency prevention programs are likened to “the dental model” in Robert Nix, “Preschool intervention programs and the process of changing children’s lives,” Prevention & Treatment 6, no. 1 (December 2003). In full: “The immunological model of intervention may be misguided, and a dental model may be more appropriate. Just as we expect to need regular visits to the dentist to prevent future cavities, we may need to provide on-going assessment and adaptive support to uphold intervention effects.”
1453 The meaning of all of those acronyms:
BPT: Behavioral Parent Training
FFT: Functional Family Therapy
MST: Multisystemic Therapy
SFT: Structural Family Therapy
BSFT: Brief Structural Family Therapy
MFGI: Multiple Family Group Intervention
FAST: Families and Schools Together
FET: Family Effectiveness Training
TFC: Treatment Foster Care
These programs and others like them are reviewed in Patricia Chamberlain and Julie Gilbert Rosicky’s paper, “The effectiveness of family therapy in the treatment of adolescents with conduct disorders and delinquency,” Journal of Marital & Family Therapy 21, no. 4 (June 1995); and W. Jeff Hinton, Carl Sheperis, and Pat Sims’s “Family-based approaches to juvenile delinquency: A review of the literature,” Family Journal: Counseling & Therapy for Couples & Families 11, no. 2 (April 2003).
1454 Recent publications by Alan Kazdin on the parenting of defiant children include Parent Management Training: Treatment for Oppositional, Aggressive, and Antisocial Behavior in Children and Adolescents (2005); and Alan E. Kazdin, P. L. Marciano, and M. Whitley, “The therapeutic alliance in cognitive-behavioral treatment of children referred for oppositional, aggressive, and antisocial behavior,” Journal of Consulting and Clinical Psychology 73, no. 4 (August 2005).
1455 For the study concluding that behavioral-communication programs could cut recidivism in half, see Patrick Tolan et al., “Family therapy with delinquents: A critical review of the literature,” Family Processes 25, no. 4 (December 1986).
1456 For the two studies finding significantly reduced recidivism among participants in family therapy, see William H. Quinn and David J. Van Dyke, “A multiple family group intervention for first-time juvenile offenders: Comparisons with probation and dropouts on recidivism,” Journal of Community Psychology 32, no. 2 (February 2004); and Cole Barton et al., “Generalizing treatment effects of functional family therapy: Three replications,” American Journal of Family Therapy 13, no. 3 (Fall 1985).
1457 Statistics on the increased incidence of arrest for violent crimes in youth from families who had received no early intervention come from Arthur J. Reynolds et al., “Long-term effects of an early childhood intervention on educational achievement and juvenile arrest,” Journal of the American Medical Association 285, no. 18 (May 9, 2001). From the abstract: “Relative to the preschool comparison group and adjusted for several covariates, children who participated in the preschool intervention for 1 or 2 years had a higher rate of high school completion (49.7% vs 38.5%; P=.01); more years of completed education (10.6 vs 10.2; P=.03); and lower rates of juvenile arrest (16.9% vs 25.1%; P=.003), violent arrests (9.0% vs 15.3%; P=.002), and school dropout (46.7% vs 55.0%; P=.047).” Nine percent vs. 15.3 percent translates to a 70 percent difference.
Reports of the Chicago Longitudinal Study, which demonstrated the effectiveness of early intervention and family therapy in reducing risk of initial offending, include Arthur J. Reynolds, Judy A. Temple, and Suh-Ruu Ou, “School-based early intervention and child well-being in the Chicago Longitudinal Study,” Child Welfare 82, no. 5 (September–October 2003); Arthur J. Reynolds, Suh-Ruu Ou, and James W. Topitzes, “Paths of effects of early childhood intervention on educational attainment and delinquency: A confirmatory analysis of the Chicago Child-Parent Centers,” Child Development 75, no. 5 (September 2004); and Arthur J. Reynolds, “Promoting well being in children and youth: Findings from the Chicago Longitudinal Study,” Children & Youth Services Review 26, no. 1 (January 2004).
From Fight Crime: Invest in Kids: “Similar savings were found for Chicago’s federally-funded Child-Parent Centers which have served 100,000 three- and four-year-olds since 1967. Research shows that similar children from low-income neighborhoods were 70 percent more likely to have been arrested for a violent crimes by age 18 than those who attended the program. This program will prevent an estimated 33,000 crimes by the time the children already served reach the age of 18. Seven dollars were saved for every $1 invested in this program, of which taxpayers alone save almost $3.”
1458 Meager implementation of family therapy by juvenile institutions was found in Karol L. Kumpfer and Rose Alvarado, “Family-strengthening approaches for the prevention of youth problem behaviors,” American Psychologist 58, nos. 6–7 (June–July 2003), page 457: “In the past 20 years, prevention researchers have developed and tested a number of effective parenting and family interventions; however, only about 10% of practitioners are implementing these family strengthening programs and only about 25% are implementing these with fidelity.”
1459 For demonstrations of the cost savings resulting from expenditures on family education, see Lawrence J. Schweinhart, Helen V. Barnes, and David P. Weikart, Significant Benefits: The High/Scope Perry Preschool Study through Age 27 (1993). For documentation of even greater savings with later-stage intervention, see Robert Barnoski, Outcome Evaluation of Washington State’s Research-Based Programs for Juvenile Offenders (2004).
1460 Criminologist Peter Greenwood compares costs of the “three strikes” law with parole and parent training in the RAND Corporation report Diverting Children from a Life of Crime: Measuring Costs and Benefits (1996); specific figures cited occur on page 25.
1461 Estimates of the total cost of the failure to provide adequate preventive services come from page 6 of Lawrence J. Schweinhart et al., Lifetime Effects: The HighScope Perry Preschool Study through Age 40 (2005).
1462 This passage is based on my interviews with Tom and Sue Klebold between 2005 and 2007, and subsequent communications. My sources on the Columbine tragedy include reports in the Denver Rocky Mountain News by Lynn Bartels, Dan Luzadder, and Kevin Vaughan (see the bibliography for all titles); David Cullen’s articles on Salon and his subsequent book, Columbine (2009); coverage in the New York Times by David Brooks and Judith Warner; Nancy Gibbs and Timothy Roche, “The Columbine tapes,” Time, December 20, 1999; Michael Paterniti, “Columbine never sleeps,” GQ, April 2004; Brooks Brown and Rob Merritt, No Easy Answers: The Truth behind Death at Columbine (2002); Ralph Larkin, Comprehending Columbine (2007); and Susan Klebold, “I will never know why,” O, The Oprah Magazine, November 2009.
1463 Nathan Dykeman said of the Klebolds, “They’re in a glass cage,” in an ABC Good Morning America interview, “More insight on Dylan Klebold,” broadcas
t April 30, 1999.
XI: Transgender
1464 The quotation from Richard C. Friedman (“. . . ‘Don’t worry—it won’t happen to you’”) comes from personal communication in 2011.
1465 Amy Bloom’s observation (“Male is not gay or straight; it’s male . . .”) occurs on page 18 of her book Normal: Transsexual CEOs, Crossdressing Cops, and Hermaphrodites with Attitude (2002).
1466 The quotations from Jan Morris (“Transsexualism is not a sexual mode or preference . . .” and “My inner uncertainty . . .”) occur on pages 8 and 7 of her memoir, Conundrum (2006). page 8: “Whatever the cause, there are thousands of people, perhaps hundreds of thousands, suffering from the condition today. It has recently been given the name trans-sexualism, and in its classic form is as distinct from transvestism as it is from homosexuality. Both transvestites and homosexuals sometimes suppose they would be happier if they could change their sex, but they are generally mistaken. The transvestite gains his gratification specifically from wearing the clothes of the opposite sex, and would sacrifice his pleasures by joining that sex: the homosexual, by definition, prefers to make love with others of is own sort, and would only alienate himself and them by changing. Trans-sexualism is something different in kind. It is not a sexual mode or preference. It is not an act of sex at all. It a passionate, lifelong, ineradicable conviction, and no true transsexual has ever been disabused of it.”
From page 7: “This was a bewilderment that would never leave me, and I see it now as the developing core of my life’s dilemma. If my landscapes were Millais or Holman Hunt, my introspections were pure Turner, as though my inner uncertainty could be represented in swirls and clouds of colour, a haze inside me. I did not know exactly where it was—in my head, in my heart, in my loins, in my dreams. Nor did I know whether to be ashamed of it, proud of it, grateful for it, resentful of it. Sometimes I thought I would be happier without it, sometimes I felt it must be essential to my being. Perhaps one day, when I grew up, I would be as solid as other people appeared to be: but is perhaps I was meant always to be a creature of wisp or spindrift, loitering in this inconsequential way almost as though I were intangible.”
1467 These definitions, commonly accepted though occasionally debated, are cataloged on pages 4–6 of Stephanie Brill and Rachel Pepper, The Transgender Child: A Handbook for Families and Professionals (2008).
1468 The quotation from Aiden Key (“My gender is who I am; my sexuality is who I bounce it off of”) comes from my interview with him in 2009.
1469 The quotation from the mother (“She’s four—I don’t think she’s got sexual desires yet”) comes from a personal interview in 2009.
1470 See Richard Green, The “Sissy Boy Syndrome” and the Development of Homosexuality (1987).
1471 My sources on ENDA and NGLTF advocacy include David Herszenhorn, “House approves broad protections for gay workers,” New York Times, November 8, 2007; and Rea Carey’s November 5, 2009, testimony before the Senate Committee on Health, Education, Labor, and Pensions. (I am a member of the Task Force board of directors, which I joined after I began researching this chapter.)
1472 Diagnostic criteria for gender identity disorder appear on pages 576–80 of the Diagnostic and Statistical Manual of Mental Disorders, DSM-IV-TR, 4th ed. (2000).
1473 Stephanie Brill and Rachel Pepper discuss the emergence of gender-stereotypical behavior in chapter 3 (pages 61–72) of The Transgender Child (2008).
1474 Unless otherwise specified, all quotations from Stephanie Brill come from my interviews with her in 2009 and subsequent communications.
1475 See Simona Giordano, “Lives in a chiaroscuro: Should we suspend the puberty of children with gender identity disorder?,” Journal of Medical Ethics 34, no. 8 (August 2008).
1476 “Official” statistics on incidence of gender reassignment surgery appear on page 579 of the Diagnostic and Statistical Manual of Mental Disorders, DSM-IV-TR (2000). I have applied those proportions to American population estimates.
1477 Lynn Conway offers her analysis of transgender population statistics in her essay “The numbers don’t add; transsexual prevalence,” GID Reform Advocates (2008), http://gidreform.org/gid30285.html.
1478 The quotation from Barbara Walters (“what’s between their legs doesn’t match what’s between their ears”) comes from her ABC News report “Transgender children face unique challenges,” 20/20, April 27, 2007.
1479 The National Center for Transgender Equality estimates that between .25 percent and 1 percent of the population is transsexual; see page 1 of the organization’s brochure “Understanding Transgender” (2009).
1480 The quotation from Holly Devor occurs on page xxvi of FTM: Female-to-Male Transsexuals in Society (1997).
1481 The word cisgender is new enough that it still awaits a place in the Oxford English Dictionary, but notable enough to have its own Wikipedia page (http://en.wikipedia.org/wiki/Cisgender); a 1991 article by German sexologist Volkmar Sigusch featured the neologism zissexuelle, and cisgender can be found in Usenet posts as far back as 1994.
1482 This passage is based on my interview with Venessia, Joseph, Josie, and Jade Romero in 2009 and subsequent communications.
1483 TransYouth Family Allies website: http://imatyfa.org/. (I am a member of the TYFA board of directors, which I joined after I began researching this chapter.)
1484 Josie agreed to be profiled in the 2010 National Geographic documentary Sex, Lies and Gender and is featured in Stephanie Innes, “Meet Josie, 9: No secret she’s transgender,” Arizona Star, July 25, 2010.
1485 A recent study has established that of the 4,508 genes actively transcribed in the mouse brain, 257 are more highly expressed in males and 355 in females; see Xia Yang et al., “Tissue-specific expression and regulation of sexually dimorphic genes in mice,” Genome Research 16, no. 8 (August 2006). These numbers are far greater than the numbers of genes involved in the differentiation of the gonads. Given the increased size and complexity of the human brain, it is likely that even larger numbers of genes are associated with sexually dimorphic processes other than reproduction, including behavior and disposition. For a useful review of current research on genetic and epigenetic contributions to sex differences in behavior, see Irfan A. Qureshi and Mark F. Mehler, “Genetic and epigenetic underpinnings of sex differences in the brain and in neurological and psychiatric disease susceptibility,” Progress in Brain Research 186 (2010). For further discussion of genetic and biological contributions to gender identity, see Louis Gooren, “The biology of human psychosexual differentiation,” Hormones & Behavior 50 (2006): 589–601; Dick F. Swaab, “Sexual differentiation of the brain and behavior,” Best Practice & Research Clinical Endocrinology & Metabolism 21, no. 3 (September 2007); and Lauren Hare et al., “Androgen receptor repeat length polymorphism associated with male-to-female transsexualism,” Biological Psychiatry 65, no. 1 (January 1, 2009).
1486 Unless otherwise specified, all quotations from Norman Spack come from my interview with him in 2009.
1487 The possible influence of DES on development of gender dysphoria is discussed on pages 226–71 of Deborah Rudacille, The Riddle of Gender: Science, Activism and Transgender Rights (2005); the survey is described on page 17.
1488 For more information on endocrine disruptors and differences in gendered behavior, see David Crews and John A. McLachlan, “Epigenetics, evolution, endocrine disruption, health, and disease,” Endocrinology 147, no. 6 (June 2006). Nicholas Kristof’s reports on the subject include “It’s time to learn from frogs,” New York Times, June 27, 2009; and “Chemicals and our health,” New York Times, July 16, 2009.
1489 The quotation from Georges Canguilhem (“Diversity is not disease; the anomalous is not the pathological”) occurs on page 137 of his book The Normal and the Pathological (1991).
1490 Diagnostic criteria for gender identity disorder appear on pages 576–80 of the Diagnostic and Statistical Manual of Mental Disorders, DSM-IV-TR, 4th ed. (2000). For in-depth discussio
n of gender-atypical behaviors common to children with GID, see Kenneth J. Zucker and Susan J. Bradley, Gender Identity Disorder and Psychosexual Problems in Children and Adolescents (1995); and the chapter “Childhood, interrupted,” on pages 192–225 of Deborah Rudacille, The Riddle of Gender (2005).
1491 Heino Meyer-Bahlburg analyzes the statistical variance of children with GID from gender-typical behavior in his paper “Gender identity disorder of childhood: Introduction,”Journal of the American Academy of Child Psychiatry 24, no. 6 (November 1985).
1492 Figures for the percentage of children with GID whose cross-gender identification persists into adolescence are based on the findings in Richard Green, The “Sissy Boy Syndrome” and the Development of Homosexuality (1987). Although Green’s study is twenty-five years old, it is cited as rigorous and relevant in nearly every paper that mentions the subject of persistence of GID into adolescence. The general principle that most children with early GID do not transition later on is supported by more recent work as well; see Kelley D. Drummond et al., “A follow-up study of girls with gender identity disorder,” Developmental Psychology 44, no. 1 (January 2008). From the abstract: “This study provided information on the natural histories of 25 girls with gender identity disorder (GID). Standardized assessment data in childhood (mean age, 8.88 years; range, 3–12 years); and at follow-up (mean age, 23.24 years; range, 15–36 years) were used to evaluate gender identity and sexual orientation. At the assessment in childhood, 60% of the girls met the Diagnostic and Statistical Manual of Mental Disorders criteria for GID, and 40% were subthreshold for the diagnosis. At follow-up, 3 participants (12%) were judged to have GID or gender dysphoria. Regarding sexual orientation, 8 participants (32%) were classified as bisexual/homosexual in fantasy, and 6 (24%) were classified as bisexual/homosexual in behavior. The remaining participants were classified as either heterosexual or asexual.” See also M. S. Wallien and Peggy T. Cohen-Kettenis, “Psychosexual outcome of gender-dysphoric children,” Journal of the American Academy of Child & Adolescent Psychiatry 47, no. 12 (December 2008). To wit: “Results: At follow-up, 30% of the 77 participants (19 boys and 4 girls) did not respond to our recruiting letter or were not traceable; 27% (12 boys and 9 girls) were still gender dysphoric (persistence group), and 43% (desistance group: 28 boys and 5 girls) were no longer gender dysphoric. Both boys and girls in the persistence group were more extremely cross-gendered in behavior and feelings and were more likely to fulfill gender identity disorder (GID) criteria in childhood than the children in the other two groups. At follow-up, nearly all male and female participants in the persistence group reported having a homosexual or bisexual sexual orientation. In the desistance group, all of the girls and half of the boys reported having a heterosexual orientation. The other half of the boys in the desistance group had a homosexual or bisexual sexual orientation.”
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