title: Psychiatric comorbidity among children with gender identity disorder.
abstract: OBJECTIVE
  To investigate the prevalence and type of comorbidity in children with gender identity disorder (GID).
  
  
  METHODS
  The Diagnostic Interview Schedule for Children-Parent version was used to assess psychopathology according to the DSM in two groups of children. The first group consisted of 120 Dutch children (age range 4-11 years) who were referred to a gender identity clinic between 1998 and 2004 (GID group) and the second group consisted of 47 Dutch children who were referred to an attention-deficit/hyperactivity disorder (ADHD) clinic between 1998 and 2004 (ADHD group; 100% response rate for both groups).
  
  
  RESULTS
  Fifty-two percent of the children diagnosed with GID had one or more diagnoses other than GID. As expected, more internalizing (37%) than externalizing (23%) psychopathology was present in both boys and girls. Furthermore, the odds ratios of having internalizing or externalizing comorbidity were 1.28 and 1.39 times higher, respectively, in the clinical comparison group (ADHD group) than in the GID group. Finally, 31% of the children with GID suffered from an anxiety disorder.
  
  
  CONCLUSIONS
  The results of this categorical diagnostic study show that children with GID are at risk for developing co-occurring problems. Because 69% of the children do not have an anxiety disorder, a full-blown anxiety disorder does not seem to be a necessary condition for the development of GID. Clinicians working with children with GID should be aware of the risk for co-occurring psychiatric problems and must realize that externalizing comorbidity, if present, can make a child with GID more vulnerable to social ostracism.
authors: Ms. Wallien is with the Department of Medical Psychology and Institute for Clinical and Experimental Neurosciences, Graduate School of Neurosciences, at the VU University Medical Center, Amsterdam, The Netherlands; Dr. Swaab is with the Department of Education and Child Studies, Subdepartment Clinical Child and Adolescent Studies, Leiden University, Leiden, The Netherlands; and Dr. Cohen-Kettenis is with the Department of Medical Psychology at the VU University Medical Center, Amsterdam. Electronic address: m.wallien@vumc.nl.
authors: Madeleine S C
authors: MSC
authors: Wallien
authors: Ms. Wallien is with the Department of Medical Psychology and Institute for Clinical and Experimental Neurosciences, Graduate School of Neurosciences, at the VU University Medical Center, Amsterdam, The Netherlands; Dr. Swaab is with the Department of Education and Child Studies, Subdepartment Clinical Child and Adolescent Studies, Leiden University, Leiden, The Netherlands; and Dr. Cohen-Kettenis is with the Department of Medical Psychology at the VU University Medical Center, Amsterdam.
authors: Hanna
authors: H
authors: Swaab
authors: Ms. Wallien is with the Department of Medical Psychology and Institute for Clinical and Experimental Neurosciences, Graduate School of Neurosciences, at the VU University Medical Center, Amsterdam, The Netherlands; Dr. Swaab is with the Department of Education and Child Studies, Subdepartment Clinical Child and Adolescent Studies, Leiden University, Leiden, The Netherlands; and Dr. Cohen-Kettenis is with the Department of Medical Psychology at the VU University Medical Center, Amsterdam.
authors: Peggy T
authors: PT
authors: Cohen-Kettenis
mesh_terms: D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003937:Diagnosis, Differential; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005783:Gender Identity; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology*; D014190:Transvestism / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*