title: Emotional and behavioral problems in late-identified Indonesian patients with disorders of sex development.
abstract: OBJECTIVE
  The aim of this study is to investigate emotional and behavioral problems among Indonesian patients with disorders of sex development (DSD) who recently came under clinical management. As diagnostic procedures and treatment had been delayed, patients progressively developed ambiguous bodies, difficult to conceal from outsiders.
  
  
  METHODS
  We compared 118 Indonesian patients with DSD aged 6-41 years (60 children, 24 adolescents, 34 adults) and 118 healthy control subjects matched for age, gender, and residential settings. We used the Child Behavioral Checklist (CBCL), Youth Self-Report (YSR), and Adult Self-Report (ASR) to examine differences between patient and control groups as well as differences within patients groups.
  
  
  RESULTS
  On the CBCL, parents of young children with DSD reported significantly more emotional and behavioral problems than parents of matched control. Parents of daughters with CAH reported that their daughters withdrew themselves from social interactions. On the ASR, adults with DSD reported significantly more internalizing problems than controls, particularly anxiety and depression. No other differences in emotional functioning were found across different diagnostic groups.
  
  
  CONCLUSIONS
  Indonesian patients with DSD who were untreated for most of their lives suffered more emotional and behavioral problems than matched controls. Differences and similarities between our findings and observations in patients from Western countries will be discussed.
authors.affiliation: Faculty of Psychology Diponegoro, University, Semarang, Indonesia; Center for Biomedical Research (CEBIOR), Faculty of Medicine, Diponegoro University, Semarang, Indonesia. Electronic address: aediati@gmail.com.
authors.forename: Annastasia
authors.initials: A
authors.lastname: Ediati
authors.affiliation: Center for Biomedical Research (CEBIOR), Faculty of Medicine, Diponegoro University, Semarang, Indonesia.
authors.forename: Sultana M H
authors.initials: SM
authors.lastname: Faradz
authors.affiliation: Center for Biomedical Research (CEBIOR), Faculty of Medicine, Diponegoro University, Semarang, Indonesia.
authors.forename: Achmad Zulfa
authors.initials: AZ
authors.lastname: Juniarto
authors.affiliation: Department of Child and Adolescence Psychiatry, Erasmus MC-Sophia, Rotterdam, The Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: van der Ende
authors.affiliation: Department of Pediatrics, Division of Pediatric Endocrinology, Erasmus MC-Sophia, Rotterdam, The Netherlands.
authors.forename: Stenvert L S
authors.initials: SL
authors.lastname: Drop
authors.affiliation: Department of Child and Adolescence Psychiatry, Erasmus MC-Sophia, Rotterdam, The Netherlands; Department of Pediatrics, Division of Pediatric Endocrinology, Erasmus MC-Sophia, Rotterdam, The Netherlands.
authors.forename: Arianne B
authors.initials: AB
authors.lastname: Dessens
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003863:Depression / Q000523:psychology*; D012734:Disorders of Sex Development / Q000523:psychology*; D004644:Emotions / Q000502:physiology; D005260:Female; D005783:Gender Identity; D006801:Humans; D008297:Male; D010290:Parents / Q000523:psychology; D000066553:Problem Behavior / Q000523:psychology*; D057566:Self Report; D055815:Young Adult
keywords: Behavioral problem; Disorders of sex development (DSD); Emotional problem; Indonesia; Untreated