Identity, Conformity, and Nonconformity: A Closer Look.

As clinicians, we have been vigilant to screen for underlying psychopathology in children and adolescents who meet criteria for gender dysphoria (GD) based on the risk these individuals have for developing externalizing and/or internalizing disorders, likely driven by a stigmatizing society. However, we have not paid careful attention to an often overlooked population, namely gender-nonconforming (GNC) children-especially those in community samples-who do not meet criteria for GD per se but who, according to the well-done and thought-provoking study featured in this issue, van der Miesen et al.'s "Behavioral and Emotional Problems in Gender-Nonconforming Children: A Canadian Community-Based Study," appear to share some similar psychiatric vulnerabilities as their peers with GD, with some unique features noted for natal boys versus natal girls. The few studies that have looked at this group of children have relied on clinical samples, which complicates whether the increased rates of psychopathology are in fact due to GNC-related factors versus inherently higher rates of psychopathology in clinical samples. Because of this, previous studies using clinical samples might overestimate the rates of psychopathology in GNC youths. Van der Miesen et al. smartly attempted to avoid that bias by drawing participants from the community and by excluding participants with any previous mental health diagnoses, including GD. This study is a refreshing shift, delving into community samples and using a validated measure, the Gender Identity Questionnaire for Children (GIQC), thus allowing comparisons to be made with prior clinical samples.