University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
Horm Res Paediatr. 2023;96(2):222-227. doi: 10.1159/000524517. Epub 2022 Apr 7.
The paediatric clinical psychology literature provides applicable evidence for use in specialist healthcare settings and services. The general approach of psychological care of children and families with paediatric conditions is recognizable as preventative and destigmatizing, aimed to maximize personal agency with shared responsibility for achieving best outcomes via multi-professional teamwork. Recent commentaries regarding healthcare for children with differences in sex development (DSD) have noted service-level pitfalls, including poor teamwork and underuse of early and integrated psychological intervention. Psychological research regarding the variously termed DSD, variations in sex development, variation in sex characteristics, or intersex has historically centred around the assessment of sex differences, gender identity, and the impact of including hormone influences on brain and behaviour. Psychological research in this specialist area has not focussed on the evaluation of specific clinical interventions or psychotherapeutic models but has investigated psychological aspects of multi-professional healthcare provision. There are new goals for psychological care of children with variations or differences in sex development (V/DSD). These require a framework of good communication to enable those receiving care to come to know and articulate their own hopes for treatment and support. Paediatric psychological intervention studies involving larger clinical groups such as diabetes provide evidence applicable to DSD populations. A risk of stigma is recognized as inherent to some physical interventions within routine paediatric care of people with V/DSD. Psychological care and intervention should be aimed at minimizing these risks via questioning and examining their assumed need. Psychological approaches can provide a foundation for ethical and rights-based multi-professional care of children with V/DSD.
儿科临床心理学文献为专业医疗保健环境和服务提供了实用的证据。针对儿科疾病儿童和家庭的心理保健的一般方法是可识别的预防性和去污名化的，旨在通过多专业团队合作最大限度地发挥个人能动性，并共同承担实现最佳结果的责任。最近关于儿童性别发育差异（DSD）的医疗保健的评论指出了服务层面的缺陷，包括团队合作不佳和早期及综合心理干预的使用不足。关于各种术语的 DSD、性别发育差异、性别特征差异或间性的心理研究，历史上一直集中在评估性别差异、性别认同以及包括激素对大脑和行为的影响。这一专业领域的心理研究并未关注特定临床干预或心理治疗模式的评估，而是调查了多专业医疗服务提供的心理方面。有新的目标针对具有性别发育差异（V/DSD）的儿童进行心理保健。这些需要一个良好沟通的框架，以使接受护理的人了解并表达他们自己对治疗和支持的希望。涉及糖尿病等更大临床群体的儿科心理干预研究为 DSD 人群提供了适用证据。在 V/DSD 人群的常规儿科护理中，一些身体干预措施固有的风险是公认的。心理保健和干预应旨在通过质疑和检查其假定的需求来最小化这些风险。心理方法可以为基于伦理和权利的 V/DSD 儿童的多专业护理提供基础。
