Transgender Youth Executive Functioning: Relationships with Anxiety Symptoms, Autism Spectrum Disorder, and Gender-Affirming Medical Treatment Status

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Strang, J. F., Chen, D., Nelson, E., Leibowitz, S. F., Nahata, L., Anthony, L. G., Song, A., Grannis, C., Graham, E. K., Henise, S., Vilain, E., Sadikova, E., Freeman, A., Pugliese, C., Khawaja, A., Maisashvili, T., Mancilla, M., & Kenworthy, L. (2021). Transgender Youth Executive Functioning: Relationships with Anxiety Symptoms, Autism Spectrum Disorder, and Gender-Affirming Medical Treatment Status. Child Psychiatry & Human Development, 53(6), 1252-1265. https://doi.org/10.1007/s10578-021-01195-6

Publication date: 19 Jun 2021 Added to AutiHub: 29 Aug 2026 Type: Article Article language: English
Publisher source (DOI) OpenAlex source

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Authors

Publication authors
18
Publication authors identified as autistic
1 / 18 (5.6%)
  1. John F. Strang
  2. Diane Chen
  3. Eric Nelson
  4. Scott F. Leibowitz
  5. Leena Nahata
  6. Laura G. Anthony
  1. Amber Song
  2. Connor Grannis
  3. Elizabeth K. Graham *
  4. Shane Henise
  5. Eric Vilain
  6. Eleonora Sadikova
  1. Andrew Freeman
  2. Cara Pugliese
  3. Ayesha Khawaja
  4. Tekla Maisashvili
  5. Michael Mancilla
  6. Lauren Kenworthy

Abstract

Executive function (EF) underlies broad health and adaptive outcomes. For transgender youth, navigating gender discernment and gender affirmation demand EF. Yet, factors associated with transgender youth EF are unknown. We investigate hypothesized predictors of EF: over-represented conditions among transgender youth (anxiety and depression symptoms, autism spectrum disorder [ASD]) and gender-affirming care. One-hundred twenty-four transgender 11-21-year-olds participated. Parents/caregivers completed EF and mental health report measures. ASD diagnostics and gender-affirming medication histories were collected. 21 % of non-autistic and 69 % of autistic transgender youth had clinically elevated EF problems. Membership in the gender-affirming hormone treatment group was associated with better EF. ASD, anxiety symptoms, and membership in the long-duration pubertal suppression group were associated with poorer EF. Given the importance of EF skills for multiple outcomes, and the unique and additional EF demands specific to transgender youths' experiences, EF skill monitoring-and when appropriate, supports-should be considered for transgender youth.

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Cited references
110
With a DOI
96
Without a DOI, from raw bibliography text
12
3 / 110 (2.7%) cited references include at least one author identified as autistic.
References with data to complete
6 / 110 (5.5%)
References with detected author names
106 / 110 (96.4%)
Without detected author names
4
Without a structured title
6
Without a stable identifier
12
References with raw author names still to review
4
References with external metadata lookup issues
0
These indicators apply to cited references displayed on this page, after technical duplicates have been merged. A reference without a DOI can still support author statistics when a title and author names are available.
Author names detected in the cited bibliography
509
From DOI or external metadata
509
From validated raw bibliography text
0
Raw names already validated
0
Raw names still to review
4
85 / 509 (16.7%) names are linked to an author already present in AutiHub. 424 / 509 (83.3%) names are not yet linked.
Names linked to a person identified as autistic
6 / 509 (1.2%)
Calculated across all author names detected in the cited bibliography. Among names linked to an author already present in AutiHub: 6 / 85 (7.1%). Distinct people identified as autistic: 5 / 448 (1.1%).
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