Researching Hidden Populations: The Littman Study and Rapid Onset Gender Dysphoria

In academia, a very hot topic now is Brown University’s response to criticism of Lisa Littman’s PLOS One paper on rapid onset gender dysphoria (see here and here). Brown initially promoted Littman’s paper which reported on her survey of 256 parents of children with late onset gender dysphoria. However, when transgender activists raised criticisms, the school pulled their press release about the study from distribution.

One of the key criticisms is that Littman posted her call for respondents on three websites which are frequented by parents who describe rapid onset gender dysphoria in their children. Critic Julia Serano called this “begging the question.” Diane Ehrensaft was quoted in the Economist as saying Littman’s recruitment “would be like recruiting from Klan or alt-right sites to demonstrate that blacks really are an inferior race.”

If Littman was trying to generally study gender dysphoria in adolescent or make a claim that the onset of all gender dysphoria in adolescence was rapid, then these criticisms might be more on point. However, Littman’s interest was more specific. She wanted to understand the relatively recent experience of rapid onset gender dysphoria in social groups where the prevalence is much greater than expected. Thus, she went where the subjects were.

The analogy offered by Ehrensaft is off because Littman wasn’t studying gender dysphoric teens in a general sense. She was trying to get a look at a subset of teens who reported gender dysphoria in the context of social groups where many such teens were reporting it. The analogy also fails because the websites Littman used for recruitment do not have negative attitudes toward transgender people in general. They do seem defensive in the face unrelenting attacks by transgender activists, but I can’t blame them for that.

Hidden Populations Are Hard to Reach

The history of research in sexuality is filled with studies of activist groups and websites. Early GLBT studies were populated by appeals to secret groups and it is still common to reach out to activist groups. In thinking about this study, I thought of the one by Ariel Shidlo and Michael Shroeder on harm done by conversion therapy. When they first recruited for subjects, they went to GLB activist groups with the following message:

Homophobic Therapies: Documenting the Damage

The National Lesbian & Gay Health Association is sponsoring an investigation of the outcomes of so-called treatments of the so-called disorder of homosexuality.

In the press release was this call for subjects:

You can be of help in the long process of getting the message out that these “conversion” therapies don’t work and do the opposite of healing *by informing your lesbian/gay/bi communities of our search for participants to be interviewed.* Please announce our project in any upcoming lesbian and gay community meetings and spread the word.

This study was a pilot study but helped to shine some light on the reactions of clients to sexual orientation change efforts. The study was widely criticized but it never claimed to be a representative sampling of all people who had tried change therapy. Therefore, the most careful interpretation of the work was focused on people who felt harmed. By analogy, that is what can be said about Littman’s study. One cannot generalize to all trans teens, nor does Littman do that. Anything that can be said can only be said about the parent reports and that is a valuable contribution at this stage of research.

Opponents Should Talk Less and Research More

Parents who see their children changing suddenly often feel struck by lightning and need empathy and support. They get some of that from talking to other parents via these websites. Critics do not help their cause by disregarding the experience of parents who know their children well and feel adrift.

For the record, I understand that the trans regret rate is less than one percent and I am not anti-trans. At the same time, I am pro-academic freedom and challenge critics to research more and criticize less. The answer to research you don’t like or disagree with is more research and academic inquiry.

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Former Dean of Harvard Medical School Criticizes Brown University’s Actions Regarding Gender Dysphoria Study

At Quillette, former Dean of Harvard’s Medical School Jeffrey Flier provides a scathing review of Brown University’s lack of support for Assistant Professor Lisa Littman and her study of rapid onset gender dysphoria (see my summary of this issue). Setting the stage for his review, Flier makes it clear that this issue is relevant to academic freedom for all:

This week’s controversy surrounding an academic paper on gender dysphoria published by Brown University assistant professor Lisa Littman—brought on by the post-publication questioning of Dr Littman’s scholarship by both the journal that published it, PLOS One, and Brown’s own School of Public Health—raises serious concerns about the ability of all academics to conduct research on controversial topics.

Flier spends the bulk of his article taking apart Brown University’s rationale for removing their press release about Littman’s PLOS One paper.  He then concludes with this stinging call for a defense of academic freedom:

At a time such as this, when a university’s academic mandate is under threat from diverse ideological actors, there is simply no substitute for a strong leader who supports academic freedom and discourse. The dean’s letter raises serious questions about whether the dean of Brown’s School of Public Health is willing to be such a leader.

For centuries, universities struggled to protect the ability of their faculties to conduct research seen as offensive—whether by the church, the state, or other powerful influences. Their success in this regard represents one of the great intellectual triumphs of modern times, one that sits at the foundation of liberal societies. This is why the stakes are high at Brown University. Its leaders must not allow any single politically charged issue—including gender dysphoria—from becoming the thin edge of a wedge that gradually undermines our precious, hard-won academic freedoms.

I certainly agree. There is a process for bringing research to the community of scholars and Littman followed it. Brown’s administrators should stand for the principle of academic freedom by leaving up the press release. The study can easily be criticized but at the same time it is similar to many pilot studies of hidden populations. Unless some kind of academic misconduct is found, Brown University should defend the work of this professor.

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Academic Freedom Under Review at Brown University

On August 16, peer reviewed journal PLOS One published “Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports” by Lisa Littman, an Assistant Professor at Brown University. In essence, Littman surveyed over 250 parents of children who expressed gender dysphoria with an onset in adolescence or later. She also found that the onset of gender dysphoria took place in the context of peer groups where others in the group became gender dysphoric. On August 22, Brown University published a press release (archived) regarding the study. Then on August 27, Brown removed the news item from the school website, stating:

Brown University Statement — Monday, Aug. 27, 2018

In light of questions raised about research design and data collection related to Lisa Littman’s study on “rapid-onset gender dysphoria,” Brown determined that removing the article from news distribution is the most responsible course of action.

As a general practice, university news offices often make determinations about publishing faculty research based on its publication in established, peer-reviewed journals considered to be in good standing. The journal PLOS ONE on the morning of Aug. 27 published a comment on the research study by Lisa Littman, who holds the position of assistant professor of the practice of behavioral and social sciences at Brown, indicating that the journal “will seek further expert assessment on the study’s methodology and analyses.” Below is the comment posted on the study in the journal PLOS ONE:

“PLOS ONE is aware of the reader concerns raised on the study’s content and methodology. We take all concerns raised about publications in the journal very seriously, and are following up on these per our policy and COPE guidelines. As part of our follow up we will seek further expert assessment on the study’s methodology and analyses. We will provide a further update once we have completed our assessment and discussions.” — PLOS ONE August 27, 2018

Then today, Brown’s Dean of the School of Public Health Bess H. Marcus issued a statement explaining the decision to remove the news item. After repeating the above statement, Dr. Marcus added the following:

Independent of the University’s removal of the article because of concerns about research methodology, the School of Public Health has heard from Brown community members expressing concerns that the conclusions of the study could be used to discredit efforts to support transgender youth and invalidate the perspectives of members of the transgender community.

The University and School have always affirmed the importance of academic freedom and the value of rigorous debate informed by research. The merits of all research should be debated vigorously, because that is the process by which knowledge ultimately advances, often through tentative findings that are often overridden or corrected in subsequent higher quality research. The spirit of free inquiry and scholarly debate is central to academic excellence. At the same time, we believe firmly that it is also incumbent on public health researchers to listen to multiple perspectives and to recognize and articulate the limitations of their work. This process includes acknowledging and considering the perspectives of those who criticize our research methods and conclusions and working to improve future research to address these limitations and better serve public health. There is an added obligation for vigilance in research design and analysis any time there are implications for the health of the communities at the center of research and study.

The School’s commitment to studying and supporting the health and well-being of sexual and gender minority populations is unwavering. Our faculty and students are on the cutting edge of research on transgender populations domestically and globally. The commitment of the School to diversity and inclusion is central to our mission, and we pride ourselves on building a community that fully recognizes and affirms the full diversity of gender and sexual identity in its members. These commitments are an unshakable part of our core values as a community.

In an effort to support robust research and constructive dialogue on gender identity in adolescents and youth, the School will be organizing a panel of experts to present the latest research in this area and to define directions for future work to optimize health in transgender communities. We believe that more and better research is needed to help guide advances in the health of the LGBTQ community. We welcome input from faculty, staff and students about the composition of this panel and scope of the discussion.

Researchers Come to Littman’s Defense

In response to Brown’s actions, a group of sexuality researchers signed a letter in support of Littman. Written by J. Michael Bailey, professor of psychology at Northwestern University, the letter cautions Brown to consider the source of criticism:

We are aware of the very loud opposition to Dr. Littman’s article from some transgender activists. This was predictable to anyone who has followed transgender issues during the past few years. However, you should not overreact to this criticism, for several reasons. First, these activists do not represent all transgender persons. There is no one transgender community that speaks as one. Second, those who are protesting the loudest are trying to silence Dr. Littman by intimidation and false or irrelevant accusations. They are not engaging in good faith scientific criticism. Some of us know this strategy all too well, having been targets of it. Third, and most importantly, ROGD is a very serious public health concern. You should be proud that Brown University has opened the door to its study, and hopefully someday, to its successful treatment.

The study has been criticized on several methodological points summarized in an article by transgender activist Julia Serano. These critiques have been answered by Roberto D’Angelo and Lisa Marchiano of the Pediatric and Adolescent Gender Dysphoria Working Group.

From my perspective, the study is a preliminary examination of a syndrome which was once rare but is now increasingly seen by clinicians. I have heard about these cases more frequently over the past decade and seen several such situations. As such, the study is worthwhile and true to the stated purpose (“A study of parent reports”).

It should go without saying that more data are needed and interviews with the teens who are in the groups identifying as transgender need to follow this study. Even so, that is no reason to walk back on this preliminary effort to examine what parents are seeing in their children.

 

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