The Recalled Childhood Gender Questionnaire-Revised: A Psychometric Analysis in a Sample of Women with Congenital Adrenal Hyperplasia
Meyer-Bahlburg, Heino F. L., Dolezal, Curtis, Zucker, Kenneth J., Kessler, Suzanne J., Schober, Justine M., New, Maria I., The Journal of Sex Research
The clinical psychological evaluation for gender development of adolescent and adult individuals with conditions such as gender identity disorder or somatic intersexuality includes a systematic review of gender role behavior and gender identity in childhood. In patients with acute gender problems, the findings may have significant implications for decisions such as the prescription of pubertyblocking medications to decrease the pressure of ego-dystonic maturational somatic changes (Cohen-Kettenis & Pfafflin, 2003) or the initiation of steps toward gender reassignment as described in the Standards of Care for Gender Identity Disorders (Meyer et al., 2001). Similarly, long-term follow-up research on these rare disorders includes the examination--retrospectively as well as prospectively--of the assumed continuity of gender-development trajectories, which underlies the clinical approach, as a function of biological and social variables.
Of the few behaviorally-oriented interviews and questionnaires available for these purposes (Zucker, 2005), only one written self-report instrument has been developed that grew directly out of work with gender-atypical children and the critical diagnostic criteria for childhood gender identity disorder of DSM-IV (American Psychiatric Association, 1994). In the 1990s, the Toronto group developed a 22-item Recalled Childhood Gender Identity Scale (Mitchell & Zucker, 1991; Zucker & Mitchell, 2002), which was later re-named the Recalled Childhood Gender Identity/Gender Role Questionnaire (Zucker et al., in press). This self-report questionnaire focuses on gender-related behaviors that are part of the clinical picture of gender identity disorder of childhood and includes items that were anticipated to yield sex differences or within-sex variation as a function of some other marker variable, such as sexual orientation (Mitchell & Zucker). Factor analysis and scale construction were based on adult convenience samples of non-intersex persons.
Recently, a small working party, the Research Protocol Work Group of the North American Task Force on Intersexuality, modified the original questionnaire by eliminating or replacing several items that did not differentiate between men and women or generated many missing responses, and by simplifying and homogenizing the wording of others. The result was an 18-item questionnaire draft, the Recalled Childhood Gender Questionnaire-Revised (RCGQ-R; available from the third author, KJZ). Our purpose in the current study was to examine the internal structure of the revised item set, to derive scales, and to present their psychometric characteristics in an adult population of 46,XX individuals with congenital adrenal hyperplasia (CAH).
CAH denotes a family of disorders of sex development (DSD) due to varying degrees of prenatal and postnatal production of adrenal androgens as a result of genetic deficiencies of one of several enzymes involved in adrenal steroidogenesis (New, 2003). The most common type of CAH is 21-hydroxylase deficiency, within which three severity subtypes are distinguished: Saltwasters (SW), the most severe subtype, in which the enzyme deficiency causes deficiencies of both glucocorticoid (glucose-regulating) and mineralocorticoid (sodium-regulating) hormones; simple virilizers (SV), with moderate deficiencies of glucocorticoids; and the mildest subtype, non-classical (NC), late-onset CAH. The degree of hyperandrogenemia increases with syndrome severity and is assumed to underlie not only the somatic masculinization/virilization seen in 46,XX individuals with CAH, but also the behavioral masculinization, which has been studied at several stages of development in the two more severe subtypes (Meyer-Bahlburg, 2001) and found to be associated with an increased rate of patient-initiated gender change to male (Dessens, Slijper, & Drop, 2005). A well-designed instrument for the retrospective assessment of gender-related behavior in childhood is expected to be sensitive enough to detect differences between these subtypes. …