208 Chapter 11 second one was an imposed stereotype. Both adolescents and professionals had diverging viewpoints regarding the increasing media-attention; some thought positively about this, while others raised doubts. Comparing the interviews of the adolescents with those of the professionals reveals that the adolescents and professionals do not agree about all topics. It is striking that, compared to the professionals, adolescents were often more cautious in their treatment views. It is important to give voice to the transgender adolescents themselves in order to prevent professionals acting upon (possibly incorrect) assumptions about the adolescents’ views instead of the adolescents’ actual considerations and opinions. Gathering more qualitative research data from transgender adolescents in other sites/countries is encouraged. Chapter 4 Chapter 4 reports on the examination of transgender adolescents’ medical decisionmaking competence (MDC) to give informed consent for starting treatment with PS. Transgender adolescents’ competence to give informed consent is an important prerequisite for PS (Coleman et al., 2012; Hembree et al., 2017). However, in society, there is doubt whether they are capable of this, which in some countries has even led to limited access to this intervention. There is no empirical evidence on transgender adolescents’ MDC to decide on PS. Therefore we assessed in a structured, replicable way, the MDC of Dutch transgender adolescents who were assessed eligible to start PS. The participants were 74 adolescents between the ages of 10 and 18. All attended the gender identity clinic in Amsterdam or Leiden, the Netherlands. All participants underwent the usual diagnostic trajectory, including a psycho-diagnostic assessment and several monthly sessions with a mental health provider over a longer period of time (usually about six months), before being assessed eligible for PS. The MacArthur Competence Assessment Tool for Treatment (MacCAT-T) was used. This is a quantitative semi-structured interview used to assess the four criteria a person needs to fulfil in order to reach MDC, being: understanding the information relevant to one’s condition and the proposed treatment, appreciation of the nature of one’s circumstances, reasoning about benefits and potential risks of the options, and being able to express a choice (Appelbaum & Grisso, 1988). The study aimed not only to assess the adolescents’ MDC, but also to investigate potential associated variables (e.g. full scale IQ, sex, age, behavioural and emotional difficulties). The parent-reported Child Behaviour Checklist (CBCL) was used to assess behavioural and emotional difficulties (Achenbach & Rescorla, 2001; Verhulst & van der Ende, 2013). The diagnostic trajectory concludes with a session for signing an informed consent (IC) statement by the adolescent and parents. This standard IC session was videotaped and used to establish the reference standard for MDC. After the IC session, the MacCAT-T interview was administered, which was also videotaped, to provide the MacCAT-T based
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