The Cass Review- Interim Report

[rogdmum]

The Cass Review Interim Report has been released. 112 pages long and it’s such a bloody relief to read common sense.

cass.independent-review.uk/publications/interim-report/

There’s so much in it, but emphasis on taking a holistic approach with a great chart on page 57 showing the complex presentations in and complex pathways.

And social transitioning has been recognised as an active intervention!

“Social transition – this may not
be thought of as an intervention or treatment, because it is not something
that happens within health services. However, it is important to view it as an active intervention because it may have significant effects on the child or young person in terms of their psychological functioning. There are different views on the benefits versus the harms of early social transition. Whatever position one takes, it is important to acknowledge that it is not a neutral act, and better information is needed about outcomes.” Pages 62/63

So much in it. So much. And there’s more to come as the review continues to work on the issues.

@TheCurrywurstPrion

With regard to social transitioning not being a neutral act, it also says on page 63:

5.20. It should also be recognised that ‘doing nothing’ cannot be considered a neutral act.

I don’t really understand that statement. I understand that “doing nothing” requires making a decision to do so, but surely the act of doing nothing is, in itself neutral? The only reason I can imagine for it not being seen as a neutral act, is that campaigners have made it so. If anyone can explain, I’m interested to understand better.

I agree that that will need to be clarified in the final report.

For now, I'm reading it as offering none of the active interventions cited in 5.19 is not a neutral act (and this would include the non-availability of counselling). Or, there are many different ways of 'doing nothing' and some are more active and intentional than others.

In clinical trial terms, and particularly after the recent elaboration of the different types of control/placebo, even a waiting list protocol is more active than passive observation of people who are neither receiving the intervention nor waiting for it.

TIDieR-Placebo: A guide and checklist for reporting placebo and sham controls
Howick J, Webster RK, Rees JL, Turner R, Macdonald H, et al. (2020) TIDieR-Placebo: A guide and checklist for reporting placebo and sham controls. PLOS Medicine 17(9): e1003294. doi.org/10.1371/journal.pmed.1003294

I agree Spart.

Societal attitudes towards gender roles and gender expression are changing. Children, teenagers and younger adults may more commonly see gender as a fluid, multi-faceted phenomenon which
does not have to be binary, whereas older generations have tended to see gender as binary and fixed. (from p 26)

Seems like a too simplistic take. It wonder just how many of the 'older generations' believe 'gender roles' are binary and fixed really? I mean, if that was the case, my mother defied a few of those 'gender roles' without any thought at all that she was doing it. So, I really think this generalisation is not helpful.

Thank you for link.

Seems like a too simplistic take. It wonder just how many of the 'older generations' believe 'gender roles' are binary and fixed really?

It also totally overlooks cross-cultural and historical perspectives ...

I mean (coff) look at women in the North of England (coff) ...

I may well be wrong, but I view at “doing nothing” as ignoring the distress your child is going through and just carrying on as usual. I would agree that this is not a neutral act. These children are in varying forms of distress and need help/support of some form, though not necessarily via affirmation/transition. Ie by doing nothing you are not following the principles of the report which is to fully explore the possible causes of distress.

Could be completely wrong here, though!

It is also important to note that any data that are available do not relate to the current predominant cohort of later-presenting birth-registered female teenagers. This is because the rapid increase in this subgroup only began from around 2014-15. Since young people may not reach a settled gender expression until their mid-20s, it is too early to assess the longer-term outcomes of this group.

It is really interesting to see this in black and white and off social media. How often have I, personally, written this on numerous threads? Especially in response to having that incredibly unbalanced Cornell link plopped down like it is some kind of 'gotcha' with its 50+ studies. Having combed through each of them, they never address the issues of this group.

Things we knew, backed up with research:

'1.14. Primary and secondary care staff have told us that they feel under pressure to adopt an unquestioning affirmative approach and that this is at odds with the standard process of clinical assessment and diagnosis that they have been trained to undertake in all other clinical encounters.'

And this:

'1.16. Another significant issue raised with us is one of diagnostic overshadowing – many of the children and young people presenting have complex needs, but once they are identified as having gender-related distress, other important healthcare issues that would normally be managed by local services can sometimes be overlooked.'

Oh this is good news. Thanks for sharing. (Bookmarking for later!)

Societal attitudes towards gender roles and gender expression are changing. Children, teenagers and younger adults may more commonly see gender as a fluid, multi-faceted phenomenon which
does not have to be binary, whereas older generations have tended to see gender as binary and fixed. (from p 26)

Agree with previous comments. Younger people may think they see gender as more fluid than older people but I think I see them as far more self defined by arbitrary stereotypical roles.

@rogdmum

I may well be wrong, but I view at “doing nothing” as ignoring the distress your child is going through and just carrying on as usual. I would agree that this is not a neutral act. These children are in varying forms of distress and need help/support of some form, though not necessarily via affirmation/transition. Ie by doing nothing you are not following the principles of the report which is to fully explore the possible causes of distress.

Could be completely wrong here, though!

I was thinking along similar lines.

Unhappy children need active support, rather than being ignored.

Children who may be neuro-diverse need active support, rather than being ignored.

And the nature of the support needs to be appropriate, evidence-based and funded.

3.23 It is also important to note that any data that are available do not relate to the current predominant cohort of later-presenting birth-registered female teenagers. This is because the rapid increase in this subgroup only began from around 2014-15. Since young people may not reach a settled gender expression until their mid-20s, it is too early to assess the longer-term outcomes of this group

Just adding the reference for later.

Thanks for this, will read later. Looks v promising though.

Thank you for the link. I'm book marking to read later, but am pleased by the comments made so far.

For those at the beginning of the thread concerned about the Dr Cass being put under pressure to change the report, I had the same thought and went to check it had been archived. It had; here's the link web.archive.org/web/20220310104606/cass.independent-review.uk/publications/interim-report/

4.5 We have heard that some young people learn through peers and social media what they should and should not say to therapy staff in order to access hormone treatment; for example, that they are advised not to admit to previous abuse or trauma, or uncertainty about their sexual orientation.

So, these children and young people are being told by others to deny their trauma to obtain a diagnosis that might not be right for them?

And activists cannot see the issue with that?

The Cunning Little Vixenkiller has a different take...

twitter.com/JolyonMaugham/status/1501884753309483010?s=20&t=XCQA2DceuQ-K6hP2EjgWqg

Since young people may not reach a settled gender expression until their mid-20s, it is too early to assess the longer-term outcomes of this group.
ScotGov - self ID at 16 with no way to legally detrans (as ever)

Thanks ROGD

@rogdmum

I may well be wrong, but I view at “doing nothing” as ignoring the distress your child is going through and just carrying on as usual. I would agree that this is not a neutral act. These children are in varying forms of distress and need help/support of some form, though not necessarily via affirmation/transition. Ie by doing nothing you are not following the principles of the report which is to fully explore the possible causes of distress.

Could be completely wrong here, though!

We could make sound arguments in several ways.

I'd say that we are more than averagely engaged readers of this report so I'd hope that the differences in interpretation are an indication to the report writers that this section needs to be clearer.

[quote Awkwardy]The Cunning Little Vixenkiller has a different take...

twitter.com/JolyonMaugham/status/1501884753309483010?s=20&t=XCQA2DceuQ-K6hP2EjgWqg[/quote]
I just see that he protected his tweets. Dying with curiosity here, what did he say?

The link works for me if I am not signed in to Twitter and don't click anything regarding cookies etc.

He had a long thread about how if a 'young trans woman' wanted blockers they'd get them one way or the other. I didn't read all of it but something about it being easier if they had rich parents who could take them abroad.

Yes what Empressaurus said. Its all very "I know better than experts", and suggests that Cass has kicked the main recommendation down the road, ie whether young people know whats best for them, or medical experts do.

[quote Awkwardy]The Cunning Little Vixenkiller has a different take...

twitter.com/JolyonMaugham/status/1501884753309483010?s=20&t=XCQA2DceuQ-K6hP2EjgWqg[/quote]
What he seems to be missing with his talk of 'trans children', is that the report would indicate that there is actually no such thing. That it's a definition grasped by children with a multitude of other issues.

Although when she discusses the fluidity of gender amongst youngsters, that does muddy the waters a bit.

And yes, as a previous poster says, that fluidity is incredibly superficial and looks as though it just involves hair dye and clothing.

The fox killer is wondering about all these parents and children left high and dry without puberty cancelling drugs. As soon as gender ideology stops getting taught in schools and off social media, that number is going to drop drastically. And those troubled children will be allowed to access the right kind of treatment for their individual conditions.

To me there's always this glaring gap when people talk about treatment for trans children, because they never bloody ask what's caused it.

Nothing shows it up more than that. If hordes of children were suddenly suffering from something that needed urgent, irreversible treatment, one of the very first things you would be asking is why they've got it.

Not, as he does, just going hell for leather about how to treat it.

I was hoping that Hilary Cass would acquire information about the dark side of this issue. The pressures at play, and the adults involved.

Her talking about children being given lines to get drugs, it would indicate that she is.

As usual, people like Maugham focus on the males. He, along with others ignore these sections:

5.9. As previously indicated, the epidemiology of gender dysphoria is changing, with an increase in the numbers of birth-registered females presenting in early teens. In addition, the majority of children and young people presenting to GIDS have other complex mental health issues and/or neurodiversity. There is also an over-representation of looked after children.

5.10. There are several implications arising from the change in epidemiology:
● Firstly, the speed of change in the numbers presenting means that services have not kept pace with demand.
● Secondly, the cohort that the original Dutch Approach was based on is different from the current more complex NHS cohort, and also from the current case-mix internationally, and therefore it is difficult to extrapolate from older literature to this current group.
● Thirdly, different subgroups may have quite different needs and outcomes, and these must be built into any service design, so that it works for all children and young people.

5.11. At present we have the least information for the largest group of patients – birth-registered females first presenting in early teen years. Since the rapid increase in this group began around 2015, they will not reach late 20s for another 5+ years, which would be the best time to assess longer-term wellbeing.

page 58.

It is always about the males. Always.