SUMMARYBehavioral assessment and diagnostic testing procedures were developed to evaluate the treatment of an 8‐yr‐old boy with a pronounced gender disturbance. When a combined response‐cost and verbal prompt contingency was applied, the single target mannerism of limping‐the‐wrist markedly decreased and response generalization of the treatment effect occurred to other mannerisms. Behavior therapy procedures successfully suppressed feminine voice inflections, doll‐play, and predominant play with girls, and increased masculine play. The treatment effects were replicated in a multiple‐baseline intrasubject design. The 2‐yr independent follow‐up found a marked shift to normal gender‐role adjustment.

Procedures for assessing children's sex-typed play were developed which (a) examined children's continuous play in four sessions totaling 20 minutes rather than measuring only initial choice of a sex-typed toy, and (b) did not impose the stimulus-specific condition of requiring an adult experimenter to be present to administer the task. Play with “masculine” and “feminine” toys was observed for 120 normal children (60 boys, 60 girls) aged 3 yr.–8 yr., and 15 similarly aged boys diagnosed as having childhood gender disturbance. Significant differences were found in the sex-typed play of the two normal groups, but no age differences were observed. The amount of feminine play by the feminoid boys was found to be significantly greater than that of normal boys, but not significantly different from the predominantly feminine play patterns of the normal girls. The usefulness of such a measure for the clinical assessment of deviant sexrole development in young children is discussed.

To our knowledge this case is the first successful change of childhood gender identity that is documented by pre- and post-diagnostic assessment procedures. Deviant sex-typed behaviors were modified in a 5-yr-old boy judged by an independent clinician to be a high risk for adult transsexualism. In Study 1, the child's mother was trained to reinforce “masculine” play behaviors and to extinguish “feminine” play behaviors in the clinic. This intrasubject study introduced new procedures designed to maximize the generalization of the treatment effect to play in the alone condition. Study 2 was designed to modify the child's cross-gender mannerisms through the use of a response-cost and verbal prompt procedure. The cross-gender mannerism “flexed elbow” decreased as a function of the treatment. At the follow-up 25 months after treatment terminated, the evaluation by an independent clinician indicated the therapeutic change to a male gender identity.