EPISODE 62 - Pioneers Series - Adolescent Identity: Riittakerttu Kaltiala

Quick Notes: Riittakerttu Kaltiala, MD, PhD, BSc, is professor of adolescent psychiatry in Tampere University and chief psychiatrist in the Department of Adolescent Psychiatry in Tampere University Hospital. She is specialist in psychiatry, adolescent psychiatry and forensic psychiatry. She has been clinically involved in carrying out research on adolescent gender identity issues since 2011 when one of the two nationally centralized gender identity services for minors was opened in Finland, in Tampere University Hospital. Riitta tells us about the shift around 2010 in Finland in which health policy makers, politicians, activists, and human rights groups pushed for inclusion of adolescent and child services for gender transition. The adolescent psychiatrists scrambled to accommodate these new demands but recognized that identity consolidation is known to take more time and they had concerns about such early interventions. Nevertheless, they began developing a program for childhood gender services based on the literature in other countries such as the UK and netherlands. They were astonished and quite confused when the populations arriving at their services reflected a very different demographic in age, sex, and presentation of other comorbid psychiatric issues. They saw a shift again around 2015 which continued to confound the clinicians. Riitta tells us about reading the littman ROGD research which accurately documented what she and colleagues were seeing Links: Dr Kaltiala’s Website: https://riittakerttu.fi/ Adolescent GD Current Perspectives: https://www.ncbi.nlm.nih.gov/pmc/arti... Lisa Marchiano - Outbreak: https://www.tandfonline.com/doi/full/... GD and ASD: A Narrative Review https://pubmed.ncbi.nlm.nih.gov/26753... Extended Notes ● Riitta talks about how she got into psychiatry and got to work in this field. ● When did Riitta first come across gender identity? She shares the backstory. ● Riitta talks about how it was decided in Finland in 2009 that children and adolescents also needed gender medical intervention. What was the motivation behind this? ● It is during adolescence that young people seek and experiment with their identity. However, it is normal for them to change or evolve in 2-3 years. It is part of the process of stabilizing their identity. ● It’s hard to expect in adolescent psychiatry during the early phases of adolescent development that the person would already be ready with any aspect of identity. ● In the beginning, most of society did not have an idea about gender identity issues so it was not discussed much including the medical field as only a small group had started to study it. ● Riitta shares the unexpected phenomena she experienced about puberty blockers of gender identity when she first learned about it. ● Social media and peer discussions usually precede gender distress cases in the US and UK. Riitta shares what data they collected in this case for Finland. ● People who came to their services had severe psychiatric problems and history and were suffering mental disorders. This was one of the issues that inspired Riitta to further her research. ● In the first years, professionals such as teachers, child welfare, psychiatrists, etc., who were around the young person when they started to express their gender dysphoria felt insecure and uncertain about their competence on how to help them. ● As contact with peers is very important for healthy adolescents, they have observed a lot of young people who displayed non-confirming gender behaviors isolated themselves as they were discriminated against and bullied. ● What was the follow up like from these services back in 2011? Where are those adolescents now and how are they doing? ● Despite changes hormonal treatments were producing was satisfying for the adolescent, it did little to relieve other psychiatric symptoms. Simply changing gender will not resolve all these problems. ● Although a lot of professionals have failed helplessly in the past, this has completely changed in Finland. People working with adolescents nowadays are more well equipped and competent. ● What does Riitta think about the concept of Rapid Onset Gender Dysphoria? ● Riitta shares that peer influence is valid as it is natural with adolescents to be susceptible to their peer groups. Similar to kids confirming their ideals in music and other interests, it can also happen with gender identity. ● It’s good that young people are able to express themselves however they feel like but making medical interventions for the healthy body must have a stronger consideration. ● Riitta talks about how highly autistic children may lack the flexibility to deal with ambiguity as they tend to obsess and fixate on things. Is it playing a big role in their gender dysphoria? This podcast is sponsored by ReIME and Genspect. Visit Rethinkime.org and Genspect.org. For more about our show: Linktr.ee/WiderLensPod