This is a continuation of a systematic study of the behavioral effects of early exposure to excess androgens in individuals with congenital adrenal hyperplasia (CAH). Previous results suggest that early androgens do affect aspects of sex-typed behavior, and it is appropriate to study in detail the nature and extent of these effects. The purpose of the proposed project is to examine: (a) behaviors that have been under- studied with respect to effects of early hormones, including those that are more common or higher in females than in males; (b) the relation between hormonally-influenced childhood play behavior and adolescent/young adult cognitive abilities and sexual orientation; (c) psychosexual development and psychological adjustment in relation to early hormones and disease characteristics, especially genital anomalies and surgery in CAH females; (d) the relative importance of prenatal versus postnatal androgens in behavioral masculinization and defeminization. Adolescent and young adults ages 9-25) with CAH--84 females and 70 males-- and their unaffected siblings--65 females and 88 males--will be assessed on sex-typed activities and interests, gender identity, cognitive abilities (spatial and mechanical abilities, verbal memory, and decoding of emotions), emotional adjustment, and, in females aged 16 and older, sexual interests and experiences. About 60% have participated in the study since childhood, so childhood behavior can be related to current behavior. A small group of CAH girls aged 3-8 who received prenatal glucocorticoid treatment who have already been tested. Results of this study will provide information about the development of basic aspects of identity, and the nature and extent of hormonal influences on important human behaviors associated with mental health and social success. Data about psychological outcome will contribute to current debates about the need for early surgical intervention and prenatal treatment of girls with CAH. These issues are increasingly important because many cases of CAH are now identified through newborn screening.
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