Gender diversity associated with patterns of brain activation seen in populations that experience childhood stress.

Introduction: Stressful childhood experiences are associated with unique brain activity patterns during emotional processing. Specifically, pediatric stress is linked to activation in the insulae, superior temporal and parahippocampal gyri, and the amygdalae, as well as differential activation in the dorsal anterior cingulate cortex when viewing emotional faces. Gender diversity is broadly associated with higher victimization and mental health disparities in children aged 9/10, but whether it is associated with stress-like alterations in brain function (BOLD signal during task-based fMRI) remains unknown. We investigate the functional brain correlates of this relationship to determine if gender-diverse youth show patterns of functional activity during an emotional task consistent with those of other populations that experience heightened stress. Methods: We used data from the Adolescent Brain Cognitive Development (ABCD) Results: Gender diversity was associated with widespread increases in BOLD signal during the faces condition of the EN-Back task. Youth's report of parental acceptance and school environment did not moderate the relationship between gender diversity and BOLD signal in the insula or fusiform gyrus. Gender diversity was related to greater parent and school-related stress, which was associated with elevated mental health problems. Conclusion: Patterns of functional activity were consistent with those reported in prior literature on childhood stress. Gender diversity was associated with increased emotional and behavioral problems, as well as parent and school-related stress. These findings indicate the importance of the home and school environments for supporting the wellbeing of gender diverse youth.