The researchers recruited 43 girls with CAH ages 3 to 18 and assessed their gender-typical behaviors and gender identities using a nine-item questionnaire. One question, for example, asks the child if she would take the opportunity to be magically turned into a boy.
In comparison with a control group of normal girls, those with CAH answered questions in a more masculine way. However, when compared with hormonally normal girls who identified as tomboys, they scored closer to typical girls. And few, says Berenbaum, actually identified as male.
"They behave in some ways more like boys, but they self-identify as girls," she explains.
"Social influences are also pretty important," she says. "I think the interesting question is how biological predisposition affects our socialization experiences."
Diane Ruble, PhD, a New York University psychologist specializing in early childhood gender identity, agrees.
"In Sheri's work, the hormonal exposure has some masculinizing influence on their play behavior," says Ruble. "That may feed into difficulties that children have even if the hormonal exposure prenatally did not actually directly affect their identities as girls or boys."
For example, she says, a girl who discovers that her behavior is slightly masculine may feel more like a typical boy than girl. She may then primarily socialize with boys, leading to even more male-typical behavior.
"Obviously, gender is both a biological and social phenomenon," says Ruble. "Researchers now really need to look carefully at the unfolding of biologically driven processes in interaction with social influences during the first three years of life and beyond."