The studies state that the majority of children diagnosed with gender dysphoria did not desire to be the other sex by puberty, with most growing up to identify as gay, lesbian, or bisexual, with or without therapeutic intervention.The prospective studies have been criticized  on the basis that they counted as desistance cases where the child was simply gender-nonconforming rather than dysphoric. While they met the criteria for gender identity disorder as defined in the DSM-III or DSM-IV, many would not have met the updated criteria for gender dysphoria in the DSM-5, established in 2013. In addition, prior to the DSM-III in 1980, there was no diagnostic criteria for gender dysphoria, so research on desistance rates published prior to 2000 reported inflated numbers of desistance.Additionally, the evidence offered has been criticized for citing studies which have been labelled conversion therapy for discouraging social transition and trying to prevent a transgender outcome. The studies have been used to argue for more caution in socially or medically transitioning transgender youth; however, they have been criticized as irrelevant due to tracking diagnoses rather than tracking evolution of gender identity or desire to transition. In addition, Bonifacio et al. state that "there is research to suggest" that some desistance of GD "may be caused, in part, by an internalizing pressure to conform rather than a natural progression to non–gender variance. "According to a review published in 2022 considering more recent studies, the majority of pre-pubertal children who socially transition persist in their identity in 5 to 7 year follow ups.
Using classical behaviour modification techniques he and a team of research assistants set about extinguishing problem feminine behaviours in three boys in particular, enlisting the help of parents and occasionally teachers to provide rewards and punishments corresponding to behaviours identified as wanted or unwanted. Rekers dissertation describes in detail, the case of Kraig (a pseudonym for Kirk Andrew Murphy) whose mother was instructed over earphones to alternately praise or ignore him depending on whether he played with a table of toys deemed to be feminine (typically dolls) or masculine (typically weapons). She was also trained to monitor his behaviour at home, with research assistants visiting weekly to ensure she was correctly completing her four times daily observations of Kraigs gendered behaviour. Physical punishment from Kraigs father is named as one of the primary consequences for feminine behaviour at home. Throughout Rekerss future work, he cites his treatments with Kraig as a success, claiming that "Kraigs feminine behaviours have apparently ceased entirely […]. "In 1974, Rekers and Ole Ivar Lovaas published the article "Behavioral Treatment of Deviant Sex-Role Behaviors in a Male Child." The article cited Green and Money as a source of the "growing evidence that childhood cross-gender manifestations are indicative of later adult sexual abnormalities; e.g., transvestism, transsexualism, or some forms of homosexuality."