In honor of Transgender Day of Visibility on March 31st, let us take a moment to celebrate youth with diverse gender identities. It requires bravery and perseverance for gender non-conforming children to live authentically given the fear and discrimination they often face. It is critical for parents, teachers, and providers to consider how best to support kids who are exploring their gender identity.
What is gender non-conformity in childhood?
Gender non-conformity (GNC) occurs when there is a difference between a child’s assigned sex at birth and their gender expression as defined by societal norms. For example, a child may prefer toys, activities, or clothes normatively associated with the opposite gender. Perhaps your son has a beloved pink princess dress, or your daughter likes to wear a tie. Nonconformity can begin early in childhood, as soon as 2 or 3 years old. Gender nonconforming children may feel a mismatch between their physical characteristics and their identity, wishing that they could be viewed as, or literally become, the opposite sex. Young children may even voice this conflict to their parents in simple terms: “I’m a boy but inside I feel like a girl.” This dissonance can be quite painful for children to experience, as well as for parents to understand and accept. However, the consequences for rejecting a child’s identity are dire. How can parents, teachers, pediatricians, and other providers best respond to gender non-conformance to set children up for healthy developmental and psychological outcomes? Self-education, acceptance, and an attitude of curiosity and joint exploration are key.
What is gender dysphoria?
In the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, DSM-5, “Gender Dysphoria” is used to describe the distress that some individuals experience when their gender identity is misaligned with their sex originally assigned at birth. Not all gender non-conforming children experience gender dysphoria, as clinical levels of distress may not occur. A 2013 study found that the intensity of early gender dysphoria is a significant predictor of the continuation of gender dysphoria into adolescence. This suggests that early gender non-conforming behaviors and preferences should be thoughtfully attended to and understood by caregivers. The course of gender non-conformity varies with development. Children may ultimately form a homosexual identity, a transgender identity, or non-conformity may wane with age.
Why are gender non-conforming children at risk?
GNC children are at greater risk for stressors related to parent and peer reactions. For example, children are more likely to reject and mock non-conforming peers. Parents may also be inclined to dissuade their child from gender non-conforming behaviors, even through subtle messages. These rejections of a child’s identity lead to increased risk for behavioral difficulties, emotional challenges, and suicidality. Puberty brings a new influx of mental health concerns as GNC children contend with changing bodies, often reinforcing that the child feels stuck in the wrong body.
What about medical intervention?
For GNC children who have intense distress related to the mismatch of their true versus assigned gender, medical intervention is an important consideration. Medications that delay the onset of puberty can allow for fuller self-understanding and support young children who may identify as transgender. Additionally, children approaching puberty can be supported through hormone treatments to facilitate physical characteristics of their true gender. Evidence has shown that mental health concerns decrease when children are supported in physically transitioning to their true gender. Families considering a transition are recommended to consult with a team of professionals including an endocrinologist, mental health provider, and PCP.
How can parents and providers offer support?
Messages that reinforce the gender binary can be harmful for kids who are still exploring their own identity and may fear commitment to one gender. Parental openness to gender fluidity can support children in feeling free to be themselves. Ensure that the home environment feels safe and secure, and that other family members are educated about respecting the child’s preferences and minimizing judgment. When possible, give your child freedom to choose clothes, toys, and accessories. If a child is facing discrimination in settings outside of the home, identify a safe adult in those settings who will be able to provide support. Remain curious! Sitting with the ambiguity of your child’s emerging identity may be difficult and anxiety provoking. Parents often benefit from their own therapeutic support to work through any negative or conflicted feelings. Making connections with parents of other non-binary children can help to form a support network and to normalize the family experience.
Resources for families
Human Rights Campaign:
https://www.hrc.org/resources/resources-on-gender-expansive-children-and-youth
Gender Spectrum:
https://www.genderspectrum.org/resources/education-2/
American Academy of Pediatrics:
References
Adelson, S. L. (2012). Practice Parameter on Gay, Lesbian, or Bisexual Sexual Orientation, Gender Nonconformity, and Gender Discordance in Children and Adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 51(9), 957–974. doi: 10.1016/j.jaac.2012.07.004
Human Rights Campaign. (n.d.). Transgender Children & Youth: Understanding the Basics. Retrieved from https://www.hrc.org/resources/transgender-children-and-youth-understanding-the-basics
Parenting and Family. (n.d.). Retrieved from https://www.genderspectrum.org/explore-topics/parenting-and-family/
Reilly, M., Desousa, V., Garza-Flores, A., & Perrin, E. C. (2019). Young Children With Gender Nonconforming Behaviors and Preferences. Journal of Developmental & Behavioral Pediatrics, 40(1), 60–71. doi: 10.1097/dbp.0000000000000612
Steensma, T. D., Mcguire, J. K., Kreukels, B. P., Beekman, A. J., & Cohen-Kettenis, P. T. (2013). Factors Associated With Desistence and Persistence of Childhood Gender Dysphoria: A Quantitative Follow-Up Study. Journal of the American Academy of Child & Adolescent Psychiatry, 52(6), 582–590. doi: 10.1016/j.jaac.2013.03.016
