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Childhood gender nonconformity (CGN) is a phenomenon in which prepubescent children do not conform to expected gender-related sociological or psychological patterns, or identify with the opposite sex/gender.[1] Typical behavior among those who exhibit the phenomenon includes but is not limited to a propensity to cross-dress, refusal to take part in activities conventionally thought suitable for the gender and the exclusive choice of play-mates of the opposite sex.

Multiple studies have correlated childhood gender nonconformity with eventual homosexuality or trans identity; in these studies, a majority of those who identify as gay, lesbian or transsexual self-report being gender nonconforming as children.[2][3][4] The therapeutic community is currently divided on the proper response to childhood gender nonconformity. One study suggested that childhood gender nonconformity is heritable.[4]

Manifestations

Gender nonconformity in children can have many forms, reflecting various ways in which a child relates to their gender. In literature, gender variance and gender atypicality are used synonymously with gender nonconformity.[5]

  • Cross gender clothing and grooming preferences;
  • Playing with toys generally associated with the opposite sex;[5]
  • Preference for playmates of the opposite sex;
  • Identification with characters of the opposite sex in stories, cartoons or films;
  • Affirmation of the desire to be a member of the opposite sex;
  • Strong verbal affirmation of a cross-gender identity ("No, I'm not a boy, I'm a girl", or "no, I'm not a girl, I'm a boy.")

the last three may be indicative of eventual transgender identity rather than homosexual.

Gender dysphoria

Children with gender dysphoria, also known as gender identity disorder (GID), exhibit the typical gender nonconforming patterns of behaviors, such as a preference for toys, playmates, clothing, and play-styles that are typically associated with the opposite-sex. Children with GID will sometimes display disgust toward their own genitals or changes that occur in puberty (e.g. facial hair or menstruation).[6] A diagnosis of GID in children requires evidence of discomfort, confusion, or aversion to the gender roles associated with the child's genetic sex. Children do not necessarily have to express a desire to be the opposite-sex, but it is still taken in consideration when making a diagnoses.[6]

Some advocates have argued that a DSM-IV diagnosis legitimizes the experiences of these children, making it easier to rally around a medically defined disorder, in order to raise public awareness, and garner funding for future research and therapies. Diagnoses of gender identity disorder in children (GIDC) remains controversial, as many argue that the label pathologizes behaviors and cognitions that fall within the normal variation within gender. The stigma associated with mental health disorders may do more harm than good.[6]

Parental reactions

Parents with gender non-conforming children may not know where to turn to express their feelings. Many parents accept their child’s choice but are more concerned for the overall well being of the child. In some cases families are not accepting of their child’s non-conformity, typically lashing out with punishment grounded on homophobia and sexism. Regardless of the stance a parent decides to take on gender non-conformity, it will affect the child and the child’s relationship with the family.

Transphobia can occur when gender nonconforming children are met with others who do not understand or accept what they are going through. Dr. Diane Ehrensaft states that, "Transphobia is the anxieties, prejudices, aspersion, aggression, and hatred cast on individuals who do not accept the gender assigned to them at birth but instead play outside that definition of self or perhaps any binary categorizations of gender, possibly to the extent of altering their body."[7] Transphobia can become a serious conflict within the family and can damage the relationship the child has with his or her family.

Parents who recognize that they have gender non-conforming children sometimes experience a feeling of loss, shock, denial, anger, and despair.[8] These feelings typically subside as a parent learns more about gender nonconformity. However, there are families that remain unaccepting of gender nonconformity and correlate it to psychological or social problems. Licensed Marriage and Family Therapist Jean Malpas says, "Some react very negatively and the gender nonconformity can become a significant source of conflict between parents and a damaging source of disconnection between parent and child."[9]

Dr. Diane Ehrensaft cites that there are three family types that can affect the outcome of a child's gender nonconformity: transformers, transphobics, and transporters.[7] Transformers: Transformers are parents that are comfortable in supporting their child in their gender variant journey and can easily identify their child as a separate person. Ehrensaft states, "These parents will stand a good chance of overcoming whatever transphobic reactions may reside within them to evolve into parents who both meet their child where he or she is and become an advocate for their gender nonconforming child in the outside world."[7] Transphobics: Transphobic parents are not comfortable in their own gender, and may not understand that gender is fluid. Transphobic parents may feel their child is an extension of themselves and respond negatively when their child is faced with his or her own adversity. Ehrensaft believes these parents deny their child with an excess of negativity and transphobic "reactivity" this allows the child no room for nonconformity and undermines the love the parent claims to have for the child. 'Transporters: Transporters are parents that appear to be completely accepting of their child's gender nonconformity but on the inside have doubts about whether or not it is an authentic conformity. Transporter parents may say thinks like, "It's just a phase," or "he or she will grow out of it."


Peer reactions

Once children reach school age, girls who are considered "tomboys" and boys who are considered to be more "sensitive" than their gender typical peers, are more likely to face challenges during childhood than their gender-typical counterparts. It is possible that their nonconformity goes unnoticed, however it is more likely that they fall victim to bullying and harassment when they reach school age.[10] In a study on gender atypical fifteen year olds, atypical males self-report being lonelier, bullied more, less likely to have male friends, and be in "greater distress" than gender-typical males in the same demographic.[11]

Needs of gender nonconforming children and families

There is still controversy regarding the best approach for gender nonconforming children, but as gender nonconformity becomes more widely accepted many parents and professionals have identified things that gender variant or gender nonconforming children need to easily adjust to their transformation.[12] Parents have suggested that their children need the ability to discuss their gender non-conformity freely with their parent, to be loved throughout their transformation, and to be permitted to make choices regarding their gender on their own. They have also suggested a peer support team and supportive counseling in addition to support from their school and schools administrators and authorities.[12]

Parents must be mindful of a child's need for parent expressions of acceptance and validation. If not validated a child may begin sharing less with their parent and more with friends, this could lead to the parent thinking the gender nonconformity was just a brief phase.[13]

Disclosure is also a very important to a family when raising a gender non-conforming child. Parents need to consider whom to talk to about their child and what type of information they decide to share. Other members of the family must also be prepared to make decisions regarding what to say and who to say it to.[14]

Regarding their own needs, parents have suggested that they need information regarding gender nonconforming children that can better assist them and their child in making their transition. Additionally, parents have stated they need increased education on gender nonconforming children, and support from surrounding friends and family to help build parental confidence. Parents have also suggested they need counseling to help provide direction, support from medical professionals and peers, and access to transgender people to help provide them with a positive portrayal of transgender communities.[12]

Clinical treatments for gender dysphoria

It is important for clinicians to identify children whose gender dysphoria will persist into adolescence and those who outgrow their gender identity disorder (GID) or gender dysphoria diagnosis. In instances where the child’s distress and discomfort continues clinicians will sometimes prescribe gonadotropin-releasing hormone (GnRH) to delay puberty.[15] Identifying stable and persistent cases of GID may reduce the number of surgeries and hormonal interventions individuals undergo in adolescence and adulthood. Gender identity disorders persist into adolescence in about 27% of children with GID diagnoses.[15]

Diagnosis and treatment of GID in children can be distressing for the parents, which can further exacerbate distress in their child. Parents had difficulties accepting their child's desire to be the opposite sex, and are resistant to children wanting to alter their bodies.[16]

Supportive professionals

Some professionals, including Dr. Edgardo J. Menvielle of the Children's National Medical Center, who has specialized in this area in his clinical practice,[17] believe that the proper response to gender variant behavior is supportive therapy aimed at helping the child deal with any social issues which may arise due to homophobia / transphobia. These professionals believe that attempts to alter these behaviors, and/or whatever mechanism is responsible for their expression, are generally ineffective and do more harm than good. While not universally advocating for what childhood transgender advocates refer to as full social transition, the CNMC model generally supports allowing a child to express cross gendered interests at home in an age appropriate fashion. Other professionals associated with a supportive model include Dr. Norman Spack of Children's Hospital Boston,[18] Catherine Tuerk, MA, RN, Herbert Schreier, MD (Children's Hospital Oakland), and Ellen C. Perrin, MD of the Center for Children with Special Needs (CCSN) at TUFTS. Rosenburg (2002) recommends a parent-centered approach that helps parents learn to accept and support their child's identity and help the child to work through the issues surrounding identity, without trying to eliminate gender-variant behaviors.[19]

See also

Exurnal links

References

  1. Error on call to Template:cite book: Parameter title must be specifiedKathleen Y. (2002). Handbook of Affirmative Psychotherapy with Lesbians and Gay Men pp. 58. Guilford Press.
  2. Error on call to Template:cite book: Parameter title must be specifiedBaumeister, Roy F. (2001). Social Psychology and Human Sexuality: Essential Readings pp. 201–2. Psychology Press.
  3. Error on call to Template:cite book: Parameter title must be specifiedCarolyn S. Schroeder (2002). Assessment and Treatment of Childhood Problems, Second Edition: A Clinician's Guide. wikipedia:Guilford Press. Retrieved on January 29, 2015.
  4. 4.0 4.1 Error on call to Template:cite book: Parameter title must be specifiedFriedman, RC (2008). Sexual Orientation and Psychodynamic Psychotherapy Sexual Science and Clinical Practice pp. 53–7. Columbia University Press.
  5. 5.0 5.1 Adelson L., Stewart (2012). ["Practice Parameter on Gay, Lesbian, or Bisexual Orientation, Gender Nonconformity, and Gender Discordance in Children and Adolescents"]. Journal of the American Academy of Child & Adolescent Psychiatry 51 (9): 957–974. . http://www.sciencedirect.com/science/article/pii/S089085671200500X. 
  6. 6.0 6.1 6.2 Langer, Susan J.; Martin, James I. (February 2004). "How Dresses Can Make You Mentally Ill: Examining Gender Identity Disorder in Children". Child and Adolescent Social Work Journal 21 (1). 
  7. 7.0 7.1 7.2 Ehrensaft, Diane, PhD. "Boys Will Be Girls, Girls will Be Boys: Children Affect Parents as Parents Affect Children in Gender Nonconformity." Psychoanalytic Psychology 28.4 (2011): 528-48. Print.
  8. Children's National Medical Center. If You Are Concerned About Your Childs Gender Behavior. N.p.: Children's National Medical Center, n.d. Children's National Medical Center. Web. 31 Oct. 2013.
  9. Malpas, Jean. "Between Pink and Blue: A Multi-Dimensional Family Approach to Gender Nonconforming Children and Their Families." Family Process 50.4 (2011): 453-470. Print.
  10. Haldeman, Douglas C (2000). "Gender atypical youth: Clinical and social issues". School Psychology Review 29 (2): 192. 
  11. Young, Robert, and Helen Sweeting. "Adolescent bullying, relationships, psychological well-being, and gender-atypical behavior: A gender diagnosticity approach." Sex Roles 50, no. 7-8 (2004): 525-537.
  12. 12.0 12.1 12.2 Reilly, Elizabeth A., Gomathi Sitharthan, Lindy Clemson, and Milton Diamond. "Recognizing the Needs of Gender-variant Children and Their Parents." Sex Education 13.6 (2013): 644-59. Print.
  13. Menvielle, Edgardo J.; Tuerk, Catherine (2002). "A Support Group for Parents of Gender-Nonconforming Boys". Journal of the American Academy of Child & Adolescent Psychiatry 41 (8): 1010–013. . 
  14. "Parent Considerations." Gender Spectrum. Gender Spectrum, n.d. Web. http://www.genderspectrum.org.
  15. 15.0 15.1 Wallien, M.S.C; Cohen-Kettenis, P.T. (2008). "Psychosexual Outcome of Gender-Dysphoric Children". Journal of the American Academy of Child and Adolescent Psychiatry 47 (12): 1413–1423. . 
  16. Hill, Darryl B.; Rozanski, C.; Carfagnini, J.; Willoughby, B. (2006). "Gender Identity Disorders in Childhood and Adolescence". Journal of Psychology & Human Sexuality 17 (3): 7–34. . 
  17. *Edgardo J. Menvielle, MD, MSHS of the Children's National Medical Center
  18. Gender Management Service (GeMS) Clinic at Children's Hospital in Boston
  19. Rosenberg, M.; Jellinek, Michael S. (2002). "Children with gender identity issues and their parents in individual and group treatment". Journal of the American Academy of Child and Adolescent Psychiatry 41 (5): 619–21. . . 
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