Children

In many cases, a person with gender dysphoria will begin to feel that there is a mismatch between their biological sex and their gender identity during early childhood.  For others, this may not happen until adulthood.

There are no physical symptoms of gender dysphoria, but there are a range of feelings that people with the condition may experience, and behaviours that they may display.

• insisting that they are of the opposite sex,
• disliking or refusing to wear clothes that are typically worn by their sex and wanting to wear clothes that are typically worn by the opposite sex,
• disliking or refusing to take part in activities and games that are typically meant for their sex, and wanting to take part in activities and games that are typically meant for the opposite sex ,
• disliking or refusing to pass urine as other members of their biological sex usually do, for example a boy may want to sit down to pass urine and a girl may want to stand up,
• insisting or hoping that their genitals will change, for example a boy may want to be rid of his penis, and a girl may want to grow a penis,
• feeling extreme distress at the physical changes of puberty.

If a child is confused about their gender or displays non-conforming behaviours in regards to its assigned gender, it is normal for parents to be concerned or confused.  However, non-conforming behaviour does not necessarily mean the child has Gender dysphoria, or that they will continue to have these feelings as they get older.  It may simply mean that the child’s preference in gender expression fits in somewhere else along the spectrum of gender expression rather than at the opposite ends of masculine and feminine.  And sometimes, it is just part of childhood and their learning and development.

For example, many girls behave in a way that can be described as ‘tomboyish’, which is often seen as part of normal female development.  It is also not uncommon for boys to role play as girls and to dress up in their mother’s or sister’s clothes.  This is usually nothing more than a phase and most children who behave in these ways do not have gender dysphoria.

Only in rare cases does the behaviour persist into the teenage years and adulthood.  Mind, the mental health charity located in England, estimates that the number of people who go on to request gender reassignment surgery is around 1 in 30,000 men and 1 in 100,000 women.

The important part is that you continue to support your child and encourage in their personal and emotional development into adolescence, and adulthood.  In fact, one of the main determinants for a positive outcome for a transgender child is the support and understanding of their family.

WHAT CAN I DO TO HELP?

As a parent you may feel worried or uncomfortable, but this is not unusual and you are not alone.  Gender identity is no-one’s fault, but children can worry about telling you how they feel, or worry that your love for them will change.  Continue to reassure your child that you love them, and that nothing will change that.  However you may feel regarding the non-conforming behaviour, be relaxed about it and do not make an issue of it.  This will help the child by not making him/her feel judged or rejected when they are, after all, just being who they are.

It is however, important to seek help if your child identifies very strongly with the opposite gender, especially if it is to the point where it’s causing the child or the family distress.

Signs of distress in a young person or child can include self-harm, destructive behaviour and depression, which is why early help is always advisable.

The route to help and advice will vary from family to family, and individual to individual.  To begin with, see your GP if you think that your child may have gender dysphoria.  Select a GP with whom you and your child will feel most comfortable.  The next step is usually a referral to CAMHS (the Child and Adolescent Mental Health Service), where psychological help will be offered.  This may involve working with the whole family, and sometimes with schools as well.  CAMHS is for under 18’s only, and if, after assessment, they deem it appropriate, your child could then be referred to the Regional Service for Gender Variant Children and Transgender Adolescents.  This service is part of the CAMHS within the Belfast Health and Social Care Trust and can only be accessed by referral from the generic CAMHS Teams in the various Trusts.

Access the CAMHS website within the Belfast Trust by clicking here.

There are strict criteria for diagnosing gender dysphoria, which differ for children and adults.  Due to the fact that gender dysphoria is so complex, specialists tend to make a diagnosis based on each individual, rather than just on the criteria.

The traditional criteria for diagnosing gender dysphoria in children are described below.

CRITERIA FOR CHILDREN

To be diagnosed with gender dysphoria, a child should:

• repeatedly insist that they want to be the opposite sex, or that they are the opposite sex, and behave as the opposite sex (this must not be just because they want any supposed advantages of being the opposite sex)
• dislike or refuse to wear clothes typically worn by their sex and insist on wearing clothes typically worn by the opposite sex, or show dislike or unhappiness with their genitalia and insist that it will change into that of the opposite sex (for example, refusing to pass urine as members of their sex usually do)
• not yet have reached puberty (when a child progresses into a sexually developed adult)
• behave this way for at least six months