Children who are persistently uncomfortable with their gender who display strong and consistent cross-gender behaviors may be experiencing gender identity disorder, or GID.
A new study to be published in the March 2012 issue of Pediatrics found that children who do not receive medical treatment or counseling for GID can be at high-risk for certain behavioral and emotional problems.
Researchers found that of the 97 patients younger than 21 years who met the criteria for GID, 44 percent had a prior history of psychiatric symptoms, 37 percent were taking psychotropic medications, and 21.6 percent had a history of self-mutilation and suicide attempts.
Study authors advocate for early evaluation of children exhibiting GID, but treatment with medications should not be started until they reach puberty.
Why would a child be uncomfortable with his or her gender?
Pediatric surgeon Kathy Graziano, M.D., of Pediatric Surgeons of Phoenix, treats patients who are born with reproductive anomalies. She says that one reason is that some girls are exposed to excess hormones at birth, and are born with male-looking parts. And some girls are born without some parts, like a vagina or a uterus.
Those are relatively rare conditions, says Graziano, who is a member of the Arizona Chapter of the American Academy of Pediatricians (AzAAP). “But there is a condition, also rare, in which a child is born with all the “right” reproductive organs but identifies with the other gender.”
This is known as gender identity disorder, gender dysphoria or gender incongruence. “This is a problem for the child and the parents from early on.”
Graziano recalls meeting — and being inspired by — a patient who always knew that she was a boy.
“She dressed as a boy, insisting on wearing a boy’s bathing suit for example, as early as anyone could remember,” says Graziano. “She only once wore a dress…at her sister’s wedding.”
Then, in middle school, she became deeply depressed — and even suicidal.
The patient and her family attended counseling. That’s where she was able to admit that she wanted to be a boy, says Graziano. “The family took an accommodative approach. They allowed her to change her name to a male name and act in society as a boy. They sought surgical solutions for her to start transforming her anatomy.”
This was slow-going, says Graziano, since in this country there have been few surgical interventions for children under the age of 18.
Graziano says that the patient ultimately started a support group for other adolescents with gender identity issues. She entered college as a male, although not anatomically. “Her story is a success in that her family’s intervention saved her life.”
There is also a therapeutic approach to treat, and try to reverse, gender identity disorder when it is recognized early, adds Graziano, but research on the success of these two approaches is lacking.
Pediatricians dealing with these issues should screen for depression and intervene as soon as possible. Parents who suspect that a child is dealing with GID should talk to their child’s physician.
“The most important thing,” says Graziano, “is to focus on the mental health of the child and the family.”
Pediatricians and parents should consult with experienced mental health professionals for children and adolescents experiencing gender-related issues. When patients are sufficiently physically mature to receive medical treatment, they should be referred to a medical specialist or program that treats patients with GID.
Resources for parents