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Gender variance in children and youth

Gender variance in children and youth. Shuvo Ghosh, MD, FAAP Developmental- Behavioural Pediatrican MCH Child Development Program. Definitions. LGBTI LGBTQ LGBTQQ LGBTQI. Definitions. Gender Variance

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Gender variance in children and youth

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  1. Gender variancein children and youth Shuvo Ghosh, MD, FAAP Developmental-BehaviouralPediatrican MCH Child Development Program

  2. Definitions • LGBTI • LGBTQ • LGBTQQ • LGBTQI

  3. Definitions • Gender Variance • Incongruence between gender role and gender identity, or more typically in younger kids, between physiologic sex and gender identity • Atypical, often a source of distress, and can be socially problematic • Usually noted by behaviours in early childhood • Sometimes called “gender non-conformity,”“gender independence,”“gender atypicality,” or “gender creativity” • These are not euphemisms!

  4. Terminology • While sex and gender are intricately linked, in the context of development it is important to understand the clear distinction between the two • Sex, from Latin sexus = gonadal structure • Gender, from Latin genus = kind/type/race • Curiously, the term “intersex” can be a gender classification

  5. Diagnostic terms • Gender expression • Transsexuality • Transgender • Gender variance • Intersex (can refer to disorders of sex differentiation) • Gender identity disorder* • Used in DSM-IV • Gender dysphoria* • DSM-V has decided to use this term

  6. The history • Vulnerable population • 14 x greater suicide attempt rate than general population • 8 x greater suicide completion rate than general population • Most bullied/teased social group in primary and secondary school • Most psychosocially distressed group in several studies looking at gender variant children in context of other vulnerable populations (abused children, kids with disabilities, children of divorce, children with stigmatising illnesses, etc) • Most likely group to be rejected by family in teen years • One of the most likely groups for high-risk behaviours if not medically supervised

  7. The history of pathologisation • Mental disorders • Brain disorders • Lifestyle choices • Deviancy • Fetishism • But why are we pathologising children who may merely be expressing interest/preferences in certain activities or attire?

  8. Gender variance across cultures

  9. Gender variance across cultures

  10. Gender variance across cultures

  11. Gender variance across cultures

  12. Gender variance across cultures

  13. Gender variance across cultures

  14. Gender variance across cultures

  15. Gender variance across cultures

  16. Gender variance across cultures

  17. Gender variance across cultures

  18. Gender variance across cultures

  19. The medical role • The need to move beyond pathological definitions to variation from the norm (or the average, typical, mean) • Honest exploration of each child’s needs, wishes and hopes • Using our expertise to best serve people rather than to control or shape people in a certain way • Understanding the needs of family members, the parents and the best way to reconcile all of these issues with the child’s experience

  20. For children • Questions • Issues • Challenges • Debates • Strategies • Current recommendations

  21. For adolescents • Questions • Issues • Challenges • Controversy • Options • Current recommendations

  22. Conditions that may affectsexual and gender development • Congential adrenal hyperplasia (CAH) • Androgen insensitivity (partial/complete) • Turner syndrome • Klinefelter syndrome • 5- reductase deficiency • Cloacal exostrophy • Congenital cryptorchidism • others

  23. Behaviours • Incongruent behaviours are not always pathologized: • Girls who prefer rough-tumble play (“tomboys”) are often encouraged to continue • Some parents allow their young sons to pursue “girlish” interests: sewing, playing with dolls, but most are considered “sissy boys” • Variation of “boy” in both cases…

  24. What? • What behaviour is especially notable in kids with gender variance? • Identification with opposite gender (non-biologic gender) • Preference for clothing or toys that are stereotypically of the opposite gender • Persistent desire to change sex or gender role • Often accompanied by depression and anxiety as well as social difficulty

  25. What? • What are the main concerns? • Parent: Will my child be gay? Will my child be a crossdresser/transsexual/drag queen (almost always in a MTF scenario)? • Child: Why did God/nature make me -- or Why was I born -- this way? Will I ever feel normal? • Professional: How to manage the situation and reduce anxiety while trying to understand the complexity of this issue?

  26. reality

  27. reality

  28. reality

  29. reality

  30. Then what? • If the situation is a concern, how can one assist the caregivers and the child with this issue? • Parents will generally minimize the behaviour at first unless it has reached a significantly tense level in the home • Get a sense of the child’s level of concern

  31. When? • When do children present with these behaviours? • As early as 2 years of life • Sometimes not expressed verbally, but parents observe it clearly • In some cases the child will not display any overt behaviours but will persistently make requests or verbalize their intent/thoughts

  32. When? • Decisions about care must be made at the following times: • In infancy for kids with ambiguous genitalia or any documented intersex condition • In school-age when intense and persistent feelings are expressed on a regular basis • At the onset of puberty • At the time of reaching majority (16+ for non-invasive care, 18 for care with legal ramifications)

  33. Where? • Where does this behaviour lead? • “Re-typicalization” after several years • Gender identity disorder of childhood (continuing into adolescence and adulthood) • Transgender behavior that persists (fetish cross-dressing, transsexualism, gender role variations) • Transsexuality • Homosexuality (as a distinct entity) or heterosexuality • Prolonged androgynous identification

  34. The main challenges • The wishes of parents • The wishes of the child • “Suggestions” from the family • The preschool (or school) setting • Comments from peers, playmates • Societal constraints

  35. Professional Role • Parents are naturally very anxious about leaving children in “the middle” but it is a responsibility of professionals to help remove the stigma associated with either intersex state or gender variant behaviours • Frank discussions must be undertaken as early as possible

  36. Conclusions • While the approach can vary to some extent given the family circumstances, the details of each case, or underlying etiologic factors, the basic principles do not change regardless of situation • It is obvious that few states carry such a high level of psychological distress and every effort must be made to remedy it

  37. Local Resources • Trans association of Québec • Project 10 • Transhealth Montreal • Head & Hands/Aux deux mains • ASTEQ • FamilleJeunes

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