Vulnerability and Resilience Among Gender Nonconforming Children and Adolescents: Mental Health Professionals Have a Key Role to Play.
ublic awareness of nonconformity in gender identity and expression among children and adolescents has P reached unprecedented heights. This increased visibility has led to frequent discourse in the media as well as in professional organizations and among policy makers. For example, The New York Times regularly publishes articles on this topic; the American Academy of Child and Adolescent Psychiatry has recommended practice guidelines for gender nonconforming children; and several US states have adopted a ban on conversion therapy that pertains to sexual orientation as well as gender identity. The ongoing debate is fueled by consideration of the appropriateness of a diagnosis of gender dysphoria, particularly for children, to be included in the DSM 5 and the upcoming revision of the International Classification of Diseases (ICD) Proponents have argued that gender dysphoria is inherently distressing, and that the diagnosis will facilitate access to clinical services to alleviate this distress, as well as foster research to further advance our understanding of the phenomenon. On the other hand, critics have argued that such a mental health diagnosis contributes to social stigma, further adding to the distress of gender nonconforming children, and therefore that the environment, not the child, needs to be the focus of intervention. We urgently need research on the different manifestations of nonconformity in gender identity and expression that has the potential to inform such public discourse and professional debate. A greater understanding of these manifestations will provide guidance to policy makers and practitioners. An example is a newly published study in this issue of the Journal that reveals that gender nonconforming children are at increased risk for self harm and suicide. Here, the data collected from children referred to a specialized gender identity service at an academic health center in the period 1976 to 2015 provided a unique opportunity to examine their vulnerability to self harm and suicide. The authors compared the parent report forms of the Child Behavior Checklist of 572 of these children, who ranged in age from 3 to 12 years, with that of their siblings, other clinic referred children, and nonclinical controls. Results indicated that children with gender dysphoria had higher rates of suicidal ideation (19.1% and self harm or suicide attempts (6.6% compared to their siblings and to nonclinical controls. Predictors included older age (for suicidal ideation) and general behavior problems (for suicidal ideation, self harm,
Journal of the American Academy of Child and Adolescent Psychiatry