Traditional therapeutic intervention=== Therapeutic approaches for GD differ from those used on adults and have included behavior therapy, psychodynamic therapy, group therapy, and parent counseling. This includes aiming to reduce<unk><unk> , making<unk>  more comfortable with their bodies, lessening ostracism, and reducing the child's psychiatric comorbidity. Traditional therapeutic intervention seeks to identify and resolve underlying factors (including familial factors), encourage the child to identify with their assigned sex, and encourage same-sex friendships. Parent counseling involves setting limits on the child's cross-gender behavior, encouraging<unk> -neutral or sex-typical activities, examining familial factors, and examining parental factors such as psychopathology. Researchers Kenneth Zucker and Susan Bradley state that it has been found that boys with GD often have mothers who, to an extent, reinforced behavior more stereotypical of young girls. They also state that<unk>  with GD tend to come from families where cross-gender role behavior was not explicitly discouraged. However, they also acknowledge that one could view these findings as merely indicative of the fact that parents who were more accepting of their child's cross-gender role behavior are also more likely to bring their<unk>  to a clinical psychiatrist as opposed to parents who are less accepting of cross-gender role behavior in their<unk> . In 2002, Zucker acknowledged limited data on<unk> , stating that "apart from a series of intrasubject behaviour therapy case reports from the 1970s, one will find not a single randomized controlled treatment trial in the literature". He has stated that "the therapist must rely on the 'clinical wisdom' that has accumulated and to utilize largely untested case formulation conceptual models to inform treatment approaches and decisions." WPATH Standards of Care and other therapeutic intervention The consensus of the World Professional Association for Transgender Health is that treatment aimed at trying to change a person's<unk>  identity and expression to become more congruent with sex assigned at birth "is no longer considered ethical." Edgardo Menvielle, a child-adolescent psychiatrist at the<unk> 's National Medical Center in Washington states, "Therapists who advocate changing<unk>  variant behaviours should be avoided." Developmental and clinical psychologist Diane Ehrensaft told the Psychiatric Times, "The mental health profession has been consistently doing harm to<unk>  who are not<unk>  normal,' and they need to retrain." The WPATH Standards of Care and other therapeutic interventions do not seek to change a child's<unk>  identity. Instead, clinicians advise<unk>  and their parents to avoid goals based on<unk>  identity and to instead cope with the child's distress by embracing psychoeducation and to be supportive of their<unk>  variant identity and behavior as it develops. A clinician may suggest that the parent be attentive, listen, and encourage an environment for the child to explore and express their identified<unk>  identity, which may be termed the true<unk> . This can remove the stigma associated with their<unk> , as well as the pressure to conform to a<unk>  identity or role they do not identify with, which may be termed the false<unk>  self. WPATH Standards of Care also recommend assessing and treating any co-existing mental health issues. Puberty blockers, hormone treatment, and surgery Treatment may also take the form of puberty blockers (such as leuprorelin), cross-sex hormones (i.e., administering estrogen to a child assigned male at birth or testosterone to a child assigned female at birth), or sex reassignment surgery with the aim of bringing one's physical body in line with their identified<unk> . Delaying puberty allows for the child to mentally mature while preventing them from developing a body they may not want, so that they may hopefully make a more informed decision about their<unk>  identity once they are an adolescent. It can also help reduce anxiety and depression. The Endocrine Society does not recommend hormone treatment of prepubertal<unk>  because clinical experience suggests that GD can be reliably assessed only after the first signs of puberty. It recommends treating transgender adolescents by suppressing puberty with puberty blockers until age 16 years old, after which cross-sex hormones may be given. In its 2017 updated version of its guideline on treating those with<unk><unk> , it states, "We recognize that there may be compelling reasons to initiate sex hormone treatment prior to the age of 16 years in some adolescents with GD/gender incongruence, even though there are minimal published studies of<unk> -affirming hormone treatments administered before age 13.5 to 14 years." The organization states, "As with the care of adolescents ≥16 years of age, we recommend that an expert multidisciplinary team of medical and mental health professionals manage this treatment." For adolescents, WPATH says that physical interventions such as puberty blockers, hormone therapy, or surgery may be appropriate. Before any physical interventions are initiated, however, a psychiatric assessment exploring the psychological, family, and social issues around the adolescent's<unk><unk>  should be undertaken. Some medical professionals disagree that adolescents are cognitively mature enough to make a decision with regard to hormone therapy or surgery, and advise that irreversible genital procedures should not be performed on individuals under the age of legal consent in their respective country. In 2020, a review article commissioned by NHS England was published by the National Institute for Health and Care Excellence, concluding that the quality of evidence for puberty blocker outcomes (for mental health, quality of life and impact on<unk><unk>  was of very low certainty based on the GRADE scale. In the UK, Bell v Tavistock considered the case of a patient who had changed her mind, now believing she was too young to have made such a decision, and concluded "Where the decision is significant and life changing then there is a greater onus to ensure that the child understands and is able to weigh the information". Following the ruling, NHS England announced that<unk>  under 16 would no longer be given puberty blockers without court authorization. This ruling was overturned on appeal in 2021, once again allowing<unk>  under 16 to consent to puberty blockers. Data from the Tavistock clinic found that<unk>  who were given puberty blockers were very likely to transition, with 43/44 (98%) of<unk>  who were given puberty blockers ultimately going on to take cross-sex hormones.
Gender dysphoria in children
Effects of domestic violence on children
Learning problems in childhood cancer
Rapid-onset gender dysphoria controversy
Child bereavement
Impact of health on intelligence
Happy life expectancy
Child psychopathology