Gender diverse children can experience high levels of emotional distress due to societal expectations around gender expression. When gender diverse children do not feel that their body matches their true identity, there are important ways to support them to thrive.

So, what is gender diversity? Gender diversity is a broad spectrum of behaviours, identities and feelings which society categorises as unusual for a person’s biological gender at birth. Gender isn’t fixed but is on a spectrum as there are children who can feel ‘in-between’ male and female.

What is important is normalising this experience for gender diverse children. Dr Karen Phillip, a counselling psychotherapist, says it’s regrettable that many people in the community see transgender and gender diversity as an illness.

“They fail to see how this can free the child, develop growth, acceptance and joy in their life once they discover whom they truly are meant to be.

“It is only with education and acceptance that we all be free to be who we were born to be, and we all deserve that right and recognition.

“Luckily, we are finding more education is creating more acceptance and understanding; however, we are only at an infant stage and have a long way to go,” said Ms Phillip.

What challenges do gender diverse children face?

Gender diverse and transgender children are likely to face discrimination and a lack of acceptance and understanding from family, friends and the wider community, which impacts their self-worth, self-esteem and self-confidence.

“Discrimination is one of the biggest hurdles transgender, and gender diverse individuals are likely to face throughout life.

“Negative school experiences can affect them deeply and negatively, which can result in school disruption, academic challenges, bullying and mental health issues.

“The child may experience guilt for the pressure family members may experience, especially their siblings from others who are uneducated and ignorant about transgender and gender diverse issues.

“Many kids struggle with the confusion of who they are and if they will be loved,” said Ms Phillip.

Psychological support can help gender diverse children

A psychologist or counsellor is vital in affirming that what the child is feeling, and experiencing is normal.

“These children often suffer an increased level of anxiety, depression and distress and support for these issues may be ongoing.

“Support, understanding and discussion with the child being treated as normal can help remove the feeling of difference.

“Laughter and fun are an important part of any therapeutic work with transgender and gender diverse kids as often all discussions are serious.”

A referral to support groups for parents and children experiencing adversity due to gender diversity is also helpful.

“Connecting with other similar kids is an important step of acceptance of self for the transgender and gender diverse child.”

How parents can support gender diverse children

A positive response from a gender diverse child’s family can have a positive impact on friends and community.

“Acceptance and support are essential. When acceptance is received, the child can start to feel more ‘normal’, as often the child can feel ostracised and different to all others, including their family members.

“Non-judgemental communication is craved by the child, especially when adolescence is experienced, and body changes begin to occur.

“Professional support for the child and family members is essential.”

The Parents of Gender Diverse Children organisation is a valuable source of information for parents of gender diverse children.

Educating teachers and the child’s peers on gender diversity and transgender issues is vital, and a change of school may be necessary for gender reassigning children, explained Ms Phillip.

“A change of schools may be beneficial where the child can start school as their true identity and name. This, combined with consultation with the school counsellor, can support the child in their school environment.”

How does gender identity develop?

The development of gender identity commences prenatally through hormone exposure in the womb, explained Dr Lefteris Patlamazoglou, a psychologist and lecturer at Monash University.

“After birth, gender identity development depends on several psychological and social factors.

“From two to three years of age, children begin to become aware of others’ distinct physical characteristics based on their sex. At this stage, many children identify as either a boy or a girl.

“Before they turn four, children are able to attribute gender labels to others, and they soon become aware of gender-role norms. This is when children tend to comply with how they are expected to speak, act, feel, and think according to these norms.

“For instance, a child who was assigned male at birth and is socially brought up as a boy is likely to express their gender by favouring toys and activities that are typically congruent with boyhood.

“Children who experience incongruence between their gender identity and the sex they were assigned at birth may feel discomfort, known as gender dysphoria.

“Children are usually able to share their gender dysphoria with those they trust by their eighth year.

“As gender identity is a fluid concept, it may change over time through social interactions and self-reflection,” said Dr Patlamazoglou.

What is gender dysphoria?

Gender dysphoria (or gender incongruence) refers to the discomfort that derives from the incongruence between an individual’s gender identity or expression and the gender-role norms associated with the sex they were assigned at birth

“Gender dysphoria may be experienced on an emotional, social, and physical level. Some individuals whose gender identity does not match the sex they were assigned at birth may not experience gender dysphoria.

“It is noteworthy that gender variant behaviour and preferences in isolation do not constitute bases for diagnosis.

“Gender incongruence is problematic only when it hinders the usual functionality of the individual, such as their school or work performance, social activity or sleep hygiene.

“Like with any disorder of mental health, the symptoms of gender incongruence may vary in terms of frequency, duration and severity,” said Dr Patlamazoglou. 

How to diagnose gender incongruence

Dr Patlamazoglou said for a diagnosis of gender incongruence in pre-pubertal children, all of the following diagnostic features must be present for approximately two years:

1. A powerful subjective experience of incongruence between one’s gender and assigned sex along.

2. A strong dislike of one’s sexual anatomy (or anticipated secondary sex characteristics) or strong desire for the primary (and/or anticipated secondary) sex characteristics of the experienced gender.

3. Make-believe, or fantasy play activities or playmates that are typical of the experienced gender rather than the assigned sex.

“The assessment of the above features should be comprehensive and multifaceted.

“A diagnosing mental health professional may conduct a number of tests and interviews with an individual to assess these features and their impact on their usual functionality.

“Information may also be drawn from family members, teachers, and peers, as well as observation in social settings.”

Effective ways of dealing with gender incongruence involve:

• Supporting the individual to explore and uncover their gender identity and possibly assisting them to express it outwardly (using preferred gender pronouns, names, disclosing their gender identity to peers).

• Support in seeking and accessing medical services that will help them acquire physical features that more closely align with their gender identity.

• Support in managing coming out to their friends and family in their terms.

As there is a high comorbidity of gender incongruence and other mental health disorders, such as depression, anxiety, substance use and psychosocial issues, including stigma, exclusion, bullying, minority stress, low self-esteem, it is imperative that the treating professionals develop a comprehensive intervention plan, said Dr Patlamazoglou.