Parents sometimes ask me what it means when their young child prefers toys which are traditionally associated with the opposite gender, like if their young son strongly prefers toys such as dolls and princesses. Sometimes this is a common part of child development, and sometimes it means something more. These conversations are important because without a supportive environment, children exploring their gender are at risk for a host of mental and behavioral concerns, bullying, physical abuse, and self-harm.
Understanding the Development of Gender Identity
The first step is to understand how children learn about gender:
School age: By the time children reach 4 to 6 years of age, they tend to separate themselves by gender during play. Gender becomes a concept that is stable and constant.
For some children, the gender they experience, or their gender identity, does not match their birth assigned sex. When these feelings are persistent, insistent, and consistent, a child may have gender dysphoria. Some symptoms include a strong dislike of one's sexual anatomy and repeatedly stated desire to be, or insistence that he or she is, the other sex. This disagreement must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Learn more about gender dysphoria here.
Most young children who explore activities and expressions (e.g., clothing) typically associated with peers of the opposite sex do not grow into adolescents or adults with gender dysphoria. However, for teens in whom the feelings of gender dysphoria increase after puberty, gender dysphoria tends to persist into adulthood. Though estimates might be limited by underreporting, one study revealed the incidence of middle-schoolers with gender dysphoria to be roughly 0.5 - 1.5 percent.
How to Support Gender Non-Conforming Youth
Here are some tips on how to support young children who may be exploring their gender:
Allow children to pursue sports and activities of their choosing, even if they don't conform to society's traditional expectations for their birth-assigned gender.
Be on the lookout for mood changes. Lack of acceptance, understanding, and support from family and peers (which may include bullying) can lead to anxiety, depression, and self-harm. Puberty can be a particularly difficult time for gender nonconforming teens, as physical changes in the body may be unwanted.
Parental support may be key to the mental health of gender nonconforming youth. A recent study found that the youth who were supported in their gender identity had typical levels of depression and only minimal elevations in anxiety. This indicates that familial support is an important factor in the emotional well-being of a gender nonconforming child.
Find experts when appropriate. When children experience insistent, persistent, and consistent feelings of mismatch between their gender identity and the sex they were assigned at birth, I will refer families to my expert colleagues.
At Children's, I am fortunate to be able to refer families with questions about gender to our Gender and Sexuality Development Clinic, just one of four pediatric comprehensive programs in the country. This multidisciplinary group provides both medical and psychosocial care for children and families, and also provides training to providers. For families who do not have access to such a clinic, finding a therapist or psychologist who has experience with supporting gender non-conforming and transgender youth can be critical. The Human Rights Campaign offers a map of comprehensive clinical care programs for transgender and gender nonconforming youth. Access it here.