When kids cross the gender divide
Does your 4-year-old son dress up in his big sister's tiaras and princess costumes?
Does your 3-year-old daughter hate dolls?
With celebrity gossip sites buzzing over Angelina Jolie's comment that her 4-year-old daughter, Shiloh, wants to be a boy, media reports spotlighting rare cases of transgender children and even children's books beginning to tackle the issue, concerned parents are sifting through a lot of contradictory information.
"I think parents are very worried and confused and there isn't clear-cut advice," says Ellen Perrin, chief of developmental-behavioral pediatrics at the Floating Hospital for Children at Tufts Medical Center in Boston. "It's a complex issue."
Childhood gender behavior varies a lot, experts say, and there is a wide range of reasons a boy may want long hair (maybe he identifies with his favorite sports star) or a girl may refuse to wear dresses (perhaps they're just not her style).
What's more challenging for parents is when a child consistently pursues a range of behaviors strongly associated with the opposite sex. A boy might play with Barbies, wear dresses, vehemently reject sports and say that he wants to be a girl. A girl might insist on playing only with boys, get a boy's haircut and express strong discomfort with her own body parts.
Often called gender variant or gender nonconforming, this pattern of behavior is still officially (and controversially) labeled childhood gender identity disorder by the American Psychiatric Association. Experts say no good data exist on how many children are affected.
Gender-variant behavior in children usually begins between ages 2 and 4, according to Ken Zucker, a psychologist and head of the Gender Identity Service at the Centre for Addiction and Mental Health in Toronto. The behavior is pronounced, broad in scope and continues over a lengthy period of time.
"We're not talking about transient, episodic behaviors," Zucker says. "Many children will engage in some cross-gender behavior or gender nonconforming behavior, but I think it's really the combination and the persistence that co-occurs with the child verbalizing the wish to be of the other sex that leads parents to want to get the opinion of the professional."
Therapists differ dramatically in their approach to these children, with some taking the relatively new approach of supporting kids who want to live openly as members of the opposite sex. Others encourage kids to discard their more pronounced behaviors, explore new interests and embrace their own gender.
Many therapists take the middle ground of, say, accepting a very determined boy's desire to wear dresses and saying it's fine for him to do so at home, but strongly encouraging him to refrain from that behavior in school, where he might encounter unpleasant responses.
"I think the general trend has been to take more of a stance of tolerance toward the behavior instead of the old type of stance where they would yell at (these boys), criticize them, punish them for any sort of girlish behavior and send them off to military schools," says Gregory Lehne, an assistant professor of medical psychology at the Johns Hopkins University School of Medicine. "That didn't work particularly well."
Parents often wonder if their gender-variant kids will grow up to be transgender adults. Statistically speaking, the answer is no.
"Between 85 percent and 90 percent of the (young) kids that we've seen don't grow up and want to become the opposite sex. They grow up and are pretty happy in their own skin. It's only a small minority that we're seeing that are persisting into adolescence," Zucker says.
Studies suggest that the majority of gender-variant boys will grow up to be gay men, with experts putting the figure at anywhere from 70 percent to 95 percent. (About a third of the gender-variant girls in a small study cited by Zucker later identified as lesbian or bisexual.)
"I really think of the majority of these (gender variant) boys as being gay boys," says Lehne. "Being gay doesn't start when you're 11 or 13 or 14. It starts some time before birth or (soon) after birth, and this is how it manifests for some kids in childhood."
Perrin says she has seen some gender-variant children whose parents tried to change their behavior without success, and others who had dropped their nonconforming behaviors by age 8 or 10 and seemingly just moved on.
"The ones I'm thinking of right offhand are boys," she says. "Now they're saying they no longer want to wear blond wigs and they no longer want to play with Barbies."
Asked if there's any way to predict which children will grow out of gender variance, Perrin responds, "very poorly."
"The best predictor is the child with actual dislike of their own body parts — those children are much less likely to actually change their minds. But that doesn't mean that they won't."
WHEN TO SEEK HELP, AND WHOM TO TALK TO
Should you be concerned about your child's atypical gender behavior?
"Parents should be concerned if their children are concerned," says Ellen Perrin, chief of developmental-behavioral pediatrics at the Floating Hospital for Children at Tufts Medical Center. "If this is causing discomfort or distress in the child, they need to talk to the child and figure out what's going on.
"Some children, they're kind of miserable, and those parents need to get some help. Nobody's going to change the child, but sometimes parents can be given advice that can make life easier."
The outreach program for gender-variant children and their families at Children's National Medical Center (childrensnational.org) in Washington, D.C., offers a free online brochure, "If you are concerned about your child's gender behaviors," with tips for choosing a therapist. Among them:
Ask the therapist how she approaches gender variance.
Ask about previous experience treating children with these issues.
Make sure that guidance and support for you and your spouse or partner are major components of the therapy.
Be concerned if the sessions only involve your child, don't address parenting questions, or don't offer you ways to help your child and your family.
Be concerned if the therapist seems to focus on the child's behaviors as the problem rather than on helping the child cope with intolerance and prejudice.