The hemoncology floor of Seattle Children’s Hospital performs Kelly Clarkson’s song “Stronger”
April 29, 2012
Gender identity and children who struggle with it [washingtonpost.com]
By Janice D’Arcy / washingtonpost.com
Gender nonconformity is a new term for many of us, but for some families it’s an issue that has gone unrecognized for too long.
Increasingly, more families with children who struggle with gender are speaking out and asking for more rights and more inclusion.
One high-profile story last year involved a mother and her transgender 7-year-old petitioning to join the Girl Scouts. Other families joined Anderson Cooper a few months ago to talk about their experiences onhis talk show.
Sarah Feliciano, who has lived in a transitional housing space for homeless gay, lesbian, bisexual and transgender youth, is a transgender female who became homeless after her mother rejected her decision to live as a woman. (Whitney Shefte – The Washington Post)
Experts are also beginning to pay attention to these children. In March, the American Academy of Pediatrics published a collection of studies on children and adolescents with gender identity disorders.
“Gender non-conformity refers to any individual, adult or child, who does not abide by our culture’s socially defined binary gender boxes,” Diane Ehrensaft told me.
Ehrensaft is a developmental and clinical psychologist and author of “Gender Born, Gender Made: Raising Healthy Gender-nonconforming Children,” (The Experiment, 2011). She is the featured speaker for tonight’s inaugural event in the Human Rights Campaign new speaker series, Equality Talks. (Details on that D.C. event are below.)
I asked her to define some of the terminology used when we talk about gender and children, and describe how parents can better support these kids, whether at home or in the community. Here’s our Q &A:
Can you explain how a parent might recognize gender non-conformity in a child?
It may involve a person saying he or she does not feel in synch with the gender listed on the birth certificate; it may involve the girl who says she will never, ever wear a dress, even when she’s supposed to be a bridesmaid or flower girl dressed in frills.
A parent will recognize it just by paying attention — it is the child who in one way or another says a transgressive “no, I don’t want to” or “no, I won’t” or “no, I can’t” to social expectations about gender, and it is the child who in one way or another says, “But here’s the way I’m going to put gender together creatively for myself, based on my own needs and desires.” If a parent can’t see it, it may be because the child has already figured out that it’s not going to be okay in the family, and therefore hides it, and that is never good for a child’s sense of well-being and confidence in who they are. Another reason a parent may not recognize it is that it hasn’t yet surfaced in the child, and may just show up at a later date.
Many children, especially toddlers, seem to arbitrarily and temporarily reject certain clothes or rules. How might a parent know when a child is going through a temporary phase or if he or she is expressing a more deeply ingrained view of him or herself?
Almost all children, at one time or another, do something that is outside the conforming gender box. A sister may think it’s fun one day to put on her brother’s football uniform. A little boy may ask to have his toenails painted red like his mommy’s.
This is to be differentiated from the child who consistently, persistently or even insistently crosses gender lines in either presentation, activities or declaration of what their gender is. Those latter children will fit the category of gender-nonconforming children. Some parents will still ask, in these situations, “But couldn’t it just be a phase?” The answer is yes, but as more time goes on and the child continues to express in gender-nonconforming ways, it is far more likely that the child is not going to outgrow the gender nonconformity, at least for the foreseeable future. The real challenge for both parents and professionals is knowing that we may have to live in a state of not-knowing for awhile, and in the meantime leaving all gender doors open.
Also, one cautionary note about “phases.” Often, in referring to our children, “phase” actually has a negative connotation — ”Don’t worry. It’s just a phase, he (she) will get over it.” With gender, holding on to the notion of phase might unwittingly transmit to your child that who your child is is not okay with you. Perhaps a better way to think about it is with “cross-section:” ”I don’t know who my child will become, but this is who my child is now at this cross-section of his or her life.”
How early might a child experience gender nonconformity?
We are seeing babies as early as the last quarter of the first year of life showing signs of gender nonconformity. Typically, it tends to show up first in the toddler and preschool years as children learn what gender is and develop language and activities to express themselves.
What are some of the most important ways a parent can guide a child through this experience?
The most important way a parent can guide a child through this experience is by always remembering that parents have little control over their children’s gender identity, but tremendous influence over their child’s gender health.
To ensure that health, a parent can listen to what their child is saying or showing about his or her gender expressions (how we act and present ourselves) or gender identity (how we identify as male, female or other) and open a space for that child to feel free to create his or her own unique authentic gender self, what I call the true gender self.
Just as the flight attendant instructs parents to administer oxygen to themselves before helping their child, the challenging task of raising a healthy gender-nonconforming child can often best be done by first reaching out for the social “oxygen” of parent support groups, listservs, educational services and informed gender specialists so that the parents are not going it alone in affirming their child’s true gender self.
You plan to talk tonight about gender creativity and gender expansiveness. Can you briefly explain what those terms mean?
Gender creativity is the thread each of us uses to create a true gender self that is a combination of nature, nurture and culture, a construction that I call the gender web. Like fingerprints, each of our gender webs will be unique to us, but unlike fingerprints, the gender web does not stay permanently the same, but can evolve and change over the course of a person’s lifetime. Gender creativity is the force within us, if allowed to express itself, that will both build and replenish the gender web as we grow.
Gender expansiveness is the opening up in both the culture and within ourselves all the permutations and combinations gender might take, without privileging one type over another. We often refer to gender expansiveness in terms of gender acceptance or gender diversity.
Ehrensaft’s talk tonight will be at the Human Rights Campaign headquarters in Washington at 6 p.m. It will also be broadcast live on the Equality Talks Web site.
February 25, 2012
Gender Identity Issues Can Harm Kids’ Mental Health: Study [health.com]
By Lisa Esposito / HealthDay Reporter
MONDAY, Feb. 20 (HealthDay News) — New studies show that children struggling with their gender identity also face higher risks for abuse and mental health problems, including post-traumatic stress disorder.
Children with gender identity disorder show a strong, persistent discomfort with their biological sex. They identify with and display behaviors usually seen in the opposite sex.
One study, from Children’s Hospital Boston, looked at the emotional and behavioral problems of children and teens referred to its specialty clinic for evaluation and possible medical treatment.
“The study only focuses on kids who experience profound distress or [sadness] with their changing bodies, so the psychiatric manifestations of that distress include much higher risks for self-injurious behavior, depression, suicide attempts and anxiety,” said Dr. Scott Leibowitz, a pediatric psychiatrist affiliated with the hospital’s Gender Management Service.
Ninety-seven patients younger than 21 were included, 43 born as males and 54 as females. Forty-three patients already had psychiatric symptoms, 20 reported self-mutilation and nine had attempted suicide.
The studies appear online and in the March issue of the journal Pediatrics.
Dr. Walter Meyer III, author of an accompanying journal editorial, said many problems arise from the reactions these children face at home and in school.
“These kids are really normal — they just want to be the other gender,” said Meyer, a psychiatrist who works with transgender patients at the University of Texas Medical Branch, in Galveston. “The ones who are well-adjusted and well-accepted by their families and at school don’t have the psychiatric issues.”
The other study, from the Harvard School of Public Health, looked at long-term data on nearly 10,000 young adults, average age 23. Those who rated high for childhood gender nonconformity were more likely to report physical, psychological and sexual abuse as children. They were almost twice as likely to have post-traumatic stress disorder as young adults.
“Gender conformity” relates to how children express themselves — through their clothes, their interests, their mannerisms — and how these behaviors mesh with what’s typical for their biological sex.
One expert said the study is “important,” and that it helps tease out why these kids have trouble coping.
It “tests one of the key proposed factors — childhood abuse,” said Stephen Russell, a professor of family studies at the University of Arizona. “There has been concern that parents may react to gender nonconformity in harsh ways. This is perhaps the first study to show evidence of that and of the lasting implications for health.”
Fear of the unknown is part of the problem.
“We’ve seen in studies of gender nonconforming LGBT [lesbian, gay, bisexual, transgender] youth that what most people think of as abuse comes from a place of concern and fear on the part of parents — that is, they think they can help their kid by ‘toughening them up’ or teaching them to ‘fit in,’ ” Russell said. “Many parents literally have no framework for understanding gender nonconformity in children.”
Meyer, meanwhile, said he sees signs of growing awareness and acceptance, spurred by the media. Once parents are onboard, treatment can begin, sometimes quite early, he said.
“At age 5 or 6, treatment is mainly psychotherapy and working with family to help them [kids] adjust,” Meyer said. “Sometimes that means reassuring them and letting them dress up at home. Some might start school taking on a new gender.”
Pent-up need for treatment appears to exist.
Since Children’s Hospital Boston established a Gender Management Service in 2007, the population of gender nonconformists seeking treatment quadrupled.
“By having clinical services that are specialized and interdisciplinary, you’re providing an avenue for parents to come and present for treatment,” Leibowitz said. “That brings a lot of people out of their closets, so to speak, and shows this is a less stigmatized issue, so that people can get the appropriate assessments and treatments that they deserve.”
Some children receive treatment to delay puberty and buy them time while deciding whether to proceed with a gender change.
Puberty blockers, which are not covered by insurance, are expensive. “Injections can cost upwards of $1,000 a month.” Leibowitz said. Newer implants cost about $3,400 for two years.
Blocking irreversible changes of puberty has advantages for those who eventually opt for full gender transition, through cross-sex hormones or sexual reassignment surgery, Leibowitz said. “In their bodies and appearance, they will be perceived by society as the gender they affirm and thus have healthier outcomes,” he explained.
“We as individuals who do not experience an incongruence between our minds and bodies take for granted how easy life is,” Leibowitz added. “You just need to meet one child and one family to see how this impacts their lives.”
http://news.health.com/2012/02/20/gender-identity-issues-can-harm-kids-mental-health-study/
February 21, 2012
Mental Health Problems Plague Transgender Kids [livescience.com]
by Stephanie Pappas / livescience.com
Kids who are distressed because they feel their physical body doesn’t match their gender suffer from high rates of psychiatric symptoms, such as depression and suicide attempts, a new study finds.
In a sample of children and adolescents treated at the Endocrine Division at Children’s Hospital Boston, young people who experienced distress about the “mismatch” between their body’s sex and their mental gender had high rates of psychiatric complications (before any gender treatment). Kids who don’t get treatment, whether for financial reasons or because their parents aren’t supportive, likely have higher rates of psychiatric problems, said study researcher Scott Leibowitz, a psychiatrist at Children’s Hospital Boston.
“Individuals who are not transgender take for granted what life must be like when our minds and bodies are incongruent with one another,” Leibowitz told LiveScience. “Personally, I’ve seen so many kids who experience such high levels of distress with their changing bodies that it impairs their emotional and social functioning,” he said.
Mind-body mismatch
Transgender people — people who feel that their biological sex does not reflect their true gender — have astonishingly high rates of mental health problems: A 2010 survey found that 41 percent of transgender people in the U.S. have attempted suicide.
Researchers attributed those rates to discrimination and stigma, as well as a lack of laws protecting transgender people from employment discrimination. Poor insurance coverage of hormones and other treatments to help a transgender person transition to their desired gender also account for the rates, the researchers found. [5 Myths About Gay People]
But the mismatch between mind and body alone can be a major source of psychological pain, Leibowitz said. Of 97 patients who came to the Endocrine Division for hormones and other treatments related to gender identity disorder between January 1998 and February 2010, 44.3 percent had significant mental health histories. Twenty percent had self-mutilated, and 9.3 percent had attempted suicide at least once. About 37 percent were taking psychiatric medication.
Treating gender identity
Growing up, many children experiment with cross-gender behaviors, but very few of them will grow up to experience distress about their biological sex. Persistent gender identity disorder is rare: In the Netherlands, where gender-treatment programs are well- established, only about 1 in every 10,000 to 30,000 people seeks treatment.
When young people start puberty and experience serious distress about their bodies developing into a gender they don’t identify with, there are solutions, Leibowitz said. The medical standard established by the Endocrine Society and the World Professional Organization for Transgender Health call for treatment with hormones that suppress puberty in teens who have not yet undergone major physical changes. These treatments “buy time,” Leibowitz said, preventing the development of secondary sex characteristics such as breasts or an Adam’s apple while kids mature mentally enough to make decisions about whether they’d like to transition to a new gender. These treatments are reversible.
Older teens, ages 16 or 17, can begin to make decisions about taking estrogen or testosterone to promote the sexual characteristics of the gender they feel they are. Puberty-suppressing treatments are also used at this stage to lessen the doses — and thus side effects — of these hormones. The effects of cross-sex hormone therapy are partially reversible.
At every step of the way, Leibowitz said, families and children are counseled and evaluated to be sure they’re ready for treatment. Doctors counsel young children and their families, but do not treat them with drugs or hormones unless their gender identity distress persists at puberty.
The cost of not treating can be high, as the new study, published today (Feb. 21) in the journal Pediatrics, highlights.
“Without treatment, a lot of these kids are prone to psychiatric disorders, including depression, suicide, self-mutilation, anxiety,” Leibowitz said.
http://www.livescience.com/16110-transgender-teen-mental-health.html
February 7, 2012
Just How Bad Is Child Abuse in America? Very. [jezebel.com]
by Cassie Murdoch / jezebel.com
Child abuse is a dark and depressing reality in American life, but until now, it’s never been clear just how widespread a problem it was. A new study, led by Dr. John Leventhal of Yale University, offers the first comprehensive estimate of serious injuries caused by child abuse in the U.S., and the results are pretty horrifying.
The study, published in the journal Pediatrics, found that nearly 4,600 children in the U.S. were hospitalized for injuries caused by physical abuse in 2006, the most recent year for which data was available. Overall, six out of every 100,000 kids under 18 were hospitalized with injuries that ranged from broken bones and burns to traumatic brain injury. The average hospital stay for these children was one week, and 300 of them ended up dying. That puts the death rate for abuse at 6 percent, which is a far higher death rate than exists for other kinds of injury or medical problem that required hospitalization.
Very young children tended to be the most common victims of abuse. For babies under one, there were 58 cases of hospitalization per 100,000 infants. Sadly, children under one who were covered by Medicaid fared worst of all, with one out of every 753 of those babies ending up in the hospital because of abuse. According to Dr. Leventhal, “Medicaid is just a marker of poverty, and poverty leads to stress.”
Stress appears to be a key factor in abuse. There was another smaller study that showed an obvious increase in abusive brain injuries after the financial crisis in 2007, which researchers attributed to added stress on parents. Leventhal said stress disproportionately affects younger kids because they are by nature, more difficult to care for:
They are challenging for some parents to take care of because they cry, it’s hard to understand what they want and parents can get frustrated, exhausted and angry.
Of course, they also can’t defend themselves or runaway as easily as older children can. A heartbreaking reality, and one Dr. Leventhal thinks we need to address urgently. According to his team, at the rate this study found abuse to be occurring, it’s a bigger threat to babies than Sudden Infant Death Syndrome. And, of course, this study only deals with kids who are hospitalized. There are many more children who endure abuse but aren’t injured severely enough to require medical attention.
So Dr. Leventhal proposes we act to stop abuse in the same way we’ve worked to stop SIDS: “We need a national campaign related to child abuse where every parent is reminded that kids can get injured.” Another probably even more effective option would be to send public health workers to do home visits with new parents to offer support and advice, a practice that is already common in a lot of European countries.
While that level of intervention sounds costly, the expense to society of caring for the abused is far more substantial. Beyond the obvious personal cost to the children and individual families, the study found that abuse-related hospitalizations ran us about $73.8 million in 2006. And in terms of the overall expense of abuse, the CDC reported that one year’s worth of child maltreatment cases costs $124 billion over a lifetime.
But no matter what the cost is, preventing abuse is worth it. Leventhal says, “This is a serious problem that affects young children. We need to figure out a way to help parents do better.” We spend so much money educating people on everything from cancer prevention to the dangers of cholesterol, but now that we’ve got a more accurate picture of the damage abuse is doing across the entire country, there’s no excuse for not going after the problem immediately on a national level—especially because the children who are falling victim to this abuse can’t advocate for themselves.
Child abuse experts calls for U.S. campaign [Reuters]
Study: Child Abuse Affects More U.S. Kids than SIDS [Time]
http://jezebel.com/5882911/just-how-bad-is-child-abuse-in-america-very
February 7, 2012
Why Spanking Doesn’t Work [time.com]
By Bonnie Rochman / time.com
Want your kid to stop whatever dangerous/annoying/forbidden behavior he’s doing right now? Spanking will probably work — for now.
But be prepared for that same child to be more aggressive toward you and his siblings, his friends and his eventual spouse. Oh, and get ready for some other antisocial behaviors too.
A new analysis of two decades of research on the long-term effects of physical punishment in children concludes that spanking doesn’t work and can actually wreak havoc on kids’ long-term development, according to an article published Monday in the Canadian Medical Association Journal.
Studying physical punishment is difficult for researchers, who can’t randomly assign children to groups that are hit and those that aren’t. Instead, they follow children over many years, monitor how much they’re spanked, and then take measure of their aggression over time. “We find children who are physically punished get more aggressive over time and those who are not physically punished get less aggressive over time,” says Joan Durrant, the article’s lead author and a child clinical psychologist and professor of family social sciences at the University of Manitoba.
In fact, regardless of the age of the children or the size of the sample, none of more than 80 studies on the effects of physical punishment have succeeded in finding positive associations. “If someone were to hit us to change our behavior, it might harm our relationship with that person. We might feel resentful,” says Durrant. “It’s no different for children. It’s not a constructive thing to do.”
Click this link to continue reading the article: http://healthland.time.com/2012/02/06/why-spanking-doesnt-work/#ixzz1lgZ6uoer
December 29, 2011
Do Sensitive Kids Turn into OCD Adults? [jezebel.com]
By Cassie Murdoch / jezebel.com
How many times have you looked at a kid meticulously lining up a series of blocks, or refusing to eat anything green on their plate, or carefully putting on their socks in just the right way (because, duh, otherwise the seams press into their toes!) and thought, “Man, that kid is going to be totally OCD when she grows up.” Well, it turns out you might not be that far off.
According to new research conducted by Professor Reuven Dar of Tel Aviv University, there is a strong connection between children who are hypersensitive and focus on following strict rituals and adults who suffer from obsessive-compulsive disorder. Professor Dar found that there is a direct correlation between the way our nervous systems process sensory input and our development of ritualistic behaviors:
When children experience heightened levels of sensitivity, they develop ritualistic behaviors to better cope with their environment. In the long term, this is one potential pathway to OCD.
Professor Dar conducted two different studies to determine this connection. The first asked parents of kindergartners to fill out questionnaires about their child’s need for ritual, their habits of repeating certain actions or ordering objects in specific ways, their anxieties, and their reactions to sensations like being touched or smelling or tasting something unusual. The second study asked adults to fill out surveys about “their OCD tendencies, their anxiety levels, and their past and current sensitivity to oral and tactile stimulation.” Taken in combination, the studies established a link between OCD tendencies and high levels of sensitivity:
In children, hypersensitivity was an indicator of ritualism, whereas in adults it was related to OCD symptoms. As a whole, these findings provide preliminary support for the idea that such sensitivities are a precursor to OCD symptoms.
Dar believes that when kids are extra sensitive, they experience sensations in such a heightened way that it can feel like they’re being attacked; they develop rituals as a way of protecting themselves against these sensory overloads and to help them “regain a sense of control.” This behavior is also a symptom of adult OCD. While the connection makes sense, further longitudinal studies are needed to confirm the link between childhood and adult ritualistic behaviors.
Of course, there are plenty of reasons kids obsess over things, so don’t stress too much about the chances of him or having OCD. In terms of potential warning signs, Dar says, “If you see that a child is very rigid with rituals, becoming anxious if unable to engage in this behavior, it is more alarming.” But it also depends on the child’s age. In a five- or six-year-old, it might not be an indication of future OCD, but if it’s happening past the time a child is eight, then it could be a red flag, particularly if they suffer from anxiety.
Childhood Hypersensitivity Linked to OCD [ScienceDaily]
http://jezebel.com/5871422/sensitive-kids-may-grow-into-ocd-adults
December 22, 2011
Can Depression Be Diagnosed with a Picture of Your Mom? [wired.com]
by Jonah Lehrer / Wired.com
Sigmund Freud gets a bad rap from modern science. (The immunologist Peter Medawar summarized the feeling of many with his remark that psychoanalysis is the “most stupendous intellectual confidence trick of the twentieth century.”) Sure, Freud’s theories mangled a lot of details — we no longer worry about penis envy or the Oedipus complex — but he was shockingly prescient on the big themes. In recent years, it’s become clear that, as Freud always insisted, the unconscious is the dominant force in our mental life. (What Freud called the id is now a network of brain areas associated with emotion, such as the amygdala and nucleus accumbens.) He was mostly right about the logic of dreams, which often regurgitate those parts of experience we store in long-term memory. And he was basically correct to imagine the mind as a set of conflicted drives, with reason competing against the urges of the passions. We expend a lot of neurotic energy holding ourselves back.
But there’s another Freudian theme that deserves a little 21st century appreciation: his obsession with the mother-child relationship and the way it shadowed people throughout life. Freud saw this parental bond as a dominant motive for behavior, influencing both our development as children and our happiness as adults. (The super-ego, for instance, begins to form when the incestuous desires of the child are thwarted by the father.) Although many of Freud’s particular claims feel like cultural relics, modern attachment theory has confirmed the crucial importance of the maternal bond. As Harry Harlow put it, “You’ve got learn how to love before you can learn how to live.” And it’s our mothers who often first teach us how to love. (Thankfully, human parenting is slowly becoming much more gender neutral. But this a recent cultural innovation.)
A new paper in PLoS ONE expands on this Freudian theme. The study involved a team of scientists at Columbia University, Beth Israel Medical Center and Albert Einstein Medical Center who performed fMRI scans on 28 female subjects between the ages of 18 and 30, half of whom were suffering from unipolar depression. (The patients were evaluated using the Beck Depression Inventory II.) While lying in the scanner, the volunteers looked at pictures of their mothers, a few friends and a selection of strangers. The scientists focused their attention on the left anterior paracingulate gyrus (aPCG), a brain area that plays an important role in the regulation of social emotion. Previous studies have linked the bit of cortex to error and conflict resolution and the understanding of intentionality.
By looking at the differential brain responses of depressed and control subjects after viewing those various faces, the scientists came up with an impressive diagnostic tool. In fact, the fMRi scans were able to predict the presence of depression in nearly 90 percent of subjects; the correlation between actual BDI scores and the predicted BDI scores based on fMRI results was 0.55, which is quite strong. Out of the 28 subjects, the fMRI diagnosis generated one false positive and two false negatives.
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