Should a parent seek therapy for a child who crosses the gender divide?



TranYouth Family Allies ( ) is the website of the National Center for Transgender Equality, helpful for families seeking legal support. has online discussion groups for parents of transgender children of all ages.

Parents, Families and Friends of Lesbians and Gays ( ) serves as peer support for parents as well.

Safe Schools South Florida, ( ) a group of professional educators committed to training education professionals to recognize and intervene in harassment and bullying of lesbian, gay, bisexual, transgender and questioning (LGBTQ) students and the children of lesbian, gay, bisexual and transgender (LGBT) parents. is a statewide education and advocacy organization dedicated to eliminating discrimination based on sexual orientation, race, gender and class.


Should you be concerned about your child's atypical gender behavior?

If your child is socially well-adjusted and overall comfortable in his or skin, the general rule is to let things be. You should seek outside support if you, your child or your family are struggling to accept your child's gender expression.

The outreach program for gender-variant children and their families at Children's National Medical Center ( in Washington, D.C., offers tips for choosing a therapist. Among them:

Ask the therapist how she or her approaches gender variance. Make sure your therapist is fine with whatever gender outcome your child has.

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 behavior as the problem rather than on helping the child cope with intolerance and prejudice.


Bullying is one of the biggest issues that transgender children face. Sit down with school administrators -- nurse, psychologist, principal and/or teachers -- to make sure everyone is aware of the circumstances.

Does your 4-year-old son dress up in his big sister's tiaras and princess costumes?

Does your 3-year-old daughter swap Barbies for Tonka Trucks?

With celebrity gossip sites buzzing over Angelina Jolie's comment that her 4-year-old daughter, Shiloh, wants to be a boy, and even children's books and popular television shows beginning to tackle the issue, transgender children have taken the media spotlight.

``It's not so much that younger children are exhibiting this behavior,'' said Nadine Smith, executive director of Equality Florida the state's largest rights group dedicated to equality to the Lesbian, Gay and Bisexual and Transgender community. ``It is something that has already existed. There is just more research and visibility.''

But with lots of new information out there, parents are left sifting through some contradictions.

``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).

If your son likes to wear his older sister's shoes from time to time but is generally happy in his own skin, doing well in school, and has normal social relations, you should not be concerned.

``If it's not broke, don't fix it,'' says Kim Pearson, executive director of TransYouth Family Alliance (TYFA), an advocacy group for transgender youths.

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 and vehemently reject sports. A girl might insist on playing only with boys, prefer a boy's haircut and express strong discomfort with her body.

``If the child is consistent, persistent and acute . . . for three to five years . . . those are the children we would transition to make their life better,'' Pearson said. An example of social transitioning would be a change in the child's name, hair style and clothing to reflect the identified sex. Medical changes would never be considered before puberty.

``Usually by 3 years of age the child has an absolute inner-conviction that they know whether they are a boy or girl,'' said Dr. Jon Shaw, professor and director, child and adolescent psychiatry, University of Miami Miller School of Medicine.

There is a difference between gender and sexuality -- sexual orientation isn't usually manifested until later in development.

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 birth 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.''

``I think a family's reaction varies considerably among parents from acceptance of child's difficulties and some realization that everyone is different and has his or her own developmental pathway, to less accepting,'' said Shaw. ``But often these children are very conflicted and they are often traumatized and bullied by other children at school.''


Equality Florida claims its primary priority is to address and eradicate bullying.

``There isn't an acceptable level of bullying that kids just have to deal with in school just like acceptable level of sex harassment that women have to deal with at work,'' Smith said.

``We need very much to be up to speed on gender identity and expression in general. Our schools are definitely behind the curve on it,'' said De Palazzo, a former Broward County teacher who now is a consultant on gay-student safety issues. ``There's been an explosion of the fluidity of gender, being more explored by young people and society.''

Educators in Broward and Miami-Dade schools have undergone training in regards to transgender children.

``Their safety is the No. 1 priority,'' said Suzy Berrios, director of Mental Health and Crisis Management Services for Miami-Dade Schools. ``We have staff from around the district trained in all our secondary schools. They receive training throughout the year. Each school has someone trained.''

This school year, Berrios hopes to officially incorporate sexual orientation and gender identity in Miami-Dade Schools' state-mandated anti-bullying policy. The School Board must approve the policy addition. ``It's only going to formalize what we already do,'' Berrios said.

Broward schools have already enumerated anti-bullying policies in terms of sexual and gender identity.

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,'' says Ken Zucker, a psychologist and head of the Gender Identity Service at the Centre for Addiction and Mental Health in Toronto.


Studies suggest that the majority of gender-variant boys will grow up to be gay, 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.)

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.''

This report was supplemented by Nara Schoenberg of The Chicago Tribune and Miami Herald staff writer Steve Rothaus.

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