Summary

Clinicians from a new gender service at a Sydney children's hospital describe the first 79 children and teens they assessed. Most were struggling: about four in ten had thought about suicide, six in ten had anxiety or depression, and one in seven was autistic. Family histories often included conflict, a parent with mental illness, separation from someone close, bullying, and abuse or neglect. The team also describes how hard it is to work in a polarised climate. This included pressure to drop a whole-person assessment of body, mind and family, and the difficulty of telling gender distress apart from anxiety, depression or sexual abuse. The authors call for mental health care that takes past trauma into account. It is a useful account from a hospital team, but it describes one clinic's patients with no comparison group, and the figures rest on the team's own assessments.

Key findings

• 79 crianças e adolescentes de 8 a 15 anos foram avaliados por um serviço de gênero recém-criado em Nova Gales do Sul; havia cerca de 1,4 menina para cada menino (por sexo de nascimento).
• 42% haviam pensado em suicídio, 16% haviam se automutilado e 10% haviam tentado suicídio.
• Outras condições eram comuns: ansiedade 63%, depressão 62%, problemas de comportamento 35% e autismo 14%.
• Experiências difíceis na infância eram frequentes: conflito familiar 66%, um dos pais com doença mental 63%, perda de alguém próximo por separação 60% e bullying 54%.
• 39% das crianças tinham histórico de abuso ou negligência.
• Os profissionais relataram pressão para abandonar uma abordagem da pessoa como um todo, preocupações de segurança e dificuldade em distinguir o sofrimento de gênero de ansiedade, depressão e abuso sexual.
• Os autores recomendam um atendimento que lide com trauma e perda não resolvidos junto com o sofrimento relacionado ao gênero.

Abstract

This prospective study examines the clinical characteristics of children (n = 79; 8.42–15.92 years old; 33 biological males and 46 biological females) presenting to a newly established, multidisciplinary Gender Service in New South Wales, Australia, and the challenges faced by the clinicians providing clinical services to these patients and their families. The clinical characteristics of the children were comparable to those described by other paediatric clinics providing gender services: a slight preponderance of biological females to males (1.4: 1); high levels of distress (including dysphoria about gender), suicidal ideation (41.8%), self-harm (16.3%), and suicide attempts (10.1%); and high rates of comorbid mental health disorders: anxiety (63.3%), depression (62.0%), behavioural disorders (35.4%), and autism (13.9%). The developmental stories told by the children and their families highlighted high rates of adverse childhood experiences, with family conflict (65.8%), parental mental illness (63.3%), loss of important figures via separation (59.5%), and bullying (54.4%) being most common. A history of maltreatment was also common (39.2%). Key challenges faced by the clinicians included the following: the effects of increasingly dominant, polarized discourses on daily clinical practice; issues pertaining to patient and clinician safety (including pressures to abandon the holistic [biopsychosocial] model); the difficulties of untangling gender dysphoria from comorbid factors such as anxiety, depression, and sexual abuse; and the factual uncertainties present in the currently available literature on longitudinal outcomes. Our results suggest the need to bring into play a biopsychosocial, trauma-informed model of mental health care for children presenting with gender dysphoria. Ongoing therapeutic work needs to address unresolved trauma and loss, the maintenance of subjective well-being, and the development of the self.

Conclusion

Our results suggest the need to bring into play a biopsychosocial, trauma-informed model of mental health care for children presenting with gender dysphoria. Ongoing therapeutic work needs to address unresolved trauma and loss, the maintenance of subjective well-being, and the development of the self.