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 barn och tonåringar i åldern 8 till 15 bedömdes av en nyinrättad könstjänst i New South Wales. Det fanns cirka 1,4 flickor för varje pojke (efter biologiskt kön).
• 42 % hade tänkt på självmord, 16 % hade skadat sig själva och 10 % hade försökt ta sitt liv.
• Andra tillstånd var vanliga: ångest 63 %, depression 62 %, beteendeproblem 35 % och autism 14 %.
• Svåra barndomsupplevelser var vanliga: familjekonflikt 66 %, en förälder med psykisk sjukdom 63 %, att förlora någon nära genom separation 60 % och mobbning 54 %.
• 39 % av barnen hade en historia av övergrepp eller försummelse.
• Kliniker rapporterade påtryckningar att överge ett helhetsförhållningssätt, säkerhetsoro och svårigheter att skilja könsrelaterat lidande från ångest, depression och sexuella övergrepp.
• Författarna rekommenderar vård som hanterar obearbetat trauma och förlust vid sidan av könsrelaterat lidande.

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.