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 trẻ em và thiếu niên từ 8 đến 15 tuổi được đánh giá bởi một dịch vụ giới tính mới thành lập ở New South Wales; có khoảng 1,4 bé gái cho mỗi bé trai (theo giới tính khi sinh).
• 42% từng nghĩ đến tự tử, 16% từng tự làm hại bản thân và 10% từng cố gắng tự tử.
• Các tình trạng khác là phổ biến: lo âu 63%, trầm cảm 62%, vấn đề hành vi 35% và tự kỷ 14%.
• Các trải nghiệm khó khăn thời thơ ấu thường xuyên: xung đột gia đình 66%, cha mẹ mắc bệnh tâm thần 63%, mất người thân thiết do chia ly 60%, và bị bắt nạt 54%.
• 39% trẻ có tiền sử bị lạm dụng hoặc bỏ bê.
• Các bác sĩ lâm sàng báo cáo áp lực phải từ bỏ cách tiếp cận toàn diện con người, lo ngại về an toàn, và khó khăn trong việc phân biệt phiền muộn giới với lo âu, trầm cảm và lạm dụng tình dục.
• Các tác giả khuyến nghị chăm sóc giải quyết chấn thương và mất mát chưa được giải quyết cùng với đau khổ liên quan đến giới.

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.