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

• 新南威尔士州一个新成立的性别服务机构评估了79名8至15岁的儿童和青少年；按出生性别，每1个男孩约有1.4个女孩。
• 42%曾想过自杀，16%曾自伤，10%曾自杀未遂。
• 其他状况很常见：焦虑63%，抑郁62%，行为问题35%，自闭症14%。
• 艰难的童年经历很常见：家庭冲突66%，父母有精神疾病63%，因分居失去亲近的人60%，霸凌54%。
• 39%的儿童有虐待或忽视的历史。
• 临床医生报告说，面临放弃全人方法的压力、安全方面的担忧，以及难以区分性别痛苦与焦虑、抑郁和性虐待。
• 作者建议，除了与性别相关的痛苦之外，还应提供处理未解决的创伤和丧失的护理。

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.