|
from Gender Identity Disorders
How Should Clinicians
Deal With GID In Children?
Psychologist Kenneth J. Zucker explains the current research
on children and adolescents who develop a Gender Identity Disorder
By Frank York
September 23, 2004 - Children and adolescents who develop a Gender Identity
Disorder (GID) are very often reared in homes where cross-gender behavior is
tolerated or encouraged as a "phase," according to Dr. Kenneth Zucker, writing
in a recent issue of Child and Adolescent Psychiatric Clinics of North America,
13 (2004) 551-568.
Dr. Zucker, with the Child and Adolescent Gender Identity Clinic, in Toronto,
Canada, observes that these children are also frequently in homes where the
maternal psychopathology is evident and that these children develop separation
anxiety because of a mother who is emotionally unavailable.
The opposite also seems to be true. In reviewing research on GID and parental
relationships, Zucker cites one clinical study by Stoller who noted that boys
who had GID had an overly close relationship with their mothers and a distant,
peripheral father-son relationship. Another researcher assessed the amount of
time fathers spent with their feminized boys during the first five years of
life. R. Green, in "The Sissy Boy Syndrome" found that fathers of feminine boys
spent less time with their sons from the second to fifth year than did fathers
of control subjects. Mothers of feminized boys also spent less time with their
sons than did mothers in a control group.
Zucker also analyzed current data on a biologic component to GID among children
and adolescents. He noted: "Researchers have been unable to identify a clear
biologic anomaly or variant that is associated specifically with GID. There is
evidence, however, that certain behavioral traits that are linked to biologic
processes may characterize children who have GID."
He surveys what is currently known about prenatal sex hormones and the impact
that these may have on the developing brain of the fetus. He points to studies
of congenital adrenal hyperplasia (CAH), an intersex condition that affects
genetic females. During fetal development, the external genitalia are
masculinized. Zucker says that it is presumed that such masculinization may also
take place in the brain. Studies of girls with CAH suggest they have higher
rates of bisexuality than others.
Zucker found that boys who had GID had a significantly greater rate of
left-handedness than other boys. In addition, GID boys also have an "excess of
brothers to sisters...and have a later birth order" than non-GID boys. He
theorizes that this may be due to "maternal immune reactions during pregnancy.
The male fetus is experienced by the mother as more 'foreign' (antigenic) than
the female fetus."
Social Reinforcement Is A Factor
Dr. Zucker says that a survey of the current literature on GID indicates that
"parents do play a role in influencing patterns of sex-dimorphic behavior but
not in the simplistic way that social learning theorists expected."
He says that children with GID are often brought up in homes where "tolerance
and non-responsiveness was common. Encouragement of these behaviors seems to be
more common than negative or discouraging reactions."
He lists three possible reasons for this tolerance as: "1. parental values and
goals regarding psychosexual development; 2. feedback from professionals that
the behavior is within normal limits and 'only a phase'; 3. parental conflicts
about issues of masculinity and femininity; and 4. parental psychopathology and
discord, which leave the parents preoccupied and unresponsive to their child's
behavior."
The Link Between Homosexuality, GID
Dr. Zucker admits that there are complex social and ethical issues surrounding
the politics of sex and gender in postmodern Western culture. He note that the
"most acute ethical issue may concern the relation between GID and a later
homosexual sexual orientation. Follow-up studies of boys who have GID that
largely is untreated, indicated that homosexuality is the most common long-term
psychosexual outcome."
Zucker says that clinicians have an ethical obligation to inform parents of the
relationship between GID and homosexuality. Clinical experience suggests that
psychosexual treatments are effective in reducing gender dysphoria and that
individual counseling and parental counseling are both effective methods of
treating GID.
He points out that it is legitimate for parents to establish limits for their
children on cross-gender behaviors. If not, the behavior is, in effect, being
reinforced.
Children and adolescents who are resistant to psychosexual treatment may be
candidates for early hormonal treatment but only after all other options have
been exhausted. The clinician may consider two options: management of the
condition until the child is 18 and can be referred to an adult clinic or the
early institution of sex hormones.
Updated: 3 September 2008
|
