Transgender child on R4 World at One

MsBeaujangles - I'm really finding what you have to say interesting. Thank you

Are there differences in approach between services?
Dr Polly Carmichael seems to take a more nuanced approach than the affirmation which seems more prevalent at Mermaids.

The Tavi is the UK's only GID service for children and young people. The psychology team there are very reflective. They write interesting academic articles about things like gender identity and feminism and what it is like being gatekeepers to physical intervention/managing the pressure placed on them to offer hormones etc.

It worries me that there are organizations going into schools teaching children they were "born into the wrong body" and no organizations going into schools teaching children that their body is an integral part of themselves and "it gets better".
It worries me too. This and the apparent lack of understanding of (or decisions to ignore) the law that schools and local authorities exhibit when it comes to meeting competing/conflicts and interests.
There are quite polarised positions being presented and so much misinformation being bandied around.

It worries me that there are organizations going into schools teaching children they were "born into the wrong body" and no organizations going into schools teaching children that their body is an integral part of themselves and "it gets better".

Is there likely to be a push to refer to Gender GP's private practise if Tavistock clinic's waiting time is seen as too long?

I know with other types of GP referrals, this does happen. The call on R4 seemed to be for parity of MH services, is this the intended outcome?

Are there differences in approach between services?

Dr Polly Carmichael seems to take a more nuanced approach than the affirmation which seems more prevalent at Mermaids.

@MrsBeaujangles that doesn't surprise me - I'm an adoptive mum and nothing is evidenced for children with the kinds of difficulties adoptive children have either. Sigh.

@NotTerfNorCis. Gender dysphoria has been around for a long time. The rise in the number of children being referred for treatment has increased dramatically in recent years. Also, there are now far more girls being referred than boys

Lots to reply to. I'll have a quick bask before feeding the hungry hoards!
@drspouse - I don't think there is a standard treatment. There is a lack of evidence to guide proper evidence based treatment.
@NowtSalamander. Your questions of why here why now etc. are very live for psychologists too. We are asking and trying to find answers to these questions.
@Wombman - I am speaking about the work of child and adolescent psychologists in the UK rather than endocrinologists
@OldCrone - gender here refers to the social and cultural expectation of how males and females should think, behave and how they should be treated by others. As I said before, I am gender critical and do not buy into sex determining femininity or masculinity. However, I do observe this being a reality for many.

@MsBeaujangles Some great posts! You sound very well informed. I was wondering, did the medical profession encounter such cases in the past - and if so, were they diagnosed differently? In children, I mean.

some children, from a very young age, present with passionately uncompromising narratives about their self-identity as male or female, despite the conflicting evidence of their sexed bodies. When talking to them, it is clear that their understanding of their own sexed bodies and of gender is complexly determined.

What, exactly, is meant by 'gender' here? 'Gender' is usually used to mean (a) a synonym of sex or (b) the stereotypes which go with being either male or female. You clearly don't mean 'sex' here, so if 'gender' does not mean stereotypes in this context, what does it mean?

They are clearly of that view.ie they go along with the girl in boy body idea

I have yet to meet a professional working in this area who thinks that changing the body is 'the treatment' for dysphoria but rather it aims to help alleviate the symptom

Then what about the endocrine soc of America and their statement of belief on another mn post?

MsBeaujangles I think what you’re saying reflects much of what other child psychologists I know say, and it’s reassuring that all professionals I know in this area are following a more conservative approach than we might hear about in the media.

Nevertheless, when I speak to them I’m struck by how our conversations reflect our separate professions. I can see that their concern is to treat the distress of the child and that requires action. Whereas for me, with my historian hat on, what’s most interesting about this phenomena of trans children is how historically specific it is to this place and time - which makes me wonder why these kids are manifesting this right now and doubt if we can really treat this as anything other than a delusion.

When my child was claiming, for many years and from a very young age, that their felt reality was different to their actual sexed body, I specifically never took them to any child psychologists for this exact reason. They’ve now grown out of it. I don’t believe this would have been the case had I taken to someone who believed this was a case that required treatment and therefore substantiated my child’s ideas. I may be wrong on this, of course!

@MsBeaujangles what is the standard psychological treatment for a child with body dysmorphia?

(Assuming, ha ha, that CAMHS actually has funding etc.)

@ArcheryAnnie. I am not a fan of Mermaids for many reasons and I think their conduct has, at times, been is unprofessional.

I loath the 'Genderbread' models and 'Ken and Barbie' continuums that get circulated and think they are ill informed and pernicious.

@Archery Annie. You are right, nobody was talking about telling a child they were being silly, I was picking up on the comment so silly that he has to identify as transgender in order to wear sparkly clothes. It would have been better to have focussed on thinking of it as being 'silly'.

@StarkStaring. It is complex - in psychological terms many psychologists, me included, would see under 25 year olds as adolescents still. The developmental task of coming to a settled sense of self is often still on-going at this age and so, in my view, struggles with gender identity could still be part of this process. I am not convinced that someone who is struggling will not come to
a settled, consistent identity that is at one with their sexed body, given time.

Having said that, I think the age of onset it important. I think there are significant differences with persistent dysphoria that starts at a young age and sudden onset dysphoria (where social contagion aspects could be at play).

What some posters on this thread may be overlooking is that some children, from a very young age, present with passionately uncompromising narratives about their self-identity as male or female, despite the conflicting evidence of their sexed bodies. When talking to them, it is clear that their understanding of their own sexed bodies and of gender is complexly determined.

and the impact of this condition shouldn't be trivialised or under-estimated

I don't think anyone is doing this here, though.

I would be interested in your view of Mermaids' approach, MsBeaujangles, because that's where I see the main problem lies - deciding on a solution and shouting "transphobe!" at anyone who wants to discuss a range of different solutions, or even anyone who suggests that more research is needed.

This does seem to be the only condition where the mind thinks the body is wrong, and steps are taken to change the body rather than work on why the mind thinks the body is wrong

I have yet to meet a professional working in this area who thinks that changing the body is 'the treatment' for dysphoria but rather it aims to help alleviate the symptoms. I haven't met any professionals who buy into the narrative of 'trapped in the wrong body' or 'brain doesn't match the body'.

But with those children we do not enter into their beliefs that they are going to choke on their food or that they are massively overweight when their BMI is 22

Linked to my point above, the professionals I know do not enter into the beliefs/ 'wrong body' beliefs.

As a psychologist (as opposed to a psychiatrist), it is unsurprising that I favour psychological over physical interventions. I am also gender critical and think that society has a lot to answer for in relation to expectations about gender conformity. I have significant reservations about the use of puberty blockers for children and other physical interventions that do not have a strong enough evidence base underpinning them. I also recognise that some children experience significant distress as a result of their gender dysphoria and the impact of this condition shouldn't be trivialised or under-estimated.

MsBeaujangles - many thanks for your helpful posts, it is so much more complex than challenging stereotypes, take it from a parent dealing with this!
What is your view of how young adults (under 25), as opposed to children, are treated by gender specialists?

Is any consideration taken of their maturity or lack of, or is this not considered appropriate?

Telling a child who is dysphoric that they are being silly or ignoring their distress is not helpful.

@MsBeaujangles I may have missed it, but I haven't seen anyone suggest that we tell distressed children that they are "silly". I think very many of us feel an intense empathy for a child who is dysphoric, not least because many of us on MN were gender nonconforming children ourselves.

What many of us disagree on, of course, is what we do about a distressed child. At the moment, any proper research or even discussion about it in the public sphere is dangerous for the professionals involved, which cannot possibly lead to a good outcome for the children involved.

When children experience distress and anxiety about their sexed bodies, and this persists, then this can be an indicator that intervention might be a good idea.

I'm sure there must be much more to it than just anxiety about their sexed bodies. Many women on here have said that they experienced great anxiety when puberty started, and really didn't want to become women, but are now glad that 'trans' was unheard of back then.

I can't see how anyone can defend giving powerful drugs such as hormone blockers to any child. If a child expressed distress at some other aspect of their body - too tall or too short for example - would medication be given to change their body, or for their mental distress?

This does seem to be the only condition where the mind thinks the body is wrong, and steps are taken to change the body rather than work on why the mind thinks the body is wrong.

Telling a child who is dysphoric that they are being silly or ignoring their distress is not helpful.

Absolutely not. Just as telling a child with irrational anxiety or body dysmorphia that they are being silly or ignoring THEIR distress would also be very wrong.

But with those children we do not enter into their beliefs that they are going to choke on their food or that they are massively overweight when their BMI is 22.

In an ideal world we alleviate their distress, though I fully appreciate with CAMHS in the state it is, they are also often sent home with self help or parenting techniques.

I honestly don't believe there is any such thing as a "trans child".

There are many, many gender nonconforming children (and I think ALL children are gender nonconforming at some point, or to some degree), and there are parents who are doing their best to navigate this, and there is an entire construct of societal pressure about gender performance, and there is now a whole extra layer of dangerous, toxis "discourse", fuelled by both the well-meaning and the TRAs, which says gender nonconforming children are "really" the opposite sex. And then there's all the entirely usual - if distressing - mental health crises that children and adolescents are subject to, and which leaves them and their parents vulnerable to the prospect of straighforward explanations and fixes. And then there's the prospect of the parents and children being elevated above the crowd, turning into special, brave parents and special, brave children.

Wait until they've grown and done a bit of exploration for themselves as adults before you slap a label on them.

This dilemma is similar, in some ways, to trying to determine whether you have an anxious child or a child with an anxiety disorder; a child whose mood is often low and one suffering from depression.

These things are hard to navigate.

When it comes to gender identity issues, professionals working in the field are also struggling because there just isn't a strong enough evidence base to guide intervention. I know that people are condemning of using children as guinea-pigs, it is not as if they are being invited in so experiments can take place. The professionals are being presented with very distressed children and young people and trying to find the best ways forward to support them.

As I have said before, I haven't come across any professionals being hung-ho about physical intervention. All very much push a watchful, waiting approach. Though this is often met with objection by the children, young people and their parents.

I think the problem is the term 'trans' is just all too encompassing. I tend to agree that being 'trans' isn't an issue for mental health professionals where trans relates to how people want to express themselves or how they make sense of their inner feelings. I think there is a mental health element when distress is experienced in relation to one's sexed body.

From the point of mental health and wellbeing, so long as children are 'doing well' (eating and sleeping well, socialising, learning, growing, having hobbies and interests etc.) then little concern needs to be given to their preferences and how they like to express themselves.

When children experience distress and anxiety about their sexed bodies, and this persists, then this can be an indicator that intervention might be a good idea. I do think parents are often pretty good at recognising when help is needed. Some do jump the gun a bit (those for whom the above about 'doing well' applies, but their child is GNC or talks about being or wanting to be of the opposite sex).

@oldcrone I think one of the main problems with any sort of representation of trans kids in a short radio segment / magazine article / tv programme, is that the concept of gender dysphoria must be incredibly difficult to communicate without using some sort of ‘stereotype’? How does a child communicate how they feel when they haven’t yet learned the language to describe it? Maybe through ‘emulating’ the clothing and behaviours of the gender they identify with? Yes, gender stereotypes are bad, but if that’s the only way kids have to communicate their feelings, surely they shouldn’t be ignored? I’m not saying that any child who wants to wear glittery shoes should be called ‘trans’, but surely that’s then where the ‘consistent, insistent, persistent’ monitoring approach comes from? It weeds out those kids who are trans, from those who are gender non-conforming / questioning.