WHAT do you do when your child wants to
be the opposite sex?
The phrase "boys will be boys" is often used
by parents as a throwaway comment to excuse
rough-and-tumble games. Delve deeper and you
might question why a girl barely out of nappies
can't help but rifle through your make-up bag
and why your small son insists on brandishing
plastic swords and toy guns around the house.
But at what stage in childhood does our gender
identity become fixed - and what if there is a
mismatch with the biological sex we are
given?
The fact is that most people conform to the
body they are born with, but for a small
minority of children, this acceptance can be a
daily battle.
Gender identity disorder (GID) is when the
biological sex of a person does not match their
gender identity, but those with GID often
describe it as "feeling trapped inside the body
of the wrong sex". According to science, our
biological sex is determined by our chromosomes
and hormones, but accepting the gender we are
given is not always so simple.
Dr Domenico Di Ceglie, a child psychiatrist
and founder of Britain's only NHS gender
identity development service, at London's
Portman Clinic, explains that people with
GID have a strong sense of conviction or a wish
to belong to the opposite sex.
"Nobody knows for sure what determines this
profound sense of perception," he explains. "It
could be a whole range of factors working
together, involving responses to traumatic
events, hormonal influences or different life
experiences at critical points of brain
development. But what we do know, is that in
some children it becomes a permanent feature of
their personality that stays with them into
adulthood."
It could be argued that it is commonplace for
children to have gender issues while they are
growing up. Plenty of women recall childhood
memories of adopting stereotypically boyish
traits such as cutting their hair short or
climbing trees.
But, explains clinical psychologist Dr Chris
Williams, "girls who are tomboys are
demonstrating distinct patterns of behaviour,
which is very different to identifying
themselves as boys and struggling emotionally to
be a girl.
"Our society is much more accepting of girls
being tomboys, which involves dressing like boys
and engaging in boyish activities," says
paediatrician Ilona Bendefy. "As a result,
parents may pick up differences in their son's
sexual behaviour much sooner than they would for
a daughter." Experts tend to agree that the
incidence of GID for both sexes may be the same,
but the prevalence among girls is less, because
society is far more tolerant of male behaviour
in females. Perhaps, it is not surprising then,
that most children referred to gender clinics
are boys. According to research, six times more
boys than girls seek guidance on how to overcome
such problems.
So how can you tell if your child has a
gender identity disorder? Most children develop
a clear sense of whether they are boys or girls
between the ages of 18 and 30 months. After this
age, a period of gender stability occurs and
children adopt stereotypical behaviour -
starting to dress and play in ways appropriate
to their gender identity.
However, children with GID may well show
different kinds of behaviour. He or she may
insist they belong to the opposite sex. Boys may
show a preference for cross-dressing or playing
the female role, while girls may adopt masculine
clothing and be drawn towards rough-and-tumble
games.
They may also show a strong preference for
friends of the opposite sex and show signs of
discomfort with their own body. For example,
boys might be disgusted with their penis and
want it to disappear as they grow older, and
girls may want to hide away their breasts and
vagina.
Although GID is a rare condition, doctors
have noticed an increase in referrals to gender
clinics.
"Society now has a better recognition of
gender issues", says Di Ceglie. "In the past,
ideas of identity were less clear or
stigmatised, but now children and parents have a
framework of naming things and know how to ask
for help if such gender questions arise."
Although there are no follow-up studies, it has
been suggested that in a minority of children,
the gender identity disorder will persist and
manifest itself as transsexualism in adulthood.
Referrals to clinics show that around one in
30,000 adult males and one in 100,000 adult
females seek gender reassignment surgery. The
remaining children who show signs of GID will
develop a homosexual, bisexual or heterosexual
orientation as adults.
Although it is still not known what causes
GID, it is regarded as a medical condition and
one study shows that amniocentesis, which tests
for spina bifida in pregnancy, can cause a surge
of hormones to the foetus, which in turn, can
trigger a hormonal imbalance in the child
resulting in GID.
Indeed, Dr Glenn Wilson, from London's
Institute of Psychiatry, believes that
hormones play a big part in gender identity. "If
there is maternal stress during pregnancy, this
can block the effect of emasculating or
feminising hormones at the point when the foetal
brain development is establishing gender
identity."
But Dr Di Ceglie is not convinced that GID in
childhood can be explained by a simple causal
model, but rather by a combination of factors.
He cites one case where an eight-year-old boy
lived with his aunt from the age of six months
and encouraged him to help her with cooking and
tidying up the house.
After her sudden death, the little boy
developed GID. He played with dolls and
fantasised that he was a mother breastfeeding
his dolls. At school he wanted to play with
girls and avoided rough-and-tumble play.
He could not talk about the death of his aunt
for several months, but therapy revealed that
his make-believe play was his way of dealing
with his loss. Eventually the features of his
GID disappeared.
Paul Shaw, whose son is now seven, first
noticed signs of GID when Josh was three. "Josh
seemed to prefer playing with dolls and make-up
rather than cars and planes like his brother,
but we put it down to the influence of his
younger sister - behaviour we now know are
typical signs of GID.
"As Josh got older, we explained the
boundaries to him. For school, we encourage him
to wear neutral clothes, but at weekends he has
free reign and can put on whatever he likes,
which is often his favourite floral jeans and
make-up."
Finding out what people will accept within
your social network and getting advice on how to
cope with prejudice is one of the solutions
offered by Mermaids, a support group for
children and teenagers with GID, which has seen
a tenfold increase in inquiries since its
formation in 1993. "Just speaking the same
language and recognising that there is a
particular issue can bring great relief to the
child," says Margaret Griffiths, who founded the
group when her daughter developed signs of
GID.
One of the most common problems reported by
parents contacting Mermaids, is that their child
is unhappy at school - often because of bullying
or feelings of alienation. "Kids are quick to
pick up on anything different: a simple hand
gesture or even a type of walk can be a dead
giveaway," says Griffiths, who remembers when
Boy George was asked how he first knew he was
different - and he replied, "when other kids
told me".
This rings true with Shaw who believes that
greater awareness at school is vital to the
wellbeing of children like Josh. "People are
aware of transsexual adults, but most of us
don't make the connection that those adults were
once children too," he says. "Teachers and other
parents can be unkind to problems they don't
understand - after all gender is one of the last
taboos."
The names of parents and children mentioned
in this article have been changed. For
information and support, contact Mermaids on
(UK) 0702 0935066 (between 12-9pm) or visit
www.mermaids.freeuk.com
