Abstract
This chapter focuses on using the child life competencies to support transgender/gender expansive children and their families. The chapter highlights challenges families face and addresses the important support they need, helping families identify coping skills and model peer interactions related to gender identity. Additionally, it is intended to provide child life specialists with foundational knowledge about gender identity which will guide and influence their work when they support children who are transgender or gender expansive.
TopIntroduction
Imagine a five-year-old who was assigned male at birth, but has explained time and time again that he loves “girl things.” His preference for all things pink and sparkly is accepted by his family. They reassure him that girls and boys play with all sorts of toys, he can choose whatever toys he likes, and they will always love him. The five-year-old is a smart, creative, kind-hearted, cooperative child and a wonderful older brother.
Then the five-year-old starts kindergarten and struggles to make friends. He isn’t interested in playing with the boys, and the girls think that it’s strange that a boy wants to play princesses. The five-year-old becomes more and more aware that he is “different” from his classmates. With this increased awareness comes great anxiety and loneliness; the once happy, secure child slowly disappears. This child comes home in tears, begging not to go back to school. He begins to have difficulty sleeping, and for the first time in his life he is beginning to have massive tantrums almost daily. He starts asking his parents, “What is wrong with me? I hate myself! I hate this world!” His parents have a feeling that all of this is related to their child’s gender expression, but avoid the complicated possibility. Then one night, crying in his mother’s arms, the five-year-old states,“I wish that we could go to Disney World and meet a Fairy Godmother and ask her to turn me into a girl. It’s too hard to live like this.” The parents must face reality and recognize their child may be transgender.
The statistics on suicide within the transgender community terrify these parents. They know every year transgender people are assaulted and killed based on their identity. They fear their child and family may be rejected and harmed. They are consumed with anxiety. How will our extended family react? How will our community respond? What will our coworkers think? What does the future hold for our transgender child and family?
These are just a few of the many questions and fears parents may ask upon discovering their child is transgender/gender expansive. Unfortunately, there are limited resources for young children and families trying to better understand gender identity. Parents may search the internet for helpful information, but when one’s child suffers with gender dysphoria, often what a parent seeks most is someone who can guide them through their unique journey. They need someone who knows their child, who understands child development, gender identity, and who can provide individualized care. Such specific psychosocial, developmental support can be difficult to find, even in large metropolitan areas. However, child life specialists armed with knowledge regarding gender identity have the clinical skills to fill this unmet need in any setting.
In 2019, applying supported evidence and personal experience, a child life specialist and mother of a transgender child created Caterpillar Child Life, a non-traditional child life practice that helps meet the needs of young transgender/gender expansive children. Caterpillar Child Life provides individual and group support to children, parents, and siblings navigating transgender/gender-expansive identity. Using play, education, expressive arts, coping techniques, and connections with peers, Caterpillar Child Life helps transgender/gender expansive children thrive despite the many challenges stacked against them. This chapter highlights the common needs of this population, resources available, and how Certified Child Life Specialists (CCLS) can serve this unique population. Additionally, the chapter provides specific information needed to best support transgender/gender expansive children and their families.
Key Terms in this Chapter
? Social Gender Transition: Social steps that can be taken by transgender people to live more fully as their true gender identity. These steps might include changes in their physical appearance, clothing, name, and/or pronouns.
Cisgender: An adjective that describes people whose gender identity matches their assigned sex at birth.
Nonbinary: An adjective that describes a person who does not identify exclusively as a man or a woman. Non-binary people may identify as being both a man and a woman, somewhere in between, or as falling completely outside these categories. While many also identify as transgender, not all non-binary people do. Non-binary can also be used as an umbrella term encompassing identities such as agender, bigender, genderqueer or gender-fluid, gender nonconforming, or gender-expansive.
Gender: Complex relationship between physical traits and one’s internal sense of self as male, female, both, or neither (gender identity), as well as one’s outward presentation and behaviors (gender expression).
Gender Identity: Our deeply held, internal sense of self as masculine, feminine, a blend of both, neither, or something else. One’s gender identity can be the same or different from their assigned sex at birth.
? Legal Gender Transition: Legal steps that can be taken by a transgender person to live more fully as their true gender identity. This may include a legal name change or legal change of their gender marker on the birth certificate, passport, driver’s license, and other government identification.
Gender Fluid: Refers to a person who does not identify with a single fixed gender or has a fluid or unfixed gender identity. People that are gender fluid may move between genders depending on the setting, the day, or who they are with. They experience gender as something that is dynamic and changing rather than static.
Transgender: An adjective describing people whose gender identity does not align with their assigned sex at birth. It can be used as an umbrella term for people whose gender identity and/or expression is different from cultural expectations based on the sex they were assigned at birth. Being transgender does not imply any specific sexual orientation. Transgender individuals also can be described as gender creative, gender expansive, or gender non-conforming.
Gender Dysphoria: Distress experienced when a person’s assigned sex at birth does not align with their gender identity. Gender dysphoria can range from mild discomfort to unbearable distress. The intensity, frequency, and triggers of gender dysphoria can vary widely from person to person and change over time as one transitions socially, medically, and legally.
Sexual Orientation: Describes an individual’s enduring physical, emotional, romantic, and/or spiritual attraction to another person. Gender identity and sexual orientation are not the same.
Gender Creative: Another term for gender expansive, gender non-conforming, or nonbinary.
Assigned Sex at Birth: The sex (male or female) assigned to a child at birth, based on the child’s external anatomy. Also referred to as birth sex, natal sex, biological sex, or sex.
? Medical Gender Transition: Medical steps that can be taken by a transgender person to live more fully as their true gender identity. These steps might include the use of puberty blockers, hormone therapy, and/or gender-affirming therapies.
Gender Expression: Refers to the external appearance of one's gender identity, usually expressed through behavior, mannerisms, clothing, hairstyles, and voice. A person’s gender expression may or may not conform to socially defined behaviors and characteristics typically associated with being either masculine or feminine.
Sex: In the United States, individuals are assigned “female” or “male” sex at birth, based on physical attributes and characteristics. This assumed physical dichotomy of sex is itself belied by a variety of naturally occurring conditions.
Intersex: One of the three categories that someone can be assigned at birth (male, female, or intersex). People may be assigned intersex at birth due to a variety of differences in their sex traits and reproductive anatomy. There is a wide variety of difference among intersex variations, including differences in genitalia, chromosomes, gonads, internal sex organs, hormone production, hormone response, and/or secondary sex traits. Intersex has more to do with biology than it does with gender, therefore many (and some would say most) people who are intersex do not identify as transgender.
Gender Expansive: Refers to a person with a wider, more flexible range of gender identity and/or expression than typically associated with the binary gender system. Often used as an umbrella term when referring to young people still exploring the possibilities of their gender expression and/or gender identity.
Transition: A series of processes that some transgender people may undergo to live more fully as their true gender. This typically includes social transition, such as changing name and pronouns, medical transition, which may include hormone therapy or gender-affirming surgeries, and legal transition, which may include changing the legal name and gender marker on government identity documents. Transgender people may choose to undergo some, all, or none of these processes.
Gender Nonconforming: A broad term referring to people who do not conform to the traditional expectations of their gender, or whose gender expression does not fit neatly into a category. While many also identify as transgender, not all gender non-conforming people do. The term Gender Expansive and Gender Creative can also be used in place of Gender Nonconforming.