Serving Transgender and Gender Diverse Students in Schools

1
Serving Transgender and Gender Diverse Students
in Schools

• Colt Meier, MA, LPA
• Clinical Psychology
• Doctoral Candidate
• Texas Licensed Psychological Associate

2
Acknowledgements

• Jo Olson, MD
• Diane Ehrensaft, Ph.D.
• Walter Meyer, MD
• NASP and TASP

3
Introduction

• Diversity in gender expression in children
• Families and schools are seeking to accommodate
  transgender and gender diverse children
• Social Transitioning

4
Objectives

• To develop a common language
• To review gender development
• To review current literature and perspectives on
  these children as well as the role of school
  psychologists who work with them

5
Gender, gender, gender

• Lack of awareness (benign ignorance)
• Did you want to be a prince or a princess when
  you were a child?
• Can you think of any gender different kids in
  your school as you were growing up?

6

• What happened to the child(ren) who did not fit
  these boxes in your schools?
• What happens to these kids now?

7
When School Starts

• Adults and kids begin to enforce gender normative
  preferences and behaviors
• Bullying, physical violence, unsupportive
  schools, and parents serve to repress these
  behaviors
• The more gender diverse a child is, the more
  likely they are to be victimized or abused at
  school (Grossman, DAugelli, Howell, Hubbard,
  2005)
• The time around puberty can differentiate trans
  from LGB youth

8
Language and Terminology(Crooks Baur, 2010)

• Physical, Biological, or Anatomical Sex
• Gender Identity
• Internal
• Child usually voices gender
• between 2 and 5 years old
• (Zucker Bradley, 2005)
• Gender Expression
• External

9
Language and Terminology

• Gender Diversity (non-conformity/variance)
• Gender expression differs from cultural
  expectations
• clothing, hair, play

10
Gender Diverse Girls (Olson, 2012)

• Insist on wearing boys clothes and having short
  hair
• Refuse to wear skirts, dresses, and female
  bathing suits
• Prefer boy playmates and interested in
  rough-and-tumble play
• May express desire to be a boy, announce that
  they really are boys, enjoy being mistaken for a
  boy

11
Gender Diverse Boys (Olson, 2012)

• Interested in girls clothes, shoes, hair, and
  make-up
• May wish to have or pretend to have long hair,
  prefer girls as playmates, avoid rough team
  sports
• May have expressed a desire to be a girl or said
  that they were a girl
• May be disgusted with penis

12
Language and Terminology

• Transgender
• Individual whose gender identity does not match
  their assigned birth sex
• Start noticing between 2-6, is consistent usually
  by 7
• MTF, FTM, etc.

13
Language and Terminology

• Gender Diversity
• Gender non-conformity
• Gender variance
• Transgender
• Gender Dysphoria

14
Language and Terminology

• Sexual Orientation
• Refers to romantic, emotional, and/or sexual
  attractions
• All people have a sexual orientation
• LGB youth may or may not be gender non-conforming
  in gender expression

15
Language and Terminology

• Gender fluidity
• Flexible range of gender expression
• Shifts over time
• Genderqueer
• Tends to refer to adolescents or adults who
  embrace a fluidity of gender expression
• Refers to gender identity as male sometimes,
  female sometimes, or belief that neither male nor
  female identifies them appropriately

16
Language and Terminology

• Asserted Male or Trans Boy
• Child who was assigned female,
• but has male gender identity
• Transgender male
• Asserted Female or Trans Girl
• Child who was assigned male, but has
• female gender identity
• Transgender female

17
Language and Terminology

• Social Transition
• Living in asserted gender
• Clothes, hairstyle, names, pronouns
• Gender expression in line with gender identity
• Fully reversible
• Controversial for children

18
Language and Terminology

• Social Transitioners
• Body distress or disphoria
• History of or current self-harm/suicidality
• Impaired social/academic and familial functioning
• Common diagnoses include depression, social
  anxiety, ASDs, school refusal
• 3-5 years of consistent, insistent, and
  persistent cross gender identity and expression

19
Adolescent Presentations

• History of consistent, insistent, and persistent
  gender diversity into adolescent years
• Adolescent with no history of gender
  non-conformity, yet gender dysphoria with onset
  of puberty

20
Gender Development

• Prenatal
• Once genitalia are developed the child is
  assigned a gender
• Differential treatment begins
• Birth to age 3
• Gender labels applied by parents/others.
• Frequent reminders of gender
• gendered behaviors are encouraged
• basic gender identity and preferences emerge.

21
Gender Development

• Age 3 to age 6
• Gender expectations consolidate male and female
  scripts
• typical gendered behaviors are imitated
• Age 7 to puberty
• gender consistency usually by age 7
• children begin to rely less exclusively on gender
  scripts/expectations
• Children begin to look to the behavior of models
  consistent with internal gender identity

22
Gender Development

• Puberty and beyond
• re-examination of self-concepts
• forming an adult gender identity
• Social pressures, changing social dynamics, and
  their identity is continually solidifying.
• This constitutes another developmental time for a
  transgender identity or gender variant self
  expression to emerge.

23
Transgender Development

• Prenatal
• not sure
• Birth to age 3
• very common to see that their child is
  significantly gender variant.
• Listen for assertions from the internal sense of
  self of the child.
• Im a boy the response is usually no youre
  not, boys have pensises or youre just
  confused.
• Theres nothing to figure out at this age.

24
Transgender Development

• Age 3 to age 6
• consistent, persistent, and insistent in
  assertion of gender identity.
• this isnt a phase and it is clear.
• Some families choose to have their child undergo
  a social gender transition before entering
  kindergarten.
• Age 7 to puberty
• transgender identity consistent.
• Developmentally, trans kids are rarely on time

25
Transgender Development

• Puberty and beyond
• Large age range in puberty/onset of puberty.
• Emergence of the awareness of sexual orientation.
  
• A child may be struggling with gender identity,
  expression, and sexual orientation.
• Need to work quickly, but you dont want to make
  a mistake or act too quickly.
• A lot of time the crisis here is a silent crisis.

26
Common Questions

• Are kids too young to know what their gender is?
• Will they grow out of this?/Is this a phase?
• Are they seeking attention/Is this real?
• Do kids take hormones?
• What about the bathroom issue?
• How can I get other people to use different name
  or pronouns if they are not legal?
• What about my religion?
• How common is this?

27

• Arent kids too young to know what their gender
  is?
• Actually, gender identity develops around
  ages 2 to 5 (Zucker, 2005), that's why we begin
  training allies in elementary school settings. We
  are not talking about sexual orientation, which
  is thought to develop closer to puberty.

28

• What about the bathroom issue?
• This situation is only as big of an issue as we
  make it. There are many creative options if the
  school won't allow the child to use the bathroom
  they feel most comfortable in. It is important to
  ensure safe access to the identified bathroom. In
  these cases, it is usually the transgender
  child's safety that is really in question not
  the safety of other students. There are more
  reported situations of transgender people being
  harmed in bathrooms than of transgender people
  harming others in bathrooms. Many schools allow
  transgender students to use the nurse's bathroom,
  however this may not be optimal.

29

• How can I get other people to use different name
  or pronouns if they are not legal?
• This may not be possible in all cases. Some
  schools have ARD meetings for trans kids to
  provide the Other Health Impairment label with
  GID as their diagnosis and include using the
  child's asserted names/pronouns and the child's
  asserted gender bathroom and dress code as part
  of the behavior plan. If not possible, it will be
  helpful if as many people as possible referred to
  the child with their desired name/pronouns.

30
This does not align with my faith. Thats ok,
you do not have to reconcile that with your
faith. In order to keep this child alive and
safe, keep these feelings away from the child.
Children who are supported by even just ONE adult
(parent, teacher, coach, grandmother) showed
decreased risk factors such as homelessness,
self-esteem suicidality, depression, drug use,
STIs. Reparative therapies to change these kids
have iatrogenic effects and are over 95
ineffective.
31

• Prevalence
• How common is this?

32
Recent Prevalence Statistics
33
Prevalence of Gender Diversity

• Best estimate right now is 1 in 500 to 1-in 2000
  individuals experience some type of gender
  dysphoria or gender diversity.

• Gender diversity may be expressed differently at
  different developmental stages
• Gender diversity does not equal a diagnosis of
  Gender Identity Disorder

34
Etiology

• No definite answers
• Things that do NOT cause a child to be
  transgender (Brill Ryan, 2009)
• divorce, neglect, wishing you had given birth to
  the other sex, using fertility drugs to conceive,
  encouraging your child to play sports too often
  or not enough, or other parental thoughts,
  behaviors or experiences
• But science is showing that transgender children
  are most likely born that way

35
Biological Basis
Rametti et al., 2010a
Rametti et al., 2010b
36
Table Time Discuss

• Gender Talk
• Share ideas about how to effectively discuss
  these children with teachers, staff, and students

37
DSM-5

• Gender Identity Disorder?
• Incredibly controversial
• Gender Incongruence/Gender Dysphoria
• First and Second proposed revision
• The Good and the Not So Good

38

• 87 verbally and 53 physically harassed due to
  their gender expression
• 26 physically assaulted due to their gender
  expression
• 40 heard school staff make negative comments
  about someones gender expression.
• 11 school staff intervened when hearing
  negative remarks about someones gender
  expression.

39

• 54 reported events where they were victimized
  at school
• 67 of those who reported the event believed
  that the school did not address it appropriately
• Almost 50 reported skipping school because they
  felt unsafe or uncomfortable

40

• Victimization, rather than gender non-conformity
  predicts negative psychosocial adjustment
• Recommendations include
• - policies and procedures and implementation
• provide education
• provide the opportunity for a social or support
  group
• structural suggestions

41

• Many gender-based rites of passage
• Physical education, pressure to date, classes
  that track the specific sexes, and the prom
• Pressures at school lead to further isolation of
  transgender youth

42
(No Transcript)
43
(No Transcript)
44
Research Netherlands

• Developmental outcomes of GV/TG kids seen from
  1989-2005 Mean Age 8.4
• 12 of the 40 (30) trans girls and 9 of 14 (64)
  the trans boys persisted after age 16 and
  requested gender affirming treatment.
• Of those who desisted (28 boys and 5 girls),
  almost all noted that their feelings and
  preferences stopped upon entering middle school.
• Those who persisted displayed more consistent and
  persistent gender variance and dysphoria.

45
Research Netherlands

• MMPI study (de Vries et al., 2011)
• Comparing Adolescents to Adults
• GnRH study (de Vries et al., 2011)
• 70 trans youth age 12-16
• Improved psychological functioning
• No change in gender dysphoria until after they
  began cross-sex hormones
• None withdrew
• All went on to make a gender transition

46
Research USA Ryans best practices

• Change files/documents to youths preferred name
  and pronoun.
• Use the name and pronoun preferred by the youth
  and REQUIRE other youth to do the same.
• Avoid using unnecessarily segregating activities
  according to gender.

47
Research USADamaging Parenting Practices

• Physical or verbal abuse to punish gender
  variance
• Excluding the child from family activities
• Blocking access to other gender variant or
  gay/lesbian friends, activities, resources
• Blaming the child for the discrimination they
  face
• Parental denigration and ridicule
• Religious-based condemnation
• Distress, denial, shame
• Silence and secrecy
• Pressure to enforce gender conformity

48
Research USAEffective Parenting Practices

• Establishing a supportive family environment
• Acting as agents of change, advocates
• Finding a unified parenting approach
• Requiring respect
• Expressing love and support for childs gender
  expression

49
Referrals

• School victimization/Bullying, Address bullying
  in MULTIPLE areas in hallways, bathrooms,
  playground, if victim denies bullying occurred,
  maybe at risk/danger for after school beating.
• suicide
• self-mutilation
• referred for sexual orientation instead of gender
  issues
• social anxiety
• ASDs

50

• Be aware of the possibility of violence both in
  school and in the family
• Be ready to reach out to family members to
  provide education, information, and support
• Help parents understand the childrens desires
  and behaviors are natural to them
• Help parents develop strategies to address
  questions from neighbors and community about
  their child

51

• Identify resources for these children, provide
  them where there are none
• Assist parents in developing mutually acceptable
  compromise strategies
• Assist transgender children with developing
  coping strategies for dealing with societal
  stigmatization, name-calling, and discrimination
  (THIS SHOULD NOT BE THE MAIN INTERVENTION!)
• Treatment for depression and associated
  difficulties should not attempt to enforce gender
  stereotypical behavior

52
Most Important Needs(Riley, Sitharthan, Clemson,
Diamond, 2011)

• To be accepted and supported
• To be heard, respected, and loved
• To have professional support
• To be allowed to express their gender
• To feel safe and protected
• To be treated and live normally
• To have peer contact
• To have school support
• To have access to puberty-delaying hormones

53
Working with Families

• Assess thoroughly - behaviors, beliefs,
  appearance, preferences, sense of self,
  consistency, how long
• Assess all possible outcomes for child
• Identity child stress levels and sources
• Evaluate for psychological disorders
• Assess the level of upheaval of all family
  members
• Inventory parenting practices
• Identify where each family member is
• Clarify your role as therapist, advocate, coach
• Help the family identify destination and map
• Get on the same page with confidentiality
• Develop referral network of gender sensitive
  professionals

54
Working with SchoolsCreating a Supportive
School Culture

• Consult with the leadership team
• What are their concerns? What information do they
  need? What are the laws that need to be
  addressed?
• Meet with school staff about gender issues and
  tolerance of gender broadness
• Not about the specific child varies case by case
• Meet with parent groups
• Not to try to change their opinions about gender
  variance
• To get support for treating all children with
  kindness and respect
• To introduce them to a parent who is similar in
  demographics and raising a transgender child
• In-class presentations, if possible

55
Recommendations for Schools (Lev Alie, 2012)

• Create an environment where gender exploration is
  normative and gender diversity is encouraged
• Develop gender affirming policies
• Educate staff about gender identities
• Use the youths preferred name and pronoun
• Provide information and resources
• Avoid gender segregation
• Consult, consult, consult

56
Working with SchoolsAddressing Administrative
Concerns

• Adopt zero tolerance for discrimination
• Update policies and forms
• Honor preferred names and pronouns
• Develop guidelines for transgender students
• Provide on-going training
• Ensure bathroom safety for all students
• Document harassment
• Provide resources and support for parents
• Evaluate schools gender sensitivity periodically

57
Warning Signs indicate its time to work faster

• Asserted boys (externalizing) frequently
  violent, punch holes in walls especially during
  menstrual cycledesires for multiple tattoos.
• Asserted girls (internalizing) withdrawing,
  becoming socially absent, computer and science
  focus, living through anime.
• At lot of time the crisis here is a silent
  crisis. Sometimes teenagers will tell parents
  right before they are planning on killing
  themselves.
• Kid will express it and then wont talk about it

58
Cases

• High functioning high school youth who is blocked
  from PE and debate conference.
• GT student in middle school with suicidal
  ideation and questionable parent support
  questionable/religious condemnation.
• Elementary school male child presents as
  extremely socially anxious, you see them for
  counseling and learn that the child wants to be a
  girl

59
Resources

• Gender Spectrum Education and Training
• http//www.genderspectrum.org
• Family Acceptance Project
• http//familyproject.sfsu.edu
• PFLAGs Transgender Family Site
• http//pflag.org/Our_Trans_Children_-_Intro.otc.0.
  html
• Legal Resource for Transgender Youth
• http//www.transgenderlawcenter.org
• Childrens National Hospital Gender and Sexuality
  Psychosocial Program
• http//www.childrensnational.org
• Trans Youth Family Allies
• http//www.imatyfa.org
• GLSEN
• http//www.glsen.org