A response to the BBC TV doco: Transgender kids, who knows best?
by Wenn B. Lawson
I am aware of Kenneth Zucker, and of his views. It saddens me that this debate even needs to happen.
The DSM-5 (APA: 2013) (American Psychiatric Association, 2013) is very clear on criteria for gender dysphoria (GD) and criteria for autism (ASD). But, the ICD 10 (International classification of Diseases and Related Health Problems (European equivalent) still calls it gender disorder. This may create some confusion. However, GD is mostly considered to be a biological disposition (therefore, determined before birth) and, although ideas of gender, in the Western world, still tend towards male and female, the ‘and’ between the two hints at gender being a much broader spectrum.
Science is always on a journey discovering and opening doors to understanding along the way. Change and development in our current understanding of gender is threatening to some and they strive to delay or abort it by staying with what they think they know. As our knowledge develops however, so should our practice.
Children, often quite instinctively, know whether they belong in the masculine and/or feminine/or somewhere in between, world, from quite a young age. Of course, each human has both male and female attributes and it’s not a black and white issue. Those born as inter sex individuals often know which ‘gender’ they identify as.. despite having equipment for both. Some individuals move between the two, and are at home with a non-binary gender identity, yet feeling the need to be either/ or on different days. For them this is a seamless activity, but, for others from the perspective of the binary population, it seems strange and is mis-understood.
The more we discover about being human, the more we realise gender is not a binary disposition, but a more fluid one. In children who identify as gender variant or living with GD, if still feeling this way by the time they reach puberty, 99% will go on to identify with the ‘trans’ gender (opposite from) rather than their cis gender (the one assigned at birth).
Zucker’s claims: There are uunderlying psychological and mental issues, not necessary related to GD. These should be explored and children should be guided into living happily with the gender they were assigned at birth.
Comment: ‘Being human and living in a flawed society presents lots of opportunity for children to develop stress and anxiety. Usually such experiences center around poor self-esteem and come from feelings of failure and/or perceived disappointment when comparing ‘self’ to ‘other. If a child has poor self-esteem, with associated stress & anxiety, this always needs addressing.
Issues around gender variance, however, often appear almost innate and, when a parent or individual reflects back they see the discord and disconnection from the cis gender was always there, even before there were words for it. So, gender related stress and anxiety comes more from the dysphoria, not from other underlying issues.
Diagnosing autism is born from assessment of behaviours that form a clinical picture, rather than any blood test or other test. This picture shows the individual has social communication difficulties and exhibits rigid or non-flexible interests and routines. When the picture appears to show this behaviour in connection to GD (e.g. the child rigidly insists they are ‘a boy’ (though assigned female) or ‘a girl’ (though assigned male) a good practitioner will explore the reasoning from different angles, before offering a diagnosis. Autism is one thing GD is another, but, they may co-occur. This also needs exploring if the practitioner sees evidence for both.’
A spokesperson from the Tavistock and Portman NHS Trust said in a statement that gender dysphoria was ‘frequently associated with stress’, especially during puberty. So, if, for instance, if a really young child showed signs of gender dysphoria, would you consider it offensive to suggest to the parents that the child be tested for autism or other psychological mental health issues as well?
Comment: ‘If a parent suspects their child is autistic, usually others have noted ‘issues’ too. The child may have difficulties with school, with forming friendships and being appropriate, or simply they don’t seem to include you in their world. This is a different picture to that seen in GD. Assessing children needlessly for umpteen issues sends a message to the child they are duds, they are bad, they are not normal. I fail to see any good reasoning for doing this. We want our children to feel good about themselves. We need to listen to them.
One of the good things about puberty blockers (if a child says they are trans or are believed to be due to rigorous assessment) is, it buys time for that child. It delays puberty, which gives the individual time. If, as they move into teenage years they change their minds, no harm is done. It is our duty, as professionals, to DO NO HARM..’ To not listen may cause irreversible harm as post-puberty cannot be undone.
As an adult trans autistic male, I didn’t have the words for my dysphoria for a very long time. As autistic individuals we are often delayed in making connections to understanding concepts, especially concepts about ‘self’ and ‘other.’ This is not a lacking in empathy issue, it’s a connection issue. Yes, we can have ‘special interests and one track thinking’ it’s our default setting. However, as we build connections via that default setting, we gain understanding and insight’.