Mental Health Issues in Transgender Children and Children with Gender Dysphoria

Imagine feeling different than how you look, like you don’t belong in the body that you were born in to. Visualize feeling like you should be a different gender, but society is pressuring you to be happy with the gender you are born in to. Try to put yourself in the shoes of a child who feels uncomfortable because society forces them to play into strict gender roles the day they are born. Now, finally, think about how hard this must be for a child to go through when their parents, their peers, their surroundings, and society does not accept them for who they are. Being bullied for wanting to look on the outside, the way they feel on the inside, is something that can happen to transgender children or children with gender dysphoria. According to Miller (2020), “Young people who are transgender feel powerfully that they wish to be — or are — the other gender. They not only want to dress and act and be accepted as the other gender, but may feel extremely uncomfortable in their bodies, and want to change them, through hormone therapy or surgery, to align with their gender identity” (para. 2). Children who feel they need to be the other gender and want to transition, need proper care and concern. Furthermore, not having the proper education, awareness, or perspective on information related to transgender children or children with gender dysphoria can lead to negative impacts such as mental health issues, or even bullying and stigma from peers, parents, and society in general. It would be a gross understatement to think that it would not have a significant impact on a child’s mental health if they are not being supported. Regardless of age, those who feel a disconnect between their experienced gender and their assigned gender experience a source of profound suffering and distress, the term for this acute distress is gender dysphoria (Miller, 2020). In this paper, I will be discussing mental health issues in transgender children and children who have gender dysphoria.

for lots of people which can consequently have lasting effects on someone's mental and physical health. As stated in an article by Arsenault et al. (2009), "bullied children manifest signs of psychological distress such as worry, sadness or nightmares" (p. 5). Arsenault et al. (2009) go on to discuss other studies that found that victims of bullying show elevated levels of social isolation and depression and that bullying victimization in childhood leads to mental health problems in late childhood or adolescence. This displays that bullying, no matter what it is about, already has an increasing likelihood of depression in a child. "A UK-representative cohort study on young children prospectively collected data on bullying victimization during the first 2 years of schooling and data on adjustment problems 2 years later. The results from this study indicated that victims of bullying…had more internalizing problems and unhappiness at school compared to children not involved in bullying" (Arseneault et al. 2009, p. 7). According to the Canadian Bullying Statistics (2012), 47% of Canadian parents report having a child that is a victim of bullying. Moreover, we can accept that not only is bullying common, but it can have a negative impact on children and their mental health. Childhood is a vulnerable time in someone's life, unfortunately experiences such as bullying can be troublesome for a vast majority of children.
Furthermore, acknowledging that bullying has a negative impact on a child's mental health, I will be discussing the impacts that it has on the mental health of a child who is transgender. As discussed in an article by Luecke (2011), it is only right that we acknowledge how the "traditional school setting in society often presumes that all children will fit in to cultural gender norms based on their anatomy" (p. 2). When children do not fit in to these norms, their life, their school, and everywhere else they spend their time, can potentially be an uncomfortable place which can consequently leave that child's social-emotional and cognitive growth impacted in a negative way (Luecke, 2011). While transgender children not only have to face the potential bullying and unacceptance from their peers, they also have to face it from society in general. According to an article by Field and Mattson (2015), transgender children have to grapple with using gender neutral bathrooms in school, using locker rooms that might not align with their identified gender, and potentially not being allowed to join the gender of sports team they identify with. It is imperative that these children get the support they need in order to be able to live the life that every child deserves. Not having that support from friends or family can evidently have an impact on a child's mental health when they are wanting to, or already have transitioned. "Transgender and gender diverse (TGD) individuals face stigmatization from family members and peers, placing this group at high risk of adverse outcomes including suicidality, substance abuse, and compromised mental health" (Abreu et al., 2019, p. 2).
In the article "Parental Reactions to Transgender and Gender Diverse Children: A Literature Review" by Abreu et al. (2019), they discuss the effects that occur when the parents of a transgender and gender diverse child are not accepting. What Abreu et al. (2019) found is that "a significant number of parents of transgender and gender diverse children are not supportive (at least initially) and fail to intervene or show support when their child is discriminated against and/or bullied" (p.3). This raises the question of why it is so hard for parents to accept their child as a new gender identity when they are supposed to love and accept their child the most. According to an article called "Parenting Transgender Children in PFLAG" by Field and Mattson (2015), for many parents there were four different (and challenging) parts that was associated with raising a transgender child. The first one was the physical changes in their child, the medical or physical experiences transgender children underwent during their transition. These parents not only have to accept their child as a different gender, but it could contain medical steps including hormone replacement therapy, voice therapy, and surgeries such as those to remove or implant breasts (top surgery) or modify genitals (bottom surgery)" (Field & Mattson, 2015, p. 6). This type of change can be very traumatic for a parent. A second part in raising a transgender child was the lack of media representation, for example "despite decades of transgender activism, for the parents in our sample it was their child's coming-out narrative that represented the first time they had ever heard that someone could be transgender" (Field & Mattson, 2015, p. 8). While this is unfortunately the case for a lot of parents, it just reiterates the distress and hardship that gender dysphoria children must have felt when growing up. Not having the education or awareness of transgender people, must have had a detrimental effect on not only the mental health of children, but the mental health of every age of person who wanted to change gender identities. The third part of raising a transgender child was the relational identity of parents of transgender children. This means that parents reported how important their child's sex at birth was to their parental identity because of the "gendered road map for parenting it implied" (Field & Mattson, 2015, p. 9). To elaborate on that, when the parenting style that once was, has to change in relation to their child changing gender, it can be hard for the parents to accept that new person. The picture of the gender of their child at birth now has to be changed and accepted. Children that are transgender not only effects the child's identity but also has an effect on the identity of their parents as well. The fourth part that was associated with parenting a transgender child in this article was how parents had to accept that when their child goes from one gender identity to another. This is not a "success" in which the child wants to stand out, instead the child wants to just fit in and be known for the gender they are now. When the child only wants to be known as the gender they transitioned to, it can consequently throw the parents memories in a "limbo, and erases both the parents emotional labour over the transition and the relationality of their identity as the parents of a daughter or son" (Field & Mattson, 2015, p. 10).
As we can see in this study, when a child becomes transgender, it not only has an impact on the mental health of the child, but also on the parents of that child. Because of the lack of education and awareness of parenting a transgender child, it can have some lasting effects on everyone involved. According to an article about the "Bullying that Transgender Kids Face", it is reported that transgender children are two to three times more likely than their peers to be bullied. Not only that, but from a 2012 survey, 61% of students have heard their peers making negative remarks about gender expressions and 27% of students face physical abuse because of their gender expression (Villines, 2018). To conclude what I have discussed, transgender children, and children with gender dysphoria, can face a lot of stigmatization and bullying. If these children do not have the support and encouragement from those around them, it can lead to negative consequences in their mental health such as depression, anxiety, and even suicidal thinking and attempts. While there is not a lot of research done with large groups of transgender children, it is imperative to acknowledge that there is a positive correlation between mental health and the support that these transgender children and gender dysphoria children feel.
Bullying and unacceptance of anything and for everyone is hard to go through, but when it comes down to being stigmatized and uncomfortable for who you are as a person, there is no wonder that these children could be at high risk of mental illness. While transgender children experience this hardship, those who are accepted by those around them perpetuate this difference in mental health. "Parental acceptance serves as a protective factor and is correlated with increased well-being for transgender and gender diverse (TGD) individuals" (Abreu et al., 2019, p. 3). For example, in a "study of 84 TGD youth, participants who identified their parents as supportive of their gender identity and expression in childhood reported higher life satisfaction, higher selfesteem, fewer depressive symptoms, and less suicidal ideation compared to participants with nonsupportive parents" (Abreu et al. 2019, p. 3). Recognising that supportive parents of TGD children can have a significant difference, it reinforces this idea that support for transgender children can have a positive impact on the child's mental health.
In an article called "Mental Health of Transgender Children Who Are Supported in Their Identities", Olson et al. (2019) did a community based national sample of 73 transgender, prepubescent children ages 2-12 years old, along with a control group of 73 non-transgender children in the same age range. A third control group was also set, which was of 49 siblings of the transgender children who were also in the same age group. The objective of this study was to see if the mental health of socially transitioned transgender children were similar or different to nontransgender children. The results of this study done by Olson et al. (2019) were that transgender children who were supported in their identities showed no elevation in depression as they did not differ from the population average. In regard to anxiety symptoms that these children felt, their mean anxiety symptoms were not in the clinical range but were slightly elevated when compared to the population average. There is growing evidence that suggests that that "the possibility that social transitions in children, a form of affirmation and support by a prepubescent child's parents, could be associated with good mental health outcomes in transgender children" (Olson et al., 2019, p. 2). When children feel as if they are comfortable and able to fully express their gender identity, there is positive impacts on their mental health. As stated by Olson et al., "allowing children to present in everyday life as their gender identity rather than their natal sex is associated with developmentally normative levels of depression and anxiety" (2019, p. 5). Furthermore, this same article by Olson et al. (2019) also discussed other studies on children with gender identity disorder. Gender identity disorder (GID) is defined as "those who (1) identify as (not merely wish) they were the "opposite" gender as their sex at birth and (2) have socially transitioned so that they appear to others as the gender they feel, rather than that assumed by their sex at birth" (Olson et al., 2019, p. 3). What they examined were studies of children with gender identity disorder reported "high rates of psychopathology, especially internalizing disorders such as anxiety and depression" (p. 2). For example, 36% of a group of 7-to 12-year-olds with GID reached the clinical range for internalizing problems" (Olson et al., 2019, p. 3).
In contrast, there were two smaller studies suggesting that children who are supported in their gender identity have good mental health. One of these studies involved 26 children ages 3 to 12 years old with GID in which they were recruited to see how their mental health would be if the parents showed support for their child's gender identity and expression. What they found was the support from the child's parents resulted in reduced rates of psychopathology when compared to other studies where gender expression was not supported (Olson et al., 2019, p. 2). Psychopathology refers to the "scientific study of mental illness, along with the factors which may contribute or be relevant to such disorders" (What is Psychopathology, 2015). In conclusion of this study by Olson et al. (2019), and to reinforce my hypothesis, "transgender children supported in their identities had internalizing symptoms that were well below even the preclinical range" (Olson et al., 2019, p. 5). These findings suggest that familial support in general, or specifically via the decision to allow their children to socially transition, may be associated with better mental health outcomes among transgender children" (Olson et al., 2019, p. 5).

Conclusion
Bullying, and the feeling of not being accepted, is an experience that can have detrimental effects on anyone. These effects can cause many mental health issues for a child, no matter the age or gender identity. When a child feels as if they do not fit in or belong, it can be hard to cope with and can have lasting psychological effects. Transgender children, and children with gender dysphoria, unfortunately have to endure the feeling of not fitting in, in more than one sense. Not only do they feel as if they don't fit in with the other children, but they also feel like they don't belong in the gender of their body that they were assigned to at birth. It would be ignorant to not acknowledge that transgender children and children with gender dysphoria, need support in order to fully embrace a life with the gender identity they feel like they belong to. Transgender children and children with gender dysphoria are not only faced with issues such as playing on sports teams, using certain bathrooms, or being accepted by their peers, but they also have to cope with their parents and the rest of society who may or may not struggle with accepting them as a different gender identity that they were born in to. As I have discussed in this paper, it is clear that transgender children, and children with gender dysphoria who feel supported and accepted, have higher levels of well-being and on average have the same mental health status as children who are not transgender. Therefore, while transgender children and children with gender dysphoria may have to configure an unfortunately difficult process and experience, being accepted for who they truly are, and feeling comfortable in their body, results in positive mental health. As discussed by Field and Mattson (2016), "the growing acceptability of transgender representation in mass media, and the increased comfort younger people seem to have with transgender and genderqueer identities and behaviors, suggests that sometime in the future-perhaps the near futuretransgender people will finally be accepted as full, equal members of society" (p. 15). All that children want is to be accepted and loved for who they are, and unfortunately society can still believe that gender should be socially constructed.
Once society can accept transgender children, and children who have gender dysphoria, and support them in their gender identity, expression, and/or behavior, then the results can be a reduction in the mental health issues these children are facing. While there is a lack of large amounts of research on this issue, it is clear to me that there should be more information on the positive effects on mental health that results from transgender children, and children with gender dysphoria, receiving the proper support when wanting to transition or when coping with their feelings of gender expression/identity. If there were larger sample sizes in studies, and more detailed results of how much it positively impacts the mental health of these children, it could result in more awareness and education on the topic of transgender children and children with gender dysphoria. Providing society with more information and more research can potentially help with normalizing children wanting to transition and possibly even reducing the stigma around it.
No child should ever feel as if they do not belong in their body or with a specific gender, being able to have education on this topic can improve the lives of not only the children who are transgender, but also the parents and everyone else involved.