When Biological Sex and Gender Identity Don't Align in Children
The extent to which the alignment between biological sex and gender identity is reinforced in psychological theory and counseling practices is dramatically illustrated in the treatment strategies employed by medicine and psychiatry with children.
We explore the ways in which the psychiatric and medical professions have treated children who either defy our assumptions about the relationship between biological sex and gender identity or have gender dysphoria (defined as psychological discomfort with one’s biological sex), often diagnosed as gender identity disorder (GID). Beginning in the 1960s, researchers explored gender variance in children, mostly boys. The leading researchers in this area—Richard Green, John Money, Robert Stoller, and Bernard Zuger—argued that gender-variant children were at greater risk of becoming homosexuals, transvestites, or transsexuals (Bryant, 1996).
A treatment approach used in GID cases to help children accept their biological sex and associated gender identity is termed rehabilitative treatment (Hill, Rozanski, Carfagnini, & Willoughby, 2005; Raj, 2002). George Rekers, Susan Coates, and Kenneth Zucker are considered leading proponents of rehabilitative treatment of GID. Supporters of this reparative therapy argue that ultimately it helps defend against the negative effects of the social ostracism that gender-nonconforming children typically experience. Reparative treatment incorporates behavioral techniques (e.g., Rekers, 1995; Zucker & Bradley, 1995). One behavioral strategy known as play reconditioning (Rekers & Lovass, 1974) requires children to wear wrist counters when playing with same-sex-typed toys. While playing, they earn points they can exchange for rewards or privileges. “Bug-in-ear” devices are also used to communicate and guide the play of children diagnosed with GID. In this “treatment,” professionals who are observing communicate via a transmission device in the child’s ear: e.g., “No, Charlie, put down that doll. Pick up the truck.” Rekers describes the use of these techniques in Handbook of Child and Adolescent Sexual Problems (1995), which was used in the 1990s to assist pediatricians with the diagnosis and treatment of gender identity disorder in children (Burke, 1996).
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