by Lisa Marchiano

Lisa Marchiano, LCSW, is a psychotherapist and certified Jungian analyst. She blogs on parenting at Big Picture Parenting, and on Jungian topics at www.theJungSoul.com. You can also find her at PSYCHED Magazine and @LisaMarchiano on Twitter. Lisa has contributed previously to 4thWaveNow (see “The Stories We Tell,”  “Layers of Meaning” and “Suicidality in trans-identified youth”).

Lisa is available to interact in the comments section of this post.

Rates of gender dysphoria in children and young people have increased dramatically in a short period of time. There is some evidence that significant numbers of those who experience dysphoria are gifted.

Since 2016, I have been consulting with families with teens or young adults who identify as transgender. Nearly all of these parents report that their child is bright or advanced, and a significant majority have shared that their transgender-identifying child was formally assessed as gifted. Four of these families report children who tested in the profoundly gifted range (verbal and/or full scale scores >150).

An investigator who presented as-yet unpublished research at the Society for Adolescent Health and Medicine conference this year described a population of adolescents and young adults presenting with a rapid onset of gender dysphoria (an abrupt onset of symptoms with no history of childhood gender dysphoria). Of the described population of 221 AYAs, nearly half (49.5%) had been formally diagnosed as academically gifted, 4.5% had a learning disability, 9.6% were both gifted and learning disabled, and 36.2% were neither.

This is a curious correlation. Could it be that gifted young people are more likely to experience dysphoria? Or is it rather that parents of gifted children are more likely to seek out my services or respond to surveys? My best guess is that it may be a little of both.

Possible Reasons for Increased Incidence of Gender Dysphoria Among the Gifted

• Correlation with Autism Spectrum Disorders

Among those with Asperger’s, there is a higher proportion of giftedness than in the general population, and there are many overlapping traits between Asperger’s individuals and gifted individuals. This is especially true for the exceptionally or profoundly gifted. It has been suggested that as many as 7% of people with Asperger’s syndrome are gifted, compared with 2% of the general population who are gifted.

Those working with gender dysphoric youth have remarked on the significant proportion of those seeking treatment who carry a diagnosis of ASD. A 2010 Dutch study found that the incidence of ASD among children referred to a gender identity clinic was ten times higher than in the general population. At the UK’s only gender identity clinic for children, a full 50% of the children referred are on the autism spectrum.

A 2017 survey of 211 detransitioned women found that 15% were on the autism spectrum. This is 29 times higher than the rate of autism among females in the general population. Many of the survey responders felt that their autism contributed to their belief that they were transgender. For example:

I would absolutely not be trans if it were not for my autism spectrum features, which caused me to be grouped with boys in my youth because I was a “little professor” who lacked the ability to perform socially and emotionally in the way girls are supposed to.

And:

I think autism had something to do with my childhood difficulties relating to other girls and understanding/performing femininity. Traits like difficulty socialising, extreme focus on very specific interests etc seemed more acceptable once I framed myself as a boy.

• Gender Atypical Preferences Among the Gifted

Research has shown that gifted children are more likely to exhibit gender atypical preferences. Gifted boys and girls may have wide and varying interests that do not conform to gender stereotypes. It is this author’s observation that most teens who self-diagnose as transgender do so on the basis of gender stereotypes. Liking video games rather than nail polish is interpreted as evidence that one is a boy, and so on.

• Awareness of Difference; Bullying

Gifted children often have particular social needs and struggles. Even at a young age, gifted kids can have a sense of being different from everyone else without understanding the reasons for this difference. Feelings of isolation and loneliness can result. These feelings can be especially intense for profoundly gifted kids, or for kids who are both gifted and learning disabled (twice-exceptional). Because the experience of the gifted child can be so qualitatively different from those of his or her peers, gifted children may struggle with social isolation.

It seems plausible that some of the gifted transgender-identifying teens whose parents I have consulted with have come to understand themselves as trans, in part, as a way of explaining their pervasive sense of difference. “I was never like the other kids. I always knew I was different, I just didn’t know why.”

Being different can also bring with it negative social attention, including bullying. The blogger, detransitioner, and PhD psychology student ThirdWayTrans has shared his story on his blog. Diagnosed as profoundly gifted and radically accelerated in certain subjects, ThirdWayTrans found himself to be the victim of violent bullying throughout much of his childhood. He transitioned at 19 and lived as a woman for 20 years before coming to the realization that his gender dysphoria and desire to transition were linked to the traumatic bullying he experienced.

When I was a child I experienced trauma issues with bullying. When I was young I was physically the slowest boy but also very intellectually advanced like a child prodigy. By fourth grade I was going to the high school to take high school math, and on the other hand I was the weakest. So I was singled out for being a kind of super nerd. This didn’t make me popular at all. It made me popular with the adults actually but not my peers. So I suffered a lot of bullying and violence. It peaked in middle school where every day I would have some sort of violence directed at me.

When I was a child I started to have this fantasy of being a girl, because it meant I could be safe and not suffer from this violence due to being at the bottom of the male hierarchy. I could also be more soft. I used to cry a lot and that was also something that was not seen as good for a boy. I could be free of all of that and also still be intellectual because everyone was saying that girls can be smart too.

ThirdWayTrans notes that as an adult, he understood intellectually that it was okay for men to be vulnerable and “feminine,”  but that his internalized child perspective made it feel unsafe for him to let go of his trans identity.

• Existential Questioning

Questioning one’s gender may go along with a predisposition to question one’s place in the world. Gifted children tend to question traditions critically, and to challenge things that others take for granted. Thinking about one’s identity may come more naturally to gifted kids.

• Perfectionism and Anxiety

Gifted children may suffer from anxiety and perfectionism. Anxiety disorders were also well-represented among the comorbid issues reported in the detransitioners survey mentioned previously. It has been suggested by some that adopting a transgender identity may in some cases be an anxiety management strategy. I am familiar with one young man with dysphoria who is both gifted and learning disabled. His preoccupation with gender waxes and wanes, but is predictably worse during exam periods, when he tends to fall behind and become overwhelmed. The feelings of dysphoria seem to allow him to distract himself from his feelings of intense anxiety and insecurity, while alleviating some of the academic pressure. When he is suffering from increased distress over gender dysphoria, his teachers and parents are more focused on his mental well-being, and they place fewer demands on him.

Outcomes

Currently there is very little data on long-term outcomes for gender dysphoric youth. To date, there is only one study that examines outcomes for those who pursued medical transition as minors. The study followed 55 individuals who pursued medical transition as minors, and showed that at one year post operation, study subjects evidenced positive outcomes according to several measures of mental health. However, it is important to note that the individuals followed in this study were carefully chosen, screened, and followed according to a strict protocol. All of those in the study had histories of lifelong gender dysphoria. It is a big leap to generalize these findings to teens exhibiting sudden onset gender dysphoria, and who may receive minimal assessment and counseling before starting hormones or undertaking other interventions.

I am aware of young people transitioning whose families report a decrease in symptoms and an improvement in academic and vocational functioning post transition. However, in my experience, this is the exception rather than the rule. Of course, families seeking my assistance are doing so mostly because of poor outcomes, so I hardly see a representative sample. Nevertheless, certain patterns have emerged through my work with parents.

Most parents with whom I have consulted have teenage children with rapid onset gender dysphoria. (In other words, their child did not exhibit any dysphoria until adolescence.) Most parents supported a social transition, allowing their child to change names, pronouns, gender presentation, etc., but drew the line at medical intervention (hormones and surgery) until adulthood. Most of the parents I have worked with noted one or more of the following changes subsequent to their child’s social transition: worsening gender dysphoria as the child became increasingly preoccupied with passing; decreased academic or vocational functioning – declining grades, etc.; increased social isolation as child spent more time on transgender internet sites, or spent time exclusively with transgender friends; worsening overall mental health evidenced by increased anxiety, self-harming behaviors, and/or depression; constriction of interests as the young person ceased to pursue pastimes and activities that had once been important to him or her; and worsening family relationships, including increased tension and anger between parent and child.

I have also known of gifted young people who desisted from a transgender identity. These young people had parents who were loving, engaged, and supportive, but who assisted them in questioning their belief that they were the opposite sex. Though the sample size is small, those who desisted from identifying as trans appeared to benefit from improved family relationships, increased social and academic engagement, and overall better mental health than during the period of transgender identification.

Conclusion

Currently, there is very little research into long-term outcomes for gender dysphoric young people. My observations indicate that a disproportionate number of those families seeking consultation with me have a transgender-identifying teen who is also gifted. There are many possible reasons for this confluence. Assessment and treatment for gender dysphoria in teens should take into account the various motivations that might influence a young person to self-diagnose as transgender. Families should be encouraged to support their child in ways that feel most appropriate to them, taking into account that a one-size-fits-all treatment for gender dysphoria is likely not suitable at this time. Further research is needed into causes and treatments.