Gender Identity & Sexual Orientation

Is your child questioning gender or sexual orientation?

Is your child:

  • Questioning why he was born a boy?
  • A girl who plays with trucks and hates dresses?
  • A boy with a pink backpack and red nail polish?
  • A teen girl who is not attracted to boys?
  • Feeling sad and withdrawn – won’t go to the dance?
  • Struggling to fit in at school – feels not boyish enough?
  • Identifying with a GLTBQ peer group?
  • Questioning sexual orientation?
  • Questioning gender identity?


A person’s identity is an important part of development. Identity contributes to self-esteem, to visualizing one’s place in the world and to seeing one’s self as different from our parents. Identity begins to emerge very young but is an important component of childhood and an even more important component of adolescence. From this perspective, gender identity also plays a critical role in development.

As psychologists, we wish to support the development of successful relationships, high self-esteem and acceptance of one’s own sense of self. Within this context, it is important to look at gender identity and sexual orientation, not as a psychological problem, but as a part of identity formation that can be impacted greatly by the social views and perspectives that surround the individual.

For example, a child who is questioning identity or identifies as gay may be supported and nurtured in some environments and may be rejected, bullied and isolated in other environments. Rejection can lead to depression, anxiety, suicidal ideation or self-harm.

Children who are Gay, Lesbian, Bisexual, Transgender or Questioning/ Queer (GLBTQ) have approximately twice the rate of suicidal ideation, compared to the general population [1]. This rate tends to increase dramatically when these individuals are bullied or victimized [1] for gender or sexual orientation differences.

In many contexts, identity is a huge part of psychological development, and many times identity formation can be a painful process that very much requires support and nurturing from a family and a community. Understanding these concerns brings to light the importance of creating ‘safe spaces’ in which all children are included and are allowed to be themselves.

These are children’s lives, not ‘controversial’ issues.

At Clear Child Psychology and, we believe that our job as adults is to empower children from diverse populations to feel safe, supported, and enabled to pursue their dreams on their own terms. This sentiment is well described here,

“All young people, regardless of sexual orientation or identity deserve a safe and supportive environment, in which to achieve their full potential.” Harvey Milk [8]


Clinically, gender and sexual orientation differences are not considered a disability. However, specifically for adolescents, children may suffer greatly due to the lack of acceptance by peers and family members. In psychology, the idea of ‘conversion’ therapy whereby the therapist is to change a person’s sexual orientation choice has been discredited and is generally thought of as discrimination.

One important factor for families to think about is the issue of awareness. Many times children have the sense that they are marginalized, different, and live some sort of inferior existence. They may feel no hope for a ‘normal life,’ in part because of society’s norms that often unintentionally stigmatize these differences as unknown, weird, or deviant. As parents and community members, it is essential to create a culture of safety for all.

“Awareness of our situation must come before inner changes which in turn come before changes in society. Nothing happens in the real world unless it first happens in the images in our heads.” Gloria E Anzaldua [8]

The current terminology for the impact of gender and sexual orientation diversity is denoted in the current Diagnostic and Statistical Manual used by psychologists and is worthy of discussion here. Further definitions are provided by the GLBTQ community and are intended to create awareness around the issues of sexuality diversity and gender diversity.

Sex: “biological indicators of male and female” [3]

Cisgender: a person who identifies with one’s assigned gender (not transgender) [8]

Gender: “the lived role in society and/or the identification as male or female that could not uniformly be associated with or predicted from the biological indicators.” [3]

Gender Identity: deeply felt sense of who we are and how we see and identify ourselves. Some identify as male, female, or combination of genders. [8]

Gender expression: what you wear, how you style your hair, pronouns you use to describe yourself, names you like to be called, what you like to do [8]

Gender non-conforming or Gender Expansive: These individuals reject typical societally acceptable norms for male and female rules. They may or may not identify as trans-gender

Gender Assignment: “refers to initial assignment as male or female. This occurs usually at birth and yields the natal gender.” [3] This gender is ‘assigned’ by way of the sex chromosomes, physical anatomy, and genitals [8]

Gender re-assignment: a change of gender with medical intervention

Gender Dysphoria: “refers to the distress that may accompany the incongruence between one’s experienced or expressed gender and one’s assigned gender” [3]. Note this term represents a shift from the previous versions of the DSM, in which gender identity disorder was included. In the current version, issues of gender dysphoria, meaning a degree of cognitive or emotional discontent, may be evident without a disorder. It is only when the individual experiences significant distress that a diagnosis may be made of Gender Dysphoria [7]

Sexual orientation: This term describes one’s physical, romantic, and/or emotional attraction to another person. Sexual orientation is NOT the same as gender identity. People who identify with a different gender may or may not be gay. [8]

Trans: is an umbrella term for multiple types of gender identification. Terms like, ‘two souls,’ ‘gender queer,’ ‘trans man,’ ‘trans woman,’ ‘non-binary,’ ‘gender fluid,’ and ‘transsexual’ all fall under the term ‘trans.’ Some trans individuals may identify with assigned gender but may cross-dress. Others may seek medical intervention to change genders, such as hormones or surgery. Others may be questioning their gender identity. Trans individuals are not necessarily gay or bisexual

Gender Fluid: A term about disrupting the gender binary. Gender identity occurs on a continuum (not linear). There is a mix between male and female. “I don’t really identify as male or female. I am gender queer. It is just not a simple binary construct” [8]

Queer: Some use the term ‘Queer’ as the ‘Q’ in GLTBQ. [8]. As a verb, to ‘queer’ something is to question the foundation of our cultural beliefs and appropriateness. Queer as a noun is an identification with one’s unassigned gender or identification with sexuality diversity [8]


The important thing for families to know is that the family’s reaction to a child with these challenges can be paramount in terms of the child’s overall well-being, resilience, and happiness. That is, family members who are open and accepting of their children’s values and beliefs about themselves are fostering resilience. Research shows that this resilience can guard against the suicidality and self-harm that is common in this population [1]. A large scale study found the following:

“Now the first longitudinal study to look at suicide ideation and self-harm in this population shows support from friends and family offers the most protection in preventing youths from thinking about suicide. Adolescents who know they can talk to their parents about problems and know they have friends who care about them are less likely to consider ending their lives”  

Be open and supportive: Allowing your child a safe place to share concerns, fears, and his or her own sense of identity can go a long way to help your child thrive.

Be patient: Your child may be unsure for a long time about issues of gender and sexual orientation. Most children with gender identity issues report that they knew from a fairly young age that they did not identify with their assigned gender. However, a child may wait for years to reveal decisions regarding gender or sexual orientation. Just as with other issues of identity development, children tend to ‘try on’ new personas and identification with different peer groups. This long journey is normal. Adolescence is a gift; it is a time when we become who we are and when where our brains are most active, and our contribution to the world tends to be most significant [4]. Allow the process to be long and arduous; your child has a right to go at his or her own pace. A recognized expert in the neurological development of adolescence development says it best,

The remodeling that goes on in the teenage brain has the potential to inspire so much more than just “immature” or rash behavior. This time of transition in the brain also inspires emotional spark, social engagement, novelty seeking, and creative exploration that can be optimized to empower adolescents to live their lives to the fullest.” Dr. Dan Siegel (2013)

Be on the lookout for bullying and victimization: The resilience factors mentioned above are contrasted to the risk factors of bullying and victimization in this population. Unfortunately, 94% of GLTBQ youth report incidents of cruelty, assault, or harassment for being gay. This victimization increases suicidal thoughts, which in turn increases the likelihood of suicide attempts. [1]

Consider therapy: Many children with gender identity or sexual orientation issues will become depressed or highly anxious at some time. If your child has a sudden loss of interest in previously pleasurable activities, disturbed patterns of sleep or eating, and a sad mood more often than not, depression may be the culprit. Your child may not be able to navigate these challenges on his or her own. Therapy from a licensed psychologist or licensed professional counselor may be an asset to your child at this time and may provide a protective factor against suicidality and self-harm behaviors.

Locate communities: Most major middle schools and high schools have a Gay Straight Alliance (GSA) Network which provides support for students who identify as GLBTQ. ‘Safe Space Networks,’ often identified with a sticker, indicate places where children with gender and sexual orientation diversity will be able to share openly in a space of acceptance, honesty, and openness. See a list of sites in the ‘Learn More’ section that may provide resources in your community.


If your child is struggling with a similar problem, not directly addressed in this section, see the list below for links to information about other related symptom areas.

  • General anxiety: many individuals who question gender or sexual identity may feel anxious
  • Social anxiety: many individuals who question gender or sexual identity feel nervous in social situations
  • Social problems (Socializing): many individuals who question gender or sexual identity may have social problems
  • Academic problems (Learning): many individuals who question gender or sexual identity have problems in school
  • Depression: many individuals who question gender or sexual identity may suffer from depression or mood issues at some point
  • Self-injury: many individuals who are questioning gender or sexual identity may cut or self-injure
  • Suicidal Ideation: unfortunately, many individuals in this population consider suicide at some point in their lives. Concerned adults should seek immediate medical attention by calling 911, national suicide prevention lifeline (1-800-273-TALK), or visiting your nearest emergency room


Children who have significant problems in this area may have any of the following potential disabilities. *Note, this information does not serve as a diagnosis in any way. See the ‘Where to Go for Help’ section for professionals who can diagnose or provide a referral.

  • Gender Dysphoria: incongruence between the assigned gender and experienced or expressed gender and evidence of distress about the incongruence. Individuals with gender dysphoria have most of the following features: a desire to be the other gender, a preference for cross-gender roles, preference for the toys and activities of the other gender, preference for playmates of the other gender, and a strong dislike of one’s sexual anatomy [3]. Many individuals with gender and sexual orientation differences feel lost and alone in their path to self-discovery and independence. Adolescents naturally experience a period of self-discovery from about the age of 12 through 21. When individuals feel a mismatch between their own level of comfort with their sense of self and with the values of the society they live in, this journey is made much more challenging
  • Autism Spectrum Disorder: although not a feature of autism, emerging research shows that gender dysphoria is more common individuals with ASD than in the general population. Some wonder if it is truly a comorbid condition or rather a part of the intense interests that individuals with ASD show in highly specific topics [7]
  • Learning Disability: learning problems may occur due to a lack of motivation to join the social order (conformity), depression, and social isolation.
  • Depression: often individuals with GLTBQ issues become depressed, as evidenced by depressed mood, disturbed patterns of sleep and eating, and lack of interest in previously pleasurable activities


If your child is struggling with this symptom to the point that it is getting in the way of his learning, relationships, or happiness, the following professionals could help; they may offer diagnosis, treatment, or both.

  • CLEAR Child Psychology: to consult ‘live’ with a psychologist or to obtain a customized profile of concerns for your child
  • Psychologist or neuropsychologist: to consider emotional distress over gender identity or sexual orientation.
  • School Psychologist: to consider symptoms in terms of social skills at school and any potential impact on learning.
  • School Counselor: may provide a safe-haven of support for your child at school as he or she navigates these challenges

These professionals may recommend or administer the following tests for mental health issues that may be related to gender or sexual orientation:

  • BASC-III: test of emotional and behavioral symptoms
  • MMPI-A: test of personality and psychological symptoms
  • Human Figure Drawing and Projectives: tests of emotional and psychological symptoms
  • Roberts or TAT: test of personality and psychological symptoms
  • BDI-II: test of depression symptoms


[1] IMPACT (Retrieved 2017) Suicide and self-harm in GLTBQ individuals:

[2] It Gets Better Project (Retrieved 2017) The It Gets Better Project’s mission is to communicate to lesbian, gay, bisexual and transgender youth around the world that it gets better, and to create and inspire the changes needed to make it better for them.

[3] American Psychiatric Association (2013) DSM-5: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

[4] Siegel, Dan (2013): Brainstorm: The Power and Purpose of the Teenage Brain. Amazon:

[5] Gamson, Joshua (2015) Modern Families: Stories of extraordinary journeys to kinship. Amazon:

[6] Partners, Families, and Friends of Lesbians and Gays (PFLAG) (Retrieved 2017):

[7] de Vries, Annelou LC.; Noens, Ilse L.J.; Cohen-KettenisIna, Peggy T.  A.; van Berckelaer-Onnes, Ina A.; Doreleijers, Theo A.  (2010). Autism Spectrum Disorders in Gender Dysphoric Children and Adolescents. Journal of Autism and Developmental Disorders.

[8] Staley, Sarah & Leonardi, Beth (Retrieved 2017).  A Queer Endeavor. School of Education – University of Colorado.

[9] Breaking the silence: Honoring the Voices of LGBTQ Youth and Allies in Supporting Our Teachers.

[10] Richardson, Justin & Parnell, Peter (2005). Tango makes three. Amazon:

[11] Out Boulder: A safe place for LGBTQ youth in Boulder, Colorado.

[12] Gay, Lesbian & Straight Education Network (GLSEN) (2003-2012, Retrieved 2017): Nationwide alliance network for research, education and advocacy issues impacting GLTBQ youth.

Image Credit:
Description Young Children Dressed as Super Heroes Standing on Track
Stock Photo ID: #533462187 (iStock)
By: RichVintage
Previously Licensed on: November 24, 2016
Stylized by Katie Harwood exclusively for CLEAR Child Psychology

Back to: Home → Daily Living