Presentation by the WPATH Standards of Care 8 Child Chapter Working Group

On September 7, 2019, members of the Standards of Care Version 8 - Child Chapter Working Group delivered a presentation at the US Professional Association of Transgender Health conference in Washington DC. This presentation outlined a significant move toward far more affirming philosophies of care, which will appear in the upcoming SOC V8.

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As reported by community rapporteur Lotus Đào, and Dr. Asa Radix, Co-Chair of the SOC8 Review Committee, member of the Board of Directors of the World Professional Association of Transgender Health and the US Professional Association of Transgender Health:

On September 7th, 2019, members of the WPATH Standards of Care 8.0 Child Chapter Working Group presented on "Prepubescent Gender Diversity: Complexities and Recommendations." Presenters opened by sharing the working group's process and naming the complexity of working within a global context in an specialty with few expertise. Following a brief research summary, presenters established a foundation of child gender diversity as an expected aspect of general human diversity, rather than a pathology.

Furthermore, gender identity should not be conflated with gender expression. In fact, research indicates that many young children exhibiting extensive gender expansive behavior while feeling cohesive with their gender identity are likely to evolve to be gay or queer by adolescence, not transgender. In addition, gender identity is sometimes static, and sometimes fluid. Some children know from a very young age who they are and their gender identity is static throughout their lifetime. For other children, their gender identity may change over time. Presenters encouraged providers and community members to practice respect and sensitivity in honoring children where they are at and releasing the cultured need to predict a child's gender identity and presentation. In regards to the mental health provider's role in working with gender expansive children, presenters emphasized that gender expansive children should not be required to be in therapy. However, guidance from mental health providers are often helpful, especially if there are external stressors (family, school, region) or the child is interested in medical treatment.

The presenters provided recommendations for providers around advocacy, including educating and supporting gender diversity is expected and not pathological; acknowledging and addressing privilege and frequent intentional and/or unintentional negating of gender diverse experience; working in partnership with schools and childcare programs to sensitive educational providers to importance of gender affirmative practices to promote curricula; and more.

Presenters shared a much anticipated report of the SOC 8 Core Competency Recommendations, which are not finalized, including compenents on Training/Credentials, Gender Development, Child/Family Mental Health, Assessment, Therapuetic Interventions, Autism and Gender, Research Knowledge and Continuing Education. Ultimately, presenters urged attendees to promote gender literacy with gender expansive children, including identifying oppressive and violent environmental messaging around gender and critically examine whether or not it is authentic. Furthermore, presenters recommended providers to not fixate on pathology or force "transgender" onto gender expansive children, but to incorporate "play" and "fun" as important aspects of working with children.