Gender-expansive youth, as the term suggests, comprise a diverse group, with each teen or child charting their own unique course. They can’t be reduced to a single entity — in much the same way that youth with ADHD resist easy categorization.

Still, collectively, gender nonconforming youth face common obstacles and common threats: discrimination, harassment, bullying, massive barriers to appropriate care, and other forms of transphobia.

In the face of these threats, support from doctors, communities, schools, and family members has a powerful protective effect. According to a national survey conducted by The Trevor Project, 45% of LGBTQ+ youth surveyed seriously considered attempting suicide in the past year, but those who felt highly supported by their family reported attempting suicide at less than half that rate. A recent study in Child Development revealed similar findings: LGBTQ+ youth who received parental support experienced significantly fewer depressive episodes.

Understanding how to best provide support may be particularly confusing for parents of gender-expansive youth with ADHD, who struggle with impulsivity, executive dysfunction, and emotional dysregulation. Here, Paul Silverman, LCSW, a family therapist at the Gender and Family Project at the Ackerman Institute for Family in New York City, offers clarity, context, and evidence-backed guidance for supporting your gender nonconforming child — and insight into why it’s so critical.

Q: What are some common myths or misconceptions about gender-expansive youth?

The biggest misconception is that their gender identities are not authentic. The growing number of children identifying as transgender or gender non-conforming (TGNC) gets too often attributed to children influencing one another. The truth is that TGNC children have always been here. Across cultures, there have always been TGNC people, and thereby there have always been TGNC children.

When we look to the 2 Spirit people of indigenous American cultures or the Hijras people of south Asia, we know that transgender people have existed as long as gender has existed. With that knowledge, we can attribute the growing number of children identifying as TGNC to increased visibility, representation, and acceptance.

Q: What is the most common concern voiced by parents of gender-expansive youth? How do you address this?

Many parents worry that their child’s life will be more difficult if they are transgender or gender conforming, that they will face increased societal hurdles. However, we know that acceptance is protection. The data and research indicate that, while many TGNC youth often present with elevated rates of eating disorders, suicidality, and impacts to their mental health, these rates are drastically lower for children who have the support of their parents.

Q: Sometimes, parents of gender-questioning youth with ADHD worry that their child’s gender exploration is driven by characteristic impulsivity. What advice can you offer to them?

For any parent concerned that their child’s gender is a phase or characterized by impulsivity or related to behaviors impacted by ADHD, I would consider the impact of supporting their child through that period regardless of the child’s long-term gender identity. Children will always carry with them the parent relationship, whether affirming or rejecting, through the time of their gender transition.

If a child exploring their gender turns out to be cisgender, they will move through that period and be more secure knowing they had their parent’s unconditional support. If that gender-exploring child turns out to be transgender, then the parent’s support during that period is all the more crucial.

Q: What’s something that’s surprised you in your work with gender-expansive youth?

When I encounter a family that is accepting of their child’s transition from the start, embracing their desired name, pronouns, and gender expression, I am surprised by just how easy and joyful the child’s life can be. The narrative about transgender youth and their experiences is often so heavy because it is burdened by transphobia. In that context, these surprising moments of joy and ease for children provide a helpful model for what we can aspire to as a society.

Q: What guidance can you offer for parents of youth who are just beginning to explore their gender?

I want to relay that their child’s gender is neither a burden nor a problem. The burdensome problem is the transphobia that their family will be up against. With this reframing, there is no need to protect the world or the child from their trans identity, but instead to stand with their child in the face of the transphobia that they will inevitably face.

A parent recently shared this Joan Ryan quote, which I think encapsulates this idea well: “Parenthood is about raising and celebrating the child you have, not the child you thought you would have. It’s about understanding that they are exactly the person they are supposed to be. And that, if you’re lucky, they just might be the teacher who turns you into the person you are supposed to be.”

Gender Nonconforming Youth with ADHD: Next Steps

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