This article was written with contributions from Hannah Larson. She is a Pediatric Therapist and LPC.
What is Gender Identity and Sexual Orientation in Childhood?
Gender identity in childhood is a deeply felt sense of who we are and how we see and identify ourselves. Gender Identity can be girl, boy, neither, or both. Gender identity is not outwardly visible to others.
Sexual orientation in childhood is the enduring physical, romantic, or emotional attraction to members of the same or other genders, including lesbian, gay, bisexual, and straight orientations. 
A person’s identity is an integral part of development. Identity contributes to self-esteem, visualizing one’s place in the world, and seeing oneself as different from our parents.
Identity begins to emerge in very young children but is a critical component of childhood and even more crucial in adolescence. From this perspective, gender identity also plays an essential role in development.
As psychologists, we wish to support the development of successful relationships, high self-esteem, and acceptance of one’s sense of self.
It is important to look at gender identity and sexual orientation within this context, not as a psychological problem, but as a part of identity formation that can be significantly impacted by the social views and perspectives surrounding the individual.
For example, a child questioning identity or identifying 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.
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Supporting Children with Gender & Sexual Orientation Differences
Sexual orientation in childhood
Children who are Gay, Lesbian, Bisexual, Transgender, or Questioning/ Queer (LGBTQ+) have approximately twice the rate of suicidal ideation compared to the general population . Furthermore, this rate increases dramatically when these individuals are bullied or victimized  for gender or sexual orientation differences. For this reason and many others, it is essential and critical that parents provide a warm and welcoming environment for their children regardless of how they land in terms of sexual orientation.
Gender identity in childhood
Gender identity is a felt sense within your child about how they identify. Each child may have a different experience with gender differences. Children and teens may share that they feel like they are in the wrong body or do not identify with being either female or male. Instead, they say they fall somewhere between both genders. While this is confusing and can be a grieving process, honor your child and take their lead. Some children who are assigned female or assigned male will tell you they knew that they were in the wrong body from a very young age. Others will tell you they started to know as they were going through puberty, and they felt like the wrong changes were happening.
Gender Identity Terms in Childhood and Teenage Years
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. In addition, further definitions are provided by the LGBTQ community and are intended to create awareness around the issues of sexual diversity and gender diversity.
Sex: refers to a person’s biological status and is typically assigned at birth, usually on the basis of external anatomy. Sex is typically categorized as male, female, or intersex. 
Cisgender: a person who identifies with one’s assigned gender at birth. (not transgender) 
Gender: “is often defined as a social construct of norms, behaviors, and roles that varies between societies and over time. Gender is often categorized as male, female or nonbinary.” 
Gender expression: is how a person presents gender outwardly, what you wear, how you style your hair, pronouns you use to describe yourself, names you like to be called, and activities you enjoy doing. 
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 transgender.
Gender Assignment: “refers to initial assignment as male or female. This usually occurs at birth and yields the natal gender.”  This gender is ‘assigned’ by way of the sex chromosomes, physical anatomy, and genitals .
Gender reassignment: is a change of gender with medical intervention around physical characteristics.
Gender transition: “is a process a person may take to bring themselves and their bodies into alignment with their gender identity. It’s not just one step. Transitioning can include any, none, or all of the following: telling one’s friends, family, and co-workers; changing one’s name and pronouns; updating legal documents; medical interventions such as hormone therapy; or surgical intervention, often called gender confirmation surgery” .
Gender Dysphoria: “refers to the distress that may accompany the incongruence between one’s experienced or expressed gender, and one’s assigned gender” . 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 .
Sexual Orientation: 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 .
Trans: is an umbrella term for multiple types of gender identification. Terms like, ‘two souls,’ ‘genderqueer,’ ‘trans man,’ ‘trans woman,’ ‘non-binary,’ ‘gender-fluid,’ and ‘transsexual’ all fall under the term ‘trans.’ 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 males and females. Gender fluid individuals might describe it thusly, “I don’t really identify as male or female. I am genderqueer. It is just not a simple binary construct”. 
Agender: Is an adjective that can describe a person who does not identify as any gender. 
Nonbinary: Is a term that can be used by people who do not describe themselves or their genders as fitting into the categories of man or woman. A range of terms are used to refer to these experiences; nonbinary and genderqueer are among the terms that are sometimes used. 
Queer: Some use the term ‘Queer’ as the ‘Q’ in LGBTQ. . 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 
How Families Can Support Gender Identity and Sexual Orientation Issues in Childhood
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.
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 .
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”
- Do not assume it is a phase: It will hurt your child if you presume and share what they are going through is a phase or believe it is something new youth are going through. Instead, support your child even if you do not understand. It will hurt your child’s mental health not to take them seriously. Know some youth may go between being non-binary to male or female, from bisexual, to lesbian and gay. It doesn’t mean they are confused. We live in a complex society. It may take your child some time to understand and accept their gender identity or sexual orientation. It is not easy to be different from mainstream society.
- Allow your child to express themselves through dress and hairstyle: Allow your child to explore their identity by changing clothes or hairstyle. For example, allowing your child to dress more masculine or feminine will not make them transgender or not straight. Instead, giving them the freedom to explore who they are will help their development and be protective of their mental health.
- Ask your child what pronouns they would like to go by: Would your child like you to use they/them, she/her, he/him, or another set of pronouns? Honor your child’s choice of pronouns. Let them know you are learning to refer to them differently, and it may take you a bit to get it right, but you are there to support them.
- Connect with other families who have a gender-diverse child: this can help your child, and you reduce social isolation as well as provide an additional level of support.
- Offer support to your child: Ask your child how you can help them through the process. For example, would they like your help talking with the school, family members, etc. Again, take your child’s lead on disclosure. Don’t allow yourself or other family members to shame or criticize your child. Instead, talk positively about your child with others. The most important thing for your child is to know they are loved and supported by you. How you respond will make a significant difference for them.
- With Gender Identity, work with a therapist and doctor specializing in transgender youth: Although as parents, we do recommend being supportive of your child’s gender identity, the actual decision to change physical genders is a serious one. Know that it will be extremely important to get direct medical and therapeutic support from an expert on these issues. To understand your options medically, speak with a trained and knowledgeable doctor about the latest options for transgender care. A therapist can help your child explore gender identity, coming out, social transition, family support, and potentially gender reassignment.
When to Seek Help for Gender & Sexual Orientation Related Challenges in Childhood
If your child is being targeted by adults or other students at their school, let someone in authority know immediately, so you can help to make it stop. It may help your child work with their school counselor and join an LGBTQ club at school.
If your child’s mental health is declining; they seem anxious, depressed, or withdrawn and struggle with their identity or sexuality, work with a therapist specializing in LGBTQ youth.
Professional Resources on Gender Identity and Sexual Orientation in Childhood
If your child is struggling to the point that it is getting in the way of their learning, relationships, or happiness, the following professionals could help. It is really important that a child receives appropriate treatment and support in their identity development.
- Psychologist or therapist: who has specialized training in working with LGBTQ youth; these children have increased risk for mental health concerns because of environmental factors like rejection by peers or family members
- Family therapy: to help family members support their child and to work on listening and open communication
- Family or pediatric physician: ask for a referral for a doctor trained in transgender care
- School counselor: may provide a safe haven of support for your child at school as your child navigates these challenges
Concerns that may relate to Gender Identity and Sexual Orientation in Childhood
Environmental factors like acceptance from family and or school community has a major impact on concerns that may be relevant for a child.
- 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: many individuals who question gender or sexual identity may have social problems
- Academic problems: 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, the national suicide prevention lifeline (1-800-273-TALK), or visit your nearest emergency room
Book and Other References
 IMPACT (Retrieved 2017) Suicide and self-harm in LGBTQ individuals.
 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. http://itgetsbetter.org
 American Psychiatric Association (2013) DSM-5: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.
 Siegel, Dan (2013): Brainstorm: The Power and Purpose of the Teenage Brain.
 Gamson, Joshua (2015) Modern Families: Stories of extraordinary journeys to kinship.
 Partners, Families, and Friends of Lesbians and Gays (PFLAG) (Retrieved 2017): https://www.pflag.org/
 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.
 Staley, Sarah & Leonardi, Beth (Retrieved 2017). A Queer Endeavor. School of Education – University of Colorado.
 Breaking the silence: Honoring the Voices of LGBTQ Youth and Allies in Supporting Our Teachers.
 Wamsley, Laurel (2021): A Guide To Gender Identity Terms
Resources on Gender Identity and Sexual Orientation
Richardson, Justin & Parnell, Peter (2005). Tango makes three.
Out Boulder: A safe place for LGBTQ youth in Boulder, Colorado.
Gay, Lesbian & Straight Education Network (GLSEN) (2003-2012, Retrieved 2017): Nationwide alliance network for research, education and advocacy issues impacting GLTBQ youth.
Mayo Clinic: Children and Gender Identity, Supporting Your Child Johns Hopkins: Gender Affirmation Nonsurgical Services and LGBTQ Resources