Lack of Prevention Programs for Gender Identity Disorder

In the summer of 2008, Angie Zapata, an 18 year old transgendered girl was brutally murdered in her Colorado home by a man by the name of, Allen Andrade. According to information contained within a police affidavit, Andrade, who had bludgeoned Angie to death, first with his fists and then with a fire extinguisher, commented to police, “I thought I had killed it”, referring to the moment that he noticed Angie gasp for breath, before he struck her with the cold steel, one last time. In the spring of 2009, a Colorado jury convicted Andrade of first degree murder and a bias related crime, representing “the first time that a state hate-crime statute had resulted in a conviction in a transgendered persons murder” (CNN, 2009).

According to the Diagnostic and Statistical Manual of Mental Disorders IV-TR (American Psychological Association, 2000), the onset of Gender Identity Disorder (GID) in children generally occurs around the age of 2-4 years. However, “only a very small number of children with Gender Identity Disorder will continue to have symptoms that meet the criteria for Gender Identity Disorder in adolescence and adulthood” (APA, 2000, p. 580). In fact, according to the DSM-IV-TR, “by late adolescence, or adulthood, about three quarters of the boys who had a childhood diagnosis of Gender Identity Disorder report a homosexual or bisexual orientation, but without concurrent Gender Identity Disorder…most of the remainder report a heterosexual orientation, also without concurrent GID” (APA, 2000; p. 580). Epidemiological studies geared at determining prevalence rates for GID in children and adolescents is, essentially, nonexistent; however, researchers conducting post hoc analyses on omnibus parent questionnaires administered in the United States indicate that the prevalence of children expressing a repeated desire to actually be a sex other than their natal sex is “quite low”, whereas, “periodic cross-gender behavior is far more common” (Zucker & Lawrence, 2009; p. 8). In fact, Zucker & Lawrence (2009), refused to draw any conclusions regarding prevalence rates of GID in children, yet indicate that girls more frequently express cross-gender behavior than boys; however, male children and adolescents are more commonly referred for psychological services to address gender identity concerns than their female counterparts. Following from the entirety of the aforementioned information, certainly one must pause to consider the rationality of the DSM-IV-TR’s pathologizing of variant forms of gender identification other than the dichotomous assignments of male and female. According to Zucker & Lawrence (2009), GID can be conceptualized as an end-point of a continuum of cross-gender identification and it is conceivable that there are now more individuals who identify within this broader spectrum of cross-gender identity (under the rubric of terms like transgenderism or even gender queer)” (p.16); as such the term gender-variant shall be utilized herein to refer to children and adolescents within the “spectrum of cross-gender identity”, under which GID is subsumed, as well as those who defy traditional gender roles, yet do not satisfy the DSM-IV-TR’s primary qualifying criterion for a diagnosis of GID, “a strong and persistent cross-gender identification” (APA, 2000; p. 581).

For example, an “effeminate” boy, or a “masculine” girl could likely experience the same type of harassment as a child with diagnosed GID, despite the fact that they show no signs of dissatisfaction with their natal gender. Research has consistently indicated that many children and adolescents face harassment within the school setting as a result of their real, or perceived, sexual orientation; however, “perceptions” of one’s sexual orientation essentially stem from their adherence to, or defiance of culturally constructed and prescribed gender norms. In his somewhat controversial book, The New Gay Teenager, Author and Cornell professor, Ritch Savin-Williams states, “Kids get bullied because they don’t act like a typical boy or a typical girl, not solely because they are homosexual. It’s because they don’t fit into a neat categorization” (National School Boards Association, 2005). Unfortunately, research has not sufficiently addressed the issue of bullying and harassment from this perspective, and wherein research cited herein has focused upon a particular sub-set of the gender-variant spectrum, the name of that sub-set shall be used. Historically, and also currently, transgendered adolescents tend to be represented within the research amongst other “sexual minority” youth (i.e., gay, lesbian, bisexual, transgender, queer, and questioning; LGBTQQ), and are rarely afforded the individualized research attention appropriate for the very specific, and often different developmental trajectory that gender-variant adolescents follow, as compared to LGBQQ individuals. Most fundamentally, while LGBQQ individuals are managing sexual orientation, gender-variant individuals are managing issues related to gender identity, a significantly dissimilar issue. However, recognizing the fact that within society at large, and thus the school environment as well, LGBTQQ individuals face similar issues with respect to social stigma and resultant harassment and victimization (Corothers, 2007), it seems justifiable to, wherein specific information fails to be available regarding gender-variant adolescents exclusively, extrapolate from research addressing these issues conducted with LGBTQQ individuals.

The reality of the aforementioned findings regarding the variability of gender expression within, and throughout childhood and adolescence, in addition to the enmeshment of gender-variant youth within the broader “sexual minority” nomenclature, present a significant challenge to the design and implementation of a comprehensive program to address the very specific needs of the population of gender-variant children and adolescents; yet surely, there is a considerable need. Gender-variant youth are vulnerable to oppression and violence in cultures that enforce a binary, conformist set of gender roles and expression (Israel & Tarver, 1997). According to a 2003 national school climate survey conducted by the Gay, Lesbian, and Straight Education Network (GLSEN), 55% of transgender youth report being physically attacked within the school environment. Furthermore, additional research indicates that 81% of transgender youth reported being sexually harassed at school, and 90% of transgender youth reported feeling unsafe at school because of their gender expression (GLSEN, 2001). In addition to the externalized oppressions and victimization faced by gender-variant children and adolescents, these individuals tend to be at a greater risk for the development of a number of emotional and behavioral problems such as, poor self-esteem, depression, alcohol and drug abuse, self-mutilation, anxiety disorders, and suicidality (Savin-Williams, 2001). Suicide attempts of transgendered youth are estimated to be as high, or higher, than they are for LGB youth (Remafedi, 1994), and reports indicate that 33.2% of transgender youth have attempted suicide (Clements-Nolle, Marx, & Katz, 2006). According to the Massachusetts Youth Risk Survey (2006), sexual minority youth are up to four times more likely to attempt suicide than their heterosexual peers. A 2007 San Francisco State University Chavez Center Institute study shows that GLBT and questioning youth who come from a rejecting family are up to nine times more likely to attempt suicide than their heterosexual peers (Ryan, Huebner, Diaz, & Sanchez, 2007). The preceding statistics are not to imply that all gender-variant, or sexual minority youth will develop such problems; rather that they are at a greater risk than the general population.

Not surprisingly, a review of the available research indicates that, there has been no prevention program designed to specifically address the protection and/or mental and emotional wellness of gender-variant children and adolescents, within the educational setting, to date. However, several promising programs have been developed that offer promising guidance in the development, design, and implementation of such a preventative effort.

The Center for the Study and Prevention of Violence (CSPV) at the University of Colorado reviewed 600 violence protection programs, and has identified eleven efficacious at-risk youth prevention programs through the utilization of strict efficacy standards and prevention science (Blueprint for Violence Prevention, 2004).The risk prevention and intervention programs address an array of at-risk youth behaviors, however, amongst bullying intervention and prevention programs, the Olweus Bullying Prevention Program (1983) represents one of the few programs identified as an efficacious, empirically sound programs currently available (Blueprint for Violence Prevention, 2004). Implemented in 1983, following the bullying and victimization induced suicides of three Norwegian boys, ages 10-14 (Kallestad & Olweus, 2003). Following the implementation of the program in 42 elementary and junior high schools for a period of three years, student reports of bullying and victimization decreased by 50% or more in the schools targeted. Furthermore, the program was responsible for a reduction in antisocial behaviors, increases in the positive “social climate”, and more positive attitudes overall regarding the schools themselves (Kallestad & Olweus, 2003). The program’s success has been attributed to its reliance upon Bronfenbrenner’s ecological model (1979; as cited in Wilmshurst, 2009), “a sociocultural framework that can increase our understanding of how child characteristics and environmental characteristics interact at various levels of influence” (Wilmshurst, 2009; p. 13) to bring about and maintain individual childhood behaviors, in a transactional and ecological manner between the various levels of sociocultural influences within a child’s life; the macrosystem, exosystem, microsystem, and the individual level (Bronfenbrenner, 1979; as cited in Wilmshurst, 2009). The Olweus Bullying Prevention Program employs a multi-level approach that targets the entire school and provides supports at the individual, family, school, and administrative levels of school ecology (Wilmshurst, 2009).

As further inspiration for the program being developed herein, The Gay, Lesbian and Straight Education Network (GLSEN; 1990), is a leading national educational organization, established in 1990, which aims to foster acceptance and respect of all individuals, regardless of their sexual orientation or gender identity/expression. As indicated on their resource abundant web-site, GLSEN focuses upon ensuring that each and every student has the opportunity to learn within a safe school, aiding schools in the development of positive climates where “difference is valued for the positive contribution it makes to creating a more vibrant and diverse community”(GLSEN, 2010). In a comprehensive and collaborative effort involving policy makers, community leaders, educators, and students, GLSEN actively endeavors to advance all-inclusive safe schools legislation, provide educators and administrators with the tools necessary to provide a safe and affirmative environment, and protect all students from victimization, harassment, and bullying. GLSEN employs community-based chapters of volunteer professionals and lay persons who have been trained and accredited by the organization to develop GLSEN’s philosophy and well-designed programs within their own local school districts and communities. They further offer an immense amount of resources; such as, curricula for all grade levels, posters, activity kits, organizing materials, etc., that aim to promote diversity, acceptance, appreciation, empathy and community, in addition to many other worthy lessons often absent from contemporary educational environments. One of the most significant contributions that GLSEN has made is the aided development of Gay-Straight Alliances (GSAs) within numerous schools nation-wide.Findings from a growing body of research demonstrate the positive impact that school-based resources, such as clubs that address LGBT student issues may have on school climate. GSAs are student-led, school-based clubs open to all members of the student body regardless of sexual orientation. GSAs often advocate for improved school climate, educate the larger school community about LGBT issues, and support LGBT students and their allies. Currently, GLSEN has registered more than 4,000 GSAs, has approximately 40 full time staff, a governing board of 20 members and two advisory committees at the national level (GLSEN, 2010).

Major Findings:
The presence of GSAs may help to make schools safer for LGBT students by sending a message that biased language and harassment will not be
tolerated. Homophobic remarks, such as faggot or dyke used in a derogatory manner, are among the most frequently heard types of biased remarks in U.S. schools.4 Students in schools with GSAs are less likely to hear homophobic remarks in school on a daily basis than students in schools without a GSA (57% compared to 75%).

GSAs are related to greater physical safety for LGBT students. LGBT students who attend schools with a GSA are less likely than those at schools without a GSA to report feeling unsafe in school because of their sexual orientation (61% vs. 68%) or because of the way in which they express their gender (38% vs. 43%).

Sexual minority youth (youth who identify as lesbian, gay, or bisexual as well as youth who have same-sex romantic attractions or engage in same-sex sexual behavior) in Massachusetts schools with GSAs were half as likely as those in schools without a GSA to report experiencing dating violence, being threatened or injured at school, or missing school because they were afraid to go.

Educators believe in the value of GSAs—more than half (53%) of secondary school teachers nationally believe that having a GSA would help to create safer schools for LGBT students.

In California, LGBT students and their allies who have a GSA in their schools are more likely to feel safe in school than their peers (76% compared to 69%).

LGBT students in schools with GSAs are less likely to miss school because they feel unsafe compared to other students: a quarter (26%) of students in schools with GSAs missed school in the past month because they felt unsafe compared to a third (32%) of students at schools without GSAs.

Students in schools with GSAs or similar student clubs are two times more likely than students without such clubs to say they hear teachers at their school make supportive or positive remarks about lesbian and gay people (24% compared to 12%).

The Promoting Equality And Compassion In Schools (PEAC IS…) program consists of primary, secondary, and tertiary prevention efforts implemented at all levels of the gender-variant child /adolescent’s ecological influence. The key components and levels of corresponding influence are: educational-policy and administration (macrosystem), school (exosystem), family (microsystem), and the individual level.