"Quiero Soy Un Niño!": Family-Based Treatment of a Mexican American Child with Gender Dysphoria and Disruptive Behaviors

Objective: Research among transgender and gender nonconforming (TGNC) youth is growing, but sparse among prepubertal children. Given that TGNC youth experience higher rates of psychological difficulties than peers, and family support of gender identity serves as a protective factor, experts have called for gender-affirmative psychological services as part of comprehensive gender care. However, research on evidence-based practices for TGNC youth is lacking, particularly among young children. The present case report seeks to add the literature on culturally-responsive, family-based treatment for TGNC children. Method: Authors describe adapting positive attending and relationship-enhancement skills from behavioral parent training for six-year-old "Dani," a Mexican American child referred to treatment for ADHD symptoms, who also exhibited behavioral issues in the context of gender dysphoria. Treatment adaptations included adjunctive parent and child sessions for gender psychoeducation and support, exclusion of a limit-setting phase, and applying positive parenting skills to affirmation of Dani's gender identity and expression. Services were also tailored for the family's cultural values and level of acculturation. Results: As parents' use of positive attending skills increased alongside support for Dani's diverse gender expression in the first phase of treatment, disruptive behaviors markedly decreased. In the second phase of treatment, family understanding and communication regarding gender was enhanced, while parent distress related to Dani's gender dysphoria reduced. Conclusions: Continued research on affirmative interventions provided in a culturally-responsive manner, such as described in this case report, are imperative, given the negative psychological outcomes among TGNC youth and the significant health service disparities among this underserved, vulnerable population. Implications for Impact StatementThe present case study describes adapting positive attending and relationship-enhancement skills from traditional behavioral parent training to provide culturally-responsive, gender-affirmative therapy with the family of a young Mexican American child with ADHD, disruptive behaviors, and gender dysphoria.