When Children with ADHD Explore Gender Identity: A Guide for Parents

There is nothing short of a cultural revolution taking place as today’s youth challenge long-held notions of gender and work to express their authentic selves. Simply put, the discussion around gender identity is no longer a taboo topic – and thank goodness. Simultaneously, many adult caregivers are left scratching their heads and playing catch-up, wondering how to understand and address the changing gender landscape to best support their children, teens, and young adults.

For children with ADHD, gender identity exploration is undoubtedly a process impacted by the unique facets of their neurodiverse brains. To fully support these children in a safe and appropriate way, parents, educators, and professionals must understand the intersection of neurodiversity and gender diversity. Doing so can help protect them from negative mental health consequences and strengthen family bonds when they are needed most.

Gender Identity in Children: Principles and Definitions

Gender Diversity 101

Childhood is one long process of creating a self, and gender is a crucial part of that identity-in-the-making. Supporting your gender-questioning child starts with understanding the vocabulary and language of gender and sexuality. Knowing these terms can enable you to speak accurately and respectfully to and about your child regarding their identity.

• Biological sex refers to the physical anatomy and biology, including physiology, hormones, and chromosomes, that determine whether someone is male or female, or intersex (the 2% of the population who present as neither male nor female at birth). One’s sex, however, can be different from one’s gender.
• Gender identity is how we feel about, perceive, and self-identify our own sense of being male, female, both, or something entirely different, which is then communicated to others through gender expression.
• Gender expression is the way we communicate our gender identity to others through our appearances (mannerisms, haircut, clothes, accessories, and play choices. how one demonstrates their gender, be it through clothing, actions, behaviors, and other interactions.
• Sexual orientation is who one is physically and emotionally attracted to, based on their sex/gender in relation to oneself.

Most of us have grown up believing that all of these components line up “neatly” along culturally-prescribed lines of what’s gender-appropriate — but this is not the case for many people. Cisgender people have a gender identity that matches their sex assigned at birth. In contrast, trans people have a gender identity that is different from the sex assigned at birth. Experiencing this disconnect, many trans people feel significant distress — called gender dysphoria — with their physical sex characteristics or how their gender is misread by others.

[Related Webinar: “Gender Diversity and Neurodiversity”]

Gender Creative Children

The term “gender creative” describes the full range of behaviors and identities which fall outside of the gender binary of male/female or outside of culturally prescribed gender roles. In her book, The Gender Creative Child: Pathways for Nurturing and Supporting Children Who Live Outside Gender Boxes (#CommissionsEarned), clinical pyschologist and gender expert Diane Ehrensat, Ph.D. describes the full range of gender-creative kids in three different categories (analogized to apples, oranges, and fruit salads) that can help families better understand gender identity and expression.

Gender Nonconforming Children

These children and teens (described as oranges in Ehrensaft’s book) go against customary gendered behavior in their play choices, dress, appearance, gestures, choice of playmates, and more. (These are the children who used to be called “tomboys” or “sissies,” terms now viewed as at best outdated or at worse offensive). Still, while their gender expression doesn’t conform to cultural prescriptions, their core gender identity remains aligned with their biological sex. As such, these children do not experience gender dysphoria and will not undergo gender transition. Ehrensaft states that many of these children and teens will later identify as lesbian, gay, bisexual, or queer, as their gender nonconformity may be an avenue to explore and express a non-heterosexual sexual orientation.

Cross-Gender Identifying Children

Referred to as apples in Ehrensaft’s book, these children tend to persistently identify as the opposite gender from a young age, and they see gender in very binary terms. Parents are often shocked at how early the child starts to show signs of gender transgression. For example, a child assigned female at birth may throw tantrums at the mere mention of wearing a dress, insisting that they are a boy. A child assigned male at birth may tie a dish towel around their head to simulate long hair, insisting that they are a girl. These children feel a lot of anguish and dysphoria with the bodies they have, particularly around the onset of puberty.

Gender Non-binary Children

Described as fruit salads by Ehrensaft, these children do not see their gender within a binary structure, as they feel neither male nor female. They may see themselves as agender (without gender), gender-neutral, or gender fluid (meaning that their gender shifts over time). Non-binary children and teens experience less body dysphoria and angst than cross-gender identifying children, but more so than gender nonconforming children. “Genderqueer” has become a catch-all identity for these children and teens, and it is a rapidly growing population.

[Get This Free Download: Evaluate Your Teen’s Emotional Control]

Gender Identity and ADHD

As the parent of a child with ADHD, you already have key parenting tools and skills to support your child on their gender identity journey. You are no stranger, for example, to living with someone who thinks outside the box. Raising an alternative learner has also required your flexibility, compassion, patience, and resourcefulness. You have also altered your expectations about who your child is versus who you think they should be. It’s a similar process for gender exploration.

Gender Identity Exploration and Executive Functioning

Several key executive functioning skills, which are already impacted by ADHD, can influence gender identity exploration.

• Impulse control: Children and teens in the process of gender exploration may want to make all changes immediately. They may feel frustrated at having to wait and move through the complicated process of exploration or transition, which may include personal, legal, medical, and other factors. Provide your child with as much information as possible about navigating these processes. Explore realistic waiting times and assist in whatever ways they ask, whenever possible.
• Emotional dysregulation. Gender identity exploration is a deeply emotional and personal process for brains that are already easily flooded by intense emotions. Kids with ADHD can be overwhelmed and preoccupied with their gender journey and extra reactive sometimes. Unmanaged, complicated feelings can lead to bigger issues, , so it’s important to make sure your child is getting therapeutic support around both emotional sensitivity and regulation.
• Organization, planning, and prioritizing: The gender transitioning and/or questioning process will often require an understanding of complex medical and insurance systems that is too much for a child or teen with ADHD to grasp fully or manage effectively. Ask your child how you can assist them and remind them that these processes are tough for all people. Make lists and use calendars to create time frames around the process. Help your child make medical appointments and navigate insurance systems.
• Focus: Your child may hyperfocus on this process, which can shut out other areas of their life. Help them zoom out and create a balanced focus. Make specific times to check in about anything related to gender exploration — from feelings to logistics. Creating a plan and timeline around the process can also help.

Supporting Gender-Creative Children with ADHD

There’s no way of telling at any one moment whether a child will turn out to be trans, non-binary, cisgender, or some other LGBTQ identity. What’s certain is that each child is on a gender journey – we just tend to not notice the gender conforming ones.

Whatever the path, as a parent, meet your child with openness, compassion, and curiosity. Your children need to know that it is OK to bring up the topic of gender identity and diversity with you. The stakes for these children are very high – unsupported trans and gender-nonconforming children see higher rates of bullying, assault, family violence, as well as mood disorders, anxiety, and suicidality, as compared to cisgender youth. But with the right support, these children often thrive.

At the same time, it is important to avoid putting words in your child’s mouth, or to prematurely categorize them before they have a chance to describe their own experience and find their sense of self.

Many children and teens with ADHD experience anxiety around their challenges with concentration and attention and their negative comparisions with neurotypical peers. For children with ADHD who are also gender questioning, there can be excessive, intense, sometimes overflowing anxiety, and a higher tendency toward emotional outbursts and frustration. It is critical for parents to validate, without judgement, the complexity of these separate and simultaneous experiences.

How to Be an Ally

• Listen to your child. Hear their words, read their body signals, and use reflective listening to make your child feel seen and heard. Be curious and inquisitive, and avoid voicing reactions which your child will interpret as judgmental.
• Acknowledge their courage. Think about how brave your child has been to own this process and share their discovery.
• Avoid standards of gender normativity, which can leave your child feeling inadequate and/or alienated.
• Rely on collaboration. Avoid “shoulds” and other statements tied to demands. Ask your child how you can help them and respect their privacy and decisions.
• Nurture resilience – the antidote to anxiety. Talk to your child about experiences they’ve overcome in the past, and the innate skills they have to do so this time.
• Celebrate your child. Focus on the positive – love and validate your child for who they are.
• Help your child make thoughtful decisions. Your child’s impulse to fully and freely express their gender-nonconformity out in the world may bump up against your impulse to protect your child. When you explain to your child that gender-bending behaviors might be met with offensive or even dangerous reactions from others, make sure you explain that the problem lies with those narrow-minded others, not with your child.
• Seek expert help. There are therapists, clinics, and other medical professionals who are gender specialists. Your usual team of helpers may not have the necessary expertise, so you may need to look for specialized providers.

How to Work on Parental Self-Management

Supporting your child also depends on managing your own feelings. These techniques can help:

• Manage your own reactions separate from your child. You may have a lot of thoughts and feelings about what your child is going through, especially when you’ve raised your child with certain expectations and harbored your own desire for their gender conformity consciously and unconsciously. It may help if you privately reflect on your own personal history with your gender — how you came to know about gender, masculinity, and femininity. Think about how others have reacted to your gender presentation over the course of your life. Your history can help explain your reactions, but your child is not a mini-you. Your child needs you to stay open and accepting.
• Identify your triggers and brainstorm coping strategies. As you deal with your gender-questioning child, what issues are the hardest for you to address and cope with? Try breathing exercises, listening to soothing music, mindfulness, meditation, and other calming strategies to regulate yourself amid intense triggers.
• Find useful, external support systems. This is a complex journey, and very few people will understand what you and your child are experiencing. Find others who do, whether it’s with other parents of gender-creative children in online or local support groups, and/or in your child’s team of caregivers.
• Practice self-compassion and patience with family members. Partners and family members may respond differently to your child’s journey. They will also need to travel through a process of understanding and acceptance. Be there for them just as you would like for them to be there for you.

The content for this article was derived from the ADDitude Expert Webinar “Gender Diversity and Neurodiversity: How to Support a Child, Teen, or Young Adult with ADHD Exploring Gender” [Video Replay & Podcast #350] with Sharon Saline, Psy.D., and Julie Mencher, MSW, which was broadcast live on April 14, 2021.

Gender Identity and ADHD: Next Steps

• Read: True Grit – Turning Your Teen Into a Trooper
• Download: Easy Mindfulness Exercises for Kids with ADHD
• Read: How to Calm an Emotionally Dysregulated Teen with ADHD

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