C.I.D.I.Ge.M CENTRO INTERDIPARTIMENTALE DISTURBI DELL’IDENTITA’ DI GENERE – MOLINETTE

1. C.I.D.I.Ge.M CENTRO INTERDIPARTIMENTALE DISTURBI DELL’IDENTITA’ DI GENERE – MOLINETTE Direttore: Prof. Dario FONTANA ISTITUTO DI TERAPIA FAMILIARE Direttore: Dott.ssa Patrizia PETIVA S.C.D.U. NEUROPSICHIATRIA INFANTILE Ospedale Infantile Regina Margherita Direttore: Prof. Roberto RIGARDETTO A PUBLIC SERVICE DIRECTED TO CHILDREN WITH ATYPICAL GENDER IDENTITY DEVELOPMENT Università degli Studi di Torino A.O.U. San Giovanni Battista Osservatorio Nazionale Identità di Genere

2. Male or Female?

3. In our society,we used to consider acceptable only two models of sex:MALE and FEMALE Depending on the outwardBy behavior ...By gender stereotypes are associated ...

4. Male or Female?

5. In most of cases children, growing, recognize themselves in their biological sex and develop their gender identity in a consistent manner with it, learning in social contexts behaviors and attitudes appropriate to express and affirm their gender role with others.

6. There is a minority of childs, boys and girls living a complete disharmony between the biological aspects and gender identity with constant and dramaticawareness of belonging to the opposite gender They are ‘normal people by a chromosomal, hormonal and somatic poit of view.

7. “Children and kidsraise questions aboutnature of their normality or health” To most of them are asked to complyand are rarely included in an appropriate manner This is a condition that tests the ability oftolerance of those around them They have unique and peculiar beliefs about themselves and are distinguished by their strangeness and to be beyond the common understanding. al di là della comune capacità di comprensione.

8. THEIR DIVERSITY • Should be considered abnormal, pathological, as something that must be changed, uprooted or "treated"? OR • Must be regarded as a manifestation of an evolutionary process peculiar to understand and protect and to which we must adapt?

9. GENDER IDENTITY DISORDER IN CHILDHOOD (D.S.M.) ATYPICAL GENDER ORGANIZATION (D.Di Ceglie, 2003)

10. PREVALENCE Adults : 1 male in 30000 1 female in 100000 Children and: APA (2000) 5 maschi: 1 femmina adolescents Di Ceglie (2002) 2 maschi: 1 femmina (under 12 years) Zucker et al.(2003) 6 maschi:1 femmina Course: • About 50% of children who showed atypical gender development identity develop a homosexual orientation in adolescence. • Only 25 % may develop a gender identity disorder

11. What happens when a child or an adolescent feels different?

12. GID IN CHILDHOOD‏ • Rare event • More frequent in males • Consequences are not always predictable • Behaviors are often isolated, wearing off before adolescence • No anatomical dysphoria but bizarre behavior and role reversal

13. GID IN ADOLESCENCE • More frequent • Male:female ratio 2:1 • Main element is anatomic dysphoria • Behavior fixed, not flexible

14. collaboration between: Centro Interdipartimentale Disturbi dell'Identità di Genere Molinette (C.I.D.I.Ge.M.) Istituto di Terapia Familiare (I.T.F.) S.C.D.U. Neuropsichiatria Infantile Ospedale Infantile Regina Margherita INTERVENTION ON CHILD PRESENTING ATYPICAL GENDER IDENTITY DEVELOPMENT

17. C.I.D.I.Ge.M. INTERDEPARTMENTAL CENTRE FOR GENDER IDENTITY DISORDERS MOLINETTE Scientific Director Professor Dario Fontana Chiara Crespi Cl.Psy Valentina Mineccia Cl.Psy

18. AGE GROUP 0 -14 YEARSThe first parent-only interview Purpose of the interview Analyse the questions asked by parents to assess the real presence of distress in the childProvide information about gender identity and its development in typical and atypical psycho-educational perspectivesProvide information about skilled psycho-medical team cooperating with our Centre

19. AGE GROUP 14-18 YEARSThe first interview requested either by the adolescent or by the family One or more interviews of demand analysis and diagnostic evaluation These interviews may be individual (the child alone or the family alone) or combined type (child and family together)

20. LIFE HISTORY - Data and biological sex- Education and employment- Any previous contact with other facilities- Composition of household- Religion and possible migration- Social activities and leisure

21. AT THE END OF THE INTERVIEWOutcome and specific information before referralThe courses are subject to periodic training and supervision through: Our gender team contact either the Family Therapy Institute or the Regina Margherita Children Hospitalto discuss the case Discussion of cases before the Family Therapy Institute and Regina Margherita Children Hospital Periodic comparison with the reference team in charge of the child and operator’s supervision

22. AT THE AGE OF 18 Final evaluation and possible transition to C.I.D.I.Ge.M. for taking charge

23. SOME CONSIDERATION… In Italy there are no guidelines about hormone treatment in children and adolescents with atypical gender identity organization We are going to make a review of the S.I.A.M.S. O.N.I.G. CONSENSUS, focusing on the possibility of treating young people after the authorization by their mental health professionals and after the beginning of pubertal development, according to the Endocrine Society Guidelines.

24. SOME CONSIDERATION… Furthermore, from a psychological treatment point of view, in Italy it’s not easy to find a public center that take care of family therapy or a public centre having experience with children and adolescents with atypical gender identity organization.

25. C.I.D.I.Ge.M CENTRO INTERDIPARTIMENTALE DISTURBI DELL’IDENTITA’ DI GENERE – MOLINETTE Direttore: Prof. Dario FONTANA ISTITUTO DI TERAPIA FAMILIARE Direttore: Dott.ssa Patrizia PETIVA S.C.D.U. NEUROPSICHIATRIA INFANTILE Ospedale Infantile Regina Margherita Direttore: Prof. Roberto RIGARDETTO THANKS Università degli Studi di Torino A.O.U. San Giovanni Battista Osservatorio Nazionale Identità di Genere