A systemic exploration of individual and family member experiences of youth gender diversity in Australia

Background
The number of referrals of children and adolescents wishing to pursue gender reassignment has increased significantly and therefore it is imperative that service providers better understand the issues affecting these young people and their families. Few researchers have specifically examined individual family member experiences within a whole of family¹ context (parents, siblings and young person experiencing gender diversity), particularly from a sibling perspective.
Objectives
The purpose of this sequential, multiphase, mixed-methods interpretive description thesis was to identify, describe and interpret the experiences of all family members living with youth experiencing gender diversity (GDI) or dysphoria (GD), within a whole of family, clinical and wider social context. The specific aims of the thesis were to: 1) explore the value of family involvement in specialist gender services in Australia to inform clinical practice; and 2) better understand youth GDI and GD by exploring individual family member experiences, involving siblings under the age of 18 years, including through the use of circular questioning² .
The research study is based on the overarching research question “what are individual family members’ experiences of youth GDI?”
Phase 1- Specialist evaluation phase (Chapter 4)
Specialists in the field of youth GDI and youth GD in Australia were asked to complete an online questionnaire in phase 1, exploring family involvement in youth GDI/GD assessment and treatment. This provided a national clinical context for the thesis.
Phase 2A and 2B- Face to Face Interviews and online questionnaire feedback (Chapter 5)
Individual family members (young people aged 12-17 years experiencing GD, siblings aged 11-17 years and parents or carers of these young people) recruited from families connected with a parent support group for gender diverse young people in Victoria, Australia, (‘Transcend’) were invited to participate in individual, face to face ‘Zoom’ videoconference interviews, with the aim of exploring individual family members’ experiences of youth with GD specifically. Qualitative data was obtained using open-ended questioning. Responses obtained in this phase were used to inform questionnaire development for phase 3.
Phase 3- Online survey completed by family members nationwide (Chapter 6)
Individual family members (parents or carers of gender diverse or gender dysphoric young people aged 12-17 years, siblings aged 12-17 years, young people aged 12-17 years experiencing GDI or GD) were invited to complete an online survey (SurveyMonkey) questionnaire in phase 3. Both quantitative and qualitative data was obtained using open-ended and circular questioning, and Likert scales.
A literature review (chapters 1 and 2) aimed to identify relevant background information and, specifically, all available studies pertaining to understanding youth GDI/GD within a family context, using specific search terms. The review found strong supporting evidence of the importance and merit of understanding youth GDI within a family or systemic context, the benefits of family member support on youth GDI outcomes, and confirmation that youth GDI affects everyone in the family to varying degrees. Similar to previous research, various themes were identified including meaning making, adjustment, carer/parent responses, lack of professional understanding or support, loss and grief, family support (or lack thereof) and a systemic (family system) understanding of youth GDI. Siblings and fathers/male caregivers were under-represented in the identified literature.
Results
Phase 1 (gender specialists, chapter 4) found that Australian specialists highly valued adopting a systemic approach, situating young people within their immediate and wider social context, and involving all family members whenever possible, including siblings, although this was not embedded in assessment protocols and rarely done in practice. Sibling experiences and the use of circular questioning were valued by all respondents in identifying new perspectives. These findings replicate previous research findings, in addition to contributing new findings (detailed above) to the research literature.
Phase 2A (face to face Zoom interviews, chapter 5) found that all family members reported positive and negative experiences of youth GD, with levels of acceptance tending to improve with time. Some siblings reported differing experiences within the same family. Most families valued a whole-of-family approach within specialist healthcare contingent on doing no harm, depending on individual circumstances and context.
Phase 3 (nationwide online survey chapter 6) found that participants reported mixed experiences of youth experiencing GD and GDI, with varying levels of understanding and support provided by family members. The majority of young people felt misunderstood by other family members and tended to report more negative experiences than other family members. Over half of all family members reported differing viewpoints in the family which often changed over time. Parents and siblings generally felt it important for healthcare professionals to ask everyone’s experience in the family, although around one-third of young people with GDI/GD felt this was important.
Conclusion
The collective thesis findings confirmed that youth GD/GDI affects all members of the family in unique and not always apparent ways. Gender diversity specialists valued adopting a systemic approach and using circular questioning, as did participants in phase 2. The majority of young people felt misunderstood by other family members and reported more negative experiences than other family members. Over half of all respondents reported differing viewpoints. Specialist gender services could benefit from adopting a systemic approach; involving all members of the immediate family if appropriate to do so, to identify strengths and barriers to support and acceptance, and to ultimately improve outcomes for gender diverse youth.
Footnotes

1 ‘Whole of family’ in this context refers to including parents, young people experiencing GD/GDI and their siblings.
2 ‘Circular’ questioning, as opposed to ‘linear’ questioning, refers to asking one person how another might be thinking or feeling; details pertaining to questions can be found in the appendix and in the published articles.