Transitioning as a child

When child H, then aged three, was brought to school dressed as a girl, the school referred the family to social services, alleging that the foster carers may be fabricating and inducing mental illness in the children. Eighteen months later in June 2017, when H began attending, the school requested that she wear a boy’s uniform, but H and the foster parents did not comply. In July 2018, social services started care proceedings, and the social worker Lisa North alleged the foster carers had a “preoccupation with an encouragement of gender dysphoria”. On 9 May 2019 the judge completely exonerated the foster carers, praising them as child-focused.

Social Services, seeking evidence for care proceedings, commissioned a consultant paediatrician, Dr Gupta, to consider the account of events they had prepared and assess whether there was “factitious or induced illness”. That is a defined category, with a developed theory of what it is and how it may be established. The theory gives twelve factors establishing FII, all of which Dr Gupta said applied in this case, even though she did not see the children. Social Services then issued care proceedings, alleging that the foster parents have manipulated children’s gender and diagnosis of additional needs, which is considered the highest division of emotional abuse. The children remained at home while the courts obtained expert evidence.

The foster parents had three of their own children, and were caring for five more. Though not related by birth or adoption, the children saw themselves as brothers and sisters. One of them, R, aged 12, had been referred to the Tavistock gender identity clinic and was living transitioned to female. R had ADHD and autistic spectrum disorder. H and C, H’s six year old brother, had both suffered abuse and neglect from their birth parents. C had had several injuries in falls while in foster care.

A psychiatrist, Dr Hellin, assessed the foster parents and found the mother had no sign of personality disorder or mental illness, but that her identity and sense of self and of competence is very much based on her role as a mother carer and the proceedings have attacked this making her feel very insecure vulnerable, self-doubting and frightened. The father was psychologically resilient, and involved with the family, and there was no sign of FII. Both were “reflective” about the issue of gender dysphoria.

Another consultant paediatrician, Dr Ward, considered the children’s medical records though did not see the children herself. She concluded that R, the elder trans girl, and another child had no inappropriate referrals or medical treatment but that H’s brother C had had accidents because of inadequate supervision.

Of H, she used male pronouns, saying H required consistent, positive and nurturing care because of trauma and physical abuse by the birth parents. The foster-carers were over-anxious about H’s health and development, and sought second opinions. With hindsight, the investigations were not clinically indicated, and there is evidence that the foster-carers had given misleading information when they suspected cerebral palsy: if the court agreed, that would be fabrication, not merely the behaviour of an anxious parent.

H had not yet been referred about gender dysphoria. Dr Ward wrote, a significant proportion of pre-pubertal children who display differences in gender identity revert to their biological gender in adolescence. Failure to seek medical support and opinion leaves H at significant risk of emotional harm as a result of being presented in school as a girl. Failure to seek medical attention in relation to this problem represents neglect of H’s emotional and physical well-being. However the gender specialist who reported on H disagreed.

Dr Ward thought K, a girl aged 4, who had also been abused by her birth parents, was normal and healthy, but that the foster-carers interpreted her response to the abuse as mental health problems, and there was “concern” that they overinterpreted, exaggerated or misreported behaviour, which led to referrals. The foster-carers seemed focussed on potential diagnoses, which might lead to K falsely perceiving herself as disabled.

I will quote the judge’s summary of Dr Pasterski’s introduction in full.

“Dr Pasterski is a chartered psychologist and gender specialist with 23 years of experience in conducting gender identity assessments in children and adolescents. In her report she identifies that there have been recent changes to the diagnostic criteria for gender dysphoria and that research on mental health and transgender children have shed light onto critical historical misunderstandings related to clinical presentation in gender dysphoria. Firstly, that children who present with gender dysphoria are likely to desist in their cross-gender identification and secondly that gender dysphoria is inherently associated with high rates of comorbid psychopathology. She notes both have been shown to be false. She identifies that these misunderstandings arise from two particular factors. Firstly earlier studies which showed that up to 80% of children desist in gender dysphoria included children who presented with gender incongruent behaviour but did not necessarily state the wish to be or that they were the other gender. Thus children displaying gender variance may have been wrongly diagnosed with gender dysphoria. As a result of this treatment protocols previously incorporated a watch and wait approach which had prevented truly dysphoric children from transitioning which had likely resulted in increased rates of depression and anxiety. As Dr Pasterski puts it ‘Put simply, many who have shown to desist were likely not dysphoric and psychopathology in those who persisted was likely due to forbidden expression of their true gender identity.’ Current guidance suggests that supporting a child who clearly and consistently states that they wish to be the other gender in their preferred gender role is associated with improved mental health and well-being.”

Dr Pasterski thought gender dysphoria could not be fabricated or induced. R was content to present as a girl, consistent with a diagnosis of gender dysphoria. It was appropriate to support her in her authentic, preferred presentation.

H appeared to be a content, alert and socially engaged little girl. She identified herself as a girl. It was right to allow her to present as she wished, even though she had not seen the GIC: there is a risk of harm from unnecessary gender related investigations (para 59 iii). The children were free to be themselves, and removing them from their loving, settled and engaging home would harm them.

The independent social worker reported that the children were well-cared for, that the foster parents worked well with social services and health professionals, following professional advice. The children were fully integrated as a family. She thought the foster-mother was closed to the possibility of H or R reverting to male, and that early transition made it more difficult to explore gender identity- that is, she disagreed with the gender specialist.

The local authority requested permission to withdraw the court proceedings. The foster-carers objected that simply withdrawing proceedings, without the court finding the facts of the case, might lead to an unjustified cloud of suspicion over them.

The law says that where it is clear that there is no basis for care proceedings the court should allow social services to withdraw their application, but where it is arguable that there should be an order about care the court should find the facts. Court proceedings create a cloud of uncertainty, intrusion and stress, bad for the welfare of the children.

The judge concluded that it was so obvious that care orders were inappropriate that no further factual findings were necessary, and in the interests of the children the court proceedings should end. This is a complete exoneration of the foster parents. To the extent that there may be individual examples which either do amount to, or could be construed as, examples of inaccurate reporting, or over medicalisation or lack of supervision they are isolated outliers in comparison to an otherwise overwhelming evidential panorama of appropriate parenting. The children are prospering, and the foster carers are good, child-focused parents.

He decides, at para 75 iii, that concerns about the early social transition of the two trans girls were “compellingly rebutted” by Dr Pasterski. Dr Ward only gave isolated examples of over-medicalisation, but the “overwhelming weight” of evidence shows the foster carers are good parents.

So this is an example of trans girls properly cared for by loving foster carers, having to undergo court proceedings because of social workers and school staff taking concerns about the trans girls’ transitions too far, though at para 81 the judge could not condemn them: they were merely less well informed than Dr Pasterski. The judge says “The concerns were comprehensively dispelled”.

The Daily Mail’s headline about this is grudging, giving undue prominence to the social workers’ concerns: Judge backs parents who allowed their four-year-old son to live as a girl and sent him to school in a girl’s uniform – despite social workers accusing them of ‘actively encouraging’ their child’s transgender identity. Note the misgendering.

The judgment is available here.