Prepubertal children with gender dysphoria: A case to illustrate the management of co-occurring attention deficit hyperactivity disorder and disruptive behavior disorders

Abstract

This chapter discusses a case of a prepubertal child with diagnoses of gender dysphoria and attention deficit hyperactivity disorder (ADHD). Many of the symptoms found in ADHD and disruptive behavior disorders can be seen in presentations with gender dysphoria (GD), such as oppositionality related to external pressures to conform their gender expression or difficulty with concentration when preoccupied or under the distress that comes with gender dysphoria. Providers need to be cautious when evaluating prepubertal youth with gender concerns to ensure conditions are not over- nor underdiagnosed. In children with ADHD and gender dysphoria, questions regarding how this may affect their presentation and how both children and families manage situations, such as surrounding disclosure, may arise in children who may have difficulty in managing impulses to express their gender in ways that not everyone may support or understand, particularly when the child lacks the ability to anticipate or detect safe or unsafe situations in their environment. These children may face additional difficulties in social functioning given the impairment that can come with ADHD in addition to challenges that may be found in finding acceptance by peers, family, and society in regard to their gender identity and expression. Evaluation and treatment considerations are discussed in relationship with children that are gender nonconforming and have symptoms of ADHD.