At the close of 2014 the media world was abuzz with the celebrity news that Angelina Jolie and Brad Pitt’s daughter, Shiloh, had asked to be called John by her family, and had adopted a male wardrobe and appearance. John appeared at a red-carpet event with his parents, clad in a smart black suit to match his brothers’.  His A-list mother told the U.K.’s Telegraph that in 2010 Shiloh asked to have her hair cut and wear boys’ clothes.

Instead of sweeping it under the popular culture rug, or denying it outright, as famously happened with Sonny and Cher Bono’s daughter, Chastity (now Chaz Bono), the Jolie-Pitts have acknowledged the desires of their eight year-old and are allowing the child to explore gender as a choice.  What, though, is the difference between a girl being a tom-boy, a child of either gender experimenting with gendering as choice, and a child with gender issues serious enough to lead them to decide to become transsexual or transgender?

The recent news on what’s commonly known as gender confusion (clinically labeled as Gender Identity Disorder) is just the latest event to highlight what child psychologists, teachers, therapists, and especially parents, have known for some time; gender is not the set in stone personality trait we like to believe it to be. In the information age, many resources are available to assist parents as they help their children navigate the performance of gender. Recent books like Cinderella Ate My Daughter and My Princess Boy provide parental insight, and even the go-to hub of parenting, Parents Magazine, features at least one article specifically on gender confusion. Most of the work available on gender identity in youngsters focuses on allowing children emotional space and time to experiment , and how parents can remain supportive while Julie demands boxer shorts and Joey dons a tiara.

The psychological and medical fields weigh in on the issue of Gender Dysmorphia (someone who feels they were born the wrong gender), at a physical level. Many noted psychiatry professionals are in agreement that true Gender Dysmorphia is in their opinion genetic, that there is a very small portion of the human population whose brains are hardwired as the opposite gender to their physical appearance. Some with Gender Dysmorphia choose to surgically alter their bodies so that they physically present as the gender they feel they are, and many simply choose to live as the gender the wish to be.

Those who treat children with gender identity issues seem split into two camps: those who, like Dr. Ken  Zucker, believe we should train children to live in the bodies/genders they’ve got, and those who feel that gender is less about “what’s between our legs,” like Dr. Diane Ehrensaft . Those therapists who fall into her camp see gender less as an either/or proposition, but something more flexible, even allowing for colloquial terminology like “gender-fluid” and “genderqueer,” both meaning someone who exhibits traits of both genders.

The two noted child gender therapy specialists were interviewed for National Public Radio’s story on gender in 2008 and that story served to highlight the differences in their approaches to treating children who present with gender confusion. Unlike other “disorders,” gender identity confusion is only diagnosable through demonstrated behavior, like what toys children choose to play with or how they dress. There are enormous gray areas within diagnostic criteria, such as whether there should be an age at which cross-gendered play goes from being experimental to being serious and potentially harmful to the child’s mental state, and whether children as young as pre-school aged should be listened to when they insist they are opposite gendered. 

Sociologists have long understood that gender is in some part an assigned trait, a decision, usually made unconsciously, by each individual. The idea of gender (behaving as a male or female) is so ingrained in human culture that children are inculcated from birth to enact either male or female gender normative behavior.  From the hospital putting pink and blue caps on newborns to toy aisles swathed in pink, society and popular culture instruct parents and children how to behave as boys or girls.

The one thing that is clear is that every child who experiments with gender is not gender dysmporphic, and those with real gender confusion experience it differently and for their own distinct reasons. Each case must be assessed individually and families given all the support they require.