Marlo Mack's son was 3 years old when he told her very adamantly that he was not a boy, but a girl.
Unsure what to do, Mack went in search of answers. She found little information online, her pediatrician knew nothing about transgender children, and even a psychologist who specialized in child identity issues couldn't answer her questions. Mack quickly learned there was almost no research that could help her determine whether to allow her son to live as a girl, or tell her what might happen if she did.
"It's like stepping into the abyss," said Mack, who uses a pseudonym to protect her child's identity. "There are almost no resources out there."
A new study by Kristina Olson, a University of Washington assistant professor of psychology, aims to provide insight that could help parents like Mack. The study's initial results, which are being published soon in Psychological Science, involved 32 transgender children ages 5 to 12 from around the U.S. who are living as their identified gender in all aspects of their lives and in supportive environments.
The paper, believed to be the first ever to focus on this group of children, is intended to launch the first large-scale, nationwide, longitudinal study of transgender children in the United States. Its co-authors are Nicholas Eaton at Stony Brook University and Aidan Key of Gender Diversity, a Seattle organization that provides training and runs support groups for families of gender-nonconforming children.
The research is part of the broader TransYouth Project, an initiative based out of the UW's Social Cognitive Development Lab that seeks to engage collaborators nationwide to better understand gender development in gender-nonconforming youth. Mack's child is participating in the research, and Olson ultimately hopes to recruit more than 100 children; families can sign up through the project's website.
Olson embarked on the project a year ago, partly out of her interest in how children think about social groups, but also because she'd witnessed the challenges of a close friend with a transgender child.
"Seeing how little scientific information there was, basically nothing for parents, was hard to watch," Olson said. "Doctors were saying, 'We just don't know,' so the parents have to make these really big decisions: Should I let my kid go to school as a girl, or should I make my kid go to school as a boy? Should he be in therapy to try to change what he says he is, or should he be supported?"
Olson's study sought to determine how deeply held a participant's gender identity was, or whether transgender children were, as others have suggested, confused or simply pretending to be the opposite gender. The research combined the children's own self-reporting about gender with tests that assessed the speed at which they associated with various concepts of male and female.
The study found that participants' responses were indistinguishable from those of two control groups, suggesting that "this identity is a deeply held one."
The findings are likely to be controversial. The notion that prepubescent children can be legitimately transgender has been met with skepticism in the public realm. And some experts believe the best approach for gender-variant children is not to allow them to live as the "opposite" gender, but to instead try to help them be comfortable with their biological gender.
But growing numbers of doctors, parents and mental health professionals are advocating that children be permitted to live as their identified gender. The attitude shift is motivated at least in part by the often tragic outcomes for transgender people. Forty-one percent of transgender people attempt suicide, compared with 4.6 percent among the general population, and transgender adults face staggeringly high rates of unemployment, poverty, discrimination and homelessness.
The risks to transgender children were driven starkly home by the Dec. 28 death of Ohio transgender teen Leelah Alcorn. The 17-year-old committed suicide after posting an online letter saying her conservative Christian parents isolated her and refused to allow her to transition from male to female.
Key, who helped to develop questions and assisted with recruitment for Olson's study, said he's met parents of transgender children as young as 5 years old who have significant anxiety and depression, even suicidal impulses.
"Families are searching for information," he said. "Nobody wants a child to say, 'I wish I were dead' when they're 6 years old."
Key said previous research and treatment have been hampered by a fear that allowing children to transition to their expressed gender will track them into becoming transgender adults. Rather than forcing children to live as their assigned gender, Key said, allowing simple measures such as using a different name or altering their hair makes them feel validated and supported.
"Then if that child were to change their mind, they would just change back," he said.
Key expects Olson's research will affirm what parents he works with have discovered -- that embracing their children's identities leads to happier, healthier young adults.
"The evidence is there in the lives of their children," he said. "The research is struggling to catch up. That's why Kristina's work is so powerful."
Olson hopes to follow the children in her initial study into adulthood to observe how the support they have received influences their development and whether it translates into more positive outcomes than in today's transgender adults.
"We have absolutely no idea what their lives will look like, because there are very few transgender adults today who lived as young kids expressing their gender identity," Olson said. "That's all the more reason why this particular generation is important to study. They're the pioneers."
Mack started a podcast, How to Be a Girl, and a blog to chronicle her experiences with her daughter and share information with other parents. She hopes Olson's work will ultimately help parents like her determine how likely their children are to remain fixed in their gender identities.
"That's the 64-million-dollar question," she said. "That's what everybody wants to know."