• How might potential reactions to an adolescent's questioning of their sexual identity or gender role impact their social environment, behavior, and self-esteem?
• As a social worker, what role can you play in assuring the best outcomes for these adolescents?

Ella Ella is a 16-year-old Korean American who identifies as non-binary. Non-binary is one term people use to describe genders that do not fall into the poles of male or female. Accordingly, Ella uses the pronouns they, their, and them. Ella lives with their parents, who emigrated from South Korea before Ella was born, and two brothers. Both English and Korean are spoken at home. Ella self-referred to me (the school social worker) after encouragement from friends, who noticed a depressed and anxious mood. Individual Sessions In our first meeting, Ella was somewhat reluctant to talk. I noticed that Ella was often squirming and appeared pained. I asked if something was wrong, and they reported that they really needed to use the restroom but that the school did not have gender-neutral facilities. Ella was not comfortable using either the girl's or the boy's bathroom and reported that they "do not drink anything all day" and "hold it in" to avoid the bathroom until arriving at home. I consulted with a school nurse to consider solutions that would allow Ella to feel comfortable while also avoiding a physical health issue due to restricting urination. At our second meeting, Ella was less agitated and was able to discuss the presenting problem. Ella reported that their legal sex is female but that they identify as non-binary and are also questioning their sexual orientation. Ella reported feeling this for several years, but it has only recently become a conflict as Ella matures and their appearance changes. Ella has come out to their friends but not to family or teachers. Since turning 16, Ella has felt immense pressure from their parents about potential interest in boys at school. Ella wears their hair in a short crop cut, binds their breasts, and wears polo shirts and jeans or khaki pants with sneakers most days. Concerned with the way Ella dresses, their parents have asked if Ella likes boys. Ella reassures their parents that they like boys but also like to dress their own way. Ella's mother comments that if Ella continues to dress that way, they will never be able to find a boyfriend. Ella does not want to disappoint their parents; however, for the past year, as their breasts have grown, Ella has had strong thoughts and feelings towards getting gender affirmation surgery to reshape their chest. Ella wants to share their identity as non-binary with their parentsalong with the fact that they are questioning their sexualitybut is afraid. Ella reported researching gender affirmation surgery and what it entails but fears that their parents will disown them if they ask for the surgery. Additionally, because of this conflictand the anxiety surrounding itElla's grades have been slipping from the normal As and Bs. Ella's parents prioritize education and see it as a source of pride. In fact, Ella's older brother will be attending an Ivy League college next fall, and Ella's parents want Ella to go somewhere similar. The pressure to perform well academically is contributing to the already existing anxiety about whether to disclose their gender identity. 2 2021 Walden University, LLC Ella's friends have noticed marked changes in their personality because of the pressure and expectations from home. Ella appears to be more depressed and has made comments about not wanting to live anymore if they cannot be who they really are. Ella reiterated that they feel strongly about who they are but are afraid to share this with their parents. Ella fears disappointing them and their idea of their "girl" and can even picture a scenario in which they get kicked out of the house. Ella and I made a plan for further meetings. They participated in theater and music groups at school, found a gender-neutral bathroom that could be used in the health center, and seemed to be demonstrating less anxiety as we continued to meet. I recommended that Ella go to a teen support group at the LGBTQ Center in town, to hear from what peers in their situation have experienced and how they have worked through it. Ultimately, Ella felt they had the resources and support to disclose their gender identity to their parents and brothers.

REFERNCES

Brandon-Friedman, R. A. (2019). Youth sexual development: A primer for social workers Links to an external site.. Social Work, 64(4), 356-364. https://doi.org/10.1093/sw/swz027

Mills-Koonce, W. R., Rehder, P. D., & McCurdy, A. L. (2018). The significance of parenting and parent-child relationships for sexual and gender minority adolescents Links to an external site..Journal of Research on Adolescence,28(3), 637-649. https://doi.org/10.1111/jora.12404

Centers for Disease Control and Prevention. (2017, June 21). Lesbian, gay, bisexual, and transgender health: LGBT youth Links to an external site.. https://www.cdc.gov/lgbthealth/youth.htm