In Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), Gender dysphoria (GD) is defined as a marked incongruence between one's experienced/expressed gender and assigned gender. Clinical pictures of GD in children show marked diversity. Because of their limited ability to express themselves verbally, children with GD might not be able to describe their discomfort or distress about this incongruence. In contrast to GD in adulthood, GD in children could be alleviated in the natural course. Thus, the clinical diagnosis of GD in children should be made carefully. Distortion of gender identity is equal to prominent confusion of identity, and has a huge psychological burden on children with GD. In addition to the distress due to dysphoria about gender, children with GD could suffer from bullying at school, loneliness among school peers or even in their family, and feelings of disgust about their physical appearance that could cause decreased self-esteem and a sense of worthlessness.
 In 2015, the Ministry of Education, Culture, Sports, Science and Technology (MEXT) in Japan encouraged all school teachers to provide appropriate support at school to sexual minority students, including students with GD. Furthermore, MEXT published a manual for school teachers to promote necessary interventions for such students at school.
 There are several papers reporting child cases of GD and comorbid psychiatric disorders. Among them, autism spectrum disorder (ASD) is one of the common comorbidities. Reflecting these conditions, recent review articles discuss possible associations between GD and ASD.
 In this paper, based on the first author's clinical experience, we describe the clinical symptoms and diagnosis of GD in children, the relationship between GD and ASD, gender-related manifestations observed in ASD, and practical support for children with GD entering primary school.
 <Authors' abstract>