Acceptability of Screening for Gender Identity in a National Sample of Parents with Young Children.

Acceptability of Screening for Gender Identity in a National Sample of Parents with Young Children - PMC Skip to main content An official website of the United States government Here's how you know Here's how you know Search Log in Primary site navigation Search Log in Search PMC Full-Text Archive Search in PMC Journal List User Guide As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with, the contents by NLM or the National Institutes of Health. Learn more: PMC Disclaimer | PMC Copyright Notice Transgend Health . 2025 Jun 5;10(3):242–251. doi: 10.1089/trgh.2023.0053 Acceptability of Screening for Gender Identity in a National Sample of Parents with Young Children Amy Hillier 1, * , Nadia Dowshen 2 , Matthew A Diemer 3 , Steven C Marcus 1 Author information Article notes Copyright and License information 1 School of Social Policy & Practice, University of Pennsylvania, Philadelphia, Pennsylvania, USA. 2 Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. 3 School of Education, University of Michigan, Ann Arbor, Michigan, USA. * Address correspondence to: Amy Hillier, MSW, PhD, School of Social Policy & Practice, University of Pennsylvania, 3718 Locust Walk, Philadelphia, PA 19104, USA, ahillier@upenn.edu i ORCID ID ( https://orcid.org/0000-0002-6332-7452 ). ii ORCID ID ( https://orcid.org/0000-0002-8466-1628 ). Collection date 2025 Jun. Copyright 2025, Mary Ann Liebert, Inc., publishers PMC Copyright notice PMCID: PMC12183499  PMID: 40557062 Abstract Purpose: Providing support for transgender and gender nonconforming children's identity before puberty has been shown to improve mental health outcomes. This study aimed to determine the acceptability of population-based screening for gender identity with parents of young children. Methods: A national sample of parents with children ages 3–12 completed an online survey about their child's gender and their own feelings about answering such questions. Multivariate linear regression models identified significant predictors of acceptability among parents and children. Results: A racially/ethnically and geographically diverse sample of parents ( N =2680) completed the survey during August 2022. Most (94.2%) reported their child's gender was consistent with their sex assigned at birth; 2.3% reported their child identified as the opposite gender and 3.4% reported their child was nonbinary. Most parents found the questions to be acceptable; 87.8% indicated they did not find the questions offensive and 87.4% indicated they would be comfortable answering the questions with a pediatrician. A small minority of parents (7%) expressed strong resistance to answering the questions, referencing religious and moral objections, a belief that young children cannot understand and should not be encouraged to think about gender identity, that such questions sexualized children, and that gender was a private issue to be kept within the family. Conclusion: Screening for gender identity with parents of young children is largely acceptable and may provide opportunities for normalizing discussions about gender and linking families in need to gender-affirming psychosocial and medical support. Keywords: acceptability, gender identity, parents, pediatric, screening Introduction An increasing number of children identify their gender as something different from their sex assigned at birth, falling under the broad umbrella of transgender and gender nonconforming (TGNC). 1–3 Based on survey data from multiple states, the Williams Institute estimates that 1.4% of adolescents ages 13–17 identify as transgender, 4 but no U.S. population-based estimates of the number of TGNC children exist. TGNC adolescents have been shown to experience higher rates of depression, anxiety, HIV/AIDs, disordered eating, substance abuse, bullying, victimization, nonsuicidal self-injury, and suicide than their cisgender peers. 5–10 Legislation banning gender-affirming care has exacerbated concerns about their well-being. 11 , 12 Research indicates that worse health outcomes are caused largely by discrimination, victimization, and the lack of support from the adults and the institutions responsible for caring for them, 13–15 with particular emphasis given to the importance of parents. 16 , 17 Identifying TGNC children early, before puberty and development of secondary sex characteristics of the birth assigned sex increase gender dysphoria, can facilitate interventions to increase parent support, and minimize disparate health outcomes in adolescence. 18 From a developmental perspective, this is possible because children usually have a sense of their gender by ages 3–5. 13 , 19 , 20 Interventions might include sharing information about gender development with pediatric primary care providers, providing referrals for counseling and gender-affirming medical care, and linking parents to peer support groups. 6 , 21 Screening adolescents about their gender during pediatric well visits has been shown to be acceptable and feasible in at least one Northern California health care system. 22 In that study, a single question about gender was included in a longer health screening instrument completed separately by adolescents and parents. If done systematically among families with children and adolescents, such screening could provide important information about the prevalence and characteristics of TGNC children and help identify families in need of additional resources and support including linkage to gender-affirming medical and mental health care. Systematic screening could also help normalize talking with all children and parents about gender. However, there are no published studies about the acceptability of screening for gender identity with younger children nor are there studies exploring this question nationally. Even when children share TGNC identities, parents may not be able or willing to comprehend such information or share it with health care professionals. The current ideological battle over appropriate care for transgender children and discussion of gender and sexuality in schools adds further uncertainty as to whether such screening would be feasible or acceptable to parents. 11 , 12 Therefore, we aimed to test potential items for a brief screening instrument and determine acceptability among parents of screening for their child's gender identity. Specifically, we aim to explore the extent to which parents are comfortable discussing the gender identity of their young children and to assess if this comfort level varies based on the parents' own demographic backgrounds or the gender identity of their children. Methods Study participants In August 2022, we recruited a national sample of 2680 parents designed to mirror the geographic distribution and demographic composition of the U.S. adult population through Lucid, a survey research firm. Lucid works with multiple suppliers who maintain research panels, prescreening members of these existing panels based on eligibility criteria and paying suppliers when members of their research panels complete surveys. In this case, eligibility was limited to people aged 18 and over living in the United States who were parents (biological, by adoption, foster care, or step) or legal guardians of children ages 3–12. Lucid has been used widely in academic research and has been shown to capture subjects similar to U.S. national benchmarks through use of demographic quotas, which were used in this survey. 23 , 24 The response rate for this survey was 34.2% based on how many clients Lucid invited versus how many completed the survey. Procedures Lucid directed participants to a Qualtrics survey. Before beginning the survey, parents gave their consent to participate in the research study. If participants had more than one child between the ages of 3 and 12, they were asked to answer questions based on who had most recently had a birthday. Participants completed the survey, including questions about their child's behavior, expression, and gender identity as well as questions about their feelings about answering such questions, in an average of 6.7 minutes (median=4.8 min). The study protocol was determined to be exempt by the University of Pennsylvania Institutional Review Board. Measures Questions about gender identity, expression, and behavior were adapted from existing instruments including the Gender Identity Questionnaire for Children (GIQC), 25 Gender Behavior and Attitude Questionnaire, 26 Gender Typicality, 27 and Utrecht Gender Dysphoria ( Table 1 ). 28 Questions regarding acceptability of asking about gender were adapted from Lau et al. ( Table 2 ). 22 Participants were asked demographic questions including parent's gender, age, sexual orientation, race/ethnicity, education level, religion, relationship to child, their choice of presidential candidate in the 2020 election, and the age, sex assigned at birth, and birth order of the child for whom questions were answered. We also asked parents two open-ended questions, “how would you describe your child's gender?” and “how do you feel about answering these questions?” Table 1. Survey Items Relating to Gender Identity with Response Options and Source Screener item and response options Item adapted from 1. Who are your child's playmates outside your family? Always or usually boys; always or usually girls; combination of boys and girls; my child doesn't play with other children Gender Identity Questionnaire for Children (GIQC) 25 2. Given the choice, would your child choose to play with action figures, dolls, or some combination? Action figures; dolls; some combination. GIQC 25 3. When your child imitates characters from TV or the movies, are they usually girls or women? Boys or men? Some combination? GIQC 25 4. When playing “house” or “family,” what role does your child usually take? Mother, daughter, or other girl/woman roles; father, son, or other boy/man roles; some combination GIQC 25 5. When playing “dress up,” who does your child dress up as? Traditionally girl/woman roles like princess; traditionally boy/man roles like policeman or fireman; some combination GIQC 25 6. How often does your child experiment with wearing cosmetics (makeup) and jewelry? Often, sometimes, never GIQC 25 7. Has your child ever said to you they wish they were a different gender, like a boy wanting to be a girl? GIQC 25 8. Has your child ever said to you they are a different gender? GIQC 25 9. Has your child ever said they do not like their sexual anatomy (“private parts”)? GIQC 25 10. How well does your child fit in with other children of their same gender? Gender typicality 26 11. How does your child prefer to wear their hair? Short, medium, long. Item developed by authors 12. How do you think other people would typically describe your child's appearance (hairstyle, clothing, etc.)? Masculine; feminine; gender neutral; sometimes masculine; sometimes feminine Socially assigned GNC 27 13. How would you describe your child's appearance (hairstyle, clothing, etc.)? Masculine; feminine; gender neutral; sometimes masculine; sometimes feminine Socially assigned GNC 27 14. Does thinking or talking about gender cause your child distress? Gender dysphoria 28 15. Does thinking or talking about your child's gender cause you distress? Gender dysphoria 28 16. Do other people ever misgender your child, that is use the wrong pronouns for them? Item developed by authors Open in a new tab GIQC, gender identity questionnaire for children; GNC, gender nonconformity. Table 2. Survey Items About Acceptability to Parents of Asking About Gender of Their Children 1. How did you feel about answering these questions? (open-ended) 2. Did you find any of these questions confusing? 3. Did any of the questions make you feel uncomfortable? 4. Did the questions feel appropriate and respectful to your family's culture, including your ethnic background or religion? If not, can you tell us why? (open-ended) 5. Did you find any of the questions offensive? 6. Would you be comfortable answering these questions during a visit with your child's pediatrician? 7. This study is trying to learn how we can identify families that might have questions about or want resources about gender. Do you think screening and discussions about gender identity would be beneficial to you and your family? Open in a new tab Questions 2, 3, and 5–7 were adapted from another study. 22 The wording was changed slightly to fit with the survey structure. Analysis Descriptive statistics were generated in SPSS v.28 to determine how often people found questions about their child's gender identity to be (1) offensive, (2) confusing, or (3) uncomfortable, (4) whether they found the questions to be respectful and appropriate based on their culture, (5) were comfortable answering such questions with a pediatrician, and (6) thought gender screening and discussion would be beneficial to their family. We computed a continuous metric of unacceptability by analyzing responses to the first three questions, as they most closely align conceptually with the notion of acceptability. The three questions were weighted equally, so total unacceptability scores ranged from 0 (low unacceptability) to 3 (high unacceptability). These three items were highly internally consistent (α=0.78), particularly for a brief measure (given that Alpha is biased downward against shorter scales). We also explored and detailed below the associations between each gender identity screener item and two key factors: the mean unacceptability score, and the proportion of respondents who reported any confusion, discomfort, or offense (specifically, unacceptability scores from 1 to 3). We present the p -values obtained from ANOVA and chi-square tests relevant to these relationships. We also conducted a stepwise linear regression model to predict the acceptability score as a function of key parental demographic characteristics that were selected based on a review of the literature about parent support and resistance to TGNC identities. 29 Analysis of open-ended responses about child's gender was guided by Modified Consensual Qualitative Research (CQR-M). 30 , 31 Two researchers independently reviewed and coded responses, initially identifying 20 categories. Upon meeting to review differences, we agreed on three broad categories: boy and masculine (including male, all boy, cisgender male, normal boy, typical boy, boyish, and very manly); girl and feminine (including female, typical girl, little princess, girly, and femenina); and nonbinary and/or transgender (including both genders, gender fluid, genderless, gender nonconforming, tomboy, and demigirl). Descriptions that could not be categorized in one of those three ways (7.4%, including natural, very evident, and the best gender) were grouped as “something else.” CQR-M was also used for analysis of the open-ended responses to the question, “how did you feel about answering these questions?” Two researchers reviewed and coded the responses, then met to talk through our initial 10 categories, ultimately agreeing to collapse these into categories for positive, neutral, ambivalent, and negative responses. We achieved consensus on this level of coding, categorizing the 6.3% of responses that did not fit these categories as “something else.” We then reviewed the negative responses together and agreed on four subcategories: age inappropriate, sexualizing children, immoral/unnatural, and invasive. We independently coded the negative responses based on these new categories, then met to discuss and work through any differences until we achieved consensus. Results In this section, we report (1) the demographics of our sample; (2) the distribution of gender identities parents reported for their children; (3) the acceptability of questions about gender, (4) parent responses to gender screening items by unacceptability scores; and (5) differences in unacceptability across key demographic groups. The demographics of parents who completed the survey are reported in Table 3 . 32–36 The population was largely representative of the general population of parents in the United States. The proportion of women (67.1%) exceeded the proportion of men (31.5%) in the survey by an amount greater than in the U.S. population of parents who live with their children under 12 (55% mothers to 45% fathers). Our sample included a lower proportion of Hispanic/Latinx participants (7.1% compared with 21.9%). Table 3. Demographics of Survey Participants (Parents) Variable N (%) US Population a Gender Men 844 (31.5) 45.0% Women 1797 (67.1) 55.0% Sexual orientation Straight/heterosexual 2306 (86.0) — Gay, lesbian, queer, bisexual 370 (14.0) — Age in years 18–24 134 (5.0) 3.4% 25–29 350 (13.1) 8.6% 30–39 1273 (47.5) 37.3% 40–49 720 (26.9) 35.8% 50+ years 203 (7.6) 15.0% Race/ethnicity Asian/pacific islander 158 (5.9) 5.8% Black, not hispanic 425 (15.9) 12.1% Hispanic/latinx 190 (7.1) 21.9% White, not hispanic 1702 (63.5) 56.9% All remaining races and combinations 205 (7.6%) 3.9% Education No high school diploma 105 (3.9) 8.8% High school diploma or equivalent 709 (26.5) 26.5% Some college or associate degree 781 (29.1) 24.3% College degree or more 1085 (40.5) 42.2% Household income Under $20,000 339 (12.7) 13.5% $20,000–$49,999 808 (30.1) 16.5% $50,000–$74,999 509 (19.0) 14.9% $75,000–$99,000 409 (15.3) 12.5% $100,000–$199,000 527 (19.7) 28.7% $200,000 or more 88 (3.3) 13.8% Religion Buddhist 41 (1.5) 0.8% Christian 1588 (59.3) 70.6% Jewish 52 (1.9) 1.4% Muslim 82 (3.1) 0.8% Something else not listed 166 (6.2) 1.4% Does not identify with any religious faith 728 (26.1) 23.3% Region of country Northeast 541 (20.2) 17.1% South 1074 (40.1) 38.6% Midwest 621 (23.2) 20.6% West 444 (16.6) 23.6% Born in US 2511 (93.7%) 83.3% Vote for president in 2020 Joseph Biden 1128 (42.1) 34.7% Donald Trump 839 (31.3) 31.4% Someone else 82 (3.1) 1.2% Did not vote 533 (19.9) 33.2% Not willing to share 98 (3.7) N/A Relationship to child Biological parent 2328 (86.9) — Parent by adoption 76 (2.8) — Foster parent 6 (0.2) — Legal Guardian 165 (6.2) — Step-parent 64 (2.4) — Something else not listed 41 (1.5) — Open in a new tab N/A, not applicable. a Data about the U.S. Population came from multiple sources because no one source had all variables broken down for parents of young children. Gender distribution is based on the 2022 Current Population Survey (CPS) and includes parents who live with their children under age 12. 32 Age, education, and race/ethnicity are based on the 2022 CPS and include parents who live with their children under age 18. 32 Religion is based on PRRI's 2020 Census of American Religion for all adults. 33 Region is based on 2022 estimates for people of all ages by the U.S. Census Bureau. 34 Place of birth is from the 2021 American Community Survey for adults ages 18–74. 35 Race/ethnicity2020 voting data is from the U.S. Census. 36 Recent estimates of the distribution of parents by sexual orientation and relationship to child were not readily available. Among parents who provided a response to the open-ended question about gender that could be categorized, most (94.2%) reported their child's gender was consistent with their sex assigned at birth. Another 2.3% reported their child identified as the opposite gender and 3.4% reported their child was nonbinary/gender fluid. Parents were significantly more likely to categorize children assigned female at birth as the opposite gender or nonbinary/gender fluid than children assigned male at birth χ 2 (3, N =2680)=57.5, p <0.001, with these differences most pronounced for 11- and 12-year-olds ( Table 4 ). Table 4. Parent Description of Child's Gender Identity by Sex Assigned at Birth Assigned male Assigned female Gender identity n % n % Boy/masculine 1251 95.5 35 3.0 Girl/feminine 23 1.8 1083 92.8 Nonbinary/gender fluid 36 2.7 49 4.2 Total 1310 1167 Open in a new tab Parent responses of “something else” for assigned sex ( n =9) were excluded. Gender identity reflects categorization of open-ended responses to the question, “how would you describe your child's gender?” Responses that could not be coded in one of these three categories were excluded from this analysis. Parent responses to the close-ended questions about gender suggest that a much larger portion of children are questioning or challenging gender norms than indicated by our coding of the open-ended gender question. For example, parents reported their children were misgendered (14.5%), distressed about their gender (15.1%), wished they were a different gender (11.9%), said they were a different gender (10.1%) and did not like their anatomy/private parts (8.3%) at a higher rate than we coded children as TGNB (5.9%). Further research is needed to refine and validate a gender diversity screener. Most parents found the questions about their child's gender to be acceptable. A relatively small proportion found the questions to be confusing (9.6%), offensive (12.2%), or uncomfortable (14.9%). Most parents (87.4%) said they would be comfortable answering the questions with their child's pediatrician. A smaller proportion (73.7%) reported that the questions felt appropriate or respectful of their family's culture, including their ethnic and religious background. A still smaller proportion (48.1%) thought gender screening and discussion would be beneficial to them and their family. Most parents (79.6%) scored 0 on the unacceptability score, meaning they did not find the questions about gender confusing, offensive, or uncomfortable. The next largest group (9.3%) scored a 1, while 5.8% scored a 2 and 5.3% scored a 3. Table 5 reports parent responses to the gender-screening items based on unacceptability scores. In all instances, unacceptability scores were significantly higher for parents reporting cross gender play and expression (i.e., children assigned female at birth usually playing with boys or children assigned male at birth dressing up as girls/women). The exception was among parents who report nonbinary/gender fluid identities; these parents had significantly lower unacceptability scores. Table 5. Unacceptability Scores by Screener Item Responses Screener item Frequency (%) Mean unacceptability Reported discomfort with questions (%) a Overall 2680 (100%) 0.367 546 (20.4) Child's playmates outside family p <0.001 b p <0.001 c Align with SAB 844 (31.5) 0.528 235 (27.8) Cross gender d 70 (2.6) 1.16 35 (50.0) Combination of boys and girls 1684 (62.8) 0.240 245 (14.5) Doesn't play w/other children 82 (3.1) 0.646 31 (37.8) Child chooses to play with p =0.004 p <0.001 Align with SAB 1652 (61.6) 0.378 350 (21.9) Cross gender 157 (5.9) 0.854 50 (31.8) Some combo dolls/action figures 871 (32.5) 0.258 136 (15.6) Imitates characters from TV p =0.015 p <0.001 Align with SAB 1581 (59.0) 0.369 322 (20.4) Cross gender 110 (4.1) 1.19 59 (53.7) Combination of characters 989 (36.9) 0.272 165 (16.7) Roles when playing house/family p <0.001 p <0.001 Align with SAB 2044 (76.3) 0.308 359 (17.6) Cross gender 157 (5.9) 1.20 90 (57.3) Combination of roles 479 (17.9) 0.347 175 (36.5) Roles when playing dress-up p =0.054 p <0.001 Align with SAB 2079 (77.6) 0.324 379 (18.2) Cross gender 162 (6.0) 1.10 86 (53.1) Combination of roles 439 (16.4) 0.301 81 (18.5) Experiments cosmetics/jewelry p <0.001 p <0.001 Align with SAB 1724 (64.3) 0.274 289 (16.8) Cross gender 313 (11.7) 0.447 74 (23.6) Never experiments 643 (24.0) 0.579 183 (28.5) Length of hair p <0.001 p <0.001 Align with SAB 2594 (96.8) 0.356 513 (19.8) Cross gender 86 (3.2) 0.698 33 (38.4) Ever said wish different gender p <0.001 p <0.001 No 2325 (86.8) 0.243 356 (15.3) Yes 355 (13.2) 1.18 190 (53.5) Ever said are a different gender p <0.001 p <0.001 No 2367 (88.3) 0.239 361 (15.3) Yes 313 (11.7) 1.34 185 (59.1) Don't like sexual anatomy p <0.001 p <0.001 No 2412 (90.0) 0.244 371 (15.4) Yes 268 (10.0) 1.48 175 (65.3) Fit well with others of same SAB p <0.001 p <0.001 Yes 2561 (95.6) 0.350 497 (19.4) No 119 (4.4) 0.731 49 (41.2) Others describe appearance p =0.002 p <0.001 Align with SAB 2117 (79.0) 0.319 380 (17.9) Cross gender 141 (5.3) 1.17 80 (56.7) Gender neutral 114 (4.3) 0.298 22 (19.3) Sometimes masc sometimes fem 308 (11.5) 0.406 64 (20.8) Parent describes appearance p =0.002 p <0.001 Align with SAB 2161 (80.6) 0.315 396 (18.3) Cross gender 119 (4.4) 1.24 67 (56.3) Gender neutral 82 (3.1) 0.354 16 (19.5) Sometimes masc sometimes fem 318 (11.9) 0.396 67 (21.1) Think/talk gender=child distress p <0.001 p <0.001 No 2254 (84.1) 0.228 326 (14.5) Maybe 148 (5.5) 0.527 42 (28.4) Yes 278 (10.4) 1.41 178 (64.0) Think/talk gender=parent distress p <0.001 p <0.001 No 2296 (85.7) 0.230 329 (14.3) Maybe 97 (3.6) 0.660 34 (35.1) Yes 287 (10.7) 1.36 183 (63.8) Others ever misgender child p <0.001 p <0.001 No 2268 (84.6) 0.367 333 (14.7) Yes 412 (15.4) 1.12 213 (51.7) Parent describes child gender p <0.001 p <0.001 Aligns with SAB 2334 (94.1) 0.287 398 (17.1) Nonbinary/fluid 85 (3.4) 0.186 10 (11.6) Opposite SAB 58 (2.3) 0.983 27 (45.0) Open in a new tab a Unacceptability scores of 1–3, meaning participant reported confusion, discomfort, and/or being offended. b p -values were calculated using Analysis of Variance (ANOVA). c p -values were calculated using χ 2 . d Screener items that offered boy/girl or masculine/feminine responses were recoded to distinguish behavior/expressions aligned with sex assigned at birth (SAB) versus cross gender. For variables about playmates, toys, roles imitated from tv/movies, chosen in house/family and dress up, and appearance to others and to parents, responses were coded as “cross gender” for children assigned female at birth who usually chose the “boy” option and children assigned male at birth who usually chose the “girl” option. Experimenting with cosmetics/jewelry and length of hair (long hair) were coded as “cross gender” for children assigned male at birth, only. In the multivariate regression model (adjusted R 2 =0.078), multiple parent characteristics were statistically significantly associated with acceptability score. Specifically, biological (β=−0.114, 95% CI: −0.372 to −0.175, p <0.001) and heterosexual parents (β=−0.082, 95% CI: −0.281 to −0.106, p <0.001) who did not go to church or reported they were atheist (β=−0.073, 95% CI: −0.212 to −0.068, p <0.001) and parents answering questions about children ages 8 and over (β=−0.048, 95% CI: −0.140 to −0.017, p =0.013) had significantly higher acceptability scores. Parents who were under 30 (β=0.036, 95% CI: −0.010 to −0.161, p <0.084), had household incomes below $20,000/year (β=0.039, 95% CI: 0.002 to −0.262, p =0.047), had no high school diploma (β=0.073, 95% CI: 0.147 to −0.463, p <0.001), or a college or graduate degree (β=0.099, 95% CI: 0.099–0.227, p <0.001), voted for Trump in 2020 (β=0.072, 95% CI: 0.060–0.192, p <0.001), and were answering questions about an oldest or only child (β=0.053, 95% CI: 0.025 to −0.147, p =0.006) had lower acceptability scores. Black (β=0.081, 95% CI: 0.087 to −0.246, p =0.047) and Hispanic/Latinx parents (β=0.056, 95% CI: 0.049 to −0.238, p =0.003) also had significantly lower acceptability scores ( Table 6 ). Table 6. Predictors of Composite Parent Unacceptability Score Based on Stepwise Multivariate Linear Regression Model Characteristic β 95% CI p (Constant) 0.461 to 0.734 <0.001 Biological parent −0.114 −0.372 to −0.175 <0.001 Heterosexual/straight −0.082 −0.281 to −0.106 <0.001 Don't go to church or atheist −0.073 −0.212 to −0.068 <0.001 Parent by adoption 0.075 0.170 to 0.570 <0.001 Black/African American 0.081 0.087 to 0.246 <0.001 College or graduate degree 0.099 0.099 to 0.227 <0.001 No high school diploma 0.073 0.147 to 0.463 <0.001 Parent is under 30 0.036 −0.010 to 0.161 0.084 Voted for Trump in 2020 0.072 0.060 to 0.192 <0.001 Hispanic/Latinx 0.056 0.049 to 0.238 0.003 First or only child 0.053 0.025 to 0.147 0.006 Child ages 8 or older −0.048 −0.140 to −0.017 0.013 Income less than $20,000/year 0.039 0.002 to 0.262 0.047 Adjusted R 2 0.078 Open in a new tab CI, confidence interval. More than one quarter of parents reported positive feelings in the open-ended responses about answering the questions, offering responses such as “great,” “good,” “comfortable,” “confident,” “confirming,” and “important to me.” Approximately half of respondents reported neutral feelings such as “fine,” “okay,” “indifferent,” “not bad,” and “normal.” A smaller group (8.6%) responded that answering the questions was “weird” and “awkward,” acknowledging some ambivalence, discomfort, or confusion. Parents who reported strong negative feelings made up less than 7% of participants. The largest group (2.9%) referenced religion, nature, or some other moral issue to explain why they found the questions unacceptable. From their perspective, children's sex assigned at birth naturally aligns with gender identity, and talk about transgender identities is ridiculous, confusing, dangerous, or disgusting. Some of these parents referenced an “agenda” and “brain washing crap” aimed at making children “feel like they are something they are not.” Others used the language of “PC” and “woke” to dismiss the legitimacy of questions about their child's gender. A second group of parents (2.8%) resisted the idea that young children can understand gender or should be encouraged to talk or think about gender identity. Younger children are “too impressionable” or “not old enough” to participate in conversations about gender. A smaller group (0.6%) objected to discussing their child's gender outside their own family, referring to this as “private” or “personal” information and the questions as “invasive.” A still smaller group (0.4%) made references to their child's sexual orientation or to concerns that the questions were sexualizing their children, suggesting they did not or could not distinguish between gender and sexuality. Discussion Widespread disinformation about gender-affirming care 37 , 38 and the lack of standardized measures for capturing gender identity in children 30 makes it difficult for researchers and health care professionals to identify TGNC children. Furthermore, the ongoing political and ideological battle about the rights of transgender children and adolescents to access gender-affirming care has clouded our ability to understand the perspectives of parents and their willingness to talk about their children's gender identity. The most important finding of our study is that the vast majority of parents, regardless of their demographic characteristics, find it acceptable to be asked about their child's gender identity (87.8%) and would be comfortable being asked about it by their child's pediatrician (87.4%). While the proportion of parents who did not find the gender questions acceptable was relatively small, it was higher than reported among parents in the study by Lau et al. 22 In that study, adolescents and their parents were asked a single close-ended question about gender; 2.8% of parents said the question was offensive and 4.4% of parents said they felt uncomfortable compared to 12.2% and 14.9%, respectively, in our study. This difference likely reflects an increased level of comfort among parents discussing gender of their children as they enter puberty; it may also be due to geographic factors (i.e., parents in their Northern California sample may be more open to discussing gender than our national sample). Also, by asking just a single question (“what is your gender?”), that study did not force parents to consider their child's fit relative to their peers or conventional gender norms. Our survey asked about several different aspects of gender; it stands to reason that questions about multiple aspects are more likely to be found offensive than a single item. Although overall it was a small minority of respondents, some parents made comments about their lack of tolerance for questions they imagined were about their child's sexuality. This may have been in response to an inclusion of the question from the GIQC: “Has your child ever said they do not like their sexual anatomy (‘private parts’)?” In future efforts to ask parents about their children's gender, researchers and clinicians should ask parents more directly about what they feel is the most appropriate terminology around bodies and genitalia, and this may also be an opportunity for education to address the common error of conflating gender identity and sexual orientation. 39 Parent acceptability varied based on parent responses to questions about their children's gender identity, behavior, and expression. This finding is important, highlighting a notable difference between two groups of parents: those who identify their child's gender as nonbinary or fluid tended to be more accepting of the questions, whereas parents whose child's gender is identified as different from their sex assigned at birth were more inclined to view the questions as unacceptable. In being able to describe their children as nonbinary or gender fluid, parents have likely moved beyond gender essentialism and thus may find questions about gender more acceptable. Overall, this finding points to the most likely source of resistance to a gender screener with parents of young children—namely, parents who notice nonconforming identities, behaviors, and expression among their children—and underscores the care with which any screener must be implemented. While most of the other significant predictors of acceptability were unsurprising, differences in parent acceptability based on birth order of the child deserve attention. If parents of oldest and only children are most likely to be offended, we can presume that the experience of being a parent makes one more flexible over time. This may be because they have been exposed to a wider range of gender identities, expressions, and behaviors among their own children and their children's peers. It is potentially consistent with intergroup conflict theory which holds that exposure to people of different identities under positive conditions increases tolerance. 40 The differences in acceptability across race/ethnicity should be interpreted cautiously. Previous research on parent attitudes about LGB children has documented homonegativity among Black and Hispanic/Latinx parents. 41 This pattern is best understood as involving sociocultural messages, deeply rooted ideas about Black masculinity and sexuality in the dominant white culture, the impact of historical discrimination and racism on the Black family, and the political influence of Black and Latinx religious institutions on communities. 42 , 43 These factors are likely also relevant to understanding attitudes about TGNC identities in children. Furthermore, deeply entrenched racism within the health care system and resulting mistrust may contribute to the reluctance of parents of color to disclose sensitive information. 44–47 Relatively few studies have focused on the underrepresentation of Black and Latinx youth in pediatric gender clinics despite studies showing higher rates of trans and identity among youth of color. 48 Therefore, it will be essential to understand how screening items can be worded in ways that are acceptable to parents across racial/ethnic identities. Our research also provided further support that a higher proportion of children than adults identify as TGNC. 4 The overall proportion of TGNC children in this study was 5.7%, including 3.4% of children who were nonbinary and 2.3% who identified with the gender opposite from their sex assigned at birth. The rate of TGNC identities was significantly higher in children assigned female at birth (7.8%) than children assigned male at birth (4.5, a finding consistent with previous research). 49 , 50 Because our survey relied on parents to indicate that children held gender identities different from their sex assigned at birth, this may still be an underestimate. Limitations Although the sample is diverse across age, race/ethnicity, and geographic region, it is a convenience sample. The parents choosing to participate in this study and the children about whom they reported may not reflect the true distribution of parents willing to talk about their child's gender or children whose parents know they identify as TGNC. Another limitation regards measurement of gender identity. Screening parents about their child's gender assumes children are able and willing to communicate their gender identity to parents and parents can understand and are willing to share that information with a researcher or a clinician. In other words, by screening parents, we are measuring a series of proxies for a child's gender identity rather than gender identity, directly. This is true in psychometrics, generally, but this is especially complicated in measuring something like gender identity. In the end, screening parents will inevitably result in underestimates of the number of TGNC children. Asking children directly might improve validity, but doing so systematically in a clinical setting before they reach adolescence is unrealistic. Also, in most cases, access to gender-affirming care requires parent support; asking children directly might improve prevalence estimates, but it would not help TGNC children access care without parent awareness and consent. Despite high levels of acceptability to parents, the feasibility of integrating a brief gender screener in clinical setting remains unknown. Lau et al. 22 demonstrated feasibility of integrating a single gender question in an adolescent/care setting, asking clinicians and parents whether they thought it would extend the length of their stay and affect the visit workflow. There are many possible concerns from pediatricians about integrating questions about gender into well visits with younger children, including their own ambivalence about talking with parents who may not want to talk about their child's gender. There is precedent for pediatricians to provide evidence-based anticipatory guidance or do screenings that some parents may not be in favor of, such as discussing vaccines or allowing for confidential time with adolescents for psychosocial SSHADESS (strengths, school, home, activities, drugs, emotions/eating, sexuality, safety) screening. 51 Further, despite increased potential burden, many large pediatric health systems have implemented electronic previsit screening questionnaires that target common issues such as developmental concerns, adolescent risk behavior, and social determinants of health which seamlessly integrate responses into the electronic health records for clinician review before the visit. Incorporating a few items on gender identity into these existing questionnaires is unlikely to increase the burden on busy clinicians. 52 Conclusion Systematic screening of gender identity with parents of young children warrants serious consideration. 53 , 54 Asking parents about their child's gender may help normalize (1) talking about gender with children, (2) gender expansive behavior and attitudes, and (3) an understanding that gender is a critical component of child's well-being. Further, this type of screening and discussion may provide opportunities for linkage to gender-affirming services and care at a critical early time point for TGNC children. This study shows that a strong majority of parents find asking such questions acceptable. Future work is needed to determine how to make screening acceptable to groups of parents who indicated lower receptivity and understanding. Studies will also be needed to determine the acceptability of this type of screening for clinicians and the feasibility of incorporating it within the constraints of the pediatric primary care setting. Identifying and addressing specific parental concerns or discomforts related to inquiries about gender can aid in achieving the broader objective of normalizing gender diversity. This can be facilitated by the widespread implementation of a gender screener, which itself may contribute to the normalization process. Authors' Contribution A.H.: Conceptualized and designed the study, drafted the initial manuscript, and critically reviewed and revised the manuscript; N.D.: Critically reviewed and revised the manuscript; M.D. and S.M.: Reviewed and helped revise the survey instrument and critically reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work. Acknowledgment We gratefully acknowledge research assistance from Nathan Nyitrai. Abbreviations Used CPS current population survey CQR-M modified consensual qualitative research GIQC gender identity questionnaire for children GNC gender nonconformity SAB sex assigned at birth SSHADESS strengths, school, home, activities, drugs, emotions/eating, sexuality, safety TGNC transgender and gender nonconforming Author Disclosure Statement None of the authors has any conflicts of interest to disclose. Funding Information This study was funded by grants from the Trustees Council of Penn Women, the Leonard Davis Institute of Health Economics, and the School of Social Policy & Practice's Franklin Fellows Program at the University of Pennsylvania, Philadelphia, Pennsylvania, USA. Cite this article as: Hillier A, Dowshen N, Diemer MA, Marcus SC (2024) Acceptability of screening for gender identity in a national sample of parents with young children, Transgender Health 10:3, 242–251, DOI: 10.1089/trgh.2023.0053. References 1. Goodman M, Adams N, Corneil T, et al. Size and distribution of transgender and gender nonconforming populations: A narrative review. Endocrinol Metab Clin North Am 2019;48(2):303–321; doi: 10.1016/j.ecl.2019.01.001 [ DOI ] [ PubMed ] [ Google Scholar ] 2. Herman JL, Flores AR, Brown TNT, et al. Age of Individuals who Identify as Transgender in the United States. The Williams Institute, University of California at Los Angeles: Los Angeles, CA, USA; 2017. Available from: https://williamsinstitute.law.ucla.edu/wp-content/uploads/Age-Trans-Individuals-Jan-2017.pdf [Last accessed: September 17, 2002]. 3. Deutsch MB. Making it count: Improving estimates of the size of transgender and gender nonconforming populations. LGBT Health 2016;3(3):181–185; doi: 10.1089/lgbt.2016.0013 [ DOI ] [ PubMed ] [ Google Scholar ] 4. Herman JL, Flores AR, O'Neill KK. How Many Adults and Youth Identify as Transgender in the United States? The Williams Institute, UCLA School of Law, University of California at Los Angeles: Los Angeles, CA, USA; 2022. Available from: https://williamsinstitute.law.ucla.edu/wp-content/uploads/Trans-Pop-Update-Jun-2022.pdf . [Last accessed: October 16, 2022] [ Google Scholar ] 5. Price-Feeney M, Green AE, Dorison S. Understanding the mental health of transgender and nonbinary youth. J Adolesc Health 2020;66(6):684–669; doi: 10.1016/j.jadohealth.2019.11.314 [ DOI ] [ PubMed ] [ Google Scholar ] 6. Taliaferro LA, McMorris B, Eisenberg ME. Connections that moderate risk of non-suicidal self-injury among transgender and gender non-conforming youth. Psychiatry Res 2018;268:65–67; doi: 10.1016/j.psychres.2018.06.068. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 7. Watson RJ, Veale JF, Saewyc EM. Disordered eating behaviors among transgender youth: Probability profiles from risk and protective factors. Int J Eat Disord 2017;50(5):515–522; doi: 10.1002/eat.22627 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 8. Whitbeck L, Lazoritz MW, Crawford D, et al. Street outreach program: Data collection study final report. University of Nebraska–Lincoln: Lincoln, NE, USA; 2016. Available from: https://www.acf.hhs.gov/archive/fysb/report/final-report-street-outreach-program-data-collection-study [Last accessed: December 2, 2022] [ Google Scholar ] 9. Kosciw JG, Palmer NA, Kull RM. Reflecting resiliency: Openness about sexual orientation and/or gender identity and its relationship to well-being and educational outcomes for LGBT students. Am J Community Psychol 2015;55(1–2):167–178; doi: 10.1007/s10464-014-9642-6 [ DOI ] [ PubMed ] [ Google Scholar ] 10. The Trevor Project. National Survey on LGBTQ Youth Mental Health. West Hollywood, CA, USA; 2021. Available from: https://www.thetrevorproject.org/wp-content/uploads/2021/05/The-Trevor-Project-National-Survey-Results-2021.pdf [Last accessed: December 2, 2022] [ Google Scholar ] 11. Abreu, RL, Sostre, JP, Gonzalez, KA, et al. Impact of gender-affirming care bans on transgender and gender diverse youth: Parental figures' perspective. J Fam Psychol 2022;36(5):643–652; doi: 10.1037/fam0000987 [ DOI ] [ PubMed ] [ Google Scholar ] 12. Kidd KM, Sequeira GM, Paglosotti T, et al. “This could mean death for my child”: Parent perspectives on laws banning gender-affirming care for transgender adolescents. J Adolesc Health 2021;68(6):1082–1088; doi: 10.1016/j.jadohealth.2020.09.010. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 13. Hidalgo MA, Ehrensaft D, Tishelman AC, et al. The Gender Affirmative Model: What we know and what we aim to learn. Hum Dev 2013;56(5):285–290; doi: 10.1159/000355235 [ DOI ] [ Google Scholar ] 14. Shelton J, Kroehle K, Andia MM. The Trans Person is not the problem: Brave spaces and structural competence as educative tools for trans justice in social work. J Sociol Soc Welf 2019;46(4):97–123; doi: 10.15453/0191-5096.4356. [ DOI ] [ Google Scholar ] 15. Durwood L, Esiner L, FLadeboe K, et al. Social support and internalizing psychopathology in transgender youth. J Youth Adolesc 2021;50(5):841–854; doi: 10.1007/s10964-020-01391-y. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 16. McConnell E, Birkett M, Mustanski B. Families matter: Social support and mental health trajectories among lesbian, gay, bisexual, and transgender youth. J Adolesc Health 2016;59(6):674–680; doi: 10.1016/j.jadohealth.2016.07.026. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 17. Simons L, Schrager SM, Clark LF, et al. Parental support and mental health among transgender adolescents. J Adolesc Health 2013;53(6):791–793; doi: 10.1016/j.jadohealth.2013.07.019. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 18. Canadian Paediatric Society. Gender identity – Caring for kids. Ontario, Canada; 2018. Available from: https://www.caringforkids.cps.ca/handouts/gender-identity [Last accessed: November 15, 2022] [ Google Scholar ] 19. Gülgöz S, Glazier JJ, Enright EA, et al. Similarity in transgender and cisgender children's gender development. PNAS 2019;116(49):24480–24485; doi: 10.1073/pnas.1909367116 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 20. Leibowitz SF, Telingator C. Assessing gender identity concerns in children and adolescents: Evaluation, treatments, and outcomes. Curr Psychiatry Rep 2021;14(2):111–120; doi: 10.1007/s11920-012-0259-x. [ DOI ] [ PubMed ] [ Google Scholar ] 21. Hillier A, Torg E. Parent participation in a support group for families with transgender and gender-nonconforming children: “Being in the company of others who do not question the reality of our experience.” Transgend Health 2019;4(1):168–175; doi: 10.1089/trgh.2018.0018 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 22. Lau JS, Kline-Simon A, Sterling S, et al. Screening for gender identity in adolescent well visits: Is it feasible and acceptable? J Adolesc Health 2021;68(6):1089–1095; doi: 10.1016/j.jadohealth.2020.07.031 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 23. Coppock A, McClellan OA. Validating the demographic, political, psychological, and experimental results obtained from a new source of online survey respondents. Res Politics 2019; 6(1):1–14; doi: 10.1177/2053168018822174 [ DOI ] [ Google Scholar ] 24. Pennycook G, McPhetres J, Zhang Y, et al. Fighting COVID-19 misinformation on social media: Experimental evidence for a scalable accuracy-nudge intervention. Psychol Sci 2020;31(7):770–780; doi: 10.1177/0956797620939054 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 25. Johnson LL, Bradley SJ, Birkenfeld-Adams AS, et al. A parent-report gender identity questionnaire for children. Arch Sex Behav 2004;33(2):105–116; doi: 10.1023/b:aseb.0000014325.68094.f3 [ DOI ] [ PubMed ] [ Google Scholar ] 26. Egan SK, Perry DG. Gender identity: A multidimensional analysis with implications for psychosocial adjustment. Dev Psychol 2001;37(4):451–463; doi: 10.1037//0012-1649.37.4.451 [ DOI ] [ PubMed ] [ Google Scholar ] 27. Wylie SA, Corliss HL. Socially assigned gender nonconformity: A brief measure for use in surveillance and investigation of health disparities. Sex Roles 2010;63(3–4):264–276; doi: 10.1007/s11199-010-9798-y [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 28. McGuire JK, Berg D, Catalpa JM, et al. Utrecht Gender Dysphoria Scale—Gender Spectrum (UGDS-GS): Construct validity among transgender, nonbinary, and LGBQ samples. Int J Transgend Health 2020;21(2):194–208; doi: 10.1080/26895269.2020.1723460 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 29. Abreu RL, Rosenkrantz DE, Ryser-Oatman JT, et al. Parental reactions to transgender and gender diverse children: A literature review. J GLBT Fam Stud 2019;15(5):461–485; doi: 10.1080/1550428X.2019.1656132 [ DOI ] [ Google Scholar ] 30. Hill CE, Knox S.. Essentials of Consensual Qualitative Research. American Psychological Association: Washington, DC; 2021. [ Google Scholar ] 31. Chloe G, Knutson D, Klooster D, et al. Fear and resilience: A modified consensual qualitative research study of LGBTQ+ Health and the COVID-19 Pandemic. Ann LGBTQ Public Pop Health 2023; doi: 10.1891/LGBTQ-2021-0046 [ DOI ] [ Google Scholar ] 32. U.S. Census Bureau. Current Population Survey. America's Families and Living Arrangements: 2022. Table A3. Parents With Coresident Children Under 18, by Living Arrangement, Sex, and Selected Characteristics: 2022. Washington, DC, USA; 2022. Available from: https://www.census.gov/data/tables/2022/demo/families/cps-2022.html [Last accessed: July 14, 2023]. 33. Public Religion Research Institute Religion. 2020. Census of American Religion. Washington, DC, USA; 2021. Available from: https://www.prri.org/research/2020-census-of-american-religion/[Last accessed: July 14, 2023]. [ Google Scholar ] 34. U.S. Census Bureau, U.S. and World Population Clock. Population by Region of the U.S. Washington, DC, USA. Available from: https://www.census.gov/popclock/data_tables.php?component=growth [Last accessed: July 14, 2023]. 35. U.S. Census Bureau, American Community Survey, 2022. Accessed from Social Explorer. Age by Sex by Place of Birth. Available from: https://www.socialexplorer.com/[Last accessed: July 10, 2023]. 36. U.S. Census Bureau. Voting and Registration in the Election of November 2020. Washington, DC, USA; 2021. Available from: https://www.census.gov/data/tables/time-series/demo/voting-and-registration/p20-585.html [Last accessed: July 14, 2023]. [ Google Scholar ] 37. Meade NG, Lepore C, Olezeski CL, et al. Understanding and addressing disinformation in gender-affirming care bans. Transgend Health 2023. [Epub ahead of print]; DOI: 10.1089/trgh.2022.0198 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 38. Lepore C, Alstott A, McNamara M. Scientific misinformation is criminalizing the standard of care for transgender youth. JAMA Pediatrics 2022;176(10):965–966; doi: 10.1001/jamapediatrics.2022.2959 [ DOI ] [ PubMed ] [ Google Scholar ] 39. National Academies of Sciences, Engineering, and Medicine. Measuring Sex, Gender Identity, and Sexual Orientation. Washington, DC, USA: The National Academies Press; 2022. Available from: 10.17226/26424 [Last accessed: March 8, 2023] [ DOI ] [ PubMed ] [ Google Scholar ] 40. Allport GW. The Nature of Prejudice. Addison-Wesley: Cambridge/Reading, MA; 1954. [ Google Scholar ] 41. Richter BEJ, Lindahl KM, Malik NM. Examining ethnic differences in parental rejection youth sexual identity. J Fam Psychol 2017;31(2):244–249; doi: 10.1037/fam0000235 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 42. Mason NC. At the Crossroads: African-American Attitudes, Perceptions, and Beliefs toward Marriage Equality. A Report by the National Black Justice Coalition in Partnership with Freedom to Marry. Mason Consulting Group, LLC Policy and Change in Action: Washington, DC and New York City, NY, USA; 2009. Available from: https://nbjc.org/wp-content/uploads/2020/11/at-the-crossroads-2009.pdf [Last accessed: September 17, 2022] 43. Crosbie-Burnett M, Foster TL, Murray CI, et al. Gays' and lesbians' families-of-origin: A social-cognitive-behavioral model of adjustment. Fam Relat 1996;45(4):397–403; doi: 10.2307/585169 [ DOI ] [ Google Scholar ] 44. Washington HA. Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present. Doubleday: New York; 2006 [ Google Scholar ] 45. Corbie-Smith G, Thomas SB, George DMMS. Distrust, race, and research. Arch Intern Med 2002;162:2458–2463; doi: 10.1001/archinte.162.21.2458 [ DOI ] [ PubMed ] [ Google Scholar ] 46. Dovidio JF, Penner LA, Albrecht TL, et al. Disparities and distrust: The implications of psychological processes for understanding racial disparities in health and health care. Soc Sci Med 2008;67(3):478–486; doi: 10.016/j.socscimed.2008.03.019.5 [ DOI ] [ PubMed ] [ Google Scholar ] 47. Armstrong K, Ravenell KL, McMurphy S, et al. Racial/ethnic difference in physician distrust in the United States. Am J Public Health 2007;97(7):1283–1289; doi: 10.2105/AJPH.2005.080762 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 48. Goldenberg T, Jadwin-Cakmak L, Popoff E, et al. Stigma, gender affirmation, and primary healthcare use among Black transgender youth. J Adolesc Health 2019;65(4):483–490; doi: 10.1016/j.jadohealth.2019.04.029. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 49. Spack NP, Edwards-Leeper L, Feldman, et al. Children and adolescents with gender identity disorder referred to a pediatric medical center. Pediatrics 2012;129(3):418–425; doi: 10.1542/peds.2011-3696 [ DOI ] [ PubMed ] [ Google Scholar ] 50. Zucker KJ, Bradley SJ, Sanikhani M. Sex differences in referral rates of children with gender identity disorder: Some hypotheses. J Abnorm Child Psychol 1997;25(3):217–227; doi: 10.1023/a:1025748032640 [ DOI ] [ PubMed ] [ Google Scholar ] 51. Ginsburg KR. The SSHADESS Screening: A Strength-Based Psychosocial Assessment. In: Reaching Teens: Strength-Based Communication Strategies to Build Resilience and Support Healthy Adolescent Development. (Ginsburg KR, Kinsman SB. eds.) American Academy of Pediatrics: Elk Grove Village, IL, USA; 2014. [ Google Scholar ] 52. Mayne SL, Hannan C, Davis M, et al. COVID-19 and adolescent depression and suicide risk screening outcomes. Pediatrics 2021;148(3):e2021051507; doi: 10.1542/peds.2021-051507 [ DOI ] [ PubMed ] [ Google Scholar ] 53. Cahill S, Makadon H. Sexual orientation and gender identity data collection in clinical settings and in electronic health records: A key to ending LGBT health disparities. LGBT Health 2014;1(1):34–41; doi: 10.1089/lgbt.2013.0001 [ DOI ] [ PubMed ] [ Google Scholar ] 54. Goldhammer H, Grasso C, Katz-Wise SL, et al. Pediatric sexual orientation and gender identity data collection in the electronic health record. J Am Med Inform Assoc 2022;29(7):1303–1309; doi: 10.1093/jamia/ocac048 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Articles from Transgender Health are provided here courtesy of SAGE Publications ACTIONS View on publisher site PDF (161.6 KB) Cite Collections Permalink RESOURCES Similar articles Cited by other articles Links to NCBI Databases Follow NCBI NCBI on X (formerly known as Twitter) NCBI on Facebook NCBI on LinkedIn NCBI on GitHub NCBI RSS feed Connect with NLM NLM on X (formerly known as Twitter) NLM on Facebook NLM on YouTube National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894 Web Policies FOIA HHS Vulnerability Disclosure Help Accessibility Careers NLM NIH HHS USA.gov Back to Top

Related documents

• Misuse of evidence in sex and gender policy#293949
• The Social Construction of Gender: Attitudes on Sexual Assault#493265
• Acceptability of screening for substance use among children at Ugandan health facilities.#1329
• Awareness of Parental Role in Curbing Adolescent Sexual Abuse Among Parents in Akpo Community Anambra State, Nigeria#100639
• Decisions granting temporary protection to unaccompanied minors by citizenship, age and sex - quarterly data#788144