Development of Brief Gender Screener for Parents of Young Children

Background and Purpose: Providing support for transgender and gender nonconforming children’s identity prior to puberty has been shown to improve mental health outcomes. This paper presentation will describe the process of developing a short gender screener for parents of children ages 3-12 and feedback from parents about the acceptability of asking questions about their child’s gender.

Methods: A national sample of 2,680 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 were used to identify significant predictors of acceptability. Confirmatory factor analysis and MIMIC modeling were used to identify a small number of items suitable for use in healthcare settings or embedded in other screening protocols. Fifteen people holding professional and/or lived experience relating to transgender children and adolescents, including researchers, mental health professionals, physicians, educators, and transgender advocates, participated in a three-stage Delphi process to review these findings and make recommendations about further refinement and screener implementation.

Results: Most (94.2%) parents 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. Characteristics of respondents significantly less likely to find the questions acceptable included those who: were parents of first or only children, had children under 8, were not biological parents, identified as male, voted for Trump in 2020, had no high school diploma, or were under 30. Parents who reported strong negative feelings about gender screening made up just 5% of participants. Their objections focused on concerns about sexualizing their children, religious beliefs and sense of morality, a “PC” or “woke” agenda, and disbelief that young children could understand their own gender identity. A five-item, unidimensional screener to assess gender identity emerged from statistical analyses of parent responses to questions about gender. Delphi survey results demonstrated support from professionals for gender screening, in the abstract, and identified a series of barriers—including anti-trans legislation, privacy concerns, lack of confidence among healthcare professionals to talk with parents about gender, and practical considerations about implementation—that need to be addressed.

Conclusions and Implications: From a quantitative data analysis perspective, developing a reliable and valid parent-report gender screener for young children is feasible. Furthermore, screening for gender identity with parents of young children is largely acceptable to parents and may provide opportunities for normalizing discussions about gender and linking families in need to gender-affirming psychosocial and medical support. Given the politicization of transgender health care for children across the U.S., further steps toward refining and implementing a gender screener needs to be done with caution and input from professionals, transgender youth and young adults, and their families.