Psychological Functioning, Parenting Stress, and Parental Support Among Clinic-Referred Prepubertal Gender-Expansive Children

Objective: The purpose of this study was to describe psychological functioning. parenting stress, and parental support of gender expansiveness in prepubertal gender-expansive children presenting to a specialized pediatric gender clinic and to examine relations between parenting factors and child psychological functioning. Method: Standard-of-care questionnaires were completed by parents of all children presenting for services. Data from prepubertal children (i.e., Tanner Stage 1 of pubertal development) seen between August 2013 and April 2018 were extracted from patient charts. Results: Data were analyzed from 71 youth ages 3-11, including 20% (n = 14) ages 5 and younger. Fourteen percent of the sample (n = 10) met diagnostic cutoff criteria for generalized anxiety disorder, and 20% (n = 14) for oppositional defiant disorder. Caregivers reported varying levels of support of their child's gender expansiveness (female caregivers: M = 78.85, SD = 8.68, range = 56-90; male caregivers: M = 77.32, SD = 10.37, range = 53-90), and only 3% (n = 2) of caregivers endorsed parenting stress levels in the high range. Parenting stress significantly predicted higher symptom counts across all 8 diagnoses. Unexpectedly. higher levels of parental support predicted more symptoms of major depressive disorder and dysthymia. Parenting stress was a significant moderator of relations between gender nonconformity and attention-deficit/hyperactivity disorder (ADHD) hyperactive-impulsive type and conduct disorder symptoms; higher levels of gender nonconformity were associated with higher symptom counts at moderate and high levels of parenting stress (but not at low levels of parenting stress). Conclusions: Clinical interventions aimed at reducing parenting stress among caregivers of gender-expansive children may have a positive effect on children's psychological functioning.