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

Victoria D. Kolbuck*, Abigail L. Muldoon, Karen Rychlik, Marco A. Hidalgo, Diane Chen

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


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 develop- ment) 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 disor- der 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.

Original languageEnglish (US)
Pages (from-to)254-266
Number of pages13
JournalClinical Practice in Pediatric Psychology
Issue number3
StatePublished - 2019


  • gender diversity
  • gender-nonconforming children
  • mental health
  • parenting
  • transgender children

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Developmental and Educational Psychology
  • Clinical Psychology
  • Applied Psychology


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