“It is obvious to anyone paying attention these days that more and more young people identify as transgender and nonbinary,” says LDI Senior Fellow Amy Hillier. “We are experiencing a generational shift that is changing what gender means.”

The need for practical and clinically relevant tools to normalize gender conversations has never been more critical. Hillier, LDI Senior Fellow Steven Marcus, and colleague Matthew Diemer, developed a preliminary screening tool to be used in pediatric offices and other health care settings. In their study, they argue that all children should be screened for gender alignment and distress, affirming that “the ability to explore gender is essential to child development and is a fundamental human right.” To learn more about this work, we spoke with Hillier, a social worker and an Associate Professor in the School of Social Policy & Practice at Penn.

What are the main objectives of the parent-report screener project and why is it important for children?

Hillier: Screening parents of young children about their child’s gender is important for all families, whether their children are transgender or not. Our main goals are to underscore for parents and pediatric staff that gender is an important part of well-being for children and to normalize gender-expansive behavior, expression, and identities in children.

How is your measure of gender identity and dysphoria in children different from existing ones?

Hillier: Existing measures of gender identity largely reinforce the gender binary, leaving little room for nonbinary identities, and they focus too much on behavior and expression. Measures of gender dysphoria seek to determine if there is a clinically significant level of distress among children. Nearly all the existing measures are too long to be used as screeners during pediatric well visits. Our measure will be short—just a few questions—and work for children across gender identities. It seeks to measure distress among children as well as their parents, recognizing that parent anxieties about their child’s gender can have negative health consequences for their child.

How does this project contribute to health care for trans and gender non-conforming youth, especially in terms of early identification and support?

Hillier: Our screener aims to normalize—not pathologize—gender expansiveness among children. By identifying families experiencing distress around their child’s gender identity, we can provide support to families in the form of follow-up conversations with pediatric staff, written information about gender development in children, and—in the limited number of cases when warranted—referrals for gender specialty care.

You mentioned your screener is brief and preliminary. What has been the response from participating parents, and what changes do you plan to make?

Hillier: One of our early research questions was whether parents of young children across the country, across religious and political identities, could tolerate answering questions about their child’s gender. The answer was yes; most parents (about 85%) found that acceptable. We are still trying to figure out the exact questions and the exact wording that will work best—from the perspective of parents and, from a measurement standpoint.

How do you see this project influencing future policies or practices for gender-affirming care for children and adolescents?

Hillier: We want to emphasize that gender is part of health and warrants dialogue between children, parents, and health care providers. State legislators should not be part of that equation. Gender impacts all of us. The ability to explore gender is essential to child development and is a fundamental human right.

We want to help normalize the discussion about gender in the context of health care. I still remember my pediatrician asking me, when I was six years old, if I wore a seat belt in the car. Pediatric staff play a special role in supporting families. By asking children and parents questions about gender, they can normalize talking about gender and open up space for children to explore who they are.

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The study, “Preliminary Development of a Brief Parent-Report Gender Identity Alignment/Distress Screener for Children,” was published on July 22, 2024 in the British Journal of Developmental Psychology. Authors include Matthew A. Diemer, Amy Hillier, and Steven C. Marcus.

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