Affirming and Gender-Informed Assessment of Gender Diverse and/or Transgender Youth Across Development

  • Scott Leibowitz
  • Aron Janssen


Youth are presenting with gender concerns at exponentially higher rates across mental health and medical settings. Some meet criteria for gender dysphoria of childhood or adolescence/adulthood, and others may not. Recognized standards of care indicate that moving forward with medical interventions and/or for appropriately assessed adolescents is important and beneficial and that timely treatment of gender dysphoria improves outcomes. The approach to the assessment of these youth has not been formally standardized, and various multidisciplinary gender identity clinics approach the assessment in a variety of ways. This chapter serves to help child and adolescent psychiatrists and other mental health professionals to think about how to assess these youth, which is becoming increasingly more complex as youth present within a variety of biopsychosocial situations and contexts.


Transgender Gender nonconforming Gender diverse children Adolescents Assessment Gender identity Sexual orientation Please add "Gender Dysphoria" to the keywords 


  1. 1.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.CrossRefGoogle Scholar
  2. 2.
    Hsieh S, Leininger J. Resource list: clinical care programs for gender-nonconforming children and adolescents. Pediatric Ann. 2014;43(6):238–44. Scholar
  3. 3.
    Adelson SL. American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Quality Issues (CQI). Practice parameter on gay, lesbian or bisexual sexual orientation, gender-nonconformity, and gender discordance in children and adolescents. J Am Acad Child Adolesc Psychiatry. 2012;51(9):957–74.CrossRefPubMedGoogle Scholar
  4. 4.
    Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, et al. Endocrine treatment of gender-dysphoric/gender-incongruent persons: an Endocrine Society* clinical practice guideline. J Clin Endocrinol Metab. 2017;102(11):3869–903. Scholar
  5. 5.
    Coleman E, Bockting W, Botzer M, Cohen-Kettenis P, DeCuypere G, Feldman J, et al. Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. Int J Transgenderism. 2012;13(4):165–232.CrossRefGoogle Scholar
  6. 6.
    Wallien MS, Swaab H, Cohen-Kettenis PT. Psychiatric comorbidity among children with gender identity disorder. J Am Acad Child Adolesc Psychiatry. 2007;46(10):1307–14.CrossRefPubMedGoogle Scholar
  7. 7.
    Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129(5):674–97.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Hendricks ML, Testa RJ. A conceptual framework for clinical work with transgender and gender nonconforming clients: an adaptation of the minority stress model. Prof Psychol Res Pr. 2012;43(5):460–7.CrossRefGoogle Scholar
  9. 9.
    Grant J, Mottet L, Tanis J, Harrison J, Herman J, Keisling M. Injustice at every turn: a report of the National Transgender Discrimination Survey. Washington, DC: National Center for Transgender Equality and National Gay and Lesbian Task Force; 2011.Google Scholar
  10. 10.
    de Vries AL, Cohen-Kettenis PT. Clinical management of gender dysphoria in children and adolescents: the Dutch approach. J Homosex. 2012;59(3):301–20. Scholar
  11. 11.
    Olson-Kennedy J. Mental health disparities among transgender youth. Rethinking the role of professionals. JAMA Pediatr. 2016;170(5):423–4.CrossRefPubMedGoogle Scholar
  12. 12.
    Ristori J, Steensma T. Gender dysphoria in childhood. Int Rev Psychiatry. 2016;28(1):13–20.CrossRefPubMedGoogle Scholar
  13. 13.
    Leibowitz SF, de Vries ALC. Gender dysphoria in adolescence. Int Rev Psychiatry. 2016;28(1):21–35.CrossRefPubMedGoogle Scholar
  14. 14.
    Cox MJ, Paley B. Families as systems. Ann Rev Psychol. 1997;48:243–67. Scholar
  15. 15.
    Minuchin P. Families and individual development: provocations from the field of family therapy. Child Dev. 1985;56:289–302.CrossRefPubMedGoogle Scholar
  16. 16.
    McConnell EA, Birkett M, Mustanski B. Families matter: social support and mental health trajectories among lesbian, gay, bisexual, and transgender youth. J Adolesc Health. 2016;59:674–80. Scholar
  17. 17.
    Katz-Wise S, Budge S, Fugate E, Flanagan K, Touloumtzis C, Rood B, et al. Transactional pathways of transgender identity development in transgender and gender-nonconforming youth and caregiver perspectives from the trans youth family study. Int J Transgenderism. 2017;18(3):243–63. Scholar
  18. 18.
    Zucker KJ. Measurement of psychosexual differentiation. Arch Sex Behav. 2005;34:375–88.CrossRefPubMedGoogle Scholar
  19. 19.
    Zucker KJ, Bradley SJ, Sullivan CB, Kuksis M, Birkenfeld-Adams A, Mitchell JN. A gender identity interview for children. J Pers Assess. 1993;61:443–56.CrossRefPubMedGoogle Scholar
  20. 20.
    Johnson LL, Bradley SJ, Birkenfeld-Adams AS, Kuksis MA, Maing DM, Mitchell JN, et al. A parent-report gender identity questionnaire for children. Arch Sex Behav. 2004;33:105–16.CrossRefPubMedGoogle Scholar
  21. 21.
    Zucker KJ, Finegan JK, Doering RW, Bradley SJ. Human figure drawings of gender-problem children: a comparison to sibling, psychiatric, and normal controls. J Abnorm Child Psychol. 1983;11:287–98.CrossRefPubMedGoogle Scholar
  22. 22.
    Schneider C, Cerwenska S, Nieder T, Briken P, Cohen-Kettenis PT, DeCuypere G, et al. Measuring gender dysphoria: a multicenter examination and comparison of the Utrecht gender dysphoria scale and the gender identity/gender dysphoria questionnaire for adolescents and adults. Arch Sex Behav. 2016;45(3):551–8.CrossRefPubMedGoogle Scholar
  23. 23.
    Lindgren TW, Pauly IB. A body image scale for evaluating transsexuals. Arch Sex Behav. 1975;4(6):639–56.CrossRefPubMedGoogle Scholar
  24. 24.
    Testa RJ, Habarth J, Peta J, Balsam K, Bockting W. Development of the gender minority stress and resilience measure. Psychol Sex Orientat Gender Diversity. 2015;2(1):65–77.CrossRefGoogle Scholar
  25. 25.
    Nahata L, Tishelman A, Caltabellotta N, Quinn G. Low fertility preservation utilization among transgender youth. J Adolesc Health. 2017;61(1):40–4.CrossRefPubMedGoogle Scholar
  26. 26.
    Steensma T, Wensing-Kruger S, Klink D. How should physicians help gender-transitioning adolescents consider the iatrogenic harms of hormone therapy? AMA J Ethics. 2017;19(8):762–70.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Scott Leibowitz
    • 1
    • 2
  • Aron Janssen
    • 3
  1. 1.Department of Psychiatry, THRIVE Gender and Sex Development ProgramNationwide Children’s HospitalColumbusUSA
  2. 2.Department of PsychiatryThe Ohio State University College of MedicineColumbusUSA
  3. 3.Department of Child and Adolescent Psychiatry, NYU Langone HealthNYU Child Study CenterNew YorkUSA

Personalised recommendations