Beyond diagnosis: Prepubescent gender expansive children on the margins of clinical measures

Few clinical measures are available for use with transgender and gender-expansive (TGE) prepubescent children. This qualitative study includes 65 TGE children, ages 4–12, with 21 identifying as boys, 34 as girls, and 10 as nonbinary. Race/ethnicity reported by parents: 72.3% White, 7.7% Asian, 6.2% Hispanic/Latinx, 4.6% multiple races, 3.1% Black/African American, 1.5% American Indian or Alaskan Native, and 4.6% were missing race/ethnicity data. Children's responses to clinical measures identified these themes: dysphoria, identity statements, gender statements, contentment with self, and anticipatory statements. Findings highlight the need to develop clinical measures that center children's voices, are inclusive of all gender identities, and go beyond diagnostic criteria to better reflect and understand the meaning children make of gender-related experiences.