Study aims to improve our understanding of TGNC children

Issues surrounding gender identity in young children who are transgender or gender non-conforming (TGNC) are poorly understood because of the limited amount of research in this area. To date, little is known about whether the identities or behaviors of TGNC children change over time, and how those identities and behaviors affect children as they grow. A $3.4M research grant awarded by the National Institute of Child Health and Human Development of the NIH will fund the first study of prepubescent TGNC children - a highly understudied age group.

The newly-funded study will run for 5 years and aims to enroll 320 TGNC children as well as their parents. Participants will periodically complete surveys and interviews focused on gender identity and mental health. This information will allow researchers to understand the interplay between mental health and gender issues as TGNC children grow. The study, led by Marco A. Hidalgo, PhD, a clinical psychologist in CHLA's Center for Transyouth Health and Development, will involve pediatric TGNC experts at medical centers with dedicated transgender youth clinics:

• Marco A. Hidalgo, PhD and Johanna Olson-Kennedy, MD - Children's Hospital Los Angeles and the Keck School of Medicine of USC
• Diane Chen, PhD - Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine
• Diane Ehrensaft, PhD - UCSF Benioff Children's Hospital San Francisco
• Amy Tishelman, PhD - Boston Children's Hospital and Harvard Medical School

This will be the largest cohort of pre-pubescent TGNC youth and their parents in a federally-funded study to date. Additionally, the study has the potential to expand and follow these individuals throughout their youth and into adulthood.

"Parents are understandably concerned and have questions about how their child will fare as they grow and mature," says Dr. Hidalgo, who is also Assistant Professor of Clinical Pediatrics at Keck School of Medicine of USC. "Right now, there simply isn't enough research to provide answers to these questions."

Dr. Hidalgo explains that findings from this study could improve mental health care among pre-pubescent TGNC children by providing a clearer picture of their needs. This will help mental health professionals to identify the best treatment trajectory for individuals. "A study of this kind is long overdue," says Shawn V. Giammattei, PhD, a clinical psychologist in California who specializes in gender identity issues in children and adolescents. "We need more information about developmental processes, family dynamics, and the mental health of gender-diverse youth. What we learn from this this study will help us provide better care for TGNC children and their families."

Dr. Hidalgo has been collaborating with Dr. Olson-Kennedy on a current study evaluating physical and psychological outcomes in TGNC adolescents old enough to receive medical care for gender dysphoria, underway at 4 sites nationally, led by Children's Hospital Los Angeles. "The missing cohort is the youngest of our patients, those who begin to express issues about their gender in childhood," says Dr. Olson-Kennedy, Medical Director of the Center for Transyouth Health and Development. "Transgender adults start as transgender kids. We need to gather evidence to best meet the needs of TGNC individuals across the lifespan."