{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T11:09:28Z","timestamp":1789124968438,"version":"build-2803163510"},"reference-count":30,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2019,9,1]],"date-time":"2019-09-01T00:00:00Z","timestamp":1567296000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["R01HD082554; R01097122"],"award-info":[{"award-number":["R01HD082554; R01097122"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000071","name":"National Institute of Child Health and Human Development","doi-asserted-by":"crossref","award":["R21HD087839; R21HD097459"],"award-info":[{"award-number":["R21HD087839; R21HD097459"]}],"id":[{"id":"10.13039\/100000071","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Clinical Practice in Pediatric Psychology"],"published-print":{"date-parts":[[2019,9]]},"abstract":"<jats:p>\n                    <jats:bold>\n                      <jats:italic toggle=\"yes\">Objective:<\/jats:italic>\n                    <\/jats:bold>\n                    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.\n                    <jats:bold>\n                      <jats:italic toggle=\"yes\">Method:<\/jats:italic>\n                    <\/jats:bold>\n                    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 development) seen between August 2013 and April 2018 were extracted from patient charts.\n                    <jats:bold>\n                      <jats:italic toggle=\"yes\">Results:<\/jats:italic>\n                    <\/jats:bold>\n                    Data were analyzed from 71 youth ages 3\u201311, including 20% (\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    = 14) ages 5 and younger. Fourteen percent of the sample (\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    = 10) met diagnostic cutoff criteria for generalized anxiety disorder, and 20% (\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    = 14) for oppositional defiant disorder. Caregivers reported varying levels of support of their child\u2019s gender expansiveness (female caregivers:\n                    <jats:italic toggle=\"yes\">M<\/jats:italic>\n                    = 78.85,\n                    <jats:italic toggle=\"yes\">SD<\/jats:italic>\n                    = 8.68, range = 56\u201390; male caregivers:\n                    <jats:italic toggle=\"yes\">M<\/jats:italic>\n                    = 77.32,\n                    <jats:italic toggle=\"yes\">SD<\/jats:italic>\n                    = 10.37, range = 53\u201390), and only 3% (\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\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\u2013impulsive type and conduct disorder 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).\n                    <jats:bold>\n                      <jats:italic toggle=\"yes\">Conclusions:<\/jats:italic>\n                    <\/jats:bold>\n                    Clinical interventions aimed at reducing parenting stress among caregivers of gender-expansive children may have a positive effect on children\u2019s psychological functioning.\n                  <\/jats:p>\n                  <jats:sec>\n                    <jats:title>Implications for Impact Statement<\/jats:title>\n                    <jats:p>Higher levels of gender nonconformity were associated with more attention-deficit\/hyperactivity disorder (ADHD) hyperactive\u2013impulsive type and conduct disorder symptoms but only at moderate or high (not low) levels of parenting stress. Thus, interventions aimed at reducing parenting stress in caregivers of gender-expansive children may improve children\u2019s psychological functioning.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1037\/cpp0000293","type":"journal-article","created":{"date-parts":[[2019,9,5]],"date-time":"2019-09-05T09:06:36Z","timestamp":1567674396000},"page":"254-266","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":16,"title":["Psychological Functioning, Parenting Stress, and Parental Support Among Clinic-Referred Prepubertal Gender-Expansive Children"],"prefix":"10.1177","volume":"7","author":[{"given":"Victoria D.","family":"Kolbuck","sequence":"first","affiliation":[{"name":"Division of Adolescent Medicine, Ann &amp; Robert H. Lurie Children\u2019s Hospital of Chicago, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abigail L.","family":"Muldoon","sequence":"additional","affiliation":[{"name":"Division of Adolescent Medicine, Ann &amp; Robert H. Lurie Children\u2019s Hospital of Chicago, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Rychlik","sequence":"additional","affiliation":[{"name":"Biostatistics Research Core, Stanley Manne Children\u2019s Research Institute, Ann &amp; Robert H. Lurie Children\u2019s Hospital of Chicago, Chicago, Illinois, and Department of Pediatrics, Northwestern University Feinberg School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco A.","family":"Hidalgo","sequence":"additional","affiliation":[{"name":"Center for Transyouth Health and Development, Division of Adolescent and Young Adult Medicine, Children\u2019s Hospital Los Angeles, Los Angeles, California, and Department of Pediatrics, Keck School of Medicine of University of Southern California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diane","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Adolescent Medicine, and Department of Child and Adolescent Psychiatry, Ann &amp; Robert H. Lurie Children\u2019s Hospital of Chicago, Chicago, Illinois, and Department of Pediatrics, and Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2019,9,1]]},"reference":[{"key":"e_1_3_1_2_1","volume-title":"Parenting Stress Index: Short form","author":"Abidin R. R.","year":"1995","unstructured":"Abidin R. R. (1995). Parenting Stress Index: Short form (4th ed.). Lutz, FL: Psychological Assessment Resources.","edition":"4"},{"key":"e_1_3_1_3_1","volume-title":"Diagnostic and statistical manual of mental disorders","author":"American Psychiatric Association","year":"1994","unstructured":"American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). 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