Gender Affirming Assessment: What Parents Need to Know
by Thảo-Châu Trịnh, Psy.D. and Rebecca MurrayMetzger, Psy.D.
Over the last decade, psychologists have grown in our awareness of the importance of understanding and supporting children who identify as transgender, nonbinary, or gender-diverse. At Mind Matters, we are committed to providing gender affirming, culturally competent assessments that recognize and respect each child’s unique gender identity. To this end, we want to share some information parents/caregivers should know about gender affirming assessments, including how we handle the assessment process, and how we support children as they explore and affirm their identities.
What Is a Gender-Affirming Assessment?
A gender-affirming assessment is a process designed to evaluate and support the unique needs of transgender, nonbinary, and gender-diverse (TGD) individuals. As with any evaluation, we aim to understand each child’s strengths, challenges, and needs while respecting their identity and ensuring that the assessment is conducted in a safe and welcoming environment. We use this information to help parents/caregivers, educators, and other professionals support the child in ways that affirm their gender identity, along with any other identities they might hold.
For parents/caregivers, understanding the purpose and process of a gender-affirming assessment can be key to supporting your child’s well-being. Here are some important elements of a Gender Affirming Assessment framework to keep in mind:
Validating Your Child’s Experience:
Gender identity can be distinct from the sex assigned at birth. A child’s understanding of their gender identity develops over time. Being transgender, nonbinary, or gender-diverse is a natural part of the human experience. Thus, your child’s gender identity should be respected and supported throughout the assessment process, whether they are certain of their gender identity or still figuring out who they are.
Understanding Minority Stress and Resilience:
Minority stress theory helps explain why trans and gender diverse children may face unique mental health challenges. Experiences of discrimination, bullying, and a lack of societal acceptance contribute to heightened stress levels. As a result, children face increased health risks, such as higher rates of depression, anxiety, and, in some cases, PTSD. It’s crucial to approach these concerns within the context of the stress and discrimination that trans, nonbinary and gender diverse children often face.
Considering The Importance of Context in Assessment:
Understanding context helps with interpreting assessment results more accurately. Some assessment tools may flag higher distress levels in trans and gender diverse individuals due to experiences of trauma or discrimination, rather than an indication of a clinical disorder. For example, scales related to paranoia or persecution in tests may reflect actual experiences of marginalization, and it’s essential to interpret these results through this lens.
Supportive Spaces Matter:
Children benefit from building resilience through positive reinforcement of gender identity and a supportive family environment. Encouraging your child to engage with supportive, affirming spaces—whether within the family, in the community, or at school—can significantly boost resilience. Our clinic also helps connect children with these types of spaces, which may help buffer some of the stress they experience.
Recognizing the Limitations of Testing Tools:
A psychoeducational evaluation involves standardized tests and questionnaires. This means that clinicians reference a published set of “norms” to compare your child’s performance or responses on these measures to the responses of other children their age (or in some cases, their grade). Most tests today utilize combined norms (meaning individuals of all genders). However, a few tests and several questionnaires are normed based on cisgender populations (male and female only), so their accuracy for trans and nonbinary children can be limited. Psychologists need to consider these factors when choosing and interpreting tests.
Steps We Take to Provide a Gender-Affirming Assessment at Mind Matters
Considering the factors above, Mind Matters clinicians collaborated to develop guidelines for a Gender Affirming Assessment. These guidelines evolve as we learn more about the experiences of trans, nonbinary and gender-diverse children, and as new tools become available to us. Here are some of the steps we take when working with children:
Culturally Competent and Affirming Care:
We take every measure to ensure that our clinic environment feels inclusive and supportive. Visible signs of inclusivity (such as the books we keep in our waiting room) alongside actions (such as introducing ourselves with our pronouns), help create a space where children feel safe. Additionally, we keep our team trained in client-centered and gender-affirming-specific constructs and terminology, which is essential given the evolving nature of language around gender diversity. We also actively seek consultation and supervision to continuously refine our approach.
Recognizing and Respecting Pronouns and Preferred Names:
From the start, we ask both the parents/caregivers and the child about pronouns and preferred names, and use these when speaking to or about the child. During the initial history intake, we inquire about the pronouns parents/caregivers would like in the report, as well as those the child prefers in the report (which might be different from the pronouns they use on a daily basis). When parents/caregivers and the child have different requests, we prioritize the child’s preference, after discussing who might see the report and preparing parents/caregivers for any differences. In cases of disagreement, we offer options such as creating two versions of the report. This flexible approach ensures that the child feels seen and respected, while allowing for situations in which parents/caregivers may need to protect their child’s privacy.
Consideration of Test Norms and Gender:
As mentioned, many psychological assessments are built on traditional norms based on cisgender individuals. For children who identify as nonbinary or are in transition, we prioritize using gender-neutral or combined norms where possible. However, if an assessment tool only offers cisgendered norms, we score the test with both male and female norms to evaluate if there’s a meaningful difference and provide a well rounded view. This approach helps us provide an accurate, context-sensitive interpretation of the child’s results and understand their needs better.
Understanding the Context:
During the assessment, we focus on the context surrounding each child’s experiences, such as family dynamics, social challenges, and any experiences of discrimination or minority stress. For example, some personality inventories may indicate elevated levels of distress that reflect lived experiences of discrimination rather than clinical pathology. Understanding the child’s life context allows us to interpret their results accurately and compassionately, ensuring that we don’t mistake these indicators for signs of mental health issues but rather understood as responses to environmental stress.
Assessing for Both Stress and Resilience:
As mentioned, many trans, nonbinary and gender diverse children face unique stressors, including higher rates of discrimination, social rejection, and, in some cases, increased health disparities. Our assessments include measures that consider both the challenges and the resilience of trans and gender diverse children. For instance, the Gender Minority Stress and Resilience Measure evaluates not only the stressors associated with minority identity but also the child’s sense of pride, community connection, and coping skills. This dual perspective enables us to provide a more balanced view of the child’s strengths and challenges.
Resources for parents/caregivers
Gender-affirming assessments aim to provide a thorough, supportive understanding of trans, nonbinary and gender diverse children’s needs and strengths. parents/caregivers play a vital role in this journey, helping create a safe and accepting environment where their child can thrive. We provide resources to help parents/caregivers learn more about Gender Affirming Care and better advocate for their child. These resources offer a wealth of information to help parents/caregivers understand and support their child’s gender identity and the associated care options.
Human Rights Campaign (HRC) – A Guide for Parents and Guardians of Gender-Expansive Children and Teens: This guide offers comprehensive information to help parents/caregivers navigate their child’s gender identity journey.
Planned Parenthood – Gender Affirming Care: Planned Parenthood provides services and resources related to gender-affirming care, including hormone therapy and support services.
UCSF Transgender Care – Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People: The University of California, San Francisco offers detailed guidelines on providing gender-affirming care, which can be insightful for parents/caregivers seeking to understand medical perspectives.
Healthline – A Parent’s Guide to Gender Affirming Care for Transgender Youth: This article provides an overview of what gender-affirming care entails and offers advice for parents/caregivers supporting transgender youth.
American Medical Association (AMA) – What to Know About Gender-Affirming Care for Younger Patients: The AMA discusses the importance and components of gender-affirming care for younger individuals, providing a medical perspective that can be helpful for parents/caregivers.
LGBTQIA+ Health Education Center – Gender-Affirming Pediatric Care Toolkit: This toolkit offers resources and guidance for healthcare providers and can be a useful reference for parents/caregivers to understand the standards of care.
Office of Population Affairs (OPA) – Gender-Affirming Care and Young People: The OPA provides an overview of gender-affirming care, emphasizing its importance for the health and well-being of transgender and nonbinary youth.
Harvard Health Publishing – The Care That Transgender Youth Need and Deserve: This article from Harvard Medical School discusses the essential aspects of care for transgender youth, offering insights into medical and psychological support.
Taking Steps Together
If you’re considering an assessment for your child, our clinic is here to help guide you through every step, offering affirming, inclusive, and culturally competent care. Our clinicians invite your feedback about how to help your child feel more comfortable and accepted. By working together, we meet your child’s needs in a way that honors their identity and supports their mental and emotional well-being.
At our offices in Berkeley and San Francisco, a dedicated Licensed Psychologist (or Licensed Educational Psychologist provides your child’s Psychoeducational and Neuropsychological evaluations. The analysis you receive from Mind Matters helps you tailor their accommodations and interventions to your child’s needs.
Reach out to our intake coordinator to ask questions and find the best evaluator for your child.
Other Services We Offer in the San Francisco Bay Area
In addition to psychoeducational and neuropsychological evaluations, we provide neurodevelopmental screenings (specifically for autism, dyslexia and ADHD). We attend school meetings for our clients too. If you aren’t sure what you’re looking for, we offer parent guidance sessions to help you decide on next steps. If you want to know how we can help support you and your neurodivergent child, reach out to us.