Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts.
Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
Pediatrics. 2022 Sep 1;150(3). doi: 10.1542/peds.2021-055347.
Parents and caregivers' responses to their child's gender identity or expression play a pivotal role in their mental health. Despite increasing visibility of transgender and gender diverse (TGD) children, few scientific resources exist to advise their parents and caregivers.
We used an online Delphi study to generate expert consensus. Expert adult participants (N = 93; 55% cisgender women, 12% cisgender men, 33% gender minority; 83% White race or ethnicity) rated statements describing parenting strategies compiled from a systematic search of community-generated online literature. Participants represented 3 distinct "panels" of expertise: parents and caregivers of a TGD child, TGD persons, and/or professionals working with TGD populations. Statements rated as essential or important by 80% to 100% of each panel were endorsed as a guideline. Three rounds of surveys were used with iterative feedback to develop consensus.
Of 813 total statements, only 125 were endorsed by all 3 panels. Key domains of consensus included: supportive strategies for parents (eg, open communication, listening), behaviors to avoid (eg, pressuring a child into a gender transition), strategies for navigating healthcare and school systems, and common responses for parents (eg, confusion). Areas of disagreement, in which professional and TGD panels concurred but the parent panel did not, included whether to allow gender identity experimentation during childhood, the value of providing access to gender diverse media, and how to avoid misgendering a child.
These consensus-based guidelines offer a unique and needed resource for parents and caregivers and clinicians and can be used to promote the mental health and well-being of TGD children.
父母和照顾者对孩子的性别认同或表达的反应对他们的心理健康起着关键作用。尽管跨性别和性别多样化（TGD）儿童的可见度不断提高，但几乎没有科学资源可以为他们的父母和照顾者提供建议。
我们使用在线德尔菲研究来产生专家共识。专家成年参与者（N=93；55%顺性别女性，12%顺性别男性，33%性别少数；83%白人种族或族裔）对从社区生成的在线文献系统搜索中编译的描述育儿策略的陈述进行了评分。参与者代表了 3 个不同的专业小组：TGD 儿童的父母和照顾者、TGD 人士以及/或从事 TGD 人群工作的专业人员。每个小组中有 80%至 100%的成员对被评为必不可少或重要的陈述表示认可，这些陈述被作为指导方针。使用三轮调查并进行迭代反馈来达成共识。
在总共 813 条陈述中，只有 125 条被三个小组全部认可。达成共识的关键领域包括：支持父母的策略（例如，开放沟通、倾听）、避免的行为（例如，迫使孩子进行性别转变）、导航医疗保健和学校系统的策略，以及父母常见的反应（例如，困惑）。存在分歧的领域是，专业人士和 TGD 小组一致认为，但父母小组不同意，包括是否允许儿童在童年时期进行性别实验、提供性别多样化媒体的价值以及如何避免错误性别认同孩子。
这些基于共识的指南为父母和照顾者以及临床医生提供了独特且急需的资源，可以用于促进 TGD 儿童的心理健康和幸福感。
