Initial assessment

In the initial assessment of children with suspected GID the professional should attempt to engage both parents as well as the child. Frequently there is reluctance by one parent, usually the father, to attend. However, this is a family matter, and the clinician needs to gain impressions of the parent-child relationship, the parent-parent relationship, and the child's behaviour from both parents as well as the child.

Assessment is directed towards understanding whether the behaviours described for the child represent a normal variant of psychosexual development or represent a disorder. Does the child overtly express dissatisfaction being the sex to which he or she was born? Is there a marked skewing of gender-typed behaviours towards those of other-sexed children or is there some mix? How long has there been cross-gender behaviour? What have parental reactions been to it initially and more recently? What is the child's response when parents attempt to frustrate the cross-gender toy or clothing preferences, if such attempts have been made? What time availability is there for each parent with the child? What do they do together? Are there other persons, for example grandparents or teachers, who may be reinforcing cross-gender behaviours? What are the parental concerns, both in the short and long term, with respect to the significance of the child's behaviours? Are there other behavioural or medical problems in addition to the gender identity issue?

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