The UK Government and UK research councils have contributed £10 million pounds to a series of research studies on service users of the newly established Children and Young People’s Gender Services.
These studies include the PATHWAYS study programme (Puberty suppression And Transitional Healthcare with Adaptive Youth Services) led by Kings College London in partnership with the NHS. This programme covers five different studies.
1) ‘PATHWAYS HORIZON’ is a longitudinal observational cohort study of all children and young people (n~3600) attending CYPGS.
2) ‘HORIZON Intensive’, encompasses a sample of those from PATHWAYS HORIZON who are not approved to receive endocrine care who will be more intensively studied as a control group for PATHWAYS TRIAL;
3) PATHWAYS TRIAL, a study of those approved to receive puberty blockers (GnRHa) as part of a research study.
4) ‘PATHWAYS CONNECT’ a study of cognition and brain development in CYP attending the services, including those who are and are not receiving GnRHa.
5) ‘PATHWAYS VOICES’ a longitudinal qualitative interview based study of CYP attending CYPGS. In this article we will focus only on the first study, PATHWAYS HORIZON.
Here I’m just focusing on the questions that will be asked under the first study, Pathways Horizon.
In this blog I want to do two things:
- Highlight some big picture concerns with the questions asked in the PATHWAYS Horizon study, alongside some recommendations for families and young trans people engaged with the new NHS England and Wales Gender Clinics.
- Outline in an accessible format all the questions that are being asked in that study, so that families and trans young people can be better informed on whether they choose to participate.
The PATHWAYS Horizon study hopes to gain the consent of 80% of young people and families to participate in it. I hope that number will be very much smaller. I do not believe it will add useful information to our academic understanding of trans young people, certainly not information that is worth the risks and harms inherent in the whole approach and service. I consider not participating in this study (or at least opting out of the more harmful tools) an act of harm reduction for trans children, young people and supportive families. When I was first given some of these exact same tools, many years ago, when I first attended a GIDS appointment as a naïve and unknowledgeable parent of a young trans child, I did not feel able to decline to participate in filling in questionnaires that made me feel really uncomfortable. I hope to empower others to make a different choice.
Big Picture Concerns
- They are asking an excessive number of questions, which is itself abusive and unreasonable – over 314 questions are here listed.
- A large number of these questions of more or less irrelevant or only tangentially relevant for trans kids – they are not clinically useful, necessary or meaningful
- These questions will never demonstrate what healthcare benefits trans children.
- The data collection shown here will be exhausting, time-consuming and expensive, a colossal waste of NHS and research resources whilst not delivering useful outcomes.
- Many of the questions outlined below are deeply pathologising, invasive, trauma-inducing and inappropriate.
- Several tools present trans children as a problem, potentially reaffirming parental biases, and potentially reinforcing trans children’s shame and self-hate.
- I continue to recommend families to avoid the new service, as it holds very little potential of offering anything of value, and high potential to cause significant harm. For many families it may just end up being a significant waste of time.
- If families choose to attend, hoping for the chance to be part of a puberty blocker trial, please think carefully before choosing to participate in this research. As an academic researcher specialising in this field, this planned research is not needed, will not lead to better care for trans youth, and in the wrong hands research of this nature can be distorted to further reinforce pathologisation, control and barriers to care. Participation in this research is not necessary to be eligible for the puberty blocker trial. Please know that you can decline participation. Please let your young person know they can decline participation.
- If you do still choose to participate, please be aware of the potential for harm and trauma in several of the tools outlined below.
- In particular I am concerned about the tools labelled the Child Behaviour Checklist (which is an awful tool to use for trans children, asking 118 questions on how much of a problem they are to the world), the Utrecht Gender Dysphoria Scale – Gender Spectrum (UGDS-GS) (which uses very outdated measures of gender dysphoria); Body Image Scale – Gender Spectrum (BIS-GS) (a horrific tool that asks children to assess how much they hate all their body parts); the ALSPAC Romantic Relations (which in spite of its name asks totally irrelevant and intrusive questions about the sex life of those aged 12-17). The SCOFF tool has a questionable name for a tool designed to screen for eating disorders.
- I continue to be concerned about the questions that will be asked under the heading ‘medical history’, which by description is far wider a category with room to ask all kinds of irrelevant questions. I expect that component could include the typical gender clinic fascinations: many questions for parents on childbirth, parenting approaches, family deaths, family tensions, family gender roles and other irrelevant and trauma-uninformed lines of questioning. I expect there will be many questions for young people on defending and justifying their theoretical understanding of gender, and questioning them on proposed causes of gender confusion including social media, peer pressure, porn viewing, childhood trauma, parental homophobia or whatever is the latest transphobic focus in a search for anything other than transness to explain transness.
- Throughout the years of the earlier GIDS clinic, there was a long and noble history of trans children, adolescents and supportive families putting the questionnaires that were offensive and harmful straight in the bin. Of asserting a right to not answer any question that feels off, that feels uncomfortable, that doesn’t seem relevant to the healthcare support being sought. Please continue this noble tradition in the new service. You should not answer any questions that make you or your young person uncomfortable. Bad questions always give bad data that will not benefit any trans young people. Research trauma is a serious concern. The NHS and associated researchers are not taking their ethical duty of care seriously, so we need service users to take this on. I’m writing this primarily to parents as I don’t think under 18s are likely to read this. But for any trans under 18s who do read this – please don’t feel pressured to answer questions that make you uncomfortable or seem strange or irrelevant. You do not have to answer and they cannot make you.
- This is the non-intensive study – an additional ‘intensive study is also planned for those who will be in the puberty blocker trial and the control group for that trial). I repeat more than 314 questions for parents and more than 314 questions for children/young people is the non-intensive study.
- These extensive, time and resource consuming, and largely irrelevant questions need to be understood in the context of a service that is trying to give the appearance of being busy, giving the appearance of doing something RIGOROUS, whilst failing to deliver any of the services that trans young people need and have a right to. It serves to keep service users distracted from the care that is not being offered. It provides baseline data on a host of largely irrelevant (or tangentially relevant) areas of mental health, generic well-being, neurodivergence etc, from which the service can seek to ‘further explore’ every one of those ‘issues’ or concerns, whilst denying or delaying affirmative healthcare. The type of intentional distraction and delay is a known component of modern conversive approaches.
- Conversion therapy in the NHS never wears a badge saying ‘I will make you cis’. It comes much more subtly: Before we talk about the support that you need, FIRST we need to ask these hundreds of questions. Before we talk about puberty blockers or HRT, we first need to explore each of these areas of mental health or neurodivergence, or sexual attraction or family functioning or body image or sex life. We need to thoroughly explore what is going on holistically before we can do anything else. We need to be thorough. We need to avoid misdiagnosis. We need to rule out other causes. We need to Explore.
- Not useful research: In spite of hundreds of questions, pages of spreadsheets and millions of pounds, this research will not answer questions that would be useful for a health service to know the answer to. Questions like: What are the things that make life harder for a trans child or adolescent? What are the things that improve things for trans children? The research isn’t answering these questions because we already know most of the answers. And our NHS and government and country does not like the answers to those questions. Cos they don’t care whether trans kids have a tough life. They don’t want to help trans kids at all. That is not the purpose of this service. It is a service to ‘study’ trans kids, to delay trans kids, and through delay to convert trans kids – pushing them to suppress their identity, to give up their fight, to think of themselves as a problem, as broken, pushing them to give up even thinking that they matter or have rights.
Number of Questions
| Tool | Parent questions | Child/Young Person Questions |
| Kidscreen-52 (generic wellbeing) | 52 | 52 |
| CBCL (Problem behaviour) | 118 | 118 |
| Parental ‘About Yourself’ Questionnaire | 2 | 0 |
| SNAP-IV tool (ADHD) | 18 | 0 |
| Social Communication Questionnaire (SCQ) (autism) | 40 | 0 |
| PATHWAYS Gender Identity Questionnaire | 0 | 2 |
| Social Transition Questionnaire | 0 | 5 |
| Adolescent Primary Care Traumatic Stress Screen (APCTSS) (trauma screen) | 5 | 5 |
| Revised Child Anxiety and Depression Scale (RCADS) (anxiety and depression) | 25 | 25 |
| Utrecht Gender Dysphoria Scale – Gender Spectrum (UGDS-GS) (dated measures of gender dysphoria) | 0 | 18 |
| Body Image Scale – Gender Spectrum (BIS-GS) (body image) | 0 | 33 |
| Ask Suicide-Screening Questions (ASQ) | 4 | 4 |
| SCOFF Questionnaire – Test for Detecting Eating Disorders | 5 | 5 |
| Difficulties in Emotion Regulation Scale (DERS) | 29 | 18 |
| Sexual Attraction | 0 | 1 |
| ALSPAC Romantic Relations (sex life) | 0 | 14 |
| Parental Attitudes of Gender Expansiveness Scale for Youth (PAGES) | 16 | 14 |
| 15 minutes questioning on ‘medical history’ that covers huge range of areas. | Unknown | Unknown |
| Annual Health Update | Unknown | Unknown |
| Total questions | Over 314 questions | Over 314 questions |
Detailed Breakdown of the exact questions being asked
52 questions for parent & 52 questions for young person from the Kidscreen-52 tool (here the parent version)
- In general how would your child rate their health? (excellent; very good; good; fair; poor)
Thinking about last week (with answers: not at all; slightly; moderately; very; extremely or never; seldom; quite often; very often; always)
- Has your child felt fit and well
- Has your child been physically active (e.g. running, climbing, biking)?
- Has your child been able to run well?
- Has your child felt full of energy
- Has your child felt that life was enjoyable
- Has your child felt pleased that they are alive
- Has your child felt satisfied with their life
- Has your child been in a good mood
- Has your child felt cheerful
- Has your child had fun
- Has your child felt that they do everything badly
- Has your child felt sad
- Has your child felt so bad that they didn’t want to do anything
- Has your child felt that everything in their life goes wrong
- Has your child felt fed up
- Has your child felt lonely
- Has your child felt under pressure
- Has your child felt happy with the way they are
- Has your child been happy with their clothes
- Has your child been happy with the way they look
- Has your child felt jealous other the way other children look
- Has your child wanted to change something about their body
- Has your child had enough time for themselves
- Has your child been able to do the things they want in their spare time
- Has your child had enough opportunity to be outside
- Has your child had enough opportunity to meet friends
- Has your child been able to choose what to do in their free time
- Has your child felt understood by their parents
- Has your child felt loved by their parents
- Has your child been happy at home
- Has your child felt that their parents had enough time for them
- Has your child felt that their parents treated them fairly
- Has your child been able to talk to their parents when they wanted to
- Has your child had enough money to do the same things as their friends
- Has your child felt they had enough money for their expenses
- Does your child feel they have enough money to do things with their friends
- Has your child spent time with their friends
- Has your child done things with other children
- Has your child had fun with their friends
- Has your child and their friends helped each other
- Has your child been able to talk about everything with their friends
- Has your child been able to rely on their friends
- Has your child been happy at school
- Has your child got on well at school
- Has your child been satisfied with their teachers
- Has your child been able to pay attention
- Has your child been enjoying school
- Has your child got along with their teachers
- Has your child been afraid of other children
- Have other children made fun of your child
- Have other children bullied your child.
(the default questions use he/she and boys/girls language – I’m assuming they will adapt to use they and child as written above)
118 questions for parent & 118 questions for young person from the Child Behaviour Checklist
For each questions the available answers are:
0=Not true (as far as you know); 1=Somewhat or sometimes true; 2=Very true or often true
- 1.Acts too young for his/her age / I act too young for my age
- 2. Drinks alcohol without parent’s approval / I drink alcohol without my parent’s approval
- 3. Argues a lot / I argue a lot
- 4. Fails to finish things he/she starts / I fail to finish things I start
- 5. There is very little that he/she enjoys / There is very little that I enjoy
- 6. Bowel movements outside toilet / I like animals
- 7. Bragging, boasting / I brag
- 8. Can’t concentrate, can’t pay attention for long / I have trouble concentrating or paying attention
- 9. Can’t get their mind off certain thoughts/obsessions (describe) / I can’t get my mind off certain thoughts/obsessions (describe)
- 10. Can’t sit still, restless or hyperactive / I have trouble sitting still
- 11. Clings to adults or too dependent / I’m too dependent on adults
- 12. Complains of loneliness / I feel lonely
- 13. Confused or seems to be in a fog / I feel confused or in a fog
- 14. Cries a lot / I cry a lot
- 15. Cruel to animals / I am pretty honest
- 16. Cruelty, bullying or meanness to others / I am mean to others
- 17. Daydreams or gets lost in his/her thoughts / I daydream a lot
- 18. Deliberately harms self or attempts suicide / I deliberately try to hurt or kill myself
- 19. Demands a lot of attention / I try to get a lot of attention
- 20. Destroys his/her own things / I destroy my own things
- 21. Destroys things belonging to his/her family or others / I destroy things belonging to others
- 22. Disobedient at home / I disobey my parents
- 23.Disobedient at school / I disobey at school
- 24. Doesn’t eat well / I don’t eat as well as I should
- 25. Doesn’t get along with other kids / I don’t get along with other kids
- 26. Doesn’t seem to feel guilty after misbehaving / I don’t feel guilty after doing something I shouldn’t
- 27. Easily jealous / I am jealous of others
- 28. Breaks rules at home, school, or elsewhere / I breaks rules at home, school, or elsewhere
- 29. Fears certain animals, situations or places other than school / I am afraid of certain animals, situations or places other than school
- 30. Fears going to school / I am afraid of going to school
- 31. Fears he/she might think or do something bad / I’m afraid I might think or do something bad
- 32. Feels he/she must be perfect / I feel that I have to be perfect
- 33. Feels or complains that no one loves him/her / I feel that no one loves me
- 34. Feels others are out to get him/her / I feel that others are out to get me
- 35. Feels worthless or inferior / I feel worthless or inferior
- 36. Gets hurt a lot/accident prone / I accidently get hurt a lot
- 37. Gets in many fights / I get in many fights
- 38. Gets teased a lot / I get teased a lot
- 39. Hangs with others who get in trouble / I hang around with kids who get into trouble
- 40. Hears sound or voices that aren’t there / I hear sound or voices that other people think aren’t there
- 41.Impulsive or acts without thinking / I act without stopping to think
- 42. Would rather be alone than with others / I would rather be alone than with others
- 43. Lying or cheating / I lie or cheat
- 44. Bites fingernails / I bite my fingernails
- 45. Nervous, high-strung, or tense / I am nervous or tense
- 46. Nervous movements or twitching (describe) / parts of my body twitch or make nervous movements
- 47. Nightmares / I have nightmares
- 48. Not liked by other kids / I am not liked by other kids
- 49. Constipated, doesn’t move bowels / I can do certain things better than other kids
- 50. Too fearful or anxious / I am too fearful or anxious
- 51. Feels dizzy or lightheaded / I feel dizzy or lightheaded
- 52. Feels too guilty / I feel too guilty
- 53. Overeating / I eat too much
- 54. Over-tired, without good reason / I feel overtired without good reason
- 55. Overweight / I am overweight
- 56. Physical problems without known medical cause:
- a) Aches or pains (not stomach or headache)
- b) Headaches
- c) Nausea, feels sick
- d) Problems with eyes (not corrected by glasses)
- e) Rashes or other skin problems
- f) Stomach aches
- g) Vomiting / throwing up
- h) Other (describe)
- 57. Physically attacks people / I physically attack people
- 58. Picks nose/skin/other part of body (describe) / I picks my nose/skin/other part of body (describe)
- 59. Plays with own sex parts in public / I can be pretty friendly
- 60. Plays with own sex parts too much / I like to try new things
- 61. Poor school work / My school work is poor
- 62. Poorly coordinated or clumsy / I am poorly coordinated or clumsy
- 63. Prefers being with older kids / I would rather be with older kids than kids my own age
- 64. Prefers being with younger kids / I would rather be with younger kids than kids my own age
- 65. Refuses to talk / I refuse to talk
- 66. Repeats certain acts over and over; compulsions (describe) / I repeat certain acts over and over; compulsions (describe)
- 67. Runs away from home / I run away from home
- 68. Screams a lot / I scream a lot
- 69. Secretive, keeps things to self / I am secretive or keep things to myself
- 70. Sees things that aren’t there / I see things that other people think aren’t there
- 71. Self-conscious or easily embarrassed / I am self-conscious or easily embarrassed
- 72. Sets fires / I set fires
- 73. Sexual problems / I can work well with my hands
- 74. Showing off or clowning / I show off or clown
- 75. Too shy or timid / I am too timid or shy
- 76. Sleeps less than most kids / I sleep less than most kids
- 77. Sleeps more than most kids during day and/or night (describe) / I sleep more than most kids during day and/or night (describe)
- 78. Inattentive or easily distracted / I am inattentive or easily distracted
- 79. Speech problem (describe) / I have a speech problem (describe)
- 80. Stares blankly / I stand up for my rights
- 81. Steals at home / I steal at home
- 82. Steals outside the home / I steal from places outside the home
- 83. Stores up too many things they don’t need (describe) / I stores up too many things I don’t need (describe)
- 84. Strange behaviour (describe) / I do things other people think are strange
- 85. Strange ideas / I have thoughts other people would think are strange (describe)
- 86. Stubborn, sullen, or irritable / I am stubborn
- 87. Sudden changes in mood or feelings / My moods or feelings change suddenly
- 88. Sulks a lot / I enjoy being with people
- 89. Suspicious / I am suspicious
- 90. Swearing or obscene language / I swear or use dirty language
- 91. Talks about killing self / I think about killing myself
- 92. Talks or walks in sleep (describe) / I like to make others laugh
- 93. Talks too much / I talk too much
- 94. Teases a lot / I tease others a lot
- 95. Temper tantrums or hot temper / I have a hot temper
- 96. Thinks about sex too much / I think about sex too much
- 97. Threatens people / I threaten to hurt people
- 98. Thumb-sucking / I like to help others
- 99. Smokes, chews, or sniffs tobacco / I smokes, chew, or sniff tobacco
- 100. Trouble sleeping / I have trouble sleeping (describe)
- 101. Truancy or unexplained absence / I cut classes or skip school
- 102. Underactive, slow moving or lacks energy / I don’t have much energy
- 103. Unhappy, sad or depressed / I am unhappy, sad or depressed
- 104. Unusually loud / I am louder than other kids
- 105. Uses dugs/alcohol for nonmedical purposes / I use drugs for non-medical purposes
- 106. Vandalism / I like to be fair to others
- 107. Wets self during the day / I enjoy a good joke
- 108. Wets the bed / I like to take life easy
- 109. Whining / I try to help other people where I can
- 110. Wishes to be of opposite sex / I wish I were of the opposite sex
- 111. Withdrawn, doesn’t get involved with others / I keep from getting involved with others
- 112. Worries / I worry a lot
- 113. Please write in any problems your child has that were not listed above.
2 questions for parents on Parental ‘About Yourself’ Questionnaire
- Do you identify’ as: ‘woman/girl’, ‘man/boy’, ‘transwoman/transgirl’, ‘transman/transboy’, ‘non-binary/genderqueer/agender/gender fluid’, ‘don’t know’, ‘prefer not to say’, ‘other’.
- What was your sex assigned at birth? ‘female’, ‘male’, ‘don’t know’, and ‘prefer not to say’.
18 questions for parents on SNAP-IV tool, assessing symptoms of ADHD
(not at all; just a little; quite a bit; very much)
- 1. Often fails to give close attention to details or makes careless mistakes in schoolwork or tasks
- 2. Often has difficulty sustaining attention in tasks or play activities
- 3. Often does not seem to listen when spoken to directly
- 4. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties
- 5. Often has difficulty organizing tasks and activities
- 6. Often avoids, dislikes, or reluctantly engages in tasks requiring sustained mental effort
- 7. Often loses things necessary for activities (e.g., toys, school assignments, pencils or books
- 8. Often is distracted by extraneous stimuli
- 9. Often is forgetful in daily activities
- 10. Often fidgets with hands or feet or squirms in seat
- 11. Often leaves seat in classroom or in other situations in which remaining seated is expected
- 12. Often runs about or climbs excessively in situations in which it is inappropriate
- 13. Often has difficulty playing or engaging in leisure activities quietly
- 14. Often is “on the go” or often acts as if “driven by a motor”
- 15. Often talks excessively
- 16. Often blurts out answers before questions have been completed
- 17. Often has difficulty awaiting turn
- 18. Often interrupts or intrudes on others (e.g., butts into conversations/ games
- 1. Is she/he now able to talk using short phrases or sentences? If no, skip to Question 8
- 2. Do you have a to-and-fro “conversation” with her/him that involves taking turns or building on what you have said
- 3. Does she/he ever use odd phrases or say the same thing over and over in almost exactly the same way (either phrases that she/he hears other people use or ones that she/he makes up).
- 4. Does she/he ever use socially inappropriate questions or statements? For example, does she/he regularly ask personal questions or make personal comments at awkward times
- 5. Does she/he ever get her/his pronouns mixed up (e.g. saying you or she/he for I).
- 6. Does she/he ever use words that she/he seems to have invented or made up herself/himself; put things in odd, indirect ways; or use metaphorical ways of saying things (e.g. saying hot rain for steam)
- 7. Does she/he ever say the same thing over and over in exactly the same way or insist that you say the same thing over and over again.
- 8. Does she/he ever have things that she/he seems to have to do in a very particular way or order or rituals that she/he insists that you go through
- 9. Does her/his facial expression usually seem appropriate to the particular situation, as far as you can tell
- 10. Does she/he ever use your hand like a tool or as if it were part of her/his own body (e.g. pointing with your finger, putting your hand on a doorknob to get you to open the door)#
- 11. Does she/he ever have any interests that preoccupy her/him and might seem odd to other people (e.g. traffic lights, drainpipes, timetables)
- 12. Does she/he ever seem to be more interested in parts of a toy or an object (e.g. spinning the wheels of a car), rather than in using the objects as it was intended.
- 13. Does she/he ever have any special interests that are unusual in their intensity but otherwise appropriate for her/his age and peer group (e.g. trains or dinosaurs)
- 14. Does she/he ever seem to be unusually interested in the sight, feel, sound, taste, or smell of things or people
- 15. Does she/he ever have any mannerisms or odd ways of moving her/his hands or fingers, such as flapping or moving her/his fingers in front of her/his eyes
- 16. Does she/he ever have any complicated movements of her/his whole body, such as spinning or repeatedly bouncing up and down.
- 17. Does she/he ever injure herself/himself deliberately, such as biting her/his arm or banging her/his head
- 18. Does she/he ever have any objects (other than a soft toy or comfort blanket) that she/he has to carry around
- 19. Does she/he ever have any particular friends or a best friend
- 20. Does she/he ever talk to you just to be friendly (rather than to get something)
- 21. Does she/he ever spontaneously copy you (or other people) or what you are doing (such as vacuuming, gardening, or mending things)
- 22. Does she/he ever spontaneously point at things around her/him just to show you things (not because she/he wants them)
- 23. Does she/he ever use gestures, other than pointing or pulling your hand, to let you know what she/he wants
- 24. Does she/he nod her/his head to indicate yes
- 25. Does she/he shake her/his head to indicate no
- 26. Does she/he usually look at you directly in the face when doing things with you or talking with you
- 27. Does she/he smile back if someone smiles at her/him
- 28. Does she/he ever show you things that interest her/him to engage your attention?
- 29. Does she/he ever offer to share things other than food with you
- 30. Does she/he ever seem to want you to join in her/his enjoyment of something
- 31. Does she/he ever try to comfort you if you are sad or hurt
- 32. If she/he wants something or wants help, does she/he look at you and use gestures with sounds or words to get your attention
- 33. Does she/he show a normal range of facial expressions
- 34. Does she/he ever spontaneously join in and try to copy the actions in social games, such as The Mulberry Bush or London Bridge Is Falling Down
- 35. Does she/he play any pretend or make-believe games
- 36. Does she/he seem interested in other children of approximately the same age whom she/he does not know
- 37. Does she/he respond positively when another child approaches her/him
- 38. If you come into a room and start talking to her/him without calling her/his name, does she/he usually look up and pay attention to you
- 39. Does she/he ever play imaginative games with another child in such a way that you can tell that each child understands what the other is pretending
- 40. Does she/he play cooperatively in games that need some form of joining in with a group of other children, such as hide-and-seek or ball games?
2 questions for young people on PATHWAYS Gender Identity Questionnaire
- 1. What best describes your gender identity?’
‘definitely a boy’, mainly a boy’, ‘in the middle’, ‘definitely a girl’, ‘mainly a girl’, ‘neither a boy or girl’, ‘not sure’ and ‘none of the above’.
- 2. Are there other words that you use to describe your gender identity? (select all that apply), ‘cisgender’, transgender’, ‘non-binary’, ‘agender’, ‘genderfluid’, ‘genderqueer’, ‘two-spirit’ and ‘other’.
5 Questions for Young people on Social Transition Questionnaire
“Have you socially transitioned in any of the following settings?”, followed by a checklist of five settings: Home, School, With Friends, Online, and Any Other Setting (e.g., holiday).
In the past month have you:
- Had bad dreams about scary experiences or other bad dreams?
- Had upsetting thoughts, pictures or sounds of scary experiences come into your mind when you didn’t want them to?
- Tried not to think about or have feelings about scary experiences?
- Been mad at yourself or someone else for making the scary experiences happen, not doing more to stop it, or to help after?
- Felt jumpy or easily startled, like when you hear a loud noise, or when something surprises you?
Children or parents rate how often symptoms occur, using a four-point scale: 0 (Never), 1 (Sometimes), 2 (Often), or 3 (Always).
The tool asks 25 different questions written for either a child to self-complete (the version below) or with slightly rephrased questions for an adult to complete (where question 1 is “My child worries about things”.
- 1. I feel sad or empty.
- 2. I worry when I think I have done poorly at something.
- 3. I would feel afraid of being on my own at home.
- 4. Nothing is much fun anymore.
- 5. I worry that something awful will happen to someone in my family.
- 6. I am afraid of being in crowded places (like shopping centers, the movies, buses, busy playgrounds).
- 7. I worry what other people think of me.
- 8. I have trouble sleeping.
- 9. I feel scared if I have to sleep on my own.
- 10. I have problems with my appetite.
- 11. I suddenly become dizzy or faint when there is no reason for this.
- 12. I have to do some things over and over again (like washing my hands, cleaning or putting things in a certain order).
- 13. I have no energy for things.
- 14. I suddenly start to tremble or shake when there is no reason for this.
- 15. I cannot think clearly.
- 16. I feel worthless.
- 17. I have to think of special thoughts (like numbers or words) to stop bad things from happening.
- 18. I think about death.
- 19. I feel like I don’t want to move.
- 20. I worry that I will suddenly get a scared feeling when there is nothing to be afraid of.
- 21. I am tired a lot.
- 22. I feel afraid that I will make a fool of myself in front of people.
- 23. I have to do some things in just the right way to stop bad things from happening.
- 24. I feel restless.
- 25. I worry that something bad will happen to me
18 Questions for young person on Utrecht Gender Dysphoria Scale – Gender Spectrum (UGDS-GS)
- I prefer to behave like my affirmed gender;
- Every time someone treats me like my assigned sex I feel hurt;
- It feels good to live as my affirmed gender;
- I always want to be treated like my affirmed gender;
- A life in my affirmed gender is more attractive for me than a life in my assigned sex;
- I feel unhappy when I have to behave like my assigned sex;
- It is uncomfortable to be sexual in my assigned sex;
- I wish I had been born as my affirmed gender;
- My life would be meaningless if I would have to live as my assigned sex;
- I feel hopeless if I have to stay in my assigned sex;
- I feel unhappy when someone misgenders me;
- I hate my birth assigned sex;
- I feel uncomfortable behaving like my assigned sex;
- It would be better not to live, than to live as my assigned sex.
- Puberty felt like a betrayal;
- Physical sexual development was stressful;
- The bodily functions of my assigned sex are distressing for me (i.e. erection, menstruation);
- I feel unhappy because I have the physical characteristics of my assigned sex.
33 Questions for Children/Young people on Body Image Scale – Gender Spectrum (BIS-GS)
Each questions asks: a) How happy are you with [insert name of a particular body part]?: With answers i) very happy ii) happy iii) neutral iv) unhappy v) very unhappy vi) don’t have.
Each question is followed up with: Would you want to change that body part if it was possible through medical or surgical treatment? i) Yes ii) No
- 1) Nose:
- 2) Shoulders
- 3) Hips
- 4) Chin
- 5) Calves
- 6) Breasts
- 7) Chest
- 8) Hands
- 9) Adam’s Apple
- 10) penis
- 11) clitoris
- 12) testes
- 13) ovaries
- 14) scrotum
- 15) vagina
- 16) Height
- 17) Thighs
- 18) Arms
- 19) Eyebrows
- 20) Waist
- 21) Buttocks
- 22) Biceps
- 23) Hair
- 24) Feet
- 25) Muscles
- 26) Facial Hair
- 27) Face
- 28) Voice
- 29) Weight
- 30) Body figure/shape
- 31) stature
- 32) Body hair
- 33) Appearance
- 1. In the past few weeks, have you wished you were dead? Yes No
- 2. In the past few weeks, have you felt that you or your family would be better off if you were dead? Yes No
- 3. In the past week, have you been having thoughts about killing yourself? Yes No
- 4. Have you ever tried to kill yourself? Yes No
- If yes, How? When?
- 1. Do you make yourself Sick because you feel uncomfortably full? Yes No
- 2. Do you worry you have lost Control over how much you eat? Yes No
- 3. Have you recently lost more than One stone in a 3 month period? Yes No
- 4. Do you believe yourself to be Fat when others say you are too thin? Yes No
- 5. Would you say that Food dominates your life? Yes No
(here the child/young person shorter version)
Statements are presented that need to be answered as Almost Never, Sometimes, About half the time, Most of the time, Almost always
- 1. I pay attention to how I feel.
- 2. I have no idea how I am feeling.
- 3. I have difficulty making sense out of my feelings.
- 4. I am attentive to my feelings.
- 5. I am confused about how I feel.
- 6. When I’m upset, I acknowledge my emotions.
- 7. When I’m upset, I become embarrassed for feeling that way.
- 8. When I’m upset, I have difficulty getting work done.
- 9. When I’m upset, I become out of control.
- 10. When I’m upset, I believe that I will remain that way for a long time.
- 11. When I’m upset, I believe that I’ll end up feeling very depressed.
- 12. When I’m upset, I have difficulty focusing on other things.
- 13. When I’m upset, I feel ashamed with myself for feeling that way.
- 14. When I’m upset, I feel guilty for feeling that way.
- 15. When I’m upset, I have difficulty concentrating.
- 16. When I’m upset, I have difficulty controlling my behaviors.
- 17. When I’m upset, I believe that wallowing in it is all I can do.
- 18. When I’m upset, I lose control over my behaviors.
1 Question for children/young people on Sexual Attraction
(question for 12 years+)
- Who are you attracted to?
Options: ‘Prefer not to say’, ‘Males’, ‘Females’, ‘Males and females’, ‘Neither’, ‘Not sure’
14 Questions for children/young people on ALSPAC Romantic Relations
(question for 12 years+)
In the past 30 days:
- 1. Have you hugged anybody?
- 2. Have you held hands?
- 3. Have you spent time alone?
- 4. Have you kissed?
- 4a. Have you been kissed by anybody?
- 5. Have you cuddled?
- 6. Have you lain down together?
- 7. Has someone put their hands under your clothing?
- 8. Have you put your hands under someone else’s clothing?
- 9. Have you been undressed with your genitals showing?
- 10. Have you touched or fondled someone’s private parts?
- 11. Has someone touched or fondled your genitals?
- 12. Have you performed oral sex?
- 13. Has someone performed oral sex on you?
- 14. Have you had sex?
(1= strongly disagree; 5= strongly agree
- 1. I am proud of my child
- 2. I am ashamed of my child
- 3. I try to hide my child’s gender identity
- 4. My child can be him- or herself around me
- 5. I advocate for the rights of my child
- 6. I protect my child and defend my child against others’ prejudice against gender-nonconforming/transgender people
- 7. I have problems with my child’s gender expression
- 8. I encourage my child to wear clothing and accessories consistent with their birth-assigned gender
- 9. I use toys, treats or other rewards to pressure my child not to gender transition and to live as his or her birth-assigned gender
- 10. My child can talk about romantic relationships and dating
- 11. I worry about how my child’s gender identity will affect our family’s image
- 12. I feel like a bad parent because I have a child that is gender-nonconforming/transgend
- 13. I think my child is gender-nonconforming/transgender because of something I did wrong
- 14. I feel like I am losing a son/daughter, or as if my child were dead
- 15. I am supportive of my child’s gender transition
- 16. I am worried that my child’s gender identity is a bad influence on my other children
Child/Young person version
- 1. My parents are proud of me
- 2. My parents are ashamed of me
- 3. My parents try to hide me
- 4. I can be myself around my parents
- 5. My parents advocate for my rights as a gender-expansive/trans* child
- 6. My parents protect me and defend me against others prejudice against gender-expansive/trans* people
- 7. My parents have problems with my gender expression
- 8. My parents use rewards or treats to pressure me to live as my sex assigned at birth
- 9. I can talk to my parents about romantic relationships and dating
- 10. My parents worry about how my gender identity will affect our family’s image
- 11. My parents probably believe they are bad parents because I am gender-expansive/trans*
- 12. My parents probably believe that I am gender-expansive/trans* because of something they did wrong
- 13. My parents are supportive of my gender transition
- 14. My parents are worried that my gender identity is a bad influence on other kids in my family
15 minutes questioning on ‘medical history’
This component is the least clear. It mentions covering the following vast topic areas that are defined as ‘Medical History’ Domains:
- 1. Family Context
- 2. Developmental History
- 3. Physical Health
- 4. Mental Health and Risk
- 5. Adverse childhood experiences
- 6. Safeguarding
- 7. Gender Development and Experiences
- 8. Sexual Development, Knowledge and Sexual Orientation
- 9. Education, Peer Relationships, and Social Context
- 10. Additional Information.
- Clinical Judgements – Impact assessments and clinical evaluation for various aspects of the CYP’s development and wellbeing;
- Parental Support – Judgements on the level of positive parental support and any conflicts between parents/carers/legal guardians or between parents/carers/legal guardians and the CYP.
Would be good to find out exactly what data is collected and why.
A questionnaire was designed to assess:
- CYP’s current height and weight,
- current prescribed medications
- diagnoses including neurodevelopmental, mental health and physical health, received in the past year. number of GP appointments
- planned surgeries or procedures
- A&E attendances or other unplanned admissions in the past year.
- The reasons for the GP appointments and A&E attendances
- Length of hospital admission for planned surgeries or procedures and admissions following an A&E attendance
Experiences of therapeutic options
Data will also be collected on rates of referral to, uptake of and completion of:
- Psychological therapy
- Occupational therapy
- Speech and language therapy,
- Clinical nursing
- Youth work support
- School/College support
- Non-endocrine pharmacological treatments
Compensation
Children/young people and parent/carer/legal guardian completing informant measures will each receive shop vouchers worth £20 for each data collection episode.
Growing Up Transgender 