(PS6-55) Transgender and Gender Non-Conforming Youth and Caregiver Perceptions of Peer and Family Relationships within Psychiatric Partial Hospitalization

Background: Higher perceived social support is related to decreased psychological distress, suicidality, and depressive symptoms in youth. Family support acts as a fundamental building block for children to develop self-worth. Transgender and gender nonconforming (TGNC) youth are at an increased risk for psychopathology, but research demonstrates that high-quality family and peer relationships can serve as protective factors. The present study examined the agreement between parent and child perceptions of family and peer relationships. We hypothesized that there would be greater discrepancies between caregiver and child perceptions of peer and family relationships in TGNC children versus cisgender children due to potential limited disclosure of peer relationships, possible familial conflict related to youth identity, or concerns about privacy surrounding revealing their gender identity. 

Method: Participants include 141 peripubertal youth (10-13 years old, Mage = 11.23, SD = .85) admitted to a partial hospital program for emotional dysregulation and behavioral challenges. Approximately 19% of youth identified as TGNC. Seventy percent of youth identified as White, 10.6% as Black, and 11.3% as Hispanic or Latinx. We include caregiver and youth reports on peer and family relationships at admission on the Patient-Reported Outcomes Measurement Information System (PROMIS) scales. Analyses examined correlations between caregiver and youth reports separately for TGNC and cisgender youth. Regression analyses examined TGNC group as a moderator on the convergence between caregiver and youth report. 

Results: The correlation between caregiver and youth reports on family relationships was r = .316 for cisgender youth and r = .297 for TGNC youth. Similarly, the correlation between informants for peer relationships was r = .258 for cisgender youth and r = .329 for TGNC youth. Approximately 28% of cisgender youth reported poor or low-quality family relationships, and 35% reported poor or low-quality peer relationships. Among TGNC youth, 48% reported poor or low-quality family relationships, and 59% reported poor or low-quality peer relationships. Regression analyses did not support gender identity moderating how convergent or divergent caregiver and youth reports were on peer (b = .11, p = .70) or family (b = -.05, p = .84) relationships. 

Discussion: Agreement between caregivers and youth was modest, supporting the use of multiple informants in clinical assessments. Although gender identity did not adjust the agreement between caregiver and youth reports, TGNC youth and their caregivers consistently reported lower quality peer and family relationships. These results further support that affirmative psychotherapy needs to be integrative, engaging family and social aspects of care.