High RSA may protect against the effects of maltreatment on aggressive behavior, though this effect may be moderated by SCL reactivity among girls.

The COVID-19 pandemic has been stressful for many, increasing levels of anxiety, depression and other mental health concerns worldwide. With the spread of the virus, many youth found themselves physically isolated from their peers and confined to their homes, and medical and mental health services previously provided in person had to adapt by providing virtual sessions. The transition to virtual care created many new challenges for clinicians and patients, including some specific to transgender youth and their families. Pre-pandemic, transgender youth comprised a marginalized and vulnerable population, with elevated risk for adverse mental health outcomes. However, community support, strong group identification and family affirmation can serve as important mitigating factors. In this paper, we will discuss unique challenges encountered in working with the parents and caregivers of transgender youth during virtual visits that have the potential to interfere with development of a therapeutic alliance and the movement toward increased family acceptance. We will provide clinical case examples and propose methods through which to address difficulties and improve care.

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There are growing concerns regarding the referral of children and youth with mental health conditions to emergency departments (EDs). These focus on upward trends in utilization, uncertainty about benefits and negative effects of ED visits, and inequities surrounding this form of care. A review was conducted to identify and describe available types of data on ED use. The authors’ interpretation of the literature is that it offers compelling evidence that children and youth in the U.S. are being sent to EDs for mental health conditions at increasing rates for reasons frequently judged as clinically inappropriate. As a major health inequity, it is infrequent that such children and youth are seen in EDs by a behavioral health professional or receive evidence-based assessment or treatment, even though they are kept in EDs far longer than those seen for reasons unrelated to mental health. The rate of increase in these referrals to EDs appears much greater for African American and Latinx children and youth than White children and is increasing for the publicly insured and uninsured while decreasing for the privately insured. A comprehensive set of strategies are recommended for improving healthcare quality and health equity. A fact sheet is provided for use by advocates in pressing this agenda.

The goals of the present article are to summarize the current state of assessment measures pertaining to the evaluation of gender in young children, identify gaps in knowledge, and propose priorities for research regarding gender identity development as concepts of gender evolve over time. We provide an overview of assessment tools that have been used to measure gender-related constructs in young children and highlight areas in which more nuanced concepts of gender have driven the creation of new approaches to assessment. We identify a number of overarching assessment limitations as well, with recommendations for research priorities: (a) developing and validating measures of gender identity in young children, (b) examining gender development in typical and gender diverse young children, (c) incorporating a nonbinary model of gender into assessment, (d) examining family and broader ecological variables as they impact gender development, and (e) studying factors that influence parental beliefs about their young child's gender. Public Significance StatementAssessments to measure gender identity in preschool youth are limited in scope, and do not take into consideration the multiple facets of gender identity, ecological variables that influence gender development and nonbinary and/or flexible identities. There is a need for increased measure development in this area.