A Parent-Report Gender Identity Questionnaire for Children: Psychometric Properties of an Italian Version

Gender diversity is correlated with dimensional neurodivergent traits but not categorical neurodevelopmental diagnoses in children

BACKGROUND

Gender clinic and single-item questionnaire-based data report increased co-occurrence of gender diversity and neurodevelopmental conditions. The nuances of these associations are under-studied. We used a transdiagnostic approach, combining categorical and dimensional characterization of neurodiversity, to further the understanding of its associations with gender diversity in identity and expression in children.

METHODS

Data from 291 children (Autism N = 104, ADHD N = 104, Autism + ADHD N = 17, neurotypical N = 66) aged 4-12 years enrolled in the Province of Ontario Neurodevelopmental Network were analyzed. Gender diversity was measured multi-dimensionally using a well-validated parent-report instrument, the Gender Identity Questionnaire for Children (GIQC). We used gamma regression models to determine the significant correlates of gender diversity among age, puberty, sex-assigned-at-birth, categorical neurodevelopmental diagnoses, and dimensional neurodivergent traits (using the Social Communication Questionnaire and the Strengths and Weaknesses of ADHD Symptoms and Normal Behavior Rating Scales). Internalizing and externalizing problems were included as covariates.

RESULTS

Neither a categorical diagnosis of autism nor ADHD significantly correlated with current GIQC-derived scores. Instead, higher early-childhood dimensional autistic social-communication traits correlated with higher current overall gender incongruence (as defined by GIQC-14 score). This correlation was potentially moderated by sex-assigned-at-birth: greater early-childhood autistic social-communication traits were associated with higher current overall gender incongruence in assigned-males-at-birth, but not assigned-females-at-birth. For fine-grained gender diversity domains, greater autistic restricted-repetitive behavior traits were associated with greater diversity in gender identity across sexes-assigned-at-birth; greater autistic social-communication traits were associated with lower stereotypical male expression across sexes-assigned-at-birth.

CONCLUSIONS

Dimensional autistic traits, rather than ADHD traits or categorical neurodevelopmental diagnoses, were associated with gender diversity domains across neurodivergent and neurotypical children. The association between early-childhood autistic social-communication traits and overall current gender diversity was most evident in assigned-males-at-birth. Nuanced interrelationships between neurodivergence and gender diversity should be better understood to clarify developmental links and to offer tailored support for neurodivergent and gender-diverse populations.

Observations on Gender Variance in Chinese Community Children Measured by the Gender Identity Questionnaire for Children

Few studies have examined how gender variance (GV), broadly defined as gender identity and behaviors (e.g., activities and preferences) that do not correspond with culturally defined gender norms, manifests in community samples, particularly in children and outside Western contexts. We present data based on the Gender Identity Questionnaire for Children (GIQC; Johnson et al., 2004) among 461 Chinese community children (4-12 years old) to gauge how well the GIQC serves as a measure of GV and the prevalence of GV. We examined the descriptive scores of GV, its relationship to a gender-typing measure that has been validated in Chinese children (the Child Play Behavior and Activity Questionnaire, CPBAQ), the scores on the GIQC of children whose gender is incongruent with birth-assigned sex, and the binned category distributions (from gender-variant to gender-conforming) in comparison to a Canadian community sample (van der Miesen et al., 2018). The Chinese children on average scored toward the gender-conforming end and children assigned female at birth showed more GV than children assigned male at birth. More importantly, the GIQC appears to be a reliable and sensitive measure of GV in the Chinese sample. GIQC scores correlated significantly with CPBAQ scores and showed a very similar reliability coefficient, gender difference effect size, and bin distribution pattern as the Canadian reference sample. Also, children reported as gender/sex incongruent had the most gender-variant GIQC scores. Although clinically gender-referred Chinese children are required to establish culturally specific cutoff points, these findings provide initial evidence for the characteristics of GV, the applicability of the GIQC as a measure of GV in Chinese community children, and the comparisons of GIQC categories between Chinese and Canadian community samples.

Children’s Perception Scale of Head Lice Infestation (CPS-HLI): Design and Psychometrics

Background: Pediculosis is a common ectoparasitic infestation that involves especially the skin of children worldwide. Studying the children’s perception of the disease’s risk factors, the effectiveness of personal preventive measures, and its implications for their health could be a major leap forward in health promotion activities. Objectives: This study aimed to develop and evaluate the psychometric properties of the Children’s Perception Scale of Head Lice Infestation (CPS-HLI) and its initial feasibility assessment for use on Iranian and possibly other elementary school children. Methods: The scale’s items were retained based on an extensive literature search and classified into the underlying constructs of the extended health belief model (EHBM). An expert panel endorsed the qualitative content and face validity of the preliminary draft, and 47 items remained for quantitative validity testing on a sample of 362 elementary school students in the city of Paveh, West of Iran. Explanatory and confirmatory factor analyses (EFA and CFA) were employed to test the content and structural validity of the constructed instrument. Cronbach's alpha and intra-class correlation coefficients were calculated to assess the internal consistency and reliability of the scale. Results: The values of Lawshe's content validity index (0.90) and content validity ratio (0.77), the subscales’ Cronbach's alpha (0.59), and intra-class correlation (0.72) coefficients confirmed plausible internal consistency of the scale. The values of root mean square error of approximation (RMSEA) (< 0.08 with χ2 < 0.05), Tucker-Lewis index (TLI), and comparative fit index (CFI) > 0.9 approved the applied statistical model’s goodness of fit. The ranges of Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy for the underlying subscales (0.49 - 0.74) and the statistically significant result of Bartlett’s test of sphericity (P < 0.001) confirmed the patterned relationship among the constructed scale’s items. The principal component analysis that was performed using STATA favored the 11-factor solution. Conclusions: The study findings support the construct validity of CPS-HLI for use in studies on children’s perception of head lice infestation risk factors, the effectiveness of personal preventive measures, and the disease implications for their health and well-being. Further cross-cultural and cross-national validation studies are recommended for using the instrument in a wider range of populations and settings.