Kidscreen 10 Gender Incongruence test

[Shedmistress]

So the Puberty Blocker trial will be using this screening tool.

https://www.kidscreen.org/english/questionnaires/language-versions-view-and-download/

Any ideas why they have chosen this in particular? None of these questions are in any way related to what they tell us is an incongruence in gender whatever that is.

Each question could be answered differently if prefixed with 'in the last day' or 'in the last month' or 'in the last year' or 'ever'.

This seems highly motivated to enable some twisting of data from the get go. If they ask 'have you felt sad' at the start and the answer is sometimes, or even always, does that just get recorded or used to make a diagnosis that puts that kid on the trial? Or would it stop the kid from going on the trial? What is the relevance to 'gender incongruence' whatever that is?

This is all so baffling.

These questions are leading.

i learnt the hard way with my first y3 class; when you start talking about some of those things the kids start to hone in on them.

And they over magnify them. Often to get more attention or more appreciation or more of what ever they feel they’re not getting. It can happen very quickly

It’s a screening tool that is widely used to explore quality of life. It’s isn’t specific to ‘gender medicine’.

Well yes I can read!

My issue is in what context has this been specifically chosen as the tool in the 'all new gender wang sterilisation of kids programme'.

I don't think this is the diagnosis tool. I would assume they'll ask the same questions after 2 years on drugs and see if the kids feel happier.

As a trial design it's still pretty obviously flawed.

Sorry to be a downer but the word 'happy' isn't mentioned so how could they be 'happier' at the end?

I think it’s been selected as it is commonly used in clinical trials.

For what it’s worth, I think subjective measures relating to wellness should be used in trials intended to improve emotional and mental health. This needs to be considered alongside objective data relating to the functional impairment that led to determining an illness or condition is present.

To be considered to have ‘gender distress’, children who think their distress is gender related need to exhibit functional impairment relating to the distress. For example, stopping attending school, self harming, restricting food intake. The functional issues leading to diagnoses/ decision to treat, should objectively improve if treatment is working, in addition to self perceptions of positive change as reported through tools like KIDSCREEN.

I am not in favour of this trial but I woukd like to see research undertaken with other interventions to reduce distress thought to be related to gender. I would not object to KIDSCREEN being used.

To be considered to have ‘gender distress’, children who think their distress is gender related need to exhibit functional impairment relating to the distress. For example, stopping attending school, self harming, restricting food intake. The functional issues leading to diagnoses/ decision to treat, should objectively improve if treatment is working, in addition to self perceptions of positive change as reported through tools like KIDSCREEN.

Have you a link to this screening tool that will be used in this trial?

I suppose if they feel more unwell it might get measured.

At the same time, the placebo effect of being included and “treated” could override the side effects

I don’t have any insider information to this trial but I do have access to a wide range of assessment and screening tools that are restricted for use in line with training and qualifications.

When you say screening tool, do you have in mind a single tool that will be used to determine if a child is eligible to participate?

There will be inclusion and exclusion criteria that set out who can be included. These usually involve lots of variables, so I don’t imagine they’ll be a single tool. They will consider lots of physical factors, especially those that increase risk of taking PB. They might exclude those with other diagnosable conditions (to reduce the chance of these skewing the findings), and I imagine they would look at quality of life - seeking to include those for whom their distress is having significant impact across quality of life domains (eg independence, social relationships).

It is a made up condition so yes, it would be good to see the screening tool. This seems to be the only one mentioned. Hence the thread.

Clinicians encounter very distressed young people whose distress is damaging their current quality of life and, potentially, their future quality of life. These young people fully believe that their distress arises because of ‘gender’. I don’t think it’s unreasonable to consider this a condition and to want to find effective treatment for it. Naming and researching this ‘condition’ Isn’t, in my view, problematic in itself. Issues arise when assumptions are made about what causes this condition.

My experience is that children with gender distress latch on to making sense of their distress through the lens of gender because they aren’t consciously aware of the real causes of their distress. I think it’s helpful to have a name for this condition. It it’s labelled ‘autism’, ptsd etc from the outset, this doesn’t provide the right information for addressing the issues at hand

Distress which a child has decided is due to 'gender' is real. What is going wrong here is adults agreeing with the child that their distress is due to their sexed body, and agreeing that changing it, or preventing puberty is a solution.

This is a mental health condition which needs solutions based in mental health treatments, not agreeing with the child that they need to alter their body (or prevent the natural changes that it's going through).

How about spending that £10m on improved mental health services for children instead of a harmful 'trial' based on tooth fairy science?

I would imagine that several screening tools will be used. After all, in addition to tracking whether the children's quality of life/mood improves or worsens with time, they also need to screen for various comorbidties, confounding factors etc etc

Anyone (like me) who has had NHS treatment for mental health conditions will be familiar with filling in several different tools such as this.

And, yes, they are pretty blunt tools, but as part of the armoury of monitoring strategies they have their place. Especially when you take into account the fact that it isn't so much how the patient answers as how their answers change over time that is considered useful in many cases

I presume it's a way of getting a general picture of the child's mental health and social wellbeing. Given the GC understanding that gender dysphoria is a psychological issue conditioned heavily by social factors, I'd be highly concerned if any study of the condition wasn't doing something along these lines!

There's another question of whether this is a well-designed survey, whether the questions are leading etc. I assume it's widely used and therefore there's a good baseline for the answers you'd expect in a cohort of typical children against which the trial subjects can be compared? But even if not presumably they're interested in whether the PBs lead to any improvement in these things over time: it's not the reliability of the absolute percentage of "always sad" children that matters most, it's whether that percentage (and the others like it) goes up or down over time.

We cannot rely on us imagining that something will happen as we know that isnt the case with this area of treatments. I couldn't imagine it ever being ethical to sterilise kids but yet this trial is going ahead.

So without this imagined screening tool or tools, this is all we have to go on, as it is the one in their trial documentation.

I wonder how they interpret the answer to question 7.

Regardless of whether it's in the last week (or in any other week prior to starting the trial), it's very difficult to imagine a situation where anyone could think a parent is treating their child "fairly" if they have signed them up to have their (likely) brain, bone and reproductive system damage tracked in a national trial. Presumably the child is delighted though and thinks that's all very fair, so will focus on other thoughts when answering the test question.

Arguably, many of the parents themselves probably haven't been treated fairly either when they were somehow led to believe this was a good idea. I'm not much of a fan of Elon Musk in general, but my heart absolutely broke for him when he talked about how he had been hoodwinked into putting his son on PBs. The pain in both his eyes and voice was almost palpable. It's a shame that Jordan Peterson talked over him at that point as it looked like he was going to say more.

And also..... what child ever thinks their parents have been fair to them if they are asked such a leading question? As WarriorN has pointed out, all the questions lend themselves to very narrow thought processes being channelled. On this question, children will naturally focus on the things they weren't allowed to do... and that will skew their answer.

Of course they do. kids want to feel unique; they want to feel special. If you told a class that they each had to publicly identify with a number one through 10 maybe more would identify as 1 or 7 but eventually every number would be taken.

I was using the word happy as a broad summary of what it's measuring. It's a general wellbeing index. They won't be interpreting the responses to individual questions, they'll be feeding it into the machine to generate a single figure 'how is this child feeling in themselves' measure that they can monitor.