First Advisor
Ben Anderson-Nathe
Term of Graduation
January 2025
Date of Publication
1-1-2025
Document Type
Dissertation
Language
English
Subjects
arts-based methods, children's agency, children's health, draw-and-tell conversations, gender-creative, pediatrics
Physical Description
1 online resource ( pages)
Abstract
A growing number of children identify in various gender-creative ways, likely due to broader social awareness and affirmation of transgenderism. Gender-creative children face higher risks for adverse social, academic, mental health, and healthcare outcomes compared to non-transgender peers. Support from loved ones along with guidance from pediatric providers can mitigate poor outcomes and ensure that gender-creative children live healthy and happy lives. Young gender-creative children’s perspectives about the aforementioned topics are markedly absent from the literature, which instead highlights adolescent and adult proxy perspectives. In this participatory arts-based study anchored by a constructivist epistemology and informed by post-structuralist, queer, and transgender theories, I sought to hear directly from gender-creative children about their social supports and experiences with pediatric clinical care using the Draw-and-Tell Conversations (DTC) method. I wanted to know what would help gender-creative children feel safe to express thoughts, feelings, and experiences related to gender; who they go to when they want to talk about their health and/or gender, and why; and what it is like for them to attend pediatric health care visits. I recruited a United States-based bicoastal sample of 12 school-aged (5–10 years old; median age 6) gender-creative children. Participants were predominantly white (n=10/12; 83.3%) and from highly educated families (n=12/12; 100%). The DTC method enabled children to express their thoughts and insights while maintaining a sense of agency and control throughout the research process. I gave each child a social story research booklet describing the research process. Children provided written assent to participate, and primary caregivers provided written consent. The Portland State University Institutional Review Board provided study oversight, and I received input from trusted community partners throughout the research process. The children drew pictures of important people in their lives and of a pediatric clinical experience. The drawings guided our subsequent conversation. I recorded and hand-transcribed interviews and kept a digital copy of each drawing. Using a mixed-methods analysis—involving visual content analysis, reflexive thematic analysis, and I-Poetry—I generated five themes: (1) “The sun means my family is warm and loving”: Sources of Social Support; (2) “I have a cat”: Animals as Social Support; (3) “I make those in my imagination”: Windows into Children’s Lifeworlds; (4) “I just want to tell you”: Talking and Not Talking About Gender; and (5) “I just take deep breaths”: Navigating Clinical Experiences. Findings suggest that gender-creative children often rely on primary caregivers, trusted loved ones, and teachers for support. Children preferred not to talk to pediatric providers about gender and healthcare encounters were frequently described as uncomfortable. The study highlights the need for pediatric providers to continue adopting child-centered, gender-affirming practices, such as empowering children with agency in conversations and decision-making, using inclusive language, and incorporating tools like drawing to facilitate rapport and engagement. Recommendations include expanding gender-affirming care training for providers, leveraging the DTC method in clinical and research settings, and fostering affirming environments within families and schools to promote the well-being of gender-creative children. This study emphasizes the importance of listening to children’s voices, positioning them as experts of their own experiences, and building systems that honor their agency and creativity.
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Recommended Citation
Lenne, Eline Leemans, "“I know who I am”: Draw-and-Tell Conversations with Gender-Creative Children" (2025). Dissertations and Theses. Paper 6850.