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This study assesses PROM appropriateness by examining five dominant measurement domains, searching for evidence of pathologisation and over-assessment across each tool. Directed content analysis identifies widespread pathologising legacy measures and highlights over-assessment as a major secondary concern. The work argues for ethical, depathologised, trans-positive PROM selection and reduced data burden.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/pathologising-legacy-measures-and-over-assessment-reconceptualising-ethical-assessment-and-data-collection-practices-in-trans-childrens-healthcare/461074/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/pathologising-legacy-measures-and-over-assessment-reconceptualising-ethical-assessment-and-data-collection-practices-in-trans-childrens-healthcare/461074.png","ImageObject",300,407,{"name":92,"@type":93},"Marglet","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-02","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":34},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What healthcare approach does the article examine regarding trans children?","Question",{"text":112,"@type":113},"The article examines how trans children’s healthcare increasingly uses Patient Reported Outcome Measures (PROMs) and how this practice interacts with a legacy paradigm that did not center depathologisation or rights-based practice.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How does the study evaluate PROMs in trans children’s healthcare?",{"text":117,"@type":113},"It uses directed content analysis to review PROMs across five measurement domains, looking specifically for signs of pathologisation and over-assessment within each measure.",{"name":119,"@type":110,"acceptedAnswer":120},"What are the key concerns identified in the reviewed PROMs?",{"text":121,"@type":113},"Pathologisation is described as widespread, especially in tools related to gender, body image, and multi-concept measures. Over-assessment is also highlighted as a second serious concern, with most reviewed PROMs showing signs of it.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},461074,1791160692,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":34,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":46,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":31,"preview_page_count":4},2336477982702,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","International Journal of Transgender Health  \nISSN: 2689-5269 (Print) 2689-5277 (Online) Journal [homepage: ](homepage: www.tandfonline.com/journals/wijt21)[www.tandfonline.com/journals/wijt21](homepage: www.tandfonline.com/journals/wijt21)  \nPathologising Legacy Measures and overassessment: reconceptualising ethical assessment and data collection practices in trans children’s healthcare  \nCal Horton, Ruth Pearce, Jai mie F. Veale, Lou Kerley & Ken C. Pang  \nTo cite this article: Cal Horton, Ruth Pearce, Jai mie F. Veale, Lou Kerley & Ken C. Pang (21 May 2026): Pathologising Legacy Measures and over-assessment: reconceptualising ethical assessment and data collection practices in trans children’s healthcare, International Journal of Transgender Health, DOI: 10.1080/26895269.2026.2664756  \nTo link to this article: [https://doi.org/10.1080/26895269.2026.2664756](https://doi.org/10.1080/26895269.2026.2664756)  \n© 2026 The Author(s) . Published with license by Taylor & Francis Group, LLC.  \n\n|  View supplementary material  |  |\n| --- | --- |\n|  Published online: 21 May 2026. |  |\n|  Submit your article to this journal  |  |\n| | Article views: 291 |\n| | View related articles  |\n|  View Crossmark data |  |\n\nFull Terms & Conditions of access and use can be found at [https://www.tandfonline.com/action/journalInformation?journalCode=wijt21](https://www.tandfonline.com/action/journalInformation?journalCode=wijt21)  \nInternatIonal Journal of transgender HealtH [https://doi.org/10.1080/26895269.2026.2664756](https://doi.org/10.1080/26895269.2026.2664756)  \nPathologising Legacy Measures and over-assessment: reconceptualising ethical assessment and data collection practices in trans children’s healthcare  \nCal Hortona , Ruth Pearceb,c , Jaimie F. Vealed , Lou Kerleye,f  and Ken C. Pange,g,h   \naCentre for diversity Policy research and Practice, oxford Brookes, oxford, uK; bschool of education, university of glasgow, glasgow, uK; cCenter for applied transgender studies, Chicago, Illinois, usa; dte Kura Whatu oho Mauri: school of Psychological and social sciences, university of Waikato, new Zealand; edepartment of Paediatrics, university of Melbourne, Melbourne, australia; fClinical sciences, Murdoch Children’s research Institute, Parkville, australia; gMurdoch Children’s research Institute, Parkville, australia; hdepartment of adolescent Medicine, royal Children’s Hospital, Parkville, australia  \nABSTRACT  \nBackground: Trans children’s healthcare services increasingly utilize Patient Reported Outcome Measures (PROMs). Many tools in current use were developed in past decades, under a different healthcare paradigm that did not center depathologisation or rights-based practice. This legacy may impact negatively on their appropriateness for use in modern trans-positive healthcare services.  \nAims: This article investigates the appropriateness of Patient Reported Outcome Measures used in trans children’s healthcare, reviewing them for signs of pathologisation andover-assessment.  \nMethods: 5 measurement domains that dominate trans children’s healthcare were investigated, including: i) gender related concepts (e.g. gender dysphoria); ii) appearance and body image; iii) social function; iv) mental health; and v) quality of life. Directed content analysis was utilized to examine and evaluate the appropriateness of these measures, identifying evidence of pathologisation and over-assessment within each PROM.  \nResults: Pathologisation is widespread across the PROMs commonly utilized in pediatric trans healthcare. It is particularly pronounced in tools relating to gender, body image and multi-concept tools. Overassessment is noted as a second serious concern in trans children’s healthcare, with a majority of reviewed PROMs showing signs of over-assessment. Discussion: PROMs bearing signs of pathologisation are here defined as ‘Pathologising Legacy Measures’ (PLMs)– clinical measures or tools impacted by a legacy of historic pathologisation and problema","cbCaioFOtmGnsnrB","https://ap.wps.com/l/cbCaioFOtmGnsnrB","pdf",1887583,"English","# Abstract\n# Introduction\n## Context and evolution of services\n## Pathologisation concepts in trans healthcare\n# Background, Aims, Methods, Results, Discussion, Implications, and Ethics\n# Methods\n## Measurement domains and analytic approach\n# Results\n## Findings on pathologisation and over-assessment","[{\"question\":\"What healthcare approach does the article examine regarding trans children?\",\"answer\":\"The article examines how trans children’s healthcare increasingly uses Patient Reported Outcome Measures (PROMs) and how this practice interacts with a legacy paradigm that did not center depathologisation or rights-based practice.\"},{\"question\":\"How does the study evaluate PROMs in trans children’s healthcare?\",\"answer\":\"It uses directed content analysis to review PROMs across five measurement domains, looking specifically for signs of pathologisation and over-assessment within each measure.\"},{\"question\":\"What are the key concerns identified in the reviewed PROMs?\",\"answer\":\"Pathologisation is described as widespread, especially in tools related to gender, body image, and multi-concept measures. Over-assessment is also highlighted as a second serious concern, with most reviewed PROMs showing signs of it.\"}]","Pathologising Legacy Measures and over-assessment: reconceptualising ethical assessment and data collection practices in trans children’s healthcare | PDF",1790760536]