Transgender youth have a high risk of adverse mental health outcomes. Family acceptance may play a protective role in transgender youth's psychosocial adjustment; however, studies have largely examined acceptance independent from gender identity, averaged across family members, and in extreme examples (i.e., high acceptance or high rejection). Grounded in interpersonal acceptance-rejection theory, this study documents transgender youth's experiences of family acceptance-rejection across family members, including siblings, and investigates the relationship between family acceptance-rejection and youth psychosocial functioning. Method: Fifty-four youth completed psychosocial questionnaires, and youth and caregivers completed semistructured clinical interviews, which were coded for family acceptance-rejection. Analyses examined associations between acceptance-rejection and psychosocial variables. Results: Lower primary caregiver past acceptance predicted increased youth depressive/anxiety symptoms/internalizing problems. Higher secondary caregiver indifference predicted increased youth depressive symptoms. Lower sibling acceptance predicted increased youth suicidal ideation. Conclusions: Findings demonstrate that family acceptance-rejection plays an important role in the psychosocial adjustment of transgender youth. New to the existing literature are the findings that caregiver indifference and sibling acceptance are associated with mental health outcomes. Implications for Impact StatementFamily acceptance and rejection play an important role in the adjustment of transgender youth. It is imperative for providers to evaluate acceptance and rejection across family members and to work with families to foster supportive relationships.

Although many siblings show resilience in the face of childhood cancer, others report clinical levels of distress during and after cancer treatment. Psychosocial care is recommended for siblings, but systematic screening to identify siblings currently experiencing or at-risk for psychosocial difficulties is not routine. As part of a program of research to develop feasible procedures for sibling screening, the current study used qualitative methods to gather the perspectives of parents and siblings regarding barriers to sibling psychosocial screening, ways to mitigate those barriers, and preferred screening procedures. A purposive sample of families of children with cancer (n ϭ 29 parents, n ϭ 17 siblings ages 8 -17) participated in semistructured qualitative interviews. Barriers to and preferences for sibling screening (e.g., timing, location, modality) were probed. Applied thematic analysis was used to distill findings. Families reported a strong need for sibling psychosocial screening but also reported barriers (i.e., family disruptions and separations, parental stress, and hesitancy to disclose emotional difficulties by both siblings and parents). Recommendations for addressing these barriers were provided. Sibling screening was preferred near diagnosis and every three months thereafter. Parent and sibling reports were both recommended. Preferred modalities included electronic questionnaire delivered in the hospital/clinic (parents) and clinical interview (siblings). In sum, families emphasized the importance of sibling psychosocial screening and suggested ways to achieve this. Involving families in the development of procedures to systematically screen siblings of children with cancer for psychosocial difficulties is an important step in developing feasible, effective strategies to identify siblings in need of clinical care.

Psychosocial screening requires sibling-specific screening items that correspond to preexisting risk (at diagnosis) and reactions to cancer (several months after diagnosis). Validated, sibling-specific screeners will facilitate identification of siblings with elevated psychosocial risk.

Childhood cancer is a significant psychosocial stressor, and sibling adjustment ranges from resilience to clinically significant psychopathology. Siblings and parents often describe siblings' psychosocial functioning differently, which may reflect parental unawareness of siblings' adjustment to cancer and increase the risk for negative sibling outcomes. The present study characterizes siblings' and parents' perceptions of parents' awareness of siblings' psychosocial functioning and describes how family functioning influences parental awareness. Parents (N ϭ 13) and siblings (N ϭ 17, ages 8 -17) from 13 families completed in-depth qualitative interviews regarding siblings' psychosocial adjustment to cancer. Interviews were coded for dimensions of family functioning based on the McMaster Model and analyzed using applied thematic analysis. Families were stratified based on higher or lower levels of parental awareness (i.e., knowledge of the presence, severity, or content of siblings' cancer-related feelings). Themes related to communication, affective involvement, roles, problem-solving, and affective responsiveness influenced parental awareness. Parental awareness was hindered by siblings' reluctance to communicate their feelings to parents due to the messages they received about cancer (e.g., be positive/helpful), siblings' hesitancy to rely on parents for emotional support, and parents not consistently asking about siblings' emotions. Additionally, parents' cancer-related stress and family disruptions reduced parental focus on siblings and decreased parents' tolerance of siblings' negative emotions. Higher parental awareness was facilitated by closer relationships prediagnosis, consistent communication, and affective problem-solving in response to cancer-related changes. Findings provide a more comprehensive understanding of the family processes underlying parental awareness and inform best practices for sibling assessment and support.

Background Poor sleep is common for children during cancer treatment, but there is limited understanding of the nature of children’s sleep throughout the treatment trajectory. The current exploratory study used an explanatory sequential mixed method approach to examine quantitative associations among sleep problems in children with cancer, parental behavior, and children’s sleep hygiene, with follow-up qualitative characterizations of children’s sleep across cancer treatment stages. Procedure Eighty parents of children with cancer (aged 2–10 years; in active treatment, maintenance treatment, or off treatment) completed an online survey querying the child’s sleep quality (Sleep Disturbance Scale for Children—Disorders of Initiating and Maintaining Sleep subscale) and behaviors (Child Sleep Hygiene Scale) and sleep-related parenting behaviors (Parental Sleep Strategies). A subsample (n = 17 parents) participated in qualitative interviews to better characterize the processes of children’s sleep and parents’ sleep-related behaviors. Results Children’s sleep quality, sleep hygiene, or parental sleep strategies were not significantly different by cancer treatment groups. Greater sleep disturbance in children was associated with their parents’ tendency to accommodate the child’s bedtime requests. Qualitatively, cancer treatment-related anxiety in both children and parents influence the onset of these disruptive sleep behaviors. Conclusion Parents’ sleep-related behaviors affect children’s sleep during cancer treatment. Parents’ accommodation may start during active treatment to alleviate cancer-related challenges, and these behaviors may continue into maintenance therapy and off treatment to reinforce sleep disturbance. Behavioral interventions targeting unhelpful parental behaviors may improve sleep in children with cancer during and after cancer treatment.