Sometimes I know before the first appointment. A parent may have been the one to reach out, to answer the question when I ask, “So, tell me what’s going on.” Maybe this is a family where the parents have already wondered about their child’s sexual orientation or gender identity (or both!). Perhaps the kid has already come out, to themselves, at school, at home, or nowhere. Sometimes it’s not on anyone’s radar - and anxiety, depression, trouble focusing, or other struggles are front and center.