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Practice Parameter on Gay, Lesbian, or Bisexual Sexual Orientation, Gender Nonconformity, and Gender Discordance in Children and Adolescents

https://doi.org/10.1016/j.jaac.2012.07.004Get rights and content
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Children and adolescents who are growing up gay, lesbian, bisexual, gender nonconforming, or gender discordant experience unique developmental challenges. They are at risk for certain mental health problems, many of which are significantly correlated with stigma and prejudice. Mental health professionals have an important role to play in fostering healthy development in this population. Influences on sexual orientation, gender nonconformity, and gender discordance, and their developmental relationships to each other, are reviewed. Practice principles and related issues of cultural competence, research needs, and ethics are discussed.

Key Words

sexual orientation
homosexuality
bisexuality
gender identity disorder
gender discordant

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This Practice Parameter was developed by Stewart L. Adelson, M.D. and the American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Quality Issues (CQI): Heather J. Walter, M.D., M.P.H., and Oscar G. Bukstein, M.D., M.P.H., Co-Chairs, and Christopher Bellonci, M.D., R. Scott Benson, M.D., Allan Chrisman, M.D., Tiffany R. Farchione, M.D., John Hamilton, M.D., Helene Keable, M.D., Joan Kinlan, M.D., Nicole Quiterio, M.D., Ulrich Schoettle, M.D., Matthew Siegel, M.D., and Saundra Stock, M.D. AACAP liaison: Jennifer Medicus.

AACAP Practice Parameters are developed by the AACAP CQI in accordance with American Medical Association policy. Parameter development is an iterative process between the primary author(s), the CQI, topic experts, and representatives from multiple constituent groups, including the AACAP membership, relevant AACAP Committees, the AACAP Assembly of Regional Organizations, and the AACAP Council. Details of the Parameter development process can be accessed on the AACAP website. Responsibility for Parameter content and review rests with the author(s), the CQI, the CQI Consensus Group, and the AACAP Council.

AACAP develops both patient-oriented and clinician-oriented Practice Parameters. Patient-oriented Parameters provide recommendations to guide clinicians toward best assessment and treatment practices. Recommendations are based on the critical appraisal of empirical evidence (when available) and clinical consensus (when not), and are graded according to the strength of the empirical and clinical support. Clinician-oriented Parameters provide clinicians with the information (stated as principles) needed to develop practice-based skills. Although empirical evidence may be available to support certain principles, principles are based primarily on clinical consensus. This Parameter is a clinician-oriented Parameter.

The primary intended audience for the AACAP Practice Parameters is child and adolescent psychiatrists; however, the information contained therein may also be useful for other mental health clinicians.

The authors acknowledge the following experts for their contributions to this Parameter: Members of the AACAP Sexual Orientation and Gender Identity Issues Committee: Sarah E. Herbert, M.D., M.S.W., Chair, and Beth Belkin, M.D., Ph.D., Ledro R. Justice, M.D., Scott Leibowitz, M.D., William Martin, M.D., Edgardo J. Menvielle, M.D., Yiu Kee Warren Ng, M.D., R. Kaan Ozbayrak, M.D., Richard R. Pleak, M.D. (former Chair), Joel J. Stoddard, M.D., William M. Womack, M.D., and other topic experts: Deborah Carter, M.D., Jennifer I. Downey, M.D., James Farrow, M.D., Richard C. Friedman, M.D., Heino F. L. Meyer-Bahlburg, Dr. rer. nat., and Cynthia Telingator, M.D.

This Practice Parameter was reviewed at the Member Forum at the AACAP Annual Meeting in October 2010.

From September 2011 to February 2012, this Parameter was reviewed by a Consensus Group convened by the CQI. Consensus Group members and their constituent groups were as follows: Heather J.Walter, M.D., M.P.H., chair, Christopher Bellonci, M.D., shepherd, and Helene Keable, M.D. and Saundra Stock, M.D., members (CQI); Gerald Dabbs, M.D. and Cynthia Telingator, M.D. (Topic Experts); Theodore Petti, M.D. and Kathleen Trello-Rishel, M.D. (AACAP Assembly of Regional Organizations); and Kathleen Kelley, M.D. and Melvin Oatis, M.D. (AACAP Council).

This Practice Parameter was approved by the AACAP Council on May 31, 2012.

This Practice Parameter is available on the Internet (www.aacap.org).

Disclosure: Oscar Bukstein, M.D., M.P.H., co-chair, has received support from the National Institute of Mental Health (NIMH), the National Institute of Child Health and Human Development (NICHD), and Shire. He has received royalties from Routledge Press. Stewart L. Adelson, M.D., and Heather J. Walter, M.D., M.P.H., co-chair, report no biomedical financial interests or potential conflicts of interest. Disclosures of potential conflicts of interest for all other individuals named above are provided on the AACAP website on the Practice Parameters page.

Correspondence to the AACAP Communications Department, 3615 Wisconsin Avenue, NW, Washington, DC 20016.

Copyright © 2012 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc.