of his or her sexual orientation or gender identity, develops from a child who must be cared for to a self-reliant individual. The developmental changes that occur are complex, particularly with the onset of puberty. LGBT youth face the same challenges as their heterosexual peers, but also stigma that may contribute to the identified disparities in health status between sexual- and gender-minority youth and heterosexual youth.

The ability to address these disparities is hampered by our lack of knowledge about LGBT youth. One of the challenges of discussing the development of children and adolescents who are LGBT is that beliefs and biases have often precluded substantive research. Not long ago, for example, a prevailing notion was that one’s sexual identity and orientation did not emerge until late adolescence and that an attraction to people of the same sex was likely a passing phase (Money, 1990). Moreover, efforts to survey young people about their sexual orientation have been fraught with difficulties at both the institutional review board and community levels. These barriers have impeded important developmental research.

While the current state of knowledge regarding the health of LGBT youth is derived from limited research, it is worth noting that much of this research has focused on mental health; little research has been conducted on the physical health of LGBT youth because, like most other youth, they generally do not struggle with chronic diseases that impact their physical health. As mentioned in previous chapters, the disparities in both mental and physical health that are seen between LGBT and heterosexual and non-gender-variant youth are influenced largely by their experiences of stigma and discrimination during the development of their sexual orientation and gender identity and throughout the life course.

This chapter begins with a discussion of the development of sexual orientation and gender identity in LGBT youth. The chapter then reviews the research on mental health and then physical health in these youth. Risk and protective factors and health services are then addressed in turn. The chapter next examines contextual influences, such as demographic characteristics and the role of the family. The chapter concludes with a summary of key findings and research opportunities. Of note, the chapter emphasizes adolescence rather than childhood because of the limited research available on younger children’s and pre-adolescents’ awareness of, feelings about, and experiences with being LGBT.

DEVELOPMENT OF SEXUAL ORIENTATION AND GENDER IDENTITY

Adolescents are engaged in an ongoing process of sexual development (Rosario et al., 2008); many adolescents may be unsure of their sexual orientation, while others have been clear about it since childhood. This ongo-



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