HIV can pass from a mother with HIV to her child during pregnancy, childbirth, or breastfeeding, called perinatal transmission of HIV. In the United States, this is the most common way children under 13 years of age get HIV. Perinatal transmission of HIV is also called mother-to-child transmission of HIV.
Treatment with HIV medicines (called antiretroviral therapy or ART) is recommended for everyone with HIV, including children and adolescents. HIV medicines help people with HIV live longer, healthier lives and reduce the risk of HIV transmission.
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Issues that make it difficult to take HIV medicines every day and exactly as prescribed (called medication adherence) can affect HIV treatment in children and adolescents. Effective HIV treatment depends on good medication adherence.
The HIVinfo fact sheet, Following an HIV Treatment Regimen: Steps to Take Before and After Starting HIV Medicines, includes tips on adherence. Some of the tips may be useful to children and adolescents with HIV and their parents or caregivers.
Likewise, many transgender elders did not even know as children that other transgender people existed, and certainly received little acknowledgment of their transgender feelings. By contrast, many transgender children and adolescents today have role models (either in the media or in real life), and their gender-variant expression is often sufficient for parents to obtain more information and access existing networks of families with gender-variant children. Moreover, transgender youth today have access to early medical intervention to alleviate any gender dysphoria (defined as discomfort with one's sex assigned at birth) they might experience.
In this report, childhood and adolescence encompasses the life course through the emergence of adulthood, generally understood by the committee to occur in the early 20s. During this phase of life, a person, regardless 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.
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.
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 ongoing process suggests that for some adolescents, self-identification of sexual orientation and the sex of sexual partners may change over time and may not necessarily be congruent (Saewyc et al., 2004).
DSM-IV includes diagnoses of gender identity disorder for children as well as for adolescents (and adults) (American Psychiatric Association, 2000b). The criteria for diagnosis of childhood gender identity disorder are listed in Box 4-1. This diagnosis has been controversial, particularly when applied to children. One objection raised is that including this phenomenon as a psychiatric diagnosis identifies gender-variant identity and expression as pathological, even though many gender-variant children do not report emotional distress; rather, distress may be related to the reaction of the social environment to the child's gender variance. Also, as noted earlier in this chapter, most children with gender-variant expression do not develop an adolescent or adult transgender identity (Wallien and Cohen-Kettenis, 2008), and many adults with a transgender identity do not report symptoms of childhood gender identity disorder (Lawrence, 2010). More specifically, this diagnosis has been criticized for conflating gender-variant expression with gender-variant identity. At least four of the five criteria are required to qualify for the diagnosis, and only one of these explicitly refers to cross-gender identification, allowing children with gender-variant expression but without a variant gender identity to qualify for the diagnosis (see also Bockting and Ehrbar, 2006).
The approach to treatment of gender identity disorder among children includes early therapeutic interventions with the child, and perhaps with the family, school, and/or community, to broaden the child's gender role interests and behavior and/or provide a safe environment to allow gender identity to develop while preventing rejection, ridicule, and abuse from peers (Benestad, 2009; Brill and Pepper, 2008; Menvielle and Tuerk, 2002; Meyer-Bahlburg, 2002; Rosenberg, 2002; Zucker, 2008). The approach to treatment of gender identity disorder among adolescents includes therapeutic interventions to assist the adolescent and his or her family to explore and understand gender variance and cope with the related stress and social adjustment, which may include a gender role transition (Di Ceglie, 2009; Meyer et al., 2001). In addition, early medical intervention is available for carefully selected youth who have persistent gender dysphoria that has increased with the initial stages of puberty and who have support from their parents for such intervention (Cohen-Kettenis et al., 2008; Hembree et al., 2009; Meyer et al., 2001). The intervention consists of administering puberty-delaying hormones (such as gonadotropin-releasing hormone [GnRH] analogs) as early as Tanner Stage II of puberty (a development stage marked by certain physical milestones as opposed to age) and cross-sex hormones as early as age 16. The puberty-delaying hormones allow for more time to monitor the development of the youth's gender identity while reducing the dysphoria associated with the pubertal development of incongruent sex characteristics, an approach that has been shown to be beneficial (Cohen-Kettenis and van Goozen, 1997; de Vries et al., 2010; Delemarre-van de Waal and Cohen-Kettenis, 2006; Smith et al., 2001, 2005).
As noted earlier, for most people, including LGBT youth, childhood and adolescence are times of good physical health. It is not surprising, then, that few studies have examined the physical health of children and adolescents who are LGBT.
Although some literature addresses the process of gender identity development among transgender youth, little of this literature is supported by empirical evidence or longitudinal data. The lack of available cohort data on the relationship between developmental issues and general health status represents a distinct gap in the literature. In addition, although some small, largely European studies in children and adolescents have examined the effects and consequences of hormone administration and/or blocking of puberty with GnRH analogs, empirical data on how these medical interventions affect overall physical health and well-being remain extremely limited. While some preliminary animal studies have suggested that GnRH analog therapy can affect sex-specific brain development, no comparable research has been done in humans.
School-based harassment, bullying, and peer victimization are the most common topics in the literature on LGB youth. This emphasis may be due to the role of schools in child and adolescent socialization and development and the increasing focus over the past 20 years on schools as a primary site of conflict, victimization, and activism for young people who are known or perceived to be LGBT.
Results of the above studies provide evidence to inform family interventions aimed at reducing risk and promoting well-being among LGBT children and adolescents, thereby reducing health disparities and affecting outcomes across the life course.
Your grade-schooler is also exposed to lots of opinions, ideas, and misconceptions that come from other children. He's likely to believe the "facts" he hears from his friends, no matter how outrageous they are.
Be calm and relaxed. It's not easy to keep from cringing when your child asks you what a "boner" is. Just do your best to speak calmly, so you can respect your child's natural curiosity without being judgmental.
Each time you successfully tackle a sensitive topic, the anxiety level (for both of you) goes down. If you avoid these talks, your child won't learn your values about sex, but will develop her own from what she gleans from friends and the media.
Many adults feel awkward talking about sex with their child because they don't have much practice doing it and because they're afraid of telling too much once a discussion gets going. The best strategy is to try to answer questions calmly and succinctly, however unusual or embarrassing it seems. If talking about sex is hard for you, try rehearsing your answers in advance, either alone or with your spouse or partner. 2ff7e9595c
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