Statements of professional consensus regarding sexual orientation and gender identity and expression.

Therapy Supporting and Affirming LGBTQ Youth

Statements of Professional Consensus

The following are the statements of professional consensus regarding sexual orientation and gender identity and expression that were developed during the July 2015 APA consensus convening.

For more information, please refer to SAMHSA'southward study "Ending Conversion Therapy: Supporting and Affirming LGBTQ Youth."

Guiding Principles

Behavioral health professionals respect human being dignity and rights. The foundational ethical principle of "cocky-determination" requires that children and adolescents be supported in their right to explore, define and articulate their own identity. The principles of "justice" and "beneficence and nonmaleficence" require that all children and adolescents have access to behavioral health treatments that will promote their health and welfare. Children and adolescents accept the correct to participate in decisions that bear upon their treatment and hereafter. Behavioral health professionals respect human diversity and strive to contain multicultural awareness into their work.

These guiding principles are based upon the codes of ethics for the professional fields of psychology, psychiatry and social work (American Psychiatric Association, 2013b; American Psychological Association, 2010; National Association of Social Workers, 2008).

Professional person Consensus on Conversion Therapy with Minors

  • Same-gender1 sexual orientation (including identity, behavior and/or attraction) and variations in gender identity and gender expression are a office of the normal spectrum of human variety and do not establish a mental disorder.

  • There is limited research on conversion therapy efforts among children and adolescents; however, none of the existing enquiry supports the premise that mental or behavioral health interventions can modify gender identity or sexual orientation.

  • Interventions aimed at a fixed outcome, such equally gender conformity or heterosexual orientation, including those aimed at changing gender identity, gender expression, and sexual orientation, are coercive, tin can be harmful, and should not exist part of behavioral health treatments. Directing the child to be befitting to any gender expression or sexual orientation, or directing the parents to identify pressure for specific gender expressions, gender identities, and sexual orientations, are inappropriate and reinforce harmful gender and sexual orientation stereotypes.

oneTo be inclusive of transgender populations, the term "same-gender" (as opposed to "same-sexual activity") is used throughout this report in guild to clearly distinguish between the constructs of gender and assigned sexual activity and to recognize that individuals mostly characterization their sexual orientation with regard to their gender identity equally opposed to assigned sex at birth.

Professional person Consensus on Sexual Orientation in Youth

  • Aforementioned-gender sexual identity, behavior and attraction are not mental disorders. Same-gender sexual attractions are office of the normal spectrum of sexual orientation. Sexual orientation alter in children and adolescents should non be a goal of mental health and behavioral interventions.

  • Sexual minority children and adolescents are specially vulnerable populations with unique developmental tasks who lack protections from involuntary or coercive treatment, and whose parents and guardians need accurate information to make informed decisions nigh behavioral health treatment.

  • There is a lack of published research on efforts to change sexual orientation among children and adolescents; no existing research supports that mental health and behavioral interventions with children and adolescents modify sexual orientation. Given the research on the secondary outcomes of such efforts, the potential for take chances of harm suggests the need for other models of behavioral health handling.

  • Behavioral health professionals provide accurate data on sexual orientation, gender identity and expression; increase family and school support; and reduce rejection of sexual minority youth. Behavioral health practitioners identify sources of distress and work to reduce distress experienced by children and adolescents. Behavioral health professionals provide efforts to encourage identity exploration and integration, adaptive coping and family acceptance to improve psychological well-existence.

Professional Consensus on Gender Identity and Gender Expression in Youth

Consensus on the Overall Phenomena of Gender Identity and Gender Expression

  • Variations in gender identity and expression are normal aspects of human multifariousness and do not constitute a mental disorder. Binary definitions of gender may not reflect emerging gender identities.

  • Pre-pubertal children and peri-pubertal adolescents who present with diverse gender expressions or gender dysphoria may or may not develop a transgender identity in adolescence or adulthood. In pubertal and post-pubertal adolescents, diverse gender expressions and transgender identity commonly keep into adulthood.

Consensus on Efforts to Modify Gender Identity

  • There is a lack of published inquiry on efforts to change gender identity amongst children and adolescents; no existing inquiry supports that mental health and behavioral interventions with children and adolescents change gender identity.

  • It is clinically inappropriate for behavioral health professionals to have a prescriptive goal related to gender identity, gender expression or sexual orientation for the ultimate developmental issue of a child'south or adolescent'southward gender identity or gender expression.

  • Mental health and behavioral interventions aimed at achieving a fixed outcome, such as gender conformity, including those aimed at changing gender identity or gender expression, are coercive, tin be harmful, and should non be part of handling. Directing the kid or boyish to adapt to whatever particular gender expression or identity, or directing parents and guardians to place pressure on the child or adolescent to conform to specific gender expressions and/or identities, is inappropriate and reinforces harmful gender stereotypes.

Consensus on Appropriate Therapeutic Intervention for Youth with Gender-Related Concerns

  • Children and adolescents experiencing gender-related concerns are an especially vulnerable population with unique developmental tasks. Parents and guardians need authentic scientific information to make informed decisions near appropriate mental health and behavioral interventions, including whether or not to initiate a social gender transition or, in the case of peri-pubertal, pubertal and postal service-pubertal adolescents, medical intervention. Handling discussions should respect the child's and boyish's developing autonomy, recognizing that adolescents are withal transitioning into adult conclusion-making capacities.

  • Approaches that focus on developmentally-appropriate identity exploration, integration, the reduction of distress, adaptive coping and family acceptance to meliorate psychological well-being are recommended for children and adolescents of all ages experiencing gender-related concerns.

Pre-Pubertal Children

  • Gender expression and gender identity are interrelated and difficult to differentiate in pre-pubertal children, and are aspects of identity that develop throughout childhood. Therefore, a detailed psychological assessment should be offered to children and families to better understand the present status of a kid's gender identity and gender expression, every bit well every bit any associated distress.

Peri-Pubertal Adolescents

  • For peri-pubertal adolescents, the purpose of pubertal suppression is to provide fourth dimension to back up identity exploration, to alleviate or avert potential distress associated with physical maturation and secondary sex characteristics2, and to meliorate future salubrious adjustment. If pubertal suppression is beingness considered, information technology is strongly recommended that parents or guardians and medical providers obtain an assessment by a licensed behavioral wellness provider to understand the nowadays status of a peri-pubertal boyish's gender identity or gender expression and associated distress, as well as to provide developmentally-advisable information to the peri-pubertal adolescent, parents or guardians, and other health intendance professionals involved in the peri-pubertal adolescent's care. The purpose of the assessment is to advise and inform treatment decisions regarding pubertal suppression after sharing details of the potential risks, benefits and implications of pubertal suppression, including the effects of pubertal suppression on behavioral health disorders, cognitive and emotional development, and future concrete and sexual health.

Pubertal and Mail-Pubertal Adolescents

  • Controlling regarding ane's developing gender identity is a highly individualized procedure and takes many forms. For pubertal and post-pubertal adolescents, if concrete gender transition (such as hormone therapy or gender affirming surgeries) is being considered, it is strongly recommended that adolescents, parents and providers obtain an assessment by a licensed behavioral health provider to sympathise the present status of an adolescent's gender identity and gender expression and associated distress, as well as to provide developmentally-appropriate data to adolescents, parents or guardians, and other health intendance professionals involved in the pubertal or post-pubertal adolescent's care. If physical transition is indicated, the potential risks, benefits and implications of the transition-related procedures beingness considered — including the effects on behavioral health disorders, cognitive and emotional evolution, and potentially irreversible effects on concrete health, fertility and sexual health — are presented to the adolescent and parents or guardians.

    Withholding timely concrete gender transition interventions for pubertal and post-pubertal adolescents, when such interventions are clinically indicated, prolongs gender dysphoria and exacerbates emotional distress.

2 Secondary sex characteristics refer to sexually dimorphic phenotypic traits that develop due to increased sex hormones in puberty. Changes due to increment in androgens includes growth of the testicles and penis, increased tiptop, increased muscle mass, changes in body shape and weight distribution (eastward.g., broadening of the shoulders and chest), growth of facial and body hair, and enlargement of the larynx and deepening of the vox. Changes due to increase in estrogens includes chest development, changes in body shape and weight distribution (e.grand., widening of the hips and narrowing of the waist), growth of underarm and pubic hair, and the onset of catamenia (Lee 1980).

Consensus Process

In early April 2015, representatives from SAMHSA and APA agreed to collaborate to address the concerns of professional associations, policymakers and the public regarding efforts to change gender identity and sexual orientation in children and adolescents (also referred to as conversion therapy). Through the support of the Federal Agencies Project, APA hosted an expert consensus convening in Washington, D.C., July 7-viii, 2015. The experts reviewed the existing research, existing association reports and consensus statements, and considered clinical manufactures and expertise. During the coming together, panelist-led discussions considered the relevant research, professional guidelines and clinical knowledge-base for each of the topics. The panel developed consensus statements on sexual orientation change efforts too as gender identity change efforts in children and adolescents for each of the relevant developmental stages: pre-pubertal children, peri-pubertal adolescents, and pubertal and post-pubertal adolescents.

The final panel of 13 experts consisted of ten psychologists, two social workers and one psychiatrist. These individuals included researchers and practitioners in kid and boyish mental health with a strong groundwork in gender development, gender identity and sexual orientation in children and adolescents. The console also included experts with a background in family unit therapy, ideals and the psychology of faith. The expert panel included: Sheri Berenbaum, PhD; Shirley Cox, MSW; Celia B. Fisher, PhD; Laura Edwards-Leeper, PhD; Marco A. Hidalgo, PhD; David Huebner, PhD; Colton L. Keo-Meier, PhD; Scott Leibowitz, Doc; Robin Lin Miller, PhD; Caitlin Ryan, PhD, ACSW; Joshua Wolff, PhD; and Mark Yarhouse, PhD. APA staff involved in the project were: Clinton W. Anderson, PhD, and Judith Glassgold, PsyD.

Panelists agreed that unanimous consensus was a strong priority, simply that if unanimity could not exist reached, 80 percentage support would constitute consensus. The panelists also agreed that minority opinions should exist reflected in the record if any dissenting practiced wished to issue such an opinion. Unanimous consensus was reached in nearly all instances. No dissenting opinions were formally registered.

Observers from interested federal agencies, health and human services professional organizations, foundations and LGBT human rights organizations as well attended the coming together. These observers were offered an opportunity to submit written questions, which the panel addressed throughout the course of the meeting.

Related

Date created: September 2017

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