New Data on Sexual Orientation, Gender Identity in Preteens

Pauline Anderson

September 18, 2018

Perceptions about sexual orientation (SO) and gender identity (GI) differ significantly between preteens and their parents, new research suggests.

New data from the ongoing Adolescent Brain Cognitive Development (ABCD) study showed that fewer than one in 100 US youth aged 9 and 10 years reported minority SO, with 0.4% identifying as transgender.

A much greater percentage of parents believed their child is or might be lesbian, gay, bisexual, or transgender (LGBT).

Most of the child respondents reported that their minority SO and GI was not a source of stress. However, a large proportion reported they didn't understand the questions surrounding these issues, note investigators.

Jerel P. Calzo, PhD, MPH

The results suggest that minority SO and GI "does pop up" sometimes in late childhood and that conversations can potentially begin earlier than they do now, said lead author Jerel P. Calzo, PhD, MPH, associate professor, Division of Health Promotion & Behavioral Science, School of Public Health, San Diego State University, California.

"By asking about SO and GI, and creating a safe space for discussing issues related to these identities, clinicians can play a key role in supporting youth who are LGBT, think they may be LGBT, or may be targeted for bullying because others think they're LGBT," Calzo told Medscape Medical News.

The study was published online September 10 in JAMA Pediatrics.


The ongoing ABCD study is investigating a range of health indicators in a nationally representative sample of 4519 children aged 9 and 10 years. The study will follow these kids throughout adolescence.

The most recently released data include information on SO and GI. Previous research has looked at these issues in children, but typically at an older age, said Calzo.

Although there has been speculation that identity surrounding sexuality is clear to individuals at a younger age, "this has not been examined systematically and definitely not in a large data set," he said.

Children in the study reported whether they self-identify as gay or bisexual and whether they think of themselves as transgender. A response of "yes" or "maybe" triggered follow-up questions about identity-related stress.

A parental figure also reported on the child's identity and stress. Among parents, 6.7% indicated that their child might be gay and 1.2% indicated that their child might be transgender.

About 0.86% of children answered "yes" or "maybe" when asked if they were gay or bisexual. Calzo said this result "goes along with" prior studies indicating that older youth have known about their identity for some time.

Nearly a quarter of the children in the study (23.8%) indicated that they did not understand the SO question.

For GI, 0.4% of children said they are or might be transgender. Here, 40.2% indicated that they did not understand the question.

Not understanding the SO/GI questions may be because of the youth's age and developmental stage, note the investigators. Because identifying as a sexual minority typically occurs in midadolescence, more youth in the ABCD study cohort may identify as a sexual minority as they mature.

Although the researchers did not look at whether children at this age are exposed to adequate sex education at school and elsewhere, Calzo said this "could be a factor" in not understanding the terminology used in the questions and how this might apply to them.

"Lack of Stress"

Most children (over 95%) reported that their minority SO and/or GI was not a source of problems with family or school. About 7% of parents reported some issues related to their child's SO and 15.3% reported some problems associated with the child's GI.

The seeming lack of stress among kids who identified as gay, bisexual, or transgender was "somewhat surprising," said Calzo. He added that research suggests that sexual and gender minority youth, especially those who identify so young, might be at risk for bullying.

One interpretation is that the children in the survey who identified as a sexual minority "are experiencing a lot of support" around them, said Calzo.

He noted that asking youth if they are gay or bisexual is assessing only one dimension of SO — identity — and doesn't include other elements such as sexual attraction, sexual behavior (who you're having sex with), and gender expression (for example, pansexual).

The ongoing ABCD study will release additional data over time. Calzo said he and his colleagues "are really excited" that future waves will include information on additional markers of SO and GI.

Such information should provide "greater nuance" to help researchers understand these various categories and whether they change as children develop, he said.

Starting Point for Discussions

Asked by Medscape Medical News to comment on the study, Kimberly McManama O'Brien, PhD, research scientist at Boston Children's Hospital and the Education Development Center, and instructor in psychiatry at Harvard Medical School, Boston, Massachusetts, said that it's worth consulting with experts on how to word questions so that younger children can understand what is being asked.

In addition, O'Brien noted that the finding of less stress wasn't surprising because the crises that 9 and 10 year olds experience tend to be centered around "competence" or the ability to do something rather than identify, which is what teen crises might center around.

"Being able to do a task in school is not necessarily affected by whether or not someone feels they are LGBT," she said. "Identity crises in adolescence, however, are directly affected by this." 

It's also important to determine rates of minority SO in young children as they are at higher risk for many public health problems, such as substance use and suicide, O'Brien noted.

She agreed that the new findings emphasize that pre-adolescence is a critical starting point for discussions around SO and GI, which should be conducted "early and often."

"If they're exposed to these conversations at an early age, it may be easier for them to make sense of their changing identities as they grow into adolescents," she said.

Without such exposure, adolescents who suddenly start to question their identity "will have a harder time processing their thoughts and feelings, which could contribute to elevated stress," added O'Brien.

Calzo and O'Brien have reported no relevant financial relationships.

JAMA Pediatr. Published online September 10, 2018. Abstract

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