Dr. Reitman: I have been talking about this topic for about 20 years now, since I was a medical student. In that time, there has been a big shift in that a lot more kids are coming out about their sexuality and at earlier ages. Ten to 15 years ago, many kids were coming out in college, if not into their early to mid-20s. Now we are seeing a trend where a lot more of these kids are coming out in high school, both to themselves, as well as to their parents and friends. Sometimes it is even earlier when they are in middle school.
CCPR: Why is that?
Dr. Reitman: I think that a lot of this has to do with images in society and in the media. There are many more role models. However, there is variation between parts of the country that tend to be more conservative versus those that are more liberal about these issues. It still may be difficult for LGBT youth who are growing up in conservative rural areas to be able to find resources or get support either from friends, for their families or to meet other kids who are like them. That is in a contrast with large, metropolitan cities such as Washington, DC or New York where it may seem as if every school has a gay-straight alliance. While we think things have changed so much and are so much better, this may not be universally true for kids throughout the country. I see a lot of kids in my practice who are still dealing with the emotional baggage from their negative experiences coming out at a younger age in high school.
CCPR: Are there other things child psychiatrists need to be aware of?
Dr. Reitman: One of the big things is the language you use. Many LGBT youth really are not ready to “label” themselves as “L, G, B or T”, and if you assign them to a label they may bristle about it. They may not respond or may think ‘this person doesn’t understand me or the issues that I am dealing with’. When interviewing kids and trying to get their history, I recommend that the psychiatrist, therapist, or physician ask something more along the lines of: “When you think about people, who are you generally attracted to? Are you attracted to guys, girls, or both?” When broaching the conversation with kids who may be struggling with their sexual identity or gender identity, we need to look at the language we are using and make sure that we are not over-labeling to exclude anyone or making assumptions.
CCPR: Is it also true that many times they don’t know how to describe themselves?
Dr. Reitman: It’s interesting. Twenty years ago, the Minnesota Youth Risk Behavioral Survey demonstrated that only about 30% of kids who had predominant attractions and sexual activity with members of the same gender would actually label themselves as GLB. In 2009, that number was just about 50%. Therefore, there are a lot of kids who have these feelings but aren’t sure what they mean and/or are not ready to label themselves. I helped write a position paper for the Society for Adolescent Health and Medicine with recommendations on how to care for LGBT adolescents (Society for Adolescent Health and Medicine, J Adolesc Health 2013;52(4):506-510; http://bit.ly/1uiDyTT).
CCPR: What kind of advice can you give to a psychiatrist who is treating a younger kid who begins to realize he or she is not straight and needs help navigating that?
Dr. Reitman: First, it’s important to identify if a kid may not be conforming to what is considered a “norm” for the family (in terms of the way the kid is acting, or dressing, or his interests). If this is perceived as an “elephant in the room,” it is okay to bring it up with the parents and ask, “Are you concerned that your child may be gay or may end up being gay?” A psychiatrist shouldn’t be afraid that the parents will think that you are trying to put ideas into their head or their kid’s head. Many times the parents will be relieved that someone is at least validating their concerns. This may also be good time for the psychiatrist to start working through some of the parents’ issues with homosexuality, so if three years down the road, the child does decide to come out, the parents have some grounding to be able to deal with this. It is okay to talk about it with younger kids because kids are coming out younger and younger.