Core aspects of healthy child and adolescent development

In order to fully understand the profound harm experienced by children and adolescents subjected to CT, it is important first to explain some of the key developmental tasks related to sexual orientation and gender identity for all children. As will be further explained, CT undermines and counteracts the building blocks of a healthy childhood, adolescence, and adulthood.

The development of gender identity and sexual orientation are universal processes that take place early in childhood. They are part of each phase of a child’s cognitive, emotional and physical development. As a child matures, their cognitive ability and identity becomes more sophisticated. Family and cultural messages about difference and identity are more evident and understood and peer acceptance becomes more important.

Sexual orientation development is heightened in adolescence during puberty when youth develop deeper friendships and intimate relationships, focus on a future occupation, achieve greater emotional independence from their parents, and develop their own values.

Gender identity diversity and nonconforming behaviors start in early childhood, but with puberty, gender diverse adolescents are faced with an increased awareness of the discordance between their gender identity and physical body, potentially leading to heightened distress.

A fundamental basis of human development is the establishment of trusting human relationships early in life; children depend on families and communities for love, protection, and safety. Most children thrive when provided with love and support and know that others are committed to their growth to adulthood. It is important that young people have spaces in which they feel safe enough to explore core aspects of their identities. However, children are vulnerable to the disapproval and rejection of others. They learn from an early age whether their feelings match cultural expectations.

Sexual orientation and gender diversity continue to be stigmatized—devalued, denigrated and seen as less-than. Positive images of gender and sexual orientation diversity are lacking, and children and adolescents are often not exposed to positive lesbian, gay, bisexual, transgender (LGBT) role models. It is a double burden to grow up without positive role models and to protect one’s self-esteem from these negative stereotypes.

At each stage of developmental change, lesbian, gay, bisexual, transgender and questioning (LGBTQ) children often feel isolated and alone. Many LGBTQ children and adolescents must navigate the awareness and acceptance of their socially marginalized sexual orientation or gender identity without adequate information and support.

Adolescents face particular challenges. The teen years are a crucial time to explore, accept, and integrate sexual orientation and a mature gender identity into their developing lives. Key questions arise: How will I fit in? Will people reject me? Will I find a partner or create a family? Do I have a future being my true self? For those who experience their LGBT orientation and identity as “less-than," bad or inadequate, these questions are even harder. Such individuals will likely develop chronic feelings of shame and/or guilt. Many will avoid or postpone key tasks of identity acceptance, integration, and family formation because the stress is so overwhelming. This is harmful as delays in adult milestones have long-term emotional, educational and employment effects resulting in a greater chance of emotional distress and lower levels of educational and vocational achievement.

Along with the isolation caused by disapproval and the shame imposed by the larger culture, many children and adolescents are exposed to actual discrimination and aggression, from disrespect to bullying to even violence. Discrimination, cultural stigma, and exposure to or threat of violence create “minority stress,” a phenomenon also experienced by other stigmatized minorities.

Minority stress is linked to poor mental and physical health, particularly psychological distress. In fact, recent research on adolescents indicates that LGBT adolescents are at a greater risk of mental distress than their heterosexual peers because of the stress of anti-LGBT prejudice and discrimination.

Importantly, these increased risks of emotional distress are not a function of the sexual orientation or gender identity of LGBT children. Rather, these negative mental health outcomes stem from the harmful impact of prejudice, discrimination, rejection, harassment, and violence directed at those who are LGBTQ or are perceived to be LGBTQ. Children and adolescents experience these negative influences more profoundly than adults due to their increased emotional vulnerability and less developed capacity to cope effectively with the harm of discrimination.

Conversion therapy worsens minority stress by reinforcing negative societal stereotypes and conveying inaccurate information; this increases depression, self-hatred, blame, and hopelessness. Rather than debunking these stereotypes, and reducing the shame and stigma faced by these children and adolescents, conversion therapy interventions undermine their self-esteem, identity acceptance and integration by telling them that their deeply-felt identity and ability to love are “wrong” and “bad.”

Similarly, for young children who are struggling with gender issues, being pressured to change their gender expression or to conform to gender stereotypes can worsen their distress because it undermines their sense of self and creates deep-seated shame.

Conversion therapy poses an additional significant risk of harm because it does not provide children and adolescents with the benefits of sound psychotherapy to bolster their mental health. In any psychotherapeutic intervention, children and youth need support, reassurance of their self-worth, and a sense that a professional is committed to helping them with openness and understanding of their conflicts and fears.

Conversion therapy does just the opposite. Individuals subjected to this negative therapeutic experience in CT will be less likely to seek out psychotherapy in the future, an impediment that creates an additional risk to their mental health. Conversion therapy also interferes with a healthy parent-child relationship. According to a decade of family research, Conversion therapy gives parents false and harmful information. It encourages parents to interact with their children in damaging ways, which can lead to children feeling even more rejected by their family and even more alone. Conversion therapy fails at the therapeutic goal of assisting families in providing a supportive environment for children and reducing behaviors that can harm children. To the contrary, Conversion therapy teaches parents to invalidate a child’s deeply felt feelings about who they are which leads to dangerous behaviors, such as suicidal ideation and suicide attempts.

Roland Behm