Children who don’t conform to expected gender stereotypes, even before age 11, are at significantly greater risk for physical, sexual and psychological abuse during childhood and symptoms of post-traumatic stress disorder (PTSD) in young adulthood, report researchers at Children’s Hospital Boston. Their findings, based on a large, national, population-based sample, appear in the March 2012 Pediatrics (published online February 20).

The NIH-funded study, led by S. Bryn Austin, ScD, of Children’s Hospital Boston and the Harvard School of Public Health, used data gathered by questionnaire from almost 9,000 young adults (average age, 23) who enrolled in the longitudinal Growing Up Today Study in 1996.

In 2007, respondents were asked to recall their childhood experiences, including favorite toys and games, roles they took in pretend play, media characters they imitated or admired, and feelings of femininity or masculinity. They were also asked about physical, sexual or emotional abuse they experienced at the hands of parents, other adults or older children, and were screened for PTSD.

Childhood gender nonconformity was reported across all sexual orientations; fully 85 percent of youth who were gender nonconforming when they were young were heterosexual in adulthood.

Women who ranked in the top 10 percent for gender nonconformity before age 11 reported a higher prevalence of all forms of childhood abuse both before age 11 and between 11 and 17, as compared with women falling below the median.  Men in the top 10 percent for nonconformity in childhood had a higher prevalence of sexual and physical abuse before age 11 and psychological abuse between 11 and 17. Both groups had a higher prevalence of PTSD as adults.

“Because we used a broad definition, our ‘high nonconformity’ group was actually 10 percent of the sample,” notes Austin, the study’s senior investigator. “That’s 1 in 10 children — a large group of kids who are at higher risk for abuse, present in every classroom and neighborhood.”

Austin and colleagues urge pediatricians and school health providers to consider abuse screening for these children and advise parents that they may need to do more to protect and support them. “People need to be aware that discrimination and abuse targeting gender-nonconforming children are widespread, affect kids at a very young age and have lasting impacts on health,” Austin says. “These vulnerable children need our care and protection.”

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