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Are Girls Underdiagnosed for Dyslexia?

By Misty Jackson-Miller for DFW Child

Chontae Feldman wasn’t sure how to tell her oldest daughter the results of McKinney Independent School District’s dyslexia evaluation. Julia had always been one step ahead of her classmates, but as her “mirror writing” and tendency to reverse letters persisted in the years after kindergarten, her mom saw something she recognized. “[I] worried that I was seeing my own experiences in her,” Feldman recalls.

The 39-year-old was identified as dyslexic when she was in the third grade. She describes her younger self as the “typical dyslexic”—“a poor reader with low comprehension, bad spelling, left/right confusion and letter reversals.” She recalls being placed in a small remediation class to address her challenges with reading and writing. She was the only girl in the class of three students.

Feldman remembers a boy in her class who “appeared to have an attention issue” and was constantly acting out. He was the de facto “class clown” of their little group. Looking back, Feldman says this makes sense to her. “As a dyslexic,” she explains, “you either try to blend in, or act out as a class clown.”

For a long time, Feldman was one of the kids who blended in. She was a twice-exceptional student, which meant she qualified for both special education and the gifted and talented program at her school. She didn’t talk about her dyslexia with friends or fellow classmates. When her family moved into a new school district, not even the teachers knew. “Nobody knew I was dyslexic,” she says. “I didn’t want them to think I was a ‘dumb kid.’”

So when Feldman sat down with her 9-year-old daughter, all of these memories gave her pause. Feldman had no idea how Julia would take the news that she had been identified as dyslexic. What she hadn’t expected was for Julia to break into a huge smile. “Her face just lit up,” Feldman remembers, “and she says, ‘You mean, I’m smart just like you?’ She was so proud.”

In fact, many people with dyslexia are highly intelligent and keenly innovative. The traits that help them compensate for their learning difficulties in school are the same traits that later help them achieve both personal and professional success.

But in kids, this creative compensation can delay the evaluation process, leaving these kids—especially girls, evidence suggests—without the academic tools they need in order to thrive.

Left Behind

Broadly speaking, dyslexia is a neurobiological-based learning difference that affects how individuals process language. In fact, it is widely agreed that dyslexia is the most prevalent language-based learning difficulty; here in Texas, reporting school districts counted 194,214 students with dyslexia and related difficulties during the 2018–2019 school year for the annual PEIMS Standard Report.

There are other things we know about dyslexia. It tends to run in families, and it is often comorbid with attention deficit hyperactivity disorder (ADHD)—that is, a child who has been diagnosed with ADHD is much more likely to also have a learning disability. And though it’s hard to nail down a precise number, dyslexia is more commonly observed in boys than in girls.

The published history of dyslexia at the intersection of gender is long and fascinating and sometimes contentious. It often circles back to the question of “Why?” Why are girls less likely to be identified as dyslexic? Is it because they’re less likely to have dyslexia, or because they are underdiagnosed?

Endia Lindo, associate professor of special education at Texas Christian University, says that “part of the issue is what you define as ‘dyslexia.’” Most researchers share a common definition of dyslexia provided by the International Dyslexia Association; however, in the classroom, the working definition of dyslexia can vary from district to district. And since dyslexia surveys tend to be based on samples of individuals identified through their public school districts, the different definitions and protocols for evaluation make it hard to determine whether dyslexia in female students is underdiagnosed.

We have determined that there are brain differences between boys and girls that could help account for the discrepancy in diagnoses. For example, girls consistently perform better on reading tests. In a 2017 study published in the Journal of Child Psychology and Psychiatry, a team of researchers confirmed the sex difference in reading ability and suggested that girls’ faster processing speeds and better inhibitory controls might explain the gap in dyslexia diagnoses.

Furthermore, a 2013 study at Georgetown University Medical Center found that the brain anatomy of people with dyslexia varies by sex. Using MRI scans, the team found less gray matter (versus a control group) in the language processing centers in males, whereas in females, they found less gray matter in the motor and sensory processing centers.

It might be that these brain differences in girls serve to mitigate some of the more obvious symptoms of dyslexia.

“They’re encouraged to be more verbal, and girls tend to use both sides and larger sections of the brain for language processing,” Lindo says. “Girls also tend to behave more in class; they tend to comply with instructions. Girls are often socialized to want to please.”

Michelle Roy is a licensed certified academic language therapist and the founder of the I Heart Learning Academy in Dallas. She’s seen hundreds of students of all ages in her practice and agrees with Lindo that “girls, dyslexic or not, mature at a faster rate, and are generally better at reading and writing. But because of their nature to please, they may be more quiet about their struggles.”

So for a girl to be diagnosed with dyslexia in the early elementary years, “you have to have some obvious signs,” Lindo explains. “If you’re not acting up, if you’re trying your best, then you might not get noticed. So you’ll try to work around it.” Over time, that will catch up to them, and without accommodations or remediation strategies in place, those girls will have a harder time trying to keep up as the curriculum shifts from learning how to read to an emphasis on vocabulary, reading comprehension and verbal reasoning.

Until a girl is found to have dyslexia, they might feel “like everyone’s got the key to the puzzle but [them],” Lindo says. “They might tell themselves, ‘I’m not smart, I can’t do those things, but I’m quiet, I’m pretty,’ Lindo continues. “It can create a sense of learned helplessness.”