Are Girls Underdiagnosed for Dyslexia?

Because of differences in how they read and process language, girls with dyslexia might be overlooked

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 discrepency 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.”

Turning Point 

Flower Mound resident Ashleigh Lay, 45, had no idea why her bright, outgoing daughter had so many hours of homework to complete every night. In fifth grade, Maisyn was diagnosed with ADHD and prescribed medication. It greatly improved her ability to focus on her lessons during the day, but after eight hours (in other words, when it was time to tackle her homework) the medication would start to wear off. Maisyn’s homework started piling up—three to four hours of homework every night. “Her little brain just stopped after two hours of homework,” Lay says. “She just hit a wall. She couldn’t do it anymore.”

One evening when Maisyn was in seventh grade, Lay sat down with her daughter and asked her to read aloud. She was completely caught off guard by what she heard. “It was very choppy. It didn’t flow as I imagined a seventh-grader should read,” the mom remembers. “I beat myself up over it. I had been so hard on her. I didn’t know she needed assistance, but I also knew she was very capable.”

It took several months, but Maisyn was eventually determined to have dyslexia and qualified for appropriate accommodations through a 504 plan; eventually she qualified for an IEP, or individualized education program, so that she could receive special education services.

For 14-year-old Maisyn, finding out she was dyslexic—“just figuring out what was going on”—was “a good moment,” she says.

While learning differences in some students can be identified as early as kindergarten, especially (but not always) when the child has accompanying behavioral issues, Roy (the academic language therapist) notes that for most students, “third grade and seventh are the years that everything comes to light” as the curriculum gets more difficult.

Still, she says, it’s never too late to be seek remediation for a learning difference. “When students get the right remediation strategies, it’s like a light bulb going off, and they’ll say, ‘How did I not know this earlier!?’”

Because girls tend to be rule-followers, “remediating girls can be easier,” Roy adds. “They can apply these rules to reading and writing.”

Thinking Forward 

Once Maisyn was identified as dyslexic, Lay threw herself into researching everything she could find. One of the books she highly recommends to other parents is The Dyslexic Advantage. In it, authors Brock and Fernette Eide explain how dyslexia should be thought of as a distinct learning style that can give students an advantage in surprising and unexpected ways. Because of their unique way of looking at the world, children with dyslexia often excel at problem solving and spatial reasoning, and they are known to make interesting connections that other people might miss.

“When there’s an impairment of the language processing parts of the brain,” Roy says, “you might see a student shift their strengths somewhere else.” In many of her female students with dyslexia, Roy sees an abundance of creativity. “In my experience, the girls I see are significantly more creative, very artistic, very expressive—they excel at theater and art and dance,” she says.

Roy challenges her students to use those strengths to their advantage in the classroom. For example, one of her students was regularly failing spelling tests. So Roy had her draw a picture of each word and put that word into the picture. The student passed her next spelling test with flying colors.

Given their original approach to problem-solving, it should therefore come as no surprise that so many girls with dyslexia have leveraged their creativity to become smart, capable women who never back down from a challenge. Among their ranks you’ll find pace-setters, dreamers and industry leaders—the likes of Erin Brockovich, Octavia Spencer, Agatha Christie and famed polar adventurer Ann Bancroft, who in 1986 became the first woman to cross the ice to the North Pole.

According to the Yale Center for Dyslexia and Creativity, Ann Bancroft often tells parents, “My dyslexia and the challenges through school were the absolute perfect training for an expedition. Expedition people are all about one step in front of the other and not going very fast, just doing the hard work. What better way to get the work ethic than by having a learning difference?”

Hard work, creativity and self-motivation—the exact qualities every parent hopes to nurture in their child, no matter their age or gender. These are things that build resilience and prepare that child for a life of adventure.

If a younger girl is struggling with dyslexia, Maisyn says she’d tell her not to worry about it. “It affects everyday life, but not as much as you think it does,” she says. “With the help of accomodations, with the help from teachers, dyslexia can actually lift you up.”

Standing Out 

Understanding dyslexia has brought Maisyn and her mother even closer together. “It brought a new perspective to all of us,” says Lay. “It changed my life.”

In fact, all the mothers interviewed for this story have very close relationships with their daughters—due in part to the dyslexia diagnosis and what it forced to the surface.

For McKinney mom Sara O’Malley, her daughter Ashley’s dyslexia diagnosis brought into focus her own struggles with reading growing up. She had never been evaluated for dyslexia. But understanding dyslexia helped her understand herself just a little bit better—she too is very likely dyslexic. As it happened, her daughter was in the same remediation class as Chontae Feldman’s daughter Julia, and the two mothers became good friends.

And Feldman? Feldman is definitely not the blending-in type anymore. “My kids got me to learn more about dyslexia, even about my own,” she says. Her younger daughter, Carly, was also identified with dyslexia and other learning difficulties at age 9. Securing the accommodations that both girls needed to succeed at school proved to be challenging because of their average academic performance; there was even a moment of “smart-shaming” when the girls’ evaluation scores were considered too high to meet the district’s criteria for dyslexia. If she hadn’t gone through the process with Julia, Feldman says she might not have known how to push back.

In 2016, Feldman founded the popular Facebook page The Dyslexia Initiative: North Texas to help parents connect with each other and better understand the evaluation process. Last year, the organization hosted Discovering Dyslexia Through Art. Thirty-one children submitted original work for the exhibit; 23 of these artists were girls.

When Feldman’s employer announced it was sponsoring a diversity seminar, she decided to speak about dyslexia in the workplace. A brilliant and well-respected colleague privately messaged her. He told her that he was dyslexic, though nobody at their company knew, and urged her not to speak about dyslexia—based on his experience, he warned, it would be “career suicide.” She spoke anyway. (And it wasn’t.)

Two years ago, Feldman helped Julia create a project board about dyslexia to display in her school’s library for Dyslexia Awareness Month. Last year, another school got Feldman’s name and asked if she’d present on dyslexia for their disability fair. Feldman checked Julia out of school that day, and they went to the fair and spoke about dyslexia—together.