Connection Between Turner Syndrome and Math Skills

"Let us choose for ourselves our path in life, and let us try to strew that path with flowers." - Emilie du Chatelet, mathematician, physicist, and author

Clinical research indicates that there are differences in learning abilities, including challenges in math and spatial skills, among individuals with TS. However, with early intervention, training, and accommodations, these challenges can be overcome, and success in math can be possible. Below is a summary of two research papers: “Variation in early number skills and mathematics achievement: Implications from cognitive profiles of children with or without Turner syndrome,” by Sarah L. Lukowski, et al; and “On the relationship between mathematics and visuospatial processing in Turner syndrome,” by Joseph M. Baker et al. These papers attempt to pinpoint the specific learning differences that can bring obstacles for individuals with TS while trying to learn math.

Terms To Know

  • visuospatial processing: the ability to perceive, analyze, manipulate, synthesize, and transform visual patterns and images.
  • cognitive phenotype: a “phenotype” is an observable trait caused by a person’s genotype interacting with the environment. A cognitive phenotype is observable traits related to intellectual activity, like thinking, reasoning, remembering, and learning.
  • neurocognitive: relating to neural (nerve) processes and the brain structures involved in cognitive abilities.
  • self-regulation skills
  • executive function
  • ability
  • achievement
  • (Put these in alphabetical order)

According to the research, the challenges TS patients experience with math stem from weakness in their visuospatial processing, among other factors. The Lukowski and Baker studies describe a more specific area or domain within visuospatial processing that is the root cause of the problem. These findings can help individuals with TS and their parents request specific kinds of support from their teachers. The findings can also inspire parents to incorporate fun elements of math and numeracy (the ability to understand and work with numbers) into daily activities with their children

Study #1

“Variation in early number skills and mathematics achievement: Implications from cognitive profiles of children with or without Turner syndrome” was conducted from 2016 to 2020.

Purpose & Funding

The purpose of this study was to assess how the cognitive phenotype of young children with TS affects their math skills. It was funded through MM National Science Foundation (US) Grant 1644748.


This primary researchers for this study, from the University of Minnesota’s Institute of Child Development in Minneapolis, were:

  • Sarah L. Lukowski, PhD
  • Michele M. Mazzocco, PhD
  • Rachel E. Olson, doctoral student
  • Emily R. Padrutt, doctoral student

Other researchers included:

  • Kyriakie Sarafoglou, MD, of the University of Minnesota Medical School’s Pediatrics Department and its Pharmacy College’s Experimental and Clinical Pharmacology Department;
  • Judith L. Ross, MD, from Thomas Jefferson University’s Nemours DuPont Hospital, Pediatrics Department, in Philadelphia; and
  • Jennifer R. Law, MD, of the University of North Carolina at Chapel Hill’s Pediatrics Department, Pediatric Endocrinology Division.


Forty-four girls with TS from 22 states enrolled in the study after a recruitment effort by coordinators of clinics and TS support groups. Two comparison groups of 44 girls each without TS were also enrolled in the study. The pairs of girls were matched based on their verbal skills and their non-symbolic magnitude comparison skills (the ability to represent and compare quantities) and their age and grade in school. The researchers strove to have as close a match as possible in all regards.

All of the girls participating were between four and eight years old, an age range that was unique for research in this subject. Identification of and early intervention with math difficulties for children of such a young age could be important.


The participants in the study were given the following two standardized tests of mathematical ability and achievement:

  • Test of Early Mathematical Ability 
  • Woodcock-Johnson Achievement Test (applied problems subtest)

They were also given the following two assessments of numerical processing:

  • Psychological Assessment of Numerical Ability
  • Numerical Ambiguity Interpretation Task 

Lastly, the girls were also given two widely used tests of receptive and expressive verbal knowledge and two composite tests to measure self-regulation skills and executive function:

  • Kaufman Brief Intelligence Test
  • Boston Naming Test

The test results of the girls with TS were compared with carefully matched peers without TS. 


This study’s results were limited by the small sample size (44 girls with TS). Also, there were fewer appropriate tests for the young age group being studied.


The study revealed that girls with TS had lower scores on the test for mathematical ability than the general population and significantly lower scores than their matched peers. However, regarding mathematical achievement, the girls with TS scored similarly to their matched peers.

This difference between mathematical ability and achievement is interesting. According to this study, girls with TS may use their verbal skills to bolster their ability to do well in math, supporting other studies that indicate they have a unique profile regarding numerical processing skills.

Key Takeaways

As mentioned above, this study supports previous research about the possible obstacles that individuals with TS may face while learning math. However, it offers encouragement, suggesting that their verbal abilities may help them to achieve in math.

This study also shows the importance of promoting math skills at home even before children with TS start school. Integrating math into play and daily routines can bolster later success in math

Work remains to determine whether and how verbal and self-regulation skills could be utilized to improve math outcomes. This work would benefit the TS community and the larger population.

Study #2

“On the relationship between mathematics and visuospatial processing in Turner syndrome” is the next study that will be discussed. This study was conducted from 2009 to 2014.

Purpose & Funding

This project’s aims included:

  • to investigate the relationship between visuospatial processing and math performance in adolescent girls with TS versus their age-matched peers;
  • to identify the visuospatial domains that are most closely related to math performance; and
  • to shed light on the neurocognitive causes for math deficits in individuals with TS.
This research was supported in part by National Institute of Health grants HD092883 (JMB, PI), MH099630, and T32MH019908 (ALR, PI), and a grant from the Stanford Maternal and Child Health Institute (JMB, PI).


The following researchers from Stanford University’s School of Medicine’s Psychiatry & Behavioral Sciences Department, Brain Sciences Division, Interdisciplinary Brain Research Center.

  • Joseph M. Baker, PhD
  • Booil Jo, PhD
  • Tamar Green, MD
  • Allan Reiss, MD

Also conducting the study was Megan Klabunde, PhD, from the University of Essex’s Psychology Department, Colchester, UK.


There were 112 participants in this study, 54 girls with TS and 58 without. All participants with TS had classic monosomy (they were lacking one chromosome from a pair), rather than a partial chromosomal loss.

The participant age range was 6 to 17 years old. Participants were matched by age.

Due to participants leaving the study, the study’s final year contained relatively few participants (18 total, 6 with TS). The girls had to travel to Stanford University once a year for four years, so many families found this inconvenient. Many other factors also led to participants withdrawing.


For four yearly visits over 4 years, the participants were given three major tests to measure a broad range of visuospatial areas:

  • The Wechsler Intelligence Scale for Children 4th Edition
  • The Wide Range Assessment of Visual Motor Abilities
  • The Developmental Neuropsychological Assessment

These tests included standardized tests of neuropsychological (the relationship between the brain’s behavioral, emotional, and learning abilities), cognitive and academic achievement of these participants.


Like the first study, the small sample size limited this study’s outreach as well. Originally, they started with 112 participants. However, by the study’s end, there were only 18 girls in the study.


The study found that girls with TS struggled to perform well in math more than their age-matched peers. Throughout the entire study, this struggle was consistent. Three visuospatial skill areas appear to be specifically affected by TS. They could create obstacles for them while learning math:

  • visual tracking: the ability to control eye movements
  • visual-motor coordination: more commonly referred to as “hand-eye coordination” 
  • figure-ground processing: the ability to differentiate an object from its background

The researchers believe that having weaker figure-ground perceptual abilities may negatively affect the girls’  abilities to identify and interpret a math equation’s various components. That is, girls with TS may have difficulty recognizing an equation’s individual elements, leading to them having more obstacles when trying to solve math problems. Thus, this causes them to not reach as much of their full potential with math as their peers.


The three visuospatial areas mentioned above are all areas that girls with TS can work on improving with targeted exercises at home and school. By being aware of the specific obstacles that girls with TS may experience, parents and teachers can empower them to persevere with math rather than give up on improving their math skills.

The Big Picture: how do these two studies compare?

First Study: “Variation in early number skills and mathematics achievement: Implications from cognitive profiles of children with or without Turner syndrome”

Second Study: “On the relationship between mathematics and visuospatial processing in Turner syndrome”


  • The first and second studies were conducted by well-qualified teams of researchers from major universities, and their results were published in peer-reviewed journals.
  • Additionally, both studies involved a relatively small number of girls with TS (Study #1 = 44, Study #2 = 54).
  • Moreover, both studies carefully matched the girls with TS to peers without TS of the same age; Study #1 had additional criteria for making the matches.
  • Furthermore, both studies used widely accepted tests to measure the math abilities of the participants; the tests were given by trained administrators in controlled settings.


  • The first study tested girls from 4-8 years old while Study #2 was testing slightly older children (6-17 years old).
  • This study also matched girls with TS with girls without TS who had similar verbal abilities in order to rule this factor out as a potential advantage.
  • Study #2 was a longitudinal study which tracked the participant over four years.

The Findings

The studies confirmed previous research indicating that girls with TS tend to have deficits in mathematics ability and visuospatial reasoning as compared to their age-matched peers.

Focus on Cognitive Abilities

Although it was not the purpose of the studies to find ways to improve the mathematics abilities of girls with TS, the findings suggest that beginning to work with children with TS at a very early age to improve visuospatial processing in collaboration with the enhancement of other cognitive abilities such as executive functioning, attention, and working memory may prove particularly beneficial. Training in these areas can be done via a computer- or tablet-based application that embeds each element in a game-like application. Parents and caregivers can also integrate math into play and daily routines. See the list below for some suggestions and additional resources.

Fun Ways to Improve Visuospatial Processing

  • Teach your child to learn dance or enroll them in a dance class. 
  • Furthermore, enroll your child in martial arts classes.
  • Moreover, you can also enjoy drawing and painting scenes with depth (one thing in front of the other)together. 
  • Additionally, make a route on a map with your child and then follow the route you chose. This could be within a building or outside. 
  • In addition, play computer games designed to teach visuospatial skills with your child.  Another option is to play games that have a big visuospatial component, such as Tetris, with them. 
  • Work together on finishing a 3-D puzzle. 
  • Make simple structures with building blocks and then ask the child to match them. 
  • Complete tangrams or other mosaic-like, open-ended puzzles with your child. 
  • Learn origami together. 
  • Practice a musical instrument.




TSF Resources

First Study: “Variation in early number skills and mathematics achievement: Implications from cognitive profiles of children with or without Turner Syndrome

Second Study: “On the relationship between mathematics and visuospatial processing in Turner Syndrome


Acknowledgements: This article was written by Catherine Martin, a TSF Blog Writer and edited by Prabhat Sharma, a TSF Blog Editor.  ©Turner Syndrome Foundation 2021.

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