Turner Syndrome Foundation
Students with Turner syndrome (TS) often have special needs in the classroom. Some experience nonverbal learning disorder (NVLD), social anxiety, or other challenges. School psychologists are in a unique position to nurture these students’ strengths and support them in their challenges. Below is a review of an article from the National Association of School Psychologists Communique newsletter, written by Michigan State University PhD candidate Mackenzie Norman.
Note: Every student with TS is different, with unique educational needs and challenges. Please consult with your personal medical providers and school staff regarding what is best for your child.
Turner Syndrome: What School Psychologists Should Know
The Turner Syndrome Foundation (TSF) is thrilled to present a review of an insightful article by Mackenzie Z. Norman, a doctoral candidate in school psychology at Michigan State University. In 2021, Mackenzie completed clinical training under the supervision of Dr. David Sandberg and was exposed to the Differences of Sex Development (DSD) clinic at University of Michigan, and specifically TS.
First, it is important to understand the clinical care guidelines for TS patients.
"My hope is that this piece encourages school psychologists to think about effective accommodations and interventions for girls with TS in the school system."
Clinical Practice Guidelines
The Clinical Practice Guidelines for the Care of Girls and Women with Turner Syndrome (Gravholt, et al., 2017) recommends that students with TS receive annual developmental and behavioral screenings and undergo neuropsychological assessments at key transitional stages. The guidelines also highlight the use of academic and occupational accommodations, when appropriate.
School psychologists can use these guidelines, particularly those that address academic accommodations and evidence-based interventions, to guide their work with students who have TS.
Guidelines for School Psychologists
Social Skills
Preliminary research has shown that existing social skills interventions, such as the Program for Education and Enrichment of Relationship Skills (PEERS), can be effective for students with TS. PEERS is an intervention used to support peer interactions and relationships by breaking down social skills into steps and teaching skills that transfer to real-world situations.
A study conducted by Wolstencroft, et al. (2019) found young women (17 to 20 years of age) participating in this intervention, as well as their parents, reported being highly motivated to improve social skills, as measured by the PEERS screening interview. Results of this study indicated that social performance significantly improved, as measured by parent reports. These gains were maintained at follow-up time intervals.
These results mean that existing social skills programs (e.g., Social Stories, Incredible Years) used by school psychologists could also help students with TS. It is important for school
psychologists to stay up-to-date on the latest research on social skills interventions for individuals with this condition.
Read TSF’s blog post on social skills and relationships in TS and our social skills page to learn more.
Accommodations
There are two important legal tools to assist students with TS in the educational system: Individualized Educational Plans (IEPs) and 504 plans.
An IEP is a personalized plan for students enrolled in special education programs in public schools. School personnel and the child’s parents collaborate to design the plan, which outlines the child’s specific challenges and the goals they are expected to achieve. These students then receive school-provided services and accommodations.
A 504 education plan helps a student with a mental or physical disability obtain the necessary accommodations for academic success and equal opportunities in school. The disability must significantly impede their ability to perform major life activities, such as learning, eating, or socializing in school.
See TSF’s website for more information on school accommodations.
Other Eligibility
Some students with TS may also qualify for services under a separate educational eligibility category. For example, some districts recognize nonverbal learning disability (NVLD) or semantic pragmatic disorder as a diagnosis. The educational classification of other health impaired (OHI), in which students exhibit some kind of health condition, either short-term or chronic, which adversely influences their educational performance. This designation may also fit well for students with TS who could benefit from additional support in the school setting.
School psychologists can also think about how they can best help children with sex chromosome aneuploidies (SCAs)–the presence of extra or absence of sex chromosomes). Children with SCAs have a higher risk of difficulties with moving, learning, speaking, paying attention, and feeling anxious (Bender et al., 1993; Boada et al., 2009; Wigby et al., 2016).
Thompson, et al. (2020) conducted a study to see how well parents of children with SCAs understood and got access to services that could help young children. They found that more than half of the parents said their child got help through early
intervention or early childhood special education. However, many parents said that it was hard to get services because the rules to qualify were confusing, and early childhood educators didn’t understand their child’s needs (Thompson et al., 2020).
This demonstrates that school psychologists need to learn more about these conditions, educate teachers about TS, and help parents get early-intervention services.
Specific Recommendations for School Psychologists
Norman offers the following specific recommendations for school psychologists in working with students with TS:
- Stay up-to-date with recent literature. Researchers such as Wolstencraft and others expand the research in the area of social skills interventions for students with TS.
- Advocate for regular screening and assessment.
- Social skills programs that school psychologists may already be implementing in their work may also be beneficial for students with TS.
- Consider accommodations/interventions, when appropriate. Help parents navigate this process.
- Consider eligibility in areas including nonverbal learning disorder (NVLD), specific learning disability (SLD), semantic pragmatic disorder, other health impairment (OHI), autism spectrum disorder (ASD), and attention-deficit/hyperactivity disorder (ADHD).
Conclusion
School psychologists who work with students with TS should advocate for regular screenings and neuropsychological assessments, classroom accommodations, and the implementation of evidence-based interventions.
Psychologists might consider how interventions aimed at the development of social skills for individuals with ASD might be adapted for students with TS. Finally, anxiety and depression in this population should be closely monitored and support provided, if needed.
TSF Can Help!
The Turner Syndrome Foundation’s (TSF’s) Learning page offers useful information for parents of students with TS (see additional links below). In reading the following recommendations, school psychologists will likely note the overlap with these suggestions and common recommendations provided to students with ADHD. This makes sense, considering the commonality in executive functioning challenges. Specifically, TSF provides the following recommendations for parents and students:
- Schedule study time.
- Create and prioritize a to-do list for studying, assignments, tests, and extracurricular activities.
- Organize each day and making sure materials are packed for school.
- Set up a workspace at home with good lighting and low noise.
- Encourage the student to ask for help from their teacher, school counselor, or school psychologist.
- Enlist a “study buddy” or homework partner.
- Request a quiet space for testing.
- If permitted, have an additional piece of paper to write answers on directly, if the test requires the use of a Scantron (bubble) answer sheet.
- Hire a professional tutor.
Sources
Neuropsychological impairment in 42 adolescents with sex chromosome abnormalities. American Journal of Medical Genetics
The cognitive phenotype in Klinefelter syndrome: A review of the literature including genetic and hormonal factors. Developmental Disabilities Research Reviews
Clinical practice guidelines for the care of girls and women with Turner syndrome: Proceedings from the 2016 Cincinnati International Turner Syndrome Meeting. European Journal of Endocrinology
Current survey of early childhood intervention services in infants and young children with sex chromosome aneuploidies. American Journal of Medical Genetics
Expanding the phenotype of triple X syndrome: A comparison of prenatal versus postnatal diagnosis. American Journal of Medical Genetics
Protocol: New approaches to managing the social deficits of Turner Syndrome using the PEERS program. F1000Research
Written by Mackenzie Norman, PhD candidate at Michigan State University, and Valeriia Muradova, TSF volunteer blog writer.. Edited and designed by Susan Herman, TSF Blog Coordinator.
© Turner Syndrome Foundation, 2023
