How Educators and Families Can Support Strengths and Challenges in Learning
Turner syndrome (TS) is a chromosomal condition affecting about 1 in 2,000 females, and while the physical characteristics may be obvious, it is lesser known that the condition also affects learning and cognition. Understanding the learning strengths and challenges associated with TS is essential so schools can provide the academic support they need to succeed.
In this blog, find out what academic strengths and challenges are typically seen in girls with TS and tools to support these students in the classroom.
Strengths and Challenges
Verbal Skills
Research shows that girls with Turner syndrome typically have verbal strengths such as verbal comprehension, expressive language, and verbal reasoning. Because of this, students with TS often excel in storytelling, reading, and oral communication.
Mathematics
Math-related difficulties are well documented among those with TS both in research and anecdotal firsthand accounts. A 2009 study found that up to 75% of women with TS experience challenges with mathematics. These challenges may appear as difficulty solving word problems, recalling math facts, or following visual diagrams. This is not due to lack of effort or intelligence, but rather the result of a specific cognitive profile that requires more research to fully understand.
Take Shannon’s story, for example. She says, “I did great in school, but always struggled with math. When I say struggled I am not just using this term loosely. It was always a huge difficulty for me, to the point I would cry while trying to do it. I always needed tutors and even with that I would barely get through it.” Because Shannon wasn’t diagnosed with TS until she was 29 years old, she never understood why math was so difficult for her. Then, after her diagnosis, she said “All my challenges as a child finally made sense.”
By understanding the impact of Turner syndrome on learning and cognition, students like Shannon can be better supported to navigate the challenges they face on their educational journey.
Processing Speed
Slow processing speed is another common cognitive feature in TS. This can impact their performance in timed tests and quizzes, ability to follow multistep instructions, and classroom discussion participation.
This may impact a students’ ability to shift between tasks quickly or recall facts. When educators understand this about their students with TS, they can take steps such as providing extra time during tests or step-by-step instructions for tasks to ensure students have the tools they need to succeed.
Executive Functioning and ADHD
Girls with TS often present challenges with executive functioning such as abstract reasoning, self-regulation, organization, and memory.
In addition, one study found that 24% of girls with TS had ADHD, compared to 1.3% of girls in the general population. This may present as behaviors like restlessness, blurting out, or difficulty sitting still, which can be misunderstood without awareness of the TS diagnosis.
Social Skills
Girls with TS often face challenges with social skills that can affect their peer relationships and overall performance in school. While many girls with TS are socially motivated, they may struggle with interpreting nonverbal cues such as facial expressions, tone of voice, and body language. This can make it difficult to follow group dynamics or participate in collaborative work.
Tayla said “I had trouble fitting in and making friends in school. I felt so disconnected from everyone my age. I still struggle with understanding social cues.” According to Viktoria, having TS “affected me in all the ways you can imagine physically, mentally and emotionally and socially as well because as a child I was always the only one in the classroom with this condition I felt alone and distanced myself from other students.”
As a result, students with TS may appear withdrawn, disengaged, or anxious in the classroom and contribute to academic underperformance. Without intentional support, these social challenges can erode confidence and create barriers to full participation in school.
Hearing Loss
While hearing loss is not a direct part of the cognitive profile associated with TS, it can significantly influence their experience in the classroom. Mild to moderate hearing loss which may go unnoticed without proper screening, and even subtle hearing difficulties can make it harder for students to follow verbal instructions, engage in discussions, or pick up on social cues, especially in noisy environments like classrooms. This can compound existing challenges with processing speed, attention, or social communication.
What Educators Can Do
Understanding the cognitive effects of Turner syndrome allows educators to proactively offer support that aligns with the student’s needs. Examples include:
- Math support: Use manipulatives, visual aids, and 1:1 instruction when possible. Allow calculators and offer alternative assessment formats.
- Extended time: This can be helpful on tests or when reading complex instructions, both to alleviate anxiety and allow additional time for processing.
- Clear instruction: Breaking assignments into manageable steps with visual reminders, such as a checklist.
- Preferential seating: This is especially useful for students with hearing difficulties or attention challenges.
- Routine check-ins: Use planners, prompts, or scheduled organizational sessions to support the student’s executive functioning needs.
Being proactive about offering accommodations is key. Audrey, a woman with TS, says “I was put on an IEP and received early intervention in preschool, and due to that, I was able to excel academically and go on to college.”
However, not all students with TS will qualify for a 504 Plan or Individualized Education Program (IEP), which typically require documentation of academic impairment. That’s where tools like the Turner Syndrome Support Plan can be helpful.
Introducing the Turner Syndrome Support Plan
A Tool for Better School-Clinic Communication
One of the biggest challenges faced by families and educators supporting girls with Turner syndrome is a lack of understanding their needs. Collaboration between educators and medical teams can ensure that there is a clear understanding of the needs and plan for accommodations.
The Turner Syndrome Support Plan is a tool introduced in the 2024 Clinical Practice Guidelines. It was designed to empower caregivers, healthcare providers, and educators to work together in support of the whole child.
“This tool is especially valuable for students who don’t qualify for formal special education services but still need targeted support for internalizing symptoms like anxiety or social isolation.”
—Mackenzie Norman, PhD
What Is the Turner Syndrome Support Plan?
The Turner Syndrome Support Plan is a downloadable, customizable document meant to:
- Educate school staff about common TS-related challenges
- Document psychosocial and educational concerns
- Suggest actionable supports and accommodations
- Encourage communication between the child’s healthcare providers, school team, and family
This structure empowers families and medical professionals to initiate the conversation with schools, even when there isn’t a formal 504 Plan or IEP process in place. Many girls with Turner syndrome “fly under the radar.” They may do well academically but struggle silently to keep up, miss out on peer connection because of social challenges, or feel like there’s something wrong with them because they learn differently than others.
By providing a formal, structured pathway to share concerns and strategies, the Support Plan helps ensure these students are seen, heard, and supported.
How to Use the Plan
✅ Download the Turner Syndrome Support Plan.
✅ Fill it out with a medical provider such as a psychologist, endocrinologist, TS clinic specialist, or any professional familiar with the student’s needs.
✅ Share it with the school via email or bring it to a school meeting to discuss accommodations and supports.
✅ Use it as a stand alone as a communication tool between home and school or to supplement a 504 or IEP.
Supporting Success Beyond the Classroom
Understanding the cognitive profile of girls with TS isn’t just about performance in school, it’s about supporting confidence, participation, and inclusion. With the right tools and knowledge, educators and families can leverage the student’s verbal strengths and navigate through challenges to help students with TS thrive.
To learn more about this topic, view the recording of the webinar: Psychosocial & Educational Considerations for Turner Syndrome presented by Mackenzie Norman, PhD.
Sources
Gravholt, C. H., et al. (2024). Clinical Practice Guidelines for the care of girls and women with Turner Syndrome. European Journal of Endocrinology.
Norman, Mackenzie Z., et al. “Turner syndrome and Psychosocial Interventions: Recommendations for collaborative communication between medical and school teams.” American Journal of Medical Genetics Part C: Seminars in Medical Genetics, vol. 199, no. 1, 13 Feb. 2025, https://doi.org/10.1002/ajmg.c.32134.
Hong, David, et al. “Cognitive Profile of Turner Syndrome.” Developmental Disabilities Research Reviews, U.S. National Library of Medicine, 2009, pmc.ncbi.nlm.nih.gov/articles/PMC3114458/.
Collaer ML;Geffner ME;Kaufman FR;Buckingham B;Hines M; “Cognitive and Behavioral Characteristics of Turner Syndrome: Exploring a Role for Ovarian Hormones in Female Sexual Differentiation.” Hormones and Behavior, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/11855899/. Accessed 17 July 2025.
Written with information presented in the webinar, Psychosocial & Educational Considerations in Turner Syndrome presented by Mackenzie Norman, PHD, Psychologist Resident in Integrated Primary Care and Behavioral Pediatrics at Oregon Health & Science University. Designed by Delvis Rodriguez, Digital Marketing Coordinator
© Turner Syndrome Foundation, 2025
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