The Burdensome Impact of Undiagnosed Learning Disabilities on Girls and Women
“It Must Be Me” Generated by Mars Parker using ChatGPT Pro. 27 Oct. 2025
School was hard for me. So hard. For a seemingly bright, earnest kid, it was more challenging and spirit-crushing than it had any right to be. Without any clear explanation for this difficulty, at a young age, I internalized the notion that I was the problem and that my academic struggles were proof that I was somehow incapable and unintelligent. At the time, my young mind only had one unfortunate word to describe who and how I was: dumb. This was the ‘80s and ‘90s, so you could still use that troublesome, ableist term to browbeat yourself as much as you liked. That this word’s usage is now considered problematic somehow only solidifies my sense of how appropriate it was. It carries the weight and scope of my past shame almost perfectly. I had no better vocabulary, no helpful data, and no diagnostic details with which to clarify the situation. I spent each school day—K through 12—swinging wildly between boredom and anxiety. I worked diligently to stay small, quiet, and unnoticed so that nothing would reveal my ineptitude to others. The best one could say is that I somehow managed to muddle through. What I did not know at the time is that I was a misplaced and hopeless cause in what is now starting to seem like a sort of contemporary classic tale: people with undiagnosed learning disabilities, especially girls and women, are failing to be seen, falling behind and through the cracks. For individuals enduring this circumstantial misfortune, there can be a host of long-lasting and detrimental effects.
After high school, I completed one year of undergraduate studies, then determinedly dropped out of college. That experience became bound up in a somewhat more refined mystery involving melancholy and my inability to cope with all the collegiate pressure. At some point in my 20s, I finally received what my doctors and my therapist at the time considered the final verdict, and you guessed it, major depressive and generalized anxiety disorders. That tale followed me through most of my adult life. How many other people have been written off in this fashion? I imagine countless men and women who, like me, shunned higher education and meaningful careers because they did not understand themselves. Furthermore, their best guess—the most accurate label anyone could offer them—was supremely lacking and named only a symptom, not the cause. There are so many of us who were swept aside by an educational system that lacked the means to recognize and assist us. And once the system was done with us, we continued to do our part by staying hidden and out of the way. Who wants to stand out when they are simultaneously so deeply confused by themselves and misunderstood by others?
Through my 30s and 40s, I clawed my way into a place of stability and relative contentment, but the riddle of why childhood, formal schooling, and early adulthood had been so fraught with strain and frustration remained. And it likely would have, had I not had the good fortune of ending up on the couch of a new therapist who happened to be dyslexic. Her insight and ability to map my lifelong laments onto dyslexic and dyscalculic traits changed everything. By 49, I was diagnosed with both of these learning disabilities and ADHD. At 50, I was diagnosed with autism. Looking back, I can see now how the labels “depressed” and “anxious” were just wool pulled over my eyes by the social, educational, and medical establishments, unable to parse my disabilities and neurodivergence.
And I am not alone in this predicament. It’s hard to imagine a time in recent history when the public or private education systems in America have managed to do right by the vast majority of people who need the most help. There has been a gross failure to see and assist children with neurodivergence and related learning disabilities. This failure falls doubly on the shoulders of female students, and this has consequences far beyond their lower SAT scores and college attendance rates; it has a devastating impact on the long-term mental health of these individuals.
In a recent interview with Melissa Lavery, a teacher at Interboro High School in Prospect Park, Pennsylvania, I asked how teachers are being trained to recognize signs of learning disabilities and neurodivergence in their students. She says they simply aren’t. “I feel like that was just not even a conversation,” she admits. Lavery concedes that there must be training to this end for those specializing in special education, but in her schooling and training as an English teacher, there were only brief, superficial references to the classic portrayals of disability and divergence. We all know these: the student who sees letters swim on a page, the boy who can’t sit still, the dysregulated child who stims and has an odd, intense interest. “We were taught our subjects and that’s it,” she confides. How can that be all? It appears that American schools are letting down these students at almost every turn. One could even argue that the trouble begins with any university and graduate-level education that fails to instruct prospective teachers to see the signs of neurodiversity and associated learning disabilities. When these new teachers begin their careers in primary and secondary schools, they may only be armed with the most rudimentary understanding and biased assumptions about these conditions. It’s heartbreaking to think of all the children sitting in confusion and ignorance, through no fault of their own, while the professionals tasked with their education and growth fail to see what is getting in the way.
It’s unsurprising, then, to see the impact that this ineffectiveness in detecting learning differences and neurodivergence in children is having on overall diagnostic outcomes. In her book Overcoming Dyslexia, Dr. Sally Shaywitz shares her research, which suggests that 20% of the population may be dyslexic (29), yet within the US school system, only 4% of children are diagnosed as such (30). That’s pretty simple math, even for my dyscalculic brain. Nevertheless, I still want to be clear—Shaywitz’s research indicates that in a classroom of 25 students, only one child might be formally identified as dyslexic, when in reality, as many as five could be struggling with the condition. Moreover, Shaywitz describes how, when left to schools, the ratio of male-to-female dyslexia diagnoses can look as high as 5:1; however, when she and her colleagues applied more rigorous, research-based criteria to populations of children, they found “no significant difference in the prevalence of reading disabilities between boys and girls” (32). Once again, for clarity’s sake, Shaywitz is asserting an actual incidence of dyslexia approaching 1:1 across gender lines. Why are girls being overlooked? It’s evident to me, both from my lived experience and from the thoughts and research presented in every source I’ve read, that the children who cause the most disruptions in the classroom are the children who are most often referred for assessment or services. Typically, this is the male student. All too often, the female student is shy, quiet, well-behaved, and doing their very best not to be noticed. Whatever the case, it’s frankly infuriating to consider even a single child who never received the life-altering and empowering knowledge that their brain just functions differently from their peers’.
This pattern repeats itself across diagnoses. Anecdotally, Lavery sees this imbalance in her high school classroom as well, where she says the vast majority of the diagnosed students are male. When asked if she thinks this is because fewer girls are actually impacted by learning disabilities, she responded, “I think girls may be masking better.” Here we have the crux of it. Masking is a sophisticated coping mechanism that any person can engage in at necessary times, but it is a strategy rigorously, and often unconsciously, used by neurodivergent women and girls in order to mimic the behaviors and norms they see utilized by their neurotypical peers. To use another term associated with these tactics, the act of masking effectively camouflages a difference or disability so that the individual can escape notice and remain securely part of the larger group or community. This ability to mask their disability seems to be exacerbating the issue. While sitting in a classroom with teachers who are ill-equipped to recognize the signs and patterns, the boys are managing to draw attention to themselves by outwardly struggling, acting out, and causing disruptions. The girls, on the other hand, are keeping their heads down and figuratively flying under the radar. In their book, Understanding Girls with ADHD, Nadeau, Littman, and Quinn share troubling detail from a study that demonstrates, “teachers and parents were more likely to refer boys rather than girls with ADHD for services when they reportedly exhibited identical behaviors” (Ohan et al. as qtd in Nadeau et al. 6). Even when the girls show symptoms and traits of these differences, others’ biases may still stand in the way.
Predictably, more and more research shows that the underdiagnosis of Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) is affecting females at higher rates than males. The National Institute of Mental Health reports that ADHD affects three times as many males as females. In their journal article in European Neuropsychopharmacology, Li et al. note similar detail, “In childhood, boys are more likely to be diagnosed with ADHD than girls,” yet, they go on to observe that, “ADHD in adults shows a more sex-balanced distribution, with male-female ratios from 1:1 to 2:1.” So, the conviction that more boys have ADHD than girls only seems to hold in research on school-aged children. The rate of diagnosis of ADHD in adults apparently comes much closer to gender parity. Likewise, it’s now understood that there is also a disparity in ASD diagnosis in school-aged children. In her book Off the Spectrum, neuroscientist Gina Rippon states that the commonly accepted ratio of male-to-female diagnoses is 4:1 (99). Rippon spends almost the entirety of her book demonstrating how inaccurate this ratio truly is; perhaps, most revealing, she claims that when considering autistic individuals with high support needs, the ratio of male-to-female diagnoses is roughly equal (100). But beyond those with severe behavioral and intellectual disabilities, that 4:1 ratio appears to hold. Rippon argues that this has little to do with reality and more to do with bias in families, schools, and even with the diagnostic criteria for ASD itself. Girls are being overlooked. She is certain, and her current research suggests, that the ratio of male to female autists is more likely to be 2:1 across the spectrum (99).
So where are the missing girls? I suspect they are hiding in plain sight, frightened and demoralized, just like I was. As Lavery suggests, we are masking throughout our schooling and into adulthood. My autism was cloaked in extreme shyness and people pleasing. My ADHD ran dark because, unlike the boys in my classes, I could sit down and keep to myself. What still frustrates me, however, is how not a soul looked at me—the kid who wrote her Ss backwards, who switched her Bs and Ds, who never stopped struggling with encoding and decoding words, who was labeled a reluctant reader from the start, who could not memorize her times tables, tell time, or even her right from her left—and saw dyslexia. We need to do better.
With nothing else to go on, a current of bewilderment, chagrin, and self-loathing ran beneath the heavy, wet blanket of my generic depression and anxiety diagnoses, contaminating every aspect of my experience. I hid from those feelings and from life—personally, academically, and professionally—as best I could. But regrettably, poisonous, self-limiting beliefs don’t usually go away on their own. Quite the contrary, they can simmer and stew. As an adolescent, I cut and burned myself. As a young adult, I self-medicated enthusiastically with drugs and alcohol. For decades, I struggled with suicidal ideation. And—oh yes—I enjoyed all the depression and anxiety I could manage, thank you very much.
This, it turns out, is all too depressingly common. We have been mismeasured, mislabeled, and misunderstood, and this has consequences. Countless children with undiagnosed learning disabilities are growing into adults with a distressing laundry list of psychiatric conditions. While finding research that details the mental health struggles of the unidentified is tricky, there is a wealth of information and research on the mental health outcomes of those who received their diagnoses. Research shows that individuals with reading and spelling impairments due to dyslexia have an overall lower self-esteem than their peers (McArthur et al. 2), and, of course, this hits girls harder than boys (McArthur et al. 3). This tracks; my self-esteem had hit rock bottom before I even began my secondary schooling. Nadeau et al. reveal the stunning finding that adults with ADHD have a 70% probability of having one or more coexisting psychiatric conditions (Biederman et al. as qtd in Nadeau et al. 9). They point to strong evidence that girls carry the heavier weight of this with a higher prevalence of conditions ranging from depression, anxiety, eating disorders, self-harm, and suicide attempts (10). By the same token, adults with ADHD are much more likely to have drinking and substance abuse disorders (Molina et al. 2). Roger that. Nothing in my personal experience refutes any of this. Things look just as bleak for autistic individuals. Henderson, Wayland, and White, the authors of Is This Autism?: A Guide for Clinicians and Everyone Else, corroborate this with their sobering report that generalized anxiety disorder, specific phobias, social anxiety disorder, and separation anxiety disorder are far more common in autistic people (176). They add that the incidence of clinical depression “[is] much higher in autistic than non-autistic people, and this may be particularly true in autistics with average to above average intellectual functioning . . . . as many as 65% of these adults are clinically depressed” (180). They also claim that autistic people are more than twice as likely as allistic people to engage in self-injurious behavior (184). This breaks my heart, because it was me. Rippon goes further to address the undiagnosed elephant in the room—the “‘Missed’ females can then be exposed to an ‘alphabet soup of diagnoses’ including major depression, generalized anxiety, social anxiety, borderline personality, bipolar, and eating disorders” (88). These labels are not the end-all, be-all of us, though; they are symptoms of a larger, more complex diagnostic reality. In an ideal world, these outcomes could have been avoided, or at least mitigated. Research is clear: individuals with learning disabilities or other forms of neurodivergence are at higher risk of developing mental illness than those without. I maintain that a lack of awareness of your differences can make the situation demonstrably more problematic. Everything is harder when you only have a few dozen of the thousand puzzle pieces. I can see now that not understanding I was disabled created an internalized mental maze of mortification that kept me fearful, unhappy, self-medicated, and self-limited. That I survived—that I never harmed myself too terribly or made a life-altering choice or mistake—I consider nothing short of a miracle.
What can be done to address this? Changing how we diagnose and support children—especially girls—will take enormous cultural and institutional effort. Even if we prepare parents, train teachers to recognize the signs, make staff and specialists available to assess children, and expand and refine the diagnostic criteria, it still seems reasonable to assume that some children will fall through the cracks.
There may never be any failsafe solutions, but in our interview, Lavery offered some glimpses of hope. Her school district now offers what it calls Freshman Seminar. Lavery calls it what it is—an executive functioning class. She explains, “[It’s] a new required class for freshmen that’s about executive functioning, self-monitoring, and growth mindset, etc.” She teaches her students about their own brains and how neurodiversity can impact learning. She provides them with scaffolding, strategies, and tools to work with their minds—neurotypical and neurodiverse alike—both in and out of the classroom. I wonder what a taste of this knowledge and instruction would have done for me during my secondary education. Would having organizational strategies and helpful hacks have assisted me in my studies? Almost certainly. Would having, for example, an understanding of working memory or processing speed have made me feel less inept? Perhaps. I would like to believe that the awareness that all brains have different capacities, that they learn differently and at different rates, would have been tremendously valuable to me. As it stands, I do not remember any interventions like this in my schooling. Only year after year of report cards detailing my unwillingness to participate in class, inability to stay focused, and chiding me to work much harder on memorizing spelling and math facts.
To further assist, in both this specialized seminar and her standard English classes, Lavery uses a teaching methodology known as differentiated instruction. She explained that when using differentiation, she offers students a choice. The students are presented with the same assignments or projects at several levels or with more than one approved modality, and each student selects the version they believe will work best for them. For example, this might take the form of a reading assignment offered at three different reading levels or a project where students can choose an approach that is either more cerebral or more artistic. Students are graded equally, regardless of the level or method they prefer. Lavery believes this strategy is functional and supportive of all students in her classes, but especially those who might have undiagnosed learning disabilities or neurodivergence. She is optimistic, “The better a teacher gets at differentiating, the more these issues are not going to be a problem.” I wish I knew what a difference this sort of approach would have made for me. The simple acknowledgment that learning at different levels was both expected and welcome would have meant a great deal. Being able to pick a means of expression that came more naturally without being penalized would have been a game-changer. What’s more, seeing my abilities reflected in the other students who functioned at the same reading level or used the same method to handle a project might have shown me that I was not alone. That it was not just me.
I want to acknowledge, with gratitude, the change and healing that have come to me with diagnoses. Rather than lacking intelligence or capacity, I have a neurotype! DysAuDHD for the record. I understand that having a diagnosis does not make you immune to the condition, but it most certainly gives you a sense of what to anticipate, and information is power. Knowing how neurodivergent brains handle anxiety and stress—what warning signs and tendencies to keep an eye out for—is profoundly helpful and, I believe, protective. I should have had this knowledge sooner. I should have been seen and assisted. I should have been given the tools and encouragement to keep me from giving up on myself. But none of this came to pass, and I suffered as a result. I will likely always grieve the education, career, and life I could have had if my disabilities had been diagnosed at a younger age. It could have been so different.
That said, I consider myself fortunate that, even at this late stage in my life, I finally have the gift of this knowledge. At long last, I make sense and can advocate for myself in ways I never could before. Beyond that, I am taking enormous strides towards healing and self-actualization. Within one year of my dyslexia and ADHD assessment, I had enrolled at Delaware County Community College. I went from hiding from the world, limiting myself, and swearing that I would never amount to anything, to publishing memoir-style blog posts, learning Spanish and math independently, and pursuing a degree in Liberal Arts. I live in a whole new, self-created world, and I would not have found myself here if it had not been for my diagnoses. It turns out that it was me all along, and I was smart, discerning, and just waiting to be uncovered and empowered. It is my dearest hope that I can use this overdue and hard-won self-awareness and my forthcoming college education to learn as much as I can about these issues, to help educate others, and to seek out and assist neurodivergent individuals of this and the next generation.
Especially the girls.
Works Cited
ChatGPT. “It Must Be Me.” Generated by Mars Parker, 27 Oct. 2025, OpenAI, https://chat.openai.com/.
Henderson, Donna, Sarah Wayland, and Jamell White. Is This Autism?: A Guide for Clinicians and Everyone Else. Routledge, 2023.
Lavery, Melissa. Personal interview. 21 Oct. 2025.
Li, Ting, et al. “ADHD Symptoms in the Adult General Population Are Associated with Factors Linked to ADHD in Adult Patients.” European Neuropsychopharmacology, vol. 29, no. 10, 2019, https://www.sciencedirect.com/science/article/abs/pii/S0924977X1930433X. Accessed 30 Oct. 2025.
McArthur, Genevieve M., et al. “Self-Concept in Poor Readers: A Systematic Review and Meta-Analysis.” PeerJ, vol. 8, 2020, p. e8772. Gale Academic OneFile Select, https://doi.org/10.7717/peerj.8772. Accessed 27 Oct. 2025.
Molina, Brooke S. G., et al. “Pathways to Alcohol Use and Problems in Adulthood for Children with Attention-Deficit/Hyperactivity Disorder (ADHD): The Role of Common Impairments above and beyond ADHD Symptom Persistence.” Journal of Psychopathology and Clinical Science, vol. 134, no. 6, 2025, pp. 651–62. EBSCOhost, https://doi.org/10.1037/abn0000986. Accessed 25 Oct. 2025.
Nadeau, Kathleen G., Ellen B. Littman, and Patricia O. Quinn. Understanding Girls with ADHD: How They Feel and Why They Do What They Do. Revised ed., Advantage Books, 2015.
National Institute of Mental Health. “Attention-Deficit/Hyperactivity Disorder (ADHD).” NIMH, U.S. Department of Health & Human Services, https://www.nimh.nih.gov/health/statistics/attention-deficit-hyperactivity-disorder-adhd. Accessed 28 Oct. 2025.
Rippon, Gina. Off the Spectrum: Autistic Girls, Gender Bias, and the Myth of Empathy Break. Bodley Head, 2024.Shaywitz, Sally E., and Jonathan Shaywitz. Overcoming Dyslexia. 2nd ed., Vintage Books, 2020.
Shaywitz, Sally E., and Jonathan Shaywitz. Overcoming Dyslexia. 2nd ed., Vintage Books, 2020.
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