PROJECT SUMMARY/ABSTRACT
Community research samples reveal near parity in the ratio of boys to girls who meet criteria for developmental
language disorder (DLD); however, in 2020-21, US school SLPs served twice as many boys as girls. Our primary
goal is to determine why girls are less likely to receive language services than boys, a goal perfectly aligned with
and highly responsive to 1) NIH's Interest in Diversity (NOT-OD-20-031), 2) the focus of the NIDCD Strategic
Plan on projects to improve women’s health, and 3) the Notice of Special Interest (NOSI): Encouraging Women’s
Health Research within the NIDCD Mission Areas (NOT-DC-23-006). The service gap could reflect legitimate
differences in need: Their tendency to demonstrate high effortful control may enable girls to stave off the disabling
consequences of language impairment such that fewer girls need services, or they need later or different services
than boys. Alternatively, the gap could reflect inequities in access to health care. The gendered beliefs and
practices that characterize families, communities, and societal institutions may encourage masking, lessen
concerns about girls, or heighten concerns about boys. These hypotheses are tested via four specific aims.
Aim 1: To determine the extent to which disability drives service receipt and whether this relationship varies by
gender. We will mine a database of academic records and use generalized linear mixed models and regression
to compare boys and girls in receipt, timing, and type of service relative to their needs.
Aim 2: To explain the relationship between language disability and temperament and determine whether this
relationship varies by gender. We will use a sequential explanatory design. In Phase 1, we will use regression
models to determine whether girls are less or differently disabled than boys, and whether the extent of disability
relates to effortful control. In Phase 2, we will interview children and parents to probe the role of high effortful
control and other aspects of temperament as compensatory mechanisms.
Aim 3: To determine the extent to which child internalizing behavior and child and caretaker gender bias affect
service receipt and whether these relationships vary by gender. We will use a sequential explanatory design. In
Phase 1, we will use regression models to determine whether child internalization and gender bias are associated
with delayed services for girls. In Phase 2, we will interview parents to document their initial concerns about their
child’s language development, the timing between initial concern and help-seeking, and the role of internalization
and other potential masking behaviors on the part of boys and girls in motivating or discouraging help-seeking.
Aim 4: To determine the extent to which professionals differentiate the language-related needs of boys and girls
and whether gender bias predicts differentiation. We will use an exploratory sequential design. In Phase 1, we
will conduct focus groups to document professionals’ observations of language function in boys vs. girls and their
gendered expectations that affect service decisions. In Phase 2, we will conduct surveys to determine
generalization and relate gendered practices to an independent measure of gender bias via regression.
