Sex and Gender Differences in Language Impairment, Disability, and Service Receipt - 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 goal is to determine why girls are less likely to receive language services than boys. 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, differing expectations of girls and boys may encourage masking, lessen concerns about girls, or heighten concerns about boys. These hypotheses are tested in four aims. Aim 1: To determine the extent to which disability drives service receipt and whether this relationship varies by sex. We will examine academic records from >1.6 million children. After controlling for language related disability, we will determine whether, compared to boys, girls receive equivalent services (Fewer Needs) or whether a gap in service delivery remains (Missed Needs). We can also determine whether girls receive later (Later Needs) or different services (Different Needs). Aim 2: To explain the relationship between language disability and temperament and determine whether this relationship varies by sex. We will assess language impairment, language-related disability, and temperament in 132 boys and girls with DLD. After controlling for language impairment, we will determine whether girls are less disabled (Fewer Needs) or differently disabled (Different Needs) than boys and whether the extent of disability relates to effortful control. We will interview children and caregivers to probe the compensatory role of effortful control and other aspects of temperament in boys and girls with DLD. Aim 3: To determine the extent to which child internalizing behavior and child and caregiver expectations affect service receipt and whether these relationships vary by sex. We will measure internalizing behavior in the same 132 children and expectations of boys and girls in the children and their caregivers. After controlling for language impairment, we will determine whether internalization and expectations are associated with a delayed service receipt for girls (Missed Needs). We will interview a subset of the caregivers 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 masking behaviors 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 their expectations of boys and girls predict differentiation. We will conduct focus groups and surveys with SLPs, reading specialists, and teachers to document observations of language function in boys vs. girls and their expectations that affect service decisions.
