How Does Turner Syndrome Affect Mental Health and Social Skills in Girls and Young Women?

What you need to know

• Girls and young women with Turner syndrome have higher rates of mental health and social challenges compared to their peers.
• About one-third met criteria for at least one mental health disorder, with anxiety and autism spectrum disorder being most common.
• Many showed traits of autism and difficulties with friendships, though they did not always recognize these challenges themselves.
• Early identification and support for social and mental health difficulties is important for this population.

Understanding Turner Syndrome

Turner syndrome is a genetic condition that affects about 1 in 2,500 female births. It occurs when a female is born with only one complete X chromosome instead of the usual two X chromosomes. This can lead to a variety of physical characteristics and health issues, including short stature, heart defects, and infertility.

While the physical aspects of Turner syndrome are well-studied, less research has focused on how it affects mental health and social development. This study aimed to fill that gap by examining mental health and social skills in a large group of girls and young women with Turner syndrome.

Mental Health Challenges

The researchers found that girls and young women with Turner syndrome experience higher rates of mental health difficulties compared to their peers:

• About 34% met criteria for at least one mental health disorder, which is 2.6 times higher than typically developing girls.
• 13% met criteria for an anxiety disorder.
• 13% met criteria for attention deficit hyperactivity disorder (ADHD), which is over 21 times higher than typically developing girls.

Interestingly, rates of depression were actually lower in the Turner syndrome group compared to the general population. This suggests that while anxiety is more common, depression may not be a particular concern for this group.

High Rates of Autism Traits

One of the most striking findings was the high rate of autism spectrum disorder (ASD) traits in girls with Turner syndrome:

• 23% met diagnostic criteria for ASD, which is 57 times higher than typically developing girls.
• 61% showed mild to severe autistic traits that impacted their daily social interactions.
• Those who met criteria for ASD were also more likely to have anxiety and/or ADHD.

It’s important to note that autism can present differently in girls compared to boys, and is often overlooked. The high rates found in this study suggest that healthcare providers should be particularly aware of the possibility of ASD in girls with Turner syndrome.

Social Challenges and Friendships

The study revealed significant social challenges faced by many girls with Turner syndrome:

• About 72% of parents reported their daughter had more difficulty making friends than average.
• 56% reported their daughter had difficulty keeping friends.
• 17% were considered to have no friends with whom they regularly spent time.

However, an interesting discrepancy emerged: the girls themselves, and their teachers, reported fewer social difficulties than parents did. This could be due to several factors:

1. The girls may have less insight into their social challenges.
2. They may be comparing themselves to a different peer group than their parents are.
3. Social difficulties may be less apparent in structured school settings.

This highlights the importance of gathering information from multiple sources when assessing social skills.

Implications for Care

These findings have important implications for the care of girls and young women with Turner syndrome:

1. Regular mental health screenings: Given the higher rates of anxiety and other mental health challenges, regular screenings should be part of routine care.

2. Autism awareness: Healthcare providers should be aware of the increased likelihood of ASD and be prepared to refer for assessment when appropriate.

3. Social skills support: Many girls with Turner syndrome may benefit from social skills interventions, even if they don’t meet full criteria for ASD.

4. Holistic care: Mental health and social development should be considered alongside physical health in the care of individuals with Turner syndrome.

5. Early intervention: Identifying and addressing mental health and social challenges early can lead to better outcomes.

Conclusions

• Girls and young women with Turner syndrome face higher rates of mental health challenges, particularly anxiety and ADHD.
• Autism spectrum traits are much more common in this population than previously recognized.
• Many experience significant social challenges, though they may not always recognize these difficulties themselves.
• A comprehensive approach to care that includes mental health and social development is crucial for supporting girls and women with Turner syndrome.
• Further research is needed to better understand the links between Turner syndrome and autism, and to develop targeted interventions for this population.

This study highlights the importance of looking beyond the physical aspects of Turner syndrome to support the overall well-being of affected individuals. By recognizing and addressing mental health and social challenges, we can help girls and women with Turner syndrome lead fuller, more satisfying lives.