Written Language Disorders

See the assessment section of the written language disorders evidence map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.

Screening

Screening of written language skills is conducted if a reading or writing disorder is suspected. It may be triggered by parent and/or teacher concerns about the child's reading and writing performance or the child's failure to meet RTI criteria.

Screening indicates the potential need for further assessment but does not result in a diagnosis. It typically includes

  • administering formal screening measures with demonstrated evidence of adequate sensitivity and specificity;
  • using informal measures (e.g., reading inventories, spelling inventories, or writing prompts), such as those designed by the clinician or published and tailored to the population being screened (e.g., preschool vs. school-age/adolescents); for a discussion of nonstandardized methods to help quantify specific reading and writing skills, see Paul and Norbury (2012);
  • observing literacy activities in the classroom and obtaining information from the classroom teacher and parents;
  • collecting progress-monitoring data from RTI services and examining RTI criteria that have not been met;
  • screening articulation and phonology, if indicated; and
  • screening spoken language.

A hearing screening should be conducted to rule out hearing loss or to identify a hearing loss (if present) so that it can be considered during the assessment. If the child wears glasses, then he or she should wear the glasses during testing, and any necessary visual accommodations should be made (e.g., large-print stimuli or other magnifications, lighting modifications).

Screening may result in

  • collaboration with classroom teachers to provide facilitative instruction in phonological awareness, spelling, or vocabulary (i.e., pre-referral intervention);
  • recommendation for comprehensive language assessment (including both spoken and written language);
  • recommendation for comprehensive speech sound assessment, if the child's speech sound system is not appropriate for his or her age;
  • referral for complete audiologic assessment;
  • referral for a vision exam, if observations during screening suggest possible visual acuity problems; and
  • referral for assessments by a physical therapist and/or an occupational therapist, if observations of handwriting during screening suggest possible motor or motor programming problems.

Comprehensive Assessment

Assessment of reading and writing skills should be linguistically appropriate, culturally relevant, and functional. It involves the collaborative efforts of families/caregivers, classroom teachers, SLPs, special educators, and other professionals as needed. A cross-disciplinary/interdisciplinary framework for assessment (and treatment) is encouraged (Berninger, 2015; Silliman & Berninger, 2011). See collaboration and teaming and assessment and evaluation of speech-language disorders in schools.

For information about specific reading and writing disorders, including differential diagnosis considerations, see disorders of reading and writing.

Both formal and informal assessment activities are used: 

  • Formal tests of written language may be administered by the SLP or another member of the special education team (e.g., special education teacher or reading specialist). When another member of the team administers the tests, the SLP works collaboratively to coordinate assessments and to interpret the collective results of formal and informal spoken and written language assessments. When possible, use measures of oral and written language that have been co-normed on the same standardization samples so that their results may be compared directly. This allows for a more integrated approach to the assessment of language and literacy skills (Nelson, 2014b; Nelson et al., 2015).
  • Informal activities can include strategic observations of students engaged in literacy activities and assessment of writing samples from curriculum-based activities. One advantage of informal curriculum-based assessment is that the SLP then can introduce scaffolding and instructional techniques to see how the student responds. These dynamic assessment techniques, which are not allowed during formal testing, can lead directly into intervention. 

See assessment tools, techniques, and data sources for procedures and data sources that may be used in assessment.

Assessment of reading and writing skills takes into consideration the child's developmental stage, language(s) used, and expected literacy skills, based on age or grade. See comprehensive assessment for disorders of reading and writing: typical components.

Assessment may result in one or more of the following:

  • Diagnosis of a written language disorder (affecting reading and/or writing, with patterns of strengths and weakness described in relation to the key components of reading decoding, written spelling, reading comprehension, and written expression)
  • Description of the characteristics and severity of the disorder
  • Diagnosis of a spoken language disorder
  • Diagnosis of a speech sound disorder
  • Diagnosis of a social communication disorder
  • Referral for further assessment of possible hearing or vision problems
  • Recommendations for intervention and support
  • Recommendations for multi-tiered systems of support (MTSS) such as RTI services to support literacy development
  • Referral to and consultation/collaboration with other professionals as needed, including the following:
    • Audiologist
    • Neuropsychologist
    • Occupational therapist
    • Ophthalmologist
    • Pediatrician
    • Physical therapist
    • Reading specialist
    • Special educator

For more information, see ASHA’s web page on Interprofessional Education/Interprofessional Practice (IPE/IPP).

Cultural and Environmental Factors

Cultural norms and values influence many aspects of language development. For example, although people in all cultures tell stories, narrative discourse and how children tell and receive stories vary widely across cultures. Background experiences shape how children infer the messages within the story as well as how they predict next steps. This results in variations in features of discourse, such as topic maintenance and event sequencing (McCabe & Bliss, 2003; Roseberry-McKibbin, 2014). Given the bidirectional relationship between spoken and written language, it is expected that children's oral narrative discourse style will influence written narrative discourse. Therefore, acceptable oral variations should be considered appropriate for written narrative discourse as well (Gorman, Fiestas, Peña, & Clark, 2011) and should never be used as symptoms for diagnosing a disorder.

Story features that might vary with cultural diversity include the following:

  • Topic maintenance—how much the story focuses on a single topic with little deviation or extraneous detail
  • Organizational structure—may be linear or more cyclical. Stories with a clear beginning, middle, and end are linear; cyclical stories may circle back from the end to the beginning to bring the story full circle
  • Character—including the nature of the relationship as well as the how the character behaves and whether or not the character is even named
  • Creative elements—embellishment, fantasy, suspense, and conflict may vary by culture

When a clinically significant reading problem is suspected, it is important to rule out environmental variables and other variables that could be having a negative impact on the child's literacy skills (Roseberry-McKibbin 2013, 2014). When circumstances are complex, dynamic assessment procedures might help identify a written language disorder, if present.

For more information, see the ASHA Practice Portal page on cultural competence.

Children Who Are Linguistically Diverse

Simultaneous And Sequential Dual Language Learners

Written language dominance may not match spoken language dominance in children who are simultaneous or sequential dual language learners. For example, children who speak a language other than English in the home have oral language skills in their first language (L1) but may not have learned how to read or write in that language (Roseberry-McKibbin, 2014).

The age of exposure to English is directly related to bilingual reading development. Early bilinguals who were exposed to English prior to the age of 3 years have reading development skills similar to those of monolingual English speakers (Kovelman, Baker, & Petitto, 2008).

Phonological awareness skills tend to be better in bilingual children than in monolingual speakers (Kovelman et al., 2008; Páez, Tabors, & López, 2007), and these skills may facilitate development of decoding and word-level literacy skills. The development of text-level skills (reading comprehension and writing) relies more heavily on oral English proficiency, including vocabulary knowledge, listening comprehension, and syntactic skills (August & Shanahan, 2006).

Characteristics of an individual's first language may influence his or her reading and writing abilities in English. 

Examples include the following: 

  • Orthography, phonology, and semantic units of the child's home language will influence written English. Alphabetic languages make different demands on language systems than do pictographic ones. Additionally, some alphabetic languages, such as Spanish, have more regular sound–symbol associations than others, such as English. On the other hand, Spanish and English are both alphabetic languages. Thus, it may be easier for a child who speaks Spanish as a primary language to acquire reading and writing skills in English than it is for a child who speaks a tonal language such as Mandarin (Wagner, Francis, & Morris, 2005).
  • Variations in vocabulary across languages also might affect reading comprehension and written expression. There may not always be a direct translation. For example, in some languages, there are several words for the English word snow, each representing the concept of “snow” plus a descriptor (e.g., soft snow or melting snow; Kaplan, 2003). However, when reading the English word snow—without a descriptor—the reader is left to interpret the writer's intended meaning (e.g., from context).
  • Syntactic differences in an individual's first language may also influence comprehension. Some languages do not distinguish the 3rd personal singular pronouns “he, she, it.” That is, the 3rd person singular pronoun in those languages can refer to a male, female, or inanimate object (e.g., Siewierska, n.d.). Sentences in English whose meaning relies on knowledge of the 3rd person singular pronoun may therefore be difficult to understand. 

Children Who Use Nonstandard American English Dialects

In contrast to bilingual children, children who use nonstandard American English dialects may have more difficulty with decoding and word-level literacy skills (e.g., spelling). In a study comparing grammar and early spelling skills, children who spoke African American English (AAE) did not differ from children who spoke Standard American English (SAE) in their recognition of inflectional grammatical morphemes. However, the children who spoke AAE tended to omit these inflections in spoken production and in spelling. The differences between groups in oral production and spelling patterns were consistent with linguistic differences between AAE and SAE. Further, the children who spoke AAE seemed to have more difficulty with dialect-sensitive orthographic patterns, such as inflections, than with dialect-neutral orthographic patterns, such as consonant and vowel patterns (Terry, 2006).

Delays in literacy acquisition for children who use AAE may be due, in part, to task complexity. For example, when home and school dialects are different, tasks such as learning to decode may be more demanding for these children (M. C. Brown et al., 2015).

Collective data from relevant research suggest that a small to moderate negative correlation between nonstandard dialect use and literacy outcome may exist. However, more research is needed to examine the relationship between dialect use and literacy skills (Gatlin & Wanzek, 2015).

For more information, see the ASHA Practice Portal page on bilingual service delivery.

Children Who Are Nonverbal Or Have Limited Speech (including Users Of AAC)

Many of the tasks used to assess literacy skills in children require a verbal response. For children who have impaired speech or no speech (including those who use augmentative and alternative communication [AAC]), it is necessary to modify these tasks so that verbal responses are not required (Barker, Saunders, & Brady, 2012). Examples of modifications for specific tasks typically used in literacy assessment (and intervention) include the following:

  • Phoneme blending—given individual spoken phonemes, pointing to a picture of the corresponding word rather than speaking the word by blending the phonemes (Fallon, Light, McNaughton, Drager, & Hammer, 2004; Truxler & O'Keefe, 2007)
  • Word segmentation—given a spoken word, writing marks on the word to indicate each phoneme rather than speaking each individual phoneme (Blischak, 1994)
  • Initial phoneme identification—given a spoken word, pointing to the printed letter(s) that correspond to the initial phoneme within the word rather than speaking the initial phoneme (Fallon et al., 2004; Millar, Light, & McNaughton, 2004)
  • Spelling (oral)—given a spoken word, using letter tiles to spell the word or using a keyboard to type the word rather than speaking the letter names (Blischak, 1994; Johnston, Davenport, Kanarowski, Rhodehouse, & McDonnell, 2009)
  • Word identification (reading at the single word level)—given a printed word, pointing to a corresponding picture rather than speaking the printed word (Fallon et al., 2004; Hanser & Erickson, 2007)

These assessment modifications can change the nature of the task. For example, by giving a set of stimuli (e.g., pictures, letters, words), the clinician essentially provides a closed set of options (vs. the open-answer format for oral responding), so that the child's response might be correct by chance alone. When assessment modifications like this are made, standardized scores cannot be used, because the tasks are fundamentally different (Barker et al., 2012). Assessment of these students should include elements of dynamic assessment and other informal assessments.

Children With Handwriting Difficulties

Handwriting difficulties can have an impact on the child's ability to spell words in writing, express thoughts adequately in writing, and complete writing tasks in a timely manner. If the child or adolescent has a diagnosed or suspected handwriting disorder, it is important to provide accommodations during assessment. Occupational therapists (OTs) can be consulted on a case-by-case basis to recommend appropriate accommodations (e.g., permitting use of a keyboard or providing a scribe).

Eligibility For Services In The Schools

Children and adolescents with written language (reading or writing) disorders are eligible for speech-language services in the schools, regardless of cognitive abilities or performance on cognitive testing.

As mandated by IDEA (2004), categorically applying a priori criteria (e.g., discrepancies between cognitive abilities and communication functioning, chronological age, or diagnosis) in making decisions on eligibility for services is not consistent with IDEA regulations. See also National Joint Committee for the Communication Needs of Persons With Severe Disabilities (2002) for information related to a priori criteria.

Eligibility for speech-language pathology services is documented in the child's individualized education program (IEP), and the child's goals and the dismissal process are explained to parents and teachers. Dismissal from speech-language pathology services occurs once the criteria for eligibility are no longer met—that is, when the child's communication problem no longer adversely affects academic achievement and functional performance.

For more information about eligibility for services in the schools, see eligibility and dismissal in schools, IDEA Part B Issue Brief: Individualized Education Programs and Eligibility for Services , and 2011 IDEA Part C Final Regulations.

Students with written language disorders are also protected by Section 504 of the Rehabilitation Act of 1973. This law requires that schools provide reasonable accommodations to students with disabilities to ensure academic success and access to the learning environment. A student who requires specialized instruction may have a 504 plan. This plan specifies any necessary accommodation, including modification of assignments, extended time for tests, and sign language interpreters. See Protecting Students With Disabilities.

Common Core State Standards

The Common Core State Standards (CCSS; Common Core State Standards Initiative, 2010) are internationally benchmarked learning standards being implemented in most states across the country. These standards or other state-based content standards constitute a framework of knowledge and skills thought necessary to prepare students to enter college and the workforce.

Students who have language disorders may require specialized instruction and support to access the CCSS because language skills are addressed across subject areas and because the English Language Arts standards focus on the use of language for communication and academic success. See Common Core State Standards: A Resource for SLPs for information and guidance on integrating the CCSS into intervention for students with language disorders.

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