Written Language Disorders

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

Intervention builds on and encourages the reciprocal relationships between spoken and written language. SLPs can take advantage of these interrelationships by showing students how to capitalize on areas of strength while working to improve areas of weakness. For example, at the sound/syllable/word level, a student could be taught to associate reading and spelling of certain orthographic and morphemic patterns in reciprocal fashion to build automaticity. At the sentence/discourse level, the student can be taught to use causal connecting words such as because or therefore to express complex relationships among ideas when writing, and then draw on this awareness of sentence construction to deconstruct sentences when reading.

The goal is to improve language and communication across both spoken and written language forms in a way that is relevant to the student's general education curriculum and that helps students achieve mastery of states' content standards (e.g., Common Core State Standards: A Resource for SLPs), particularly in English Language Arts. Guidelines for literacy considerations that apply to broad populations of older students are included in the resource section of this page.

It is also important to consider the child's functioning in areas related to spoken and written language, including hearing, cognition, and speech sound production. In addition, children bring different backgrounds to the treatment setting. Direct instruction in morphosyntax and dialect-influenced inflections benefit children who use AAE (Terry, 2006). For bilingual children, the clinician must consider the language(s) used during intervention. First language skills may be used to access higher order English literacy skills (e.g., providing definitions and interpreting metaphors) to develop English literacy (August & Shanahan, 2006). For more information, see the ASHA Practice Portal page on bilingual service delivery.

Treatment Approaches

Intervention for reading, writing, and spelling is complex. Literacy activities in the classroom rarely involve only one of these skills; for example, writing a story requires writing (process and product) as well as spelling and reading (e.g., proofreading for editing, making content revisions).

It is important to design literacy intervention programs with a balanced focus on all areas of difficulty, which may include both sound/syllable/word–level decoding/encoding (spelling) and sentence/discourse–level comprehension and composition. Although the focus of intervention may, at times, be on specific skills, it is important to teach them in the context of authentic language uses whenever possible.

The following reading, writing, and spelling approaches are listed separately and by skill area for descriptive purposes only. Multiple approaches are often used in combination, and more than one skill can be addressed at any given time (Weaver, 1998).

Reading

  • Word structure approaches focus on reading decoding — systematic and explicit approaches that are designed to teach such elements as grapheme-phoneme correspondences (for reading and spelling regular words), irregular orthographic patterns, and associations of morphemic components of words and orthographic patterns.
  • Language comprehension approaches focus on identifying and closing gaps in comprehension that may be due to problems with discourse organization, understanding of cohesive devices, unpacking of syntactic complexity, recognition of unknown vocabulary, and the ability to make sense of words in context.

Writing

  • Process-oriented approaches focus on the processes involved in writing, including developing ideas, planning (pre-writing), organizing, drafting, reflecting, revising, and editing.
  • Product-oriented approaches focus on the written form, including vocabulary, spelling, and grammar; use of cohesive devices; use of writing conventions; and effectiveness of intended communication.

    Address both process and product simultaneously, when possible.

Spelling

  • Auditory (e.g., phonemic awareness)
  • Visual (e.g., attending to words in print—orthographic pattern awareness)
  • Kinesthetic (e.g., tracing letters of a new word)
  • Multisensory approaches that integrate auditory, visual, and kinesthetic approaches
  • Developmental sequence of spelling to facilitate acquisition of conventional spelling skills
  • Memorization and testing of selected words in list format and in composition

Intervention Targets

Basic principles of effective intervention include the following (Roth & Worthington, 2015):

  • Provide intervention that includes ongoing assessment of the child's progress in relation to his or her goals, modifying them as necessary.
  • Provide intervention that is individualized, based on the nature of a child's deficits and individual learning style.
  • Tailor treatment goals to promote a child's knowledge, one step beyond the current level.

See intervention target areas for a listing of target areas by developmental level.

Treatment Options

Below are brief descriptions of general and specific treatments for addressing disorders of reading and writing. Some attempt has been made to organize treatment options into broader categories, recognizing that they do not always fit neatly into one particular category. This list is not exhaustive, and the inclusion of any specific treatment does not imply endorsement from ASHA. Further, treatment targets (see intervention target areas) should guide selection of treatment options. Ideally, clinicians use a variety of approaches and tools, based on the needs of the individual.

SLPs and educators determine which methods and strategies are appropriate by taking into consideration the individual's language profile and learning style, his or her cultural background and values, the severity of the language disorder, factors related to language functioning (e.g., hearing impairment and cognitive functioning), communication needs, and available research evidence (see the written language disorders evidence map).

Comprehension Strategy Instruction

Comprehension strategy instruction involves teaching students (via direct instruction, modeling, guided practice, and application) to use specific strategies to facilitate reading comprehension (e.g., Stahl, 2004). Strategies include prediction (using inferencing and drawing on prior knowledge); imagery (creating mental images that help keep track of what was read); summarizing (condensing/paraphrasing key information from text); and questioning (monitoring comprehension and generating questions to keep track of what was read and how ideas are related).

Cooperative Integrated Reading and Composition®

Cooperative Integrated Reading and Composition® (CIRC®; e.g., Stevens, Slavin & Farnish, 1991) is a reading and writing program for students in Grades 2–6 that consists of story-related activities, reading comprehension instruction, and integrated language arts/writing. Students practice in pairs and small groups. Activities include reading to each other; predicting story endings; discussing the main idea of a story; writing responses to questions; and practicing vocabulary, decoding and spelling. A Spanish version of the program is available for Grades 2–5.

Dyslexia Training Program

The Dyslexia Training Program (e.g., Beckham & Biddle, 1989) is a reading intervention program that uses direct and systematic instruction to teach reading and spelling. The program has a strong emphasis on phonemic awareness and alphabetic code knowledge. Multisensory lessons target phonemic awareness, phonics, reading fluency, vocabulary, and reading comprehension. A daily lesson plan cycle introduces new concepts and provides the student with opportunities to practice skills in alphabetic knowledge, reading, spelling, reading comprehension, and handwriting. The Dyslexia Training Program is most appropriate for Grades 2–5.

Enhanced Proactive Reading

Enhanced Proactive Reading (e.g., Vaughn et al., 2006) is a comprehensive curriculum that integrates reading, language arts, and English language development. It targets first-grade English language learners (ELLs) who have had difficulty learning to read through conventional methods of instruction. Teachers provide students with daily reading lessons in small groups. Lessons focus on phonemic awareness, letter knowledge, word recognition, reading fluency, and reading comprehension. All students are given the opportunity to participate and are given individual feedback.

Graphic Organizers

Graphic organizers, also referred to as knowledge maps, concept diagrams, and cognitive organizers, are visual displays that show the relationships among facts, terms, and ideas. Examples of graphic organizers used for different tasks include problem–solution maps, sequential episode maps, comparison–contrast maps, and cause–effect maps. Graphic organizers can be used to support reading comprehension by helping students to take notes and to understand various text genres (e.g., Kim, Vaughn, Wanzek, & Wei, 2004).

Lindamood Phoneme Sequencing®

Lindamood Phoneme Sequencing® (LiPS®; Lindamood & Lindamood, 1998) is a comprehensive multisensory program that uses systematic and explicit instruction to teach phonological awareness, decoding, spelling, and reading skills. The goal of the program is to develop fluent readers and competent spellers. Tasks progress from articulatory movement to sound, then to letter; students develop an oral–motor, auditory, and visual feedback system that enables them to verify the identity, number, and order of phonemes in syllables and words. Phonemic awareness, once established, can be applied to reading, spelling, and speech. LiPS® can be used with individuals (of all ages), small groups, and classrooms.

Orton-Gillingham–Based Interventions

The Orton-Gillingham approach (e.g., Ritchey & Goeke, 2006) is an intensive, sequential, phonics-based system that teaches the basics of word formation before whole meaning. It is a language-based, multisensory instructional approach that uses visual, auditory, and kinesthetic learning modalities. This approach is used for students with reading, spelling, and writing difficulties typically associated with dyslexia. It is most often associated with one-on-one instruction, but its use in small-group instruction is not uncommon. An adaptation of the approach has been used for classroom instruction, as well.

Alphabetic Phonics

Alphabetic Phonics (e.g., Cox, 1985) is an Orton-Gillingham–based approach that teaches phonics and the structure of language at both elementary and secondary levels. The program simultaneously engages visual, auditory, and kinesthetic modalities to teach spelling, reading, reading comprehension, handwriting, and oral and written expression. Materials include lesson plans, workbooks, drill cards, and tests for assessing performance.

Barton Reading and Spelling System®

The Barton Reading & Spelling System® (Barton, 2000) is a one-to-one tutor­ing system designed for students of any age who struggle with reading accuracy, fluency, spelling, or writing. Although the program is designed to be one-to-one, it can also be used in small-group settings. It consists of 10 levels that cover the methods and sequence of teaching reading, spelling, and writing. To participate, students must speak and understand English at or above the second-grade level; it is also recommended that they pass screenings for significant deficits in auditory discrimination and/or auditory memory.

Wilson Reading System®

The Wilson Reading System® (Wilson, 1998) is a supplemental reading and writing program based on Orton-Gillingham principles. It is designed to promote reading and spelling skills by teaching phonemic awareness, sound–symbol relationships, spelling, vocabulary, oral expression, sight word reading, reading fluency, and reading comprehension. Activities include hearing sounds, practicing syllables, and listening to others read, as well as reading aloud and summarizing what was read.

Reading Apprenticeship®

Reading Apprenticeship® (e.g., Schoenbach, Greenleaf, Cziko, & Hurwitz, 1999) is an instructional program intended for students in middle school, high school, and community college and is designed to improve their engagement, fluency, and comprehension of content-area materials and texts. It includes professional development activities for teachers and an academic literacy curriculum for students. Teachers model and guide students' text-based problem-solving to facilitate the development of comprehension strategies. The discussion of the reading processes within content-area classes helps students to understand and regulate their own reading processes as well as to develop strategies for overcoming reading obstacles and improving comprehension of texts from core academic disciplines.

Reading-aloud Interventions

Dialogic Reading

Dialogic reading is an interactive, shared, picture book–reading activity designed to enhance the language and literacy skills of young children (e.g., Zevenbergen & Whitehurst, 2003). During the shared reading practice, the child and adult take turns “reading.” In this way, the child learns to become the storyteller with the help of the adult, who takes on the role of an active listener and questioner. Interactive Shared Book Reading and Shared Book Reading are two related practices.

Repeated Reading

Repeated reading is a practice designed to increase oral reading fluency (e.g., Lo, Cooke, & Starling, 2011). It can be used with students who have word reading skills but demonstrate inadequate reading fluency for their grade level. The student reads a passage aloud to the teacher at least three times. If the student misreads a word or hesitates longer than 5 seconds, then the teacher reads the word aloud, and the student repeats it correctly. The student can also request help from the teacher on a particular word. The student continues to reread the passage until an adequate level of fluency is achieved. Other methods for improving oral reading fluency include reading while listening or echo reading, choral reading, and neurological impress or shadowing.

Road to the Code

Road to the Code (Blachman, Ball, Black, & Tangel, 2000) is a phonological awareness program for young children focusing on phonemic awareness and letter–sound correspondence. Lessons are developmentally sequenced and provide students with repeated opportunities to practice and enhance beginning reading and spelling skills. Each lesson consists of three activities: say-it-and-move-it (a phoneme segmentation activity), letter name and sound instruction, and phonological awareness practice.

Self-regulated Strategy Development (SRSD)

Self-regulated strategy development (SRSD) is an instructional approach designed to help students learn and use the strategies used by skilled writers (Harris & Graham, 1992). For example, skilled writers plan extensively, consider the audience, organize their ideas, recognize problems in the written product, and revise it accordingly. The SRSD approach adds self-regulation to strategy instruction for writing, which encourages students to monitor, evaluate, and revise their writing. Like other types of strategy instruction, the aim of SRSD instruction is to help students develop executive function skills by becoming self-directed writers and integrating strategies into the overall writing process.

SPELL-Links To Reading And Writing

SPELL-Links to Reading and Writing (Wasowicz, Apel, Masterson, & Whitney, 2012) is a word study curriculum that targets phonological awareness, phonics, vocabulary, word parts and related words, and mental images of words. It includes games, activities, and guided learning opportunities. Activities can be administered to individuals, small groups or whole classrooms. The curriculum teaches critical word study strategies and promotes word study across the curriculum.

Stepping Stones To Literacy (SSL)

Stepping Stones to Literacy (SSL; Gonzalez & Nelson, 2003) is a supplemental curriculum for kindergarten and older preschool children who have been identified as at risk for reading failure. SSL focuses on critical skills for reading success, including listening, awareness of print conventions, phonemic awareness, and rapid naming of familiar visual stimuli (e.g., letters and colors). The curriculum consists of 25 intensive daily lessons delivered individually or in small groups.

Teaching Story Grammar

Teaching story grammar is a technique for familiarizing students with the components of narrative story structure­ (e.g., setting, main characters, problem, and resolution) to help them understand stories and make predictions while reading. Visual symbols or manipulables that represent each story component are used as cues to facilitate initial learning and guide later narrative comprehension (e.g., Dymock, 2007). Students are often taught sentence structure (e.g., microstructure) in conjunction with story grammar (macrostructure) instruction.

Words Their Way™

Words Their Way™ (Bear, Invernizzi, Templeton, & Johnston, 2015) is an approach to teaching phonics, vocabulary, and spelling to students in kindergarten through high school. Five developmental stages are targeted: emergent; letter name–alphabetic; within-word pattern; syllables and affixes; and derivational relations. The program provides a practical way to study words (i.e., examine, manipulate, compare, and categorize); discover logic and consistency in written language; and learn to recognize, spell, and define words.

Writing Lab Approach

The writing lab approach uses computers to support literacy instruction and writing opportunities. Using this approach, SLPs work collaboratively with general and special educators to foster language growth using inclusive, curriculum-based, computer-supported writing process instruction. Students engage in authentic writing projects and use recurrent writing processes consisting of planning, organizing, revising, editing, publishing, and presenting. Students are supported through instructional scaffolding, and their individualized needs can be addressed while working toward general curriculum goals (Nelson & Van Meter, 2006; Nelson, Van Meter, Chamberlain, & Bahr, 2001).

Computer-Based Technologies

A variety of computer-based technologies are available to promote independent and successful reading and writing by enabling individuals to accomplish tasks that were previously difficult for them to perform. These technologies include software programs that help improve phonological awareness and facilitate vocabulary acquisition and spelling; convert text to speech (screen readers) and speech to text (voice recognition); predict words while writing; and help students plan, compose, and revise their written work.

Some computer-based technologies are designed for general use or to supplement classroom literacy activities. Others are specifically targeted for use by individuals who struggle with reading and/or writing.

A variety of apps are also available for iPads and other tablet devices (see the ASHA web page titled Applications (Apps) for Speech-Language Pathology Practice).

The following list is not exhaustive, and any specific product does not imply endorsement from ASHA. Treatment targets (see intervention target area) should guide selection of treatment options. Ideally, clinicians use a variety of tools based on the needs of the individual.

ABC Phonics Word Family Writing

ABC Phonics Word Family Writing is an iPad application that uses an interactive game format to help children learn how to write, spell, and read. Using word families and more than 600 vocabulary words, the game helps children recognize common word patterns and understand how the initial consonant, middle vowels, and ending consonant affect pronunciation. The application includes two learning modules—Word Flashcards, which allows the child to see the spelling and hear the word, and Writing Words, which allows the child to practice spelling the words using a “trace letter-by-letter” format.

Co:Writer®

Co:Writer® is a type-and-speak writing tool developed to help users write complete and correct sentences with very few keystrokes. As letters are typed, Co:Writer® predicts and suggests possible words from its grammar-smart dictionary, and the user can choose the most appropriate word with one keystroke or mouse click. Co:Writer® can speak the suggested words and, if needed, can speak letters, words, and finished sentences as they are entered. Co:Writer® can be used in combination with other computer applications (e.g., word processor and story-writing programs).

First Author

First Author is a writing software product used to promote independent writing in students with complex instructional needs (e.g., severe speech and physical impairments). The program helps students plan, compose, revise, and publish by guiding them through a three-step process—choosing a topic, selecting a picture prompt, and writing with the help of built-in accommodations. The student's writing progress is tracked and graphed automatically.

Lexia® Learning Systems

Lexia® Learning Systems are software programs designed to supplement classroom reading instruction. They use a variety of activities to enhance phonics skills via word-attack strategies at the letter, word, sentence and paragraph levels. Lexia Phonics-Based Reading™ for younger children contains three levels of practice, beginning with letter/sound correspondence for short vowels and consonants, advancing to decoding from simple words to more complex words, and moving on to constructing one- and two-syllable words. Lexia Strategies for Older Students™ is designed to help struggling students in the higher grades increase automatic word recognition by reinforcing phonics and sound–symbol correspondence.

Read 180®

READ 180®is a reading program designed to meet the needs of students in elementary through high school whose reading achievement is below the proficient level. The program addresses student needs through use of computer software, literature of interest to the student, and direct reading instruction. Students participate in whole-group and small-group instruction, including computer work as well as reading and writing activities. The software allows for individualized instruction by collecting student response data and adjusting the instructional level accordingly.

Read, Write & TypeTM

Read, Write & Type™ is a software program and set of materials that address phonics, spelling, keyboarding, and word processing skills. It enables children to write whatever they can say. Read, Write & Type™ was developed for 6- to 9-year-old students who are just beginning to read and for students who are struggling to read and write. The program helps students develop an awareness of English phonemes by teaching them to associate each phoneme with a letter or a combination of letters and by pairing each phoneme with a finger stroke on the keyboard. Children also learn to identify sounds in words, sound out words fluently, and type and read regularly spelled words.

WordQ®

WordQ® is a writing tool that provides spelling, grammar, and punctuation assistance. It is designed for individuals who struggle with writing. Using advanced word prediction, WordQ suggests words and provides spoken (text-to-speech) feedback, so students hear sentences repeated and detect mistakes as they go. Although WordQ is primarily a writing tool, it can also assist with reading; using its text-to-speech function, any text (e.g., e-mails and website content) can be selected and “read aloud.”

WriteAssist

WriteAssist is a word prediction software program designed for use by individuals with dyslexia or learning disabilities. It uses context-dependent word prediction to suggest the next possible word, based on grammatical patterns and context. WriteAssist can also incorporate new words into its extensive dictionary. In addition to predicting words, the program also reads text and checks for correct spelling of homophones (i.e., words with different spellings, meanings, or origins but the same pronunciation, like stake and steak). WriteAssist can read text aloud at the word, sentence, paragraph, or completed document levels.

Intervention For Children With Handwriting Difficulties

SLPs rarely work on the motoric aspects of handwriting, but they may collaborate with OTs to help students develop self-talk strategies associated with performing the systematic, sequential movements required to form letters. Letter formation may be taught in association with letter recognition and with the pronunciation and perception of related phonemes as part of a comprehensive multisensory or multisystemic approach to developing sound–symbol associations and word structure knowledge (e.g., Andrews & Lombardino, 2014; Gillingham & Stillman, 1997; Wolf, 2005).

See collaboration and teaming and ASHA's web page on Interprofessional Education/Interprofessional Practice (IPE/IPP).

Intervention For Children With Complex Communication Needs

Children with limited cognitive abilities and/or severe physical impairments often have had limited early literacy experiences, reading instruction, or access to physically manageable writing systems (Koppenhaver, Coleman, Kalman, & Yoder, 1991; Koppenhaver & Yoder, 1993; Light, Binger, & Kelford Smith, 1994; Light & Kelford Smith, 1993; Light & McNaughton, 1993).

It is important to provide access to literacy through writing for this population (Sturm, 2012). Intervention may include opportunities to hear written language read aloud (e.g., via text-to-speech programs) and to provide assistive technology (e.g., computers, tablets, AAC devices, etc.) and other supports (e.g., scribes) to foster independent reading and writing. For example, AAC systems and technologies that support both communication and literacy instruction—and that allow ease of movement between reading, writing, and communicating—would be ideal (Sturm, 2003; Sturm, Erickson, & Yoder, 2002).

Intervention for Children Who Are Deaf Or Hard of Hearing

Children who are deaf or hard of hearing (DHH) traditionally demonstrate lower reading achievement levels when compared with their hearing peers (e.g., Holt, Traxler, & Allen, 1997; Karchmer & Mitchell, 2003; Nelson & Crumpton, 2015; Traxler, 2000).

Lack of adequate access to phonological information and problems acquiring grapheme–phoneme knowledge may contribute to lower reading achievement in this population (Perfetti & Sandak, 2000; Trezek, Wang, & Paul, 2010). Strategies that have been used to support grapheme–phoneme acquisition, or that serve as an alternate for children who are DHH, include the following (Trucci, Trussel, & Easterbrooks, 2014):

  • Visual phonics—a system that uses distinct hand shapes for each English phoneme to clarify sound–symbol relationships; hand shapes represent movements of the mouth, tongue, and throat during oral production that can be associated with the printed letter or letters
  • Fingerspelling—a system that uses hand shapes, each of which corresponds to a letter in the English alphabet

Children who are DHH may also be at a disadvantage when it comes to comprehending what they read. Skilled readers have extensive background knowledge that they can relate to information in the text to help them understand what they read (Pressley, 2002). Children who are DHH often do not have the same amount of background knowledge as their hearing peers (Schirmer, 2000), possibly due to fewer opportunities for incidental learning (e.g., McIntosh, Sulzen, Reeder, & Kidd, 1994). Their background knowledge may also be less richly connected (McEvoy, Marschark, & Nelson, 1999), and they are less likely to make connections while reading (Marschark & Wauters, 2008). Strategies to improve reading comprehension in this population include

  • giving explicit instruction in using comprehension strategies (e.g., prediction, questioning, and summarizing) and
  • providing opportunities to gain and activate background knowledge (e.g., in-class experiences; watching videos about a topic; using mental imagery to imagine what you might experience in a story; Luckner & Handley, 2008).

See ASHA's Practice Portal pages on permanent childhood hearing loss and hearing loss - beyond early childhood.

Transitioning Youth and Postsecondary Students

Difficulties experienced by children and adolescents with written language impairment can continue to affect functioning in postsecondary education and vocational settings. This potential impact highlights the need for continued support to facilitate a successful transition to young adulthood.

A functional curriculum approach is frequently taken for transitioning students. This approach focuses on teaching skills that will help the student function independently in society. Functional goals might include reading and evaluating job ads, reading and completing applications for jobs or for postsecondary school, reading and comprehending a driver's test manual, and learning to self-advocate for accommodations and services in the classroom and workplace. For more information about transition planning and goals, support services, and relevant laws, see ASHA's page on transitioning youth.

Service Delivery

In addition to determining the type of speech and language treatment that is optimal for children with written language disorders, SLPs consider other service delivery variables—including format, provider, dosage, timing, and setting—that may affect treatment outcomes. See Cirrin et al. (2010) for a review of research on the effects of different service delivery models on communication outcomes in elementary school–age children.

  • Format—whether a person is seen for treatment one-on-one (i.e., individual) or as part of a group
  • Provider—the person providing treatment (e.g., SLP, trained volunteer, caregiver)
  • Dosage—the frequency, intensity, and duration of service
  • Timing—when the intervention is conducted relative to the diagnosis
  • Setting—the location of treatment (e.g., home, community-based, school)

Content Disclaimer: The Practice Portal, ASHA policy documents, and guidelines contain information for use in all settings; however, members must consider all applicable local, state and federal requirements when applying the information in their specific work setting.