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Written Language Disorders

See the Written Language Disorders (School-Age) Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.

The scope of this Practice Portal page is limited to written language disorders (i.e., disorders of reading and writing) in preschool and school-age children (3–21 years old). It can be understood best in relation to the companion Practice Portal on Spoken Language Disorders.

A disorder of written language involves a significant impairment in fluent word reading (i.e., reading decoding and sight word recognition), reading comprehension, written spelling, and/or written expression (Ehri, 2000; Gough & Tunmer, 1986; Kamhi & Catts, 2012; Tunmer & Chapman, 2007, 2012). A word reading disorder is also known as dyslexia.

An appropriate assessment and treatment of written language disorders often incorporates interprofessional education/interprofessional practice (IPE/IPP). Members of the interprofessional practice team may include, but are not limited to, the following:

  • reading specialist
  • occupational therapist
  • special educator
  • learning specialist
  • physical therapist
  • speech-language pathologist
  • “English as a second language” teacher

Written language disorders, as with spoken language disorders, can involve any or a combination of the five language domains (i.e., phonology, morphology, syntax, semantics, and pragmatics) as well as the spelling system of a language, or orthography. Problems can occur in the awareness, comprehension, and production of language at the phonemic, syllable, word, sentence, and discourse levels, as indicated below (Nelson, 2014; Nelson et al., 2015). In cases of dyslexia, phonological processing problems are a core deficit (Hogan et al., 2005; Seidenberg, 2017). See ASHA's resources on Disorders of Reading and Writing and Language In Brief for further information.

Sound-, Syllable-, and Word-Level Difficulties

  • Difficulty with phonological and morphological structures of words
  • Difficulty forming stable associations with the orthographic representations of words and letters in print
  • Impaired reading decoding and written spelling skills

Sentence- and Discourse-Level Difficulties

  • Difficulty recognizing discourse components
  • Difficulty using syntax and cohesive devices to represent relationships among ideas
  • Impaired reading comprehension and formulation of academic discourse (narrative and expository) and social communication

A relationship may exist between language disorders and learning disabilities, as indicated in the following definition of specific learning disability:

The term “specific learning disability” means a disorder in one or more of the psychological processes involved in understanding or in using language, spoken or written, which may manifest itself in an imperfect ability to listen, speak, read, write, spell, or do mathematical calculations. (Individuals with Disabilities Education Improvement Act of 2004)

A learning disability label may be used once academic struggles with reading and writing are identified, even though the underlying issue is a language disorder (Sun & Wallach, 2014).

A written language disorder may occur in the presence of other conditions, such as the following:

  • spoken language disorder
  • attention-deficit/hyperactivity disorder
  • emotional disability
  • intellectual disability
  • deaf or hard of hearing
  • autism spectrum disorder

Relationship Between Spoken and Written Language in Alphabetic Systems

There are strong relationships between spoken and written language, such as the role of phonological awareness in decoding as well as the roles of vocabulary and syntax in reading (e.g., Hulme & Snowling, 2013; Kamhi & Catts, 2012). These relationships are underscored in the simple (or narrow) view of reading, which includes decoding and linguistic comprehension as the primary components (Gough & Tunmer, 1986). Understanding the relationships of spoken and written language is key to developing reading comprehension skills (Tunmer & Chapman, 2012) as well as developing automatic retrieval (for spelling) and automatic identification (for reading; Ehri, 2014; Richards et al., 2006).

Children need strong knowledge of both spoken and written language in order to be successful readers and writers. Children with spoken language problems frequently have difficulty learning to read and write, and conversely, children with reading and writing problems often have difficulty with spoken language (Kamhi & Catts, 2012). For more details, see the Practice Portal page on Spoken Language Disorders; see also Language In Brief and Disorders of Reading and Writing.

Reading

Reading is the process by which an individual constructs meaning by transforming printed symbols in the form of letters or visual characters into recognizable words. Components of reading are outlined in the following definitions:

  • Word recognition—the ability to identify words when reading, either through word decoding or sight word identification
    • Phonological decoding—the ability to transform letter strings into the phonological components of a corresponding spoken word
    • Sight word identification—automatic visual recognition of a word and its meaning
  • Reading fluency—the ability to recognize and read words within a text with accuracy, using appropriate intonation, rhythm, and speed
    • Reading fluency is affected by reading automaticity, which is the ability to read a list of words serially and accurately within a specified time.
    • Reading fluency combines rapid decoding and sight word identification.
  • Reading comprehension—the ability to understand the meaning of written text
    • Comprehension includes vocabulary knowledge, using morphological structures of written words to extract word meaning, using cues to “unpack” complex syntax, and understanding different discourse structures (e.g., fiction or expository text).
    • Comprehension requires executive function skills (e.g., the ability to use prior knowledge and make inferences and predictions, the ability to monitor one’s reading comprehension).

For information about research supporting the five key components of reading instruction (i.e., phonemic awareness, phonics, fluency, vocabulary, and text comprehension), see the National Reading Panel report (National Institute of Child Health and Human Development, 2000).

Writing

Writing is the process of communicating ideas using printed symbols in the form of letters or visual characters, which make up words. Words are formulated into sentences; these sentences are organized into larger paragraphs and often into different discourse genres (narrative, expository, persuasive, poetic, etc.).

Writing includes the following:

  • Writing process—the ability to plan, organize, draft, reflect on, revise, and edit written text; the ability to address specific audience needs and convey the purpose of the text (e.g., persuasion)
  • Written product—the end product of the writing process

The written product may be described in terms of the following components:

  • Word level—word choice, spelling, morphology
  • Sentence level—syntax and complexity, content and punctuation
  • Text level—organizational structure, coherence and cohesiveness
  • Writing conventions—capitalization and punctuation of a written product
  • Communication functions—to inform, to persuade
  • Organizational structure—chronological, sequential, compare and contrast
  • Effectiveness in meeting the information needs of the audience

Handwriting difficulties can have an impact on a child’s ability to spell words in writing, express thoughts adequately in writing, and complete writing tasks in a timely manner. Developmental handwriting difficulties are associated with deficits in orthographic coding, which involves mapping the abstract representation of letters to the motor movements used to write words (McCloskey & Rapp, 2017). It is important to provide accommodations during assessment and for instruction if the child or adolescent has been diagnosed as or is suspected of having a handwriting disorder. Occupational therapists can be consulted on a case-by-case basis to recommend appropriate accommodations (e.g., permitting use of a keyboard or providing a scribe). However, handwriting is not only a motor skill; it is also a written language skill, and handwriting instruction may be integrated with reading and writing instruction when appropriate.

Spelling

Spelling, or phonological encoding, is the process of mapping from phoneme to grapheme to spell the spoken word in written form. Spelling requires the ability to segment words into phonemes (units of sound that distinguish one word from another, e.g., /k/ as in /kʌp/) and the ability to map those phonemes onto graphemes (units of letters that represent sounds, e.g., “c” as in “cup”) in the correct order in written form. Words may be spelled regularly (i.e., follow traditional spelling conventions) or irregularly (i.e., do not follow traditional spelling conventions). In addition, children learn spelling or graphotactic rules often taught through phonics instruction (Treiman, 2018). Only about 4% English words are irregular, and English spelling is more predictable when considering language of origin and history, meaning and part(s) of speech, speech sound spelling patterns, and word position constraints (Moats, 2005/2006).

Difficulty or progress in either spelling or the foundational language knowledge areas that support it can influence word-level reading, reading comprehension, and writing composition (Apel, 2009). Given the interconnectedness of spelling and the language areas above, spelling ability affects other areas of literacy. This interconnectedness also helps explain why individuals could be adept at reading and still have challenges with spelling and/or writing. 

Foundational language knowledge areas that support spelling include the following:

  • Phonological knowledge—the conscious and active recognition and manipulation of individual sounds (phonemes) in words. It supports spelling when phonological knowledge is used to segment words into individual phonemes to spell unknown words (Kamhi & Catts, 2012).
  • Orthographic knowledge—the understanding of how oral language is represented in writing (Apel, 2011; Apel et al., 2019)
    • Orthographic pattern knowledge includes the set of patterns or conventions that govern the translation of speech into print. This may include knowledge of letter sounds (e.g., “j,” “g,” “gde” for /ʤ/), permissible letter combinations (e.g., “qu,” not “qw”), rules for spelling roots and base words (e.g., “strike” and “made” have a long vowel and a silent “e”), and positional constraints for letters across word positions (e.g., “pr” is typically found only in initial and medial positions).
    • Mental graphemic representations (MGRs) or mental orthographic images refer to mental images of written words or word parts stored in the mental orthographic lexicon. When MGRs or mental orthographic images are strong, spellers (and readers) perform fluently and accurately without expending cognitive energy for composition or decoding.
  • Semantic knowledge relates to the recognition of how meaning impacts spelling. Writers use semantic knowledge to explicitly consider how spelling is influenced by meaning, and vice versa (“there”/“their”/“they’re”). With this knowledge, writers can choose accurate spellings of words to convey their intended meaning (Kamhi & Catts, 2012).
  • Morphological knowledge helps spellers direct explicit attention to the morphemic structure of words. This includes changes that occur when morphemes are added to base words (“hop” to “hopped,” doubling the “p”), the relationship between morphological word families (“read”: “reread,” “reader,” “nonreader,” “reading,” “reads,” “unreadable”), and recognition of the fixed spelling of affixes (anti–, sub–, –ed, –ness; Kamhi & Catts, 2012).

Spelling depends on phonological awareness, orthographic pattern awareness, and semantic/morphological awareness; conscious (explicitly taught) and subconscious (statistically learned) knowledge of phonological, orthographic, and morphological representations of words and their parts; the development of orthographic representations (also called “MGRs” and “mental images”) of specific words and word parts in long-term memory (called the orthographic lexicon); and the ability to create mental models of their interrelationships (e.g., Apel & Masterson, 2001; Berninger et al., 2008; Bourassa & Treiman, 2001; Ehri, 2000; Masterson & Apel, 2007).

Reading and Writing Across Languages and in Dual Language Learners (DLLs)

Writing systems across languages vary in their spelling-to-sound relations or grapheme–phoneme consistency. Extensive research indicates that readers in consistent or shallow orthographies (e.g., Spanish, Finnish, Greek) have an advantage during the early stages of reading for the establishment of spelling-to-sound relations or decoding (Caravolas et al., 2019; Seymour et al., 2003; Spencer & Hanley, 2004). DLLs can effectively learn to read and write across languages following a biliteracy approach (August & Shanahan, 2006; Butvilofsky et al., 2016). For DLLs with reading difficulties, biliteracy can afford the benefits of a shallow orthography during the early stages of reading. That is, the consistency in spelling-to-sound relations can facilitate decoding and phonological awareness in struggling DLL readers.

Incidence of written language disorders refers to the number of new cases identified in a specified time period. Prevalence of written language disorders refers to the number of people who are living with the condition in a given time period.

Incidence and prevalence of written language disorders vary across research studies due to differences in participant characteristics, study designs, methodology (e.g., different outcomes measured), and diagnostic classification criteria within and across subtypes of written language disorder.

Reading and Writing Disorders

Based on a population-based birth cohort in Rochester, Minnesota, between 5.3% and 11.8% of children and adolescents were estimated to have a reading disorder (Katusic et al., 2001), and between 6.9% and 14.7% were estimated to have a writing disorder by 19 years of age (Katusic et al., 2009). In an epidemiological study that involved 493 participants, Catts, Compton, et al. (2012) estimated that approximately 32% of the participants in the study experienced reading difficulties that could be considered a reading disability at one or more grades. Of the 32% of participants with reading difficulties, 6% had early reading problems, 52% were persistent poor readers (i.e., poor readers throughout all grades), and 42% were late poor readers (i.e., reading problems were evident after the fourth grade). Many poor readers, however, do not always qualify as having reading disorders.

Co-Occurring Speech and Language Impairments

Higher rates of all forms of written language disorders have been documented in children with speech and/or language impairments. By the end of kindergarten, more than 25% of children with language impairment were reported to also be poor readers (Murphy et al., 2016). Additionally, Stoeckel et al. (2013) compared the cumulative incidence of written language disorder by the age of 19 years in children with and without speech and/or language impairments. The findings revealed higher incidences of writing disorders with accompanying reading disorders as well as writing disorders alone among children with communication impairments (see Table 1).

Individuals with speech and/or language impairments Individuals without speech and/or language impairments
Written language disorder only 9.1% 4.1%
Written language disorder with reading disorder 50.1% 9.9%

Table 1. Rates of written language disorder in children with and without speech and/or language impairments.

Additional Considerations

Gender

Studies reported results based on gender; however, there were no indications on whether the data collected were based on sex assigned at birth, gender identity, or both. Males were estimated to be 1.83 times more likely than females to be identified with reading problems. Findings also indicated that the gender differences between males and females increased with more severe reading problems (Quinn, 2018). Based on Stoeckel et al. (2013), the cumulative incidence of written language disorder was also higher in males compared to females, including those with (61.4% vs. 55.1%) and those without (18.5% vs. 9.4%) speech and/or language impairments.

Attention-Deficit/Hyperactivity Disorder (ADHD)

Children with ADHD have demonstrated a greater risk for written language disorder and/or reading disability. By 19 years of age, the cumulative incidences of written language disorder with an accompanying reading disability and written language disorder alone were estimated to be 45.9% and 16.6%, respectively, in children with ADHD (Yoshimasu et al., 2011). Similarly, the cumulative incidence of reading disability was revealed to be significantly higher in children with ADHD (51% in boys, 46.7% in girls; Yoshimasu et al., 2010).

Autism Spectrum Disorder

Mayes and Calhoun (2006) revealed that 60% of children with autism without intellectual disability had a learning disability in written expression. Learning disabilities in reading and spelling among children with autism were indicated to be lower, with 6% and 9%, respectively. Although children with autism without intellectual disability were found to have similar rates of reading disability as the general population, findings from Baixauli et al. (2021) indicated that adolescents with autism who do not have an intellectual disability performed significantly poorer on reading comprehension tasks requiring cognitive flexibility (e.g., perception, conflict monitoring).

Youth in the Juvenile Justice System

Youth with reading disabilities were found to be prevalent in the juvenile justice system. According to a British study, approximately 43%–57% of participating juvenile offenders could be classified with a reading disability. Almost 39% of juvenile offenders demonstrated phonological difficulties, a skill associated with reading development (Snowling et al., 2000).

Signs and symptoms of written language disorders vary across individuals, depending on the language domain(s) affected, severity and level of disruption to communication, age of the individual, and stage of linguistic development.

In preschool and kindergarten, children who are at risk for reading disorders are likely to have difficulty with phonological awareness and phonics (Torgesen, 2002, 2004). This problem may continue as they work to develop the skills they need for accurate and fluent word recognition.

Some children are identified as having reading difficulties only when they reach higher elementary grades (fourth grade and above), when the focus of reading changes from “learning to read” to “reading to learn” (Chall, 1983) and the emphasis shifts from word recognition and spelling to reading comprehension and use of reading comprehension strategies (Leach et al., 2003).

Poor reading comprehension test scores in these post-primary grades can be the first indicators of reading problems. These difficulties are likely to be accompanied by weak higher order comprehension skills in areas such as metacognitive awareness (e.g., Anderson, 1980; Wong & Wong, 1986) and use of strategies to aid comprehension (e.g., Hare & Pulliam, 1980; Kletzein, 1991). Comprehension difficulties also may reflect mild or well-disguised reading acquisition problems (e.g., word-level reading skills) that become more severe with increasing word-level decoding demands (e.g., Juel, 1991; LaBerge & Samuels, 1974; Perfetti, 1985; Salceda et al., 2013).

See Signs and Symptoms of Written Language Disorders. Be mindful that some signs and symptoms may be influenced by cultural and linguistic variations and are not indicative of a disorder.

Language-Based Causes

Reading is a language-based skill that relies heavily on an individual’s phonological, semantic, syntactic, and pragmatic knowledge; thus, weaknesses in one or more of these aspects of language could negatively impact the ability to read (Kamhi & Catts, 2012). Children with reading disorders may have difficulty with the following:

  • Phonological processing skills (Kamhi & Catts, 2012)
    • Phonological awareness—attending to the sound structure of speech for analysis and manipulation. The term phonemic awareness is used when the units being manipulated are phonemes.
    • Phonological retrieval—recalling phonological information (phonemes associated with specific graphemes). Difficulties may include substitutions, circumlocutions, or overuse of nonspecific words.
    • Phonological memory—encoding and storage of phonological information in memory, also known as phonological coding.
    • Phonological production—speech production abilities, including producing complex speech sound sequences.
  • Receptive and expressive vocabulary (Wise et al., 2007)
  • Use and comprehension of morphology and syntax (Rispens et al., 2004)
  • Production and comprehension of text-level language (Hagtvet, 2003)

The primary cause of word-level reading difficulties is phonological processing deficits (e.g., Kamhi & Catts, 2012; Torgesen et al., 1997; Wagner & Torgesen, 1987). Comprehension difficulties can result from word-level reading problems, language deficits, knowledge deficiencies, and many other factors (e.g., engagement, interest, motivation, and attention; Kamhi & Catts, 2012; Snow, 2010). Children with a history of oral language difficulty are at high risk for difficulty learning to read and write (Kamhi & Catts, 2012). Most children learn to read without much difficulty; their early literacy experiences support the development of skills needed for learning to read and write. Other children have more limited literacy experiences but go on to develop written language skills given appropriate high-quality instruction (e.g., Justice et al., 2003, 2008; Scanlon & Vellutino, 1996, 1997).

Successful reading skills depend on adequate language development; therefore, language weaknesses can result in reading difficulties (e.g., weak sound–symbol correspondence, decreased reading comprehension, difficulty planning and organizing written products). However, the relationship between reading skills and language skills is reciprocal—reading weaknesses can also result in language difficulties (e.g., weak phonological awareness skills, restricted vocabulary development, reduced ability to use text to demonstrate comprehension).

External Factors

External factors are environmental variables that can have a negative impact on the child’s reading acquisition. They include the following:

  • Limited early literacy experience, such as shared picture book reading, can adversely affect language development by reducing children’s exposure to vocabulary, advanced grammar, and narrative discourse (Stothard et al., 1998). In addition, early literacy experiences expose children to increased awareness of print with positive effects on later reading.
  • Insufficient and/or inadequate reading and writing instruction (Vellutino et al., 1996).
  • Insufficient early oral language experience that is too constrained to support the acquisition of literacy (Hoff, 2013).
  • Low socioeconomic status is associated with late reading difficulties (Kieffer, 2010). In the National Assessment of Educational Progress (2019) report, the lowest reading scores across the nation were among students living in poverty.
  • Matthew effects (Duff et al., 2015; Stanovich, 1986; Wood et al., 2020)—negative consequences associated with low performance in reading and writing (e.g., child is in a low-ability group) that can lead to low expectations, poor motivation, and limited practice, which affect written language development.

Internal Factors

Internal factors are those particular to a child. They include genetic and neurological factors as well as spoken language deficits (see the relationship between spoken and written language in the Overview section of this page).

  • Genetic factors—Several genes have been associated with reading disabilities or with increased susceptibility to reading disabilities (see Meaburn et al., 2008; Paracchini et al., 2007).

    Studies comparing identical and fraternal twins report a higher co-occurrence of reading disabilities in identical twins than in fraternal twins (DeFries & Alarcón, 1996; J. G. Light & DeFries, 1995). Genetic influences are reflected in early reading performance, but environmental factors (e.g., family and school) can influence subsequent growth in early reading skills (Petrill et al., 2010).

  • Neurological basis—Differences in brain structure and function have been found in individuals with reading disabilities as compared with typical readers, although the relationship is not clear. It may be that some differences are the result—rather than the cause—of reading problems (Catts, Kamhi, & Adlof, 2012).
    • Structural differences include the following:
      • Atypical patterns of symmetry in the temporal lobe (e.g., Galaburda, 1988)
      • Presence of focal dysplasias in the cortex (Galaburda, 1991)
      • Differences in the corpus callosum (e.g., Duara et al., 1991), inferior parietal lobe (e.g., W. E. Brown et al., 2001), and cerebellum (e.g., Eckert et al., 2003)
      • Atypical structure and/or function in the inferior frontal cortex, superior temporal cortex, temporoparietal cortex, and occipitotemporal cortex (Ozernov-Palchik et al., 2016)
    • Functional differences include the following:
      • Less left-hemisphere dominance than typical readers (see Bryden, 1982; Gerber, 1993)
      • Differences in activation (overactivation or underactivation) in various brain regions (e.g., Hoeft et al., 2011; Meyler et al., 2008; Richlan et al., 2009; Shaywitz et al., 1998; Temple et al., 2001)

Visually based deficits, auditory processing deficits, and attention-based deficits have often been proposed as core causes for reading disabilities, but they can also be part of comorbid disorders (see Catts et al., 2012; Hendren et al., 2018).

  • Visually based deficits include reversal errors (e.g., reading or writing “b” for “d”), erratic eye movements (e.g., more or longer fixations than typical readers), and transient processing deficits (i.e., problems processing global visual features). There is no general support that visually based deficits cause reading disabilities (Handler & Fierson, 2017). In fact, these “deficits” may reflect typical development (reversal error) or cognitive processing difficulties (erratic eye movements) during reading—or may be linked to phonological processing deficits (transient processing deficits).
  • Auditory processing deficits include deficits in auditory perception (e.g., problems perceiving rapid sound changes) and lack of sensitivity to syllable-level prosodic information. Research findings are inconsistent regarding the presence of auditory processing deficits in poor readers and whether these deficits are sufficient to cause reading problems.
  • Attention-based deficits (particularly inattention) are thought to be associated with reading difficulties because reading demands significant attention. However, research does not support a causal relationship. Although attention deficits and reading difficulties can co-occur, they appear to be distinct developmental disorders with different causes. When they co-occur, inattention may contribute to reading comprehension difficulties. Attention deficits related to reading difficulty have been found in auditory and visual domains and may contribute to phonological deficits (Hendren et al., 2018).

Speech-language pathologists (SLPs) play a critical and direct role in the development of literacy in children and adolescents and in the diagnosis, assessment, and treatment of written language disorders, including dyslexia, given that

  • SLPs have unique knowledge about the subsystems of language as they relate to spoken and written language and knowledge of the metalinguistic skills required for reading and writing (e.g., phonological, semantic, orthographic, and morphological awareness);
  • spoken language provides the foundation for the development of reading and writing abilities;
  • spoken and written language are interconnected at every level;
  • children with spoken language problems and with language impairment often have difficulty learning to read and write; and
  • instruction in one modality (spoken or written) can influence growth in the other modality.

The following roles and activities for SLPs include clinical services (assessment, diagnosis, planning, and treatment); prevention and advocacy; and education, administration, and research (ASHA, 2016b):

  • Providing prevention information to individuals and groups known to be at risk for written language disorders as well as to individuals working with those at risk
  • Helping to prevent written language problems by fostering language acquisition and emergent literacy
  • Being involved in initiatives (e.g., response to intervention [RTI]) to prevent academic failure as a result of reading and writing difficulties
  • Establishing collaborative partnerships with teachers, administrators, reading specialists, and others to foster literacy acquisition among students at risk for or experiencing reading and writing disorders
  • Educating other professionals on the needs of persons with written language disorders and the role of SLPs in diagnosing and managing these disorders
  • Participating in activities that will result in early identification of language-based difficulties that put young children (preschool through kindergarten) at risk for literacy problems
  • Screening individuals at risk for reading and writing difficulties, including determining the need for further assessment and/or referral for other services
  • Considering whether students who are already being treated for spoken language difficulties might require assessment related to reading and writing
  • Conducting a comprehensive, culturally and linguistically appropriate assessment of written language skills, including performance in additional language(s) as applicable (reading and writing)
  • Understanding the influences of additional languages or dialects on reading and writing
  • Understanding potential situational bias and test-item bias in assessment
  • Diagnosing disorders of reading and writing—including dyslexia—and describing the relationship between these disorders and the student’s spoken language difficulties
  • Referring to other professionals to rule out other conditions, determine etiology, and facilitate access to comprehensive services
  • Making decisions about the management of written language disorders
  • Making recommendations for a multitiered system of supports (e.g., RTI) in the schools to support speech and language development
  • Developing culturally and linguistically appropriate treatment plans, providing treatment, documenting progress, and determining appropriate dismissal criteria
  • Using appropriate materials to promote biliteracy and strengthen oral language skills in additional language(s)
  • Counseling persons with written language disorders and their families regarding communication-related issues and providing education aimed at preventing further complications relating to written language disorders
  • Consulting and collaborating with other professionals, family members, caregivers, and others to facilitate program development and to provide supervision, evaluation, and/or expert testimony, as appropriate
  • Serving as a member of the interprofessional team within the schools and providing a focus on the language underpinnings of the curriculum to help students meet state curriculum standards (see Interprofessional Education/Interprofessional Practice [IPE/IPP])
  • Remaining informed of research in the area of written language disorders and helping advance the knowledge base related to the nature and treatment of these disorders
  • Advocating for individuals with written language disorders and their families at the local, state, and national levels
  • Providing quality control and risk management

As indicated in the Code of Ethics (ASHA, 2016a), SLPs who serve this population should be specifically educated and appropriately trained to do so.

The role of the SLP in literacy intervention may vary by setting and availability of other professionals (e.g., reading teacher and resource personnel) who also provide written language intervention. Regardless of the SLP’s specific role, it is important that intervention be collaborative. For example, the SLP can be part of the team helping to implement Common Core State Standards in English Language Arts (Common Core State Standards Initiative, 2010).

See the Assessment section of the Written Language Disorders (School-Age) 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 response to intervention (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 such as those designed by the clinician or published and tailored to the population being screened (for a discussion of nonstandardized methods to help quantify specific reading and writing skills, see Paul & Norbury, 2012);
  • using elicitation and analysis of language samples, writing samples, and dynamic assessment across languages in dual language learners (DLLs) and in students who use additional varieties of English (e.g., African American English [AAE]);
  • 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 in or rule out hearing loss so that it can be considered during the assessment. If the child wears glasses, then they 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 their age;
  • referral for a complete audiologic assessment;
  • referral for a vision exam if observations during screening suggest possible visual acuity problems;
  • 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; and
  • referral to a language-matched bilingual service provider or securing an interpreter to assist in bilingual assessment, as warranted.

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. Also, please see ASHA’s Practice Portal pages on Cultural Responsiveness, Bilingual Service Delivery, and Collaborating With Interpreters, Transliterators, and Translators.

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, discussed as follows:

  • 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 interpret the results. When possible, the SLP uses 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, 2014; Nelson et al., 2015).
  • Informal activities can include 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 and develop instructional techniques to see how the student responds. These dynamic assessment techniques 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. Typical components of a comprehensive assessment for disorders of reading and writing include the following.

Case History

  • History of speech, language, and/or literacy difficulties in the family
  • History of hearing or vision problems
  • Language(s) used in home, including spoken language(s) and preferred written language(s)
  • Developmental milestones
  • Child’s interest in reading and writing activities
  • Beliefs about the importance of literacy and literacy-building activities
  • Family’s and teacher’s concerns about the child’s reading and writing skills

See the ASHA Practice Portal page on Cultural Responsiveness for guidance on taking a case history with all clients.

Hearing Screening

This is conducted if not completed during screening. See ASHA’s Practice Portal page on Childhood Hearing Screening.

Spoken Language Assessment

See the Assessment section of the ASHA Practice Portal page on Spoken Language Disorders.

Speech Sound Assessment (If Indicated)

See the Assessment section of the ASHA Practice Portal page on Speech Sound Disorders: Articulation and Phonology.

Phonological Processing

This includes the following:

  • Phonological awareness—attending to the sound structure of speech for analysis and manipulation. The term phonemic awareness is used when the units being manipulated are phonemes.
    • Assessment tasks include speech sound segmentation and blending at the word, onset–rime, syllable, and phonemic levels.
  • Phonological retrieval—recalling phonological information (phonemes associated with specific graphemes). Difficulty may include substitutions, circumlocutions, or overuse of nonspecific words.
    • Assessment tasks include phonological retrieval, which can be assessed by rapid naming tasks (e.g., rapid naming of letters and numbers).
  • Phonological memory—encoding and storage of phonological information in memory, also known as phonological coding.
    • Assessment tasks include nonword repetition (e.g., repeat /pæg/).
  • Phonological production—speech production abilities.
    • Assessment tasks may include producing complex speech sound sequences (Kamhi & Catts, 2012).

Social Communication (If Indicated)

See the Assessment section of the ASHA Practice Portal page on Social Communication Disorder.

Curriculum-Based Assessment

  • Analyze the language demands of curricular activities.
  • Observe the student as they attempt curricular activities without assistance.
  • Identify gaps between the demands of the task and the abilities of the student.

Literacy Assessment

This includes basic and higher-level reading, writing, and spelling skills, listed roughly in developmental order.

Reading

The purpose of reading assessment across languages is to identify reading processes that are difficult for the child, such as decoding, identifying words, accessing word meanings, and the automaticity of these processes. The interconnections between oral and reading fluency, language use, and language of instruction must be considered when planning assessment.

One of the challenges of identifying reading disorders in DLLs is that they cannot be compared to monolingual readers (Caravolas et al., 2019). Most formal reading assessments are normed on monolingual readers, and caution must be exercised. A reading assessment for DLLs should take place in the language of reading instruction and include oral reading discrepancies across modalities (e.g., decoding, word recognition, fluency, reading comprehension; Ijalba et al., 2020). The following are components of reading evaluation:

  • Print awareness—recognizing that books have a front and a back and that the direction of words is from left to right; recognizing where words on the page start and stop; recognizing word boundaries; recognizing environmental signs or logos.
  • Phonological awareness—including phonemic awareness; rhyming, blending, and segmenting; manipulating syllables and sounds.
  • Alphabet knowledge—including naming alphabetic letters from A to Z.
  • Alphabetic principle—understanding that written letters represent spoken sounds.
  • Sound–symbol correspondence—knowing the sounds for corresponding letters and letter combinations.
  • Phonemic decoding—using sound–symbol knowledge to segment and blend sounds in grade-level words. Reading decoding may be assessed with tasks that involve nonword or pseudoword reading.
  • Set for variability—the ability to derive an approximate pronunciation for a printed word and then use semantic knowledge and phonological ability to correct an imperfect pronunciation.
  • Word recognition—the ability to identify words when reading, either through word decoding or sight word identification. Word recognition must be assessed with tasks that involve real words.
  • Reading automaticity—reading isolated words rapidly and accurately.
  • Reading fluency—reading connected text smoothly and accurately with appropriate intonation and without frequent or significant pausing.
  • Knowledge of derivational morphology—prefixes and suffixes that change the part of speech or meaning of a word
  • Knowledge of inflectional morphology—changes in word form that mark tense, number, possession, or comparison
  • Knowledge of orthographic patterns of irregularly spelled words (e.g., “right,” “might,” “tight”; “could,” “should,” “would”)
  • Knowledge of variations in text structures and genres (e.g., narratives vs. expository text) and different purposes of text (to persuade, inform, or entertain)
  • Reading comprehension
    • Retelling or summarizing a passage while maintaining meaning
    • Answering questions about a passage to demonstrate the following:
      • Knowledge of multiple-meaning words
      • Knowledge of age-appropriate vocabulary
      • Knowledge of synonyms and antonyms
      • Knowledge of figurative language (e.g., idioms, metaphors, proverbs)
      • Ability to understand complex sentences
      • Ability to make inferences and integrate meaning within text
    • Using strategies to facilitate comprehension (e.g., skimming, using end-of-chapter questions to guide reading, rereading, and taking notes)
    • Using strategies to demonstrate comprehension of a reading passage
    • Using strategies for managing different styles of reading (e.g., reading for overview, critical reading for complete meaning and interpretation, using background knowledge to aid comprehension)
Spelling

It is important to consider the following items to accurately assess a child’s spelling ability:

  • Phonological awareness—including phonemic awareness; segmenting syllables, onset–rimes, phonemes; discriminating and identifying phonemes; identifying syllable stress.
  • Alphabetic principle—understanding that written letters represent spoken sounds.
  • Orthographic pattern awareness—knowledge about sublexical units of a written word. This includes letter–sound relationships, orthographic patterns and rules, and orthotactic constraints and probabilities.
  • Orthographic lexicon—stored representations of specific written words and word parts (including affixes).
  • Semantic awareness and knowledge—awareness of the effect of word meaning on spelling and use of word meaning to spell words including the spelling of homophones (words that have identical phonological representations but different spellings and meanings, e.g., “bear”–“bare”) and words that share a common letter pattern and meaning (e.g., “magic,” “magician,” “magical,” “magically”).
  • Knowledge and awareness of inflectional morphology (changes in word form that mark tense, number, possession, or comparison) and the letter–meaning relationships for inflectional morphemes represented in written form.
  • Knowledge and awareness of derivational morphology (prefixes and suffixes that change the part of speech or meaning of a word) and the letter–meaning relationships for derivational morphemes represented in written form.
  • Application of all the above to spell an unfamiliar word instead of avoiding the use of the word when uncertain of the word’s spelling or to correct the spelling of a misspelled word.
  • Spelling automaticity—spelling words rapidly and accurately. This requires a well-established orthographic lexicon.
  • Demonstrating understanding of the phonemic, morphological, and orthographic components of spelling in context.

Please note that several of the items listed above may be duplicates of definitions under the Reading section. The repeated terminology is intentional, as those items pertain to skills necessary for both successful reading and spelling.

For further information regarding assessing a child’s spelling ability, obtaining information about foundational linguistic skills, developing goals for intervention, and strengthening written language skills through spelling intervention, see the works of Brimo (2013), Masterson and Apel (2010, 2013), and Moxam (2020).

Writing

It is important to consider the following abilities to accurately assess a child’s writing ability:

  • Making marks on paper
  • Showing intent to communicate meaning in writing
  • Printing all letters of the alphabet
  • Printing first and last name
  • Labeling pictures
  • Producing conventional text via copying dictation
  • Demonstrating fluency with text production via handwriting and/or keyboarding
  • Writing process
    • Planning and organizing, composing, reflection
    • Drafting
    • Revising and editing content, spelling, and writing conventions
  • Writing product
    • Fluency (number of words produced in a specified time period)
    • Vocabulary and lexical diversity
      • Word choice
      • Word inflection in sentence contexts
      • Use of multisyllabic words
    • Evidence of morphemic awareness in word choice and spelling
    • Sentence formulation (e.g., diversity of sentence types, using end punctuation)
    • Appropriate grammar of sentences (coding for correct vs. incorrect sentences)
    • Sentence complexity
      • Code for simple versus complex sentences
      • Calculate clause density ratios
      • Calculate mean length of T-unit
    • Ability to write within an assigned genre
    • Ability to ensure completeness, organization, and cohesiveness
    • Writing conventions (capitalization, punctuation, and paragraph formations)

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 weaknesses 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, speech sound, or social communication disorder
  • Referral for further assessment of possible hearing or vision problems
  • Recommendations for intervention and support, including multitiered systems of support such as RTI services to support literacy development
  • Referral to and consultation or collaboration with other professionals as needed, including the following:
    • audiologist
    • neuropsychologist
    • occupational therapist
    • ophthalmologist
    • pediatrician
    • physical therapist
    • reading specialist
    • special educator
    • “English as a second language” teacher

For more information, see ASHA’s webpage 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 messages within a story and 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 et al., 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—a story with a clear beginning, middle, and end or
    • cyclical—a story that ends in the same place it began
  • Character—including the nature of the relationship as well as how the character behaves and if the character is 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 Responsiveness.

Children Who Are Linguistically Diverse

Simultaneous and Sequential DLLs

Written language dominance may not match spoken language dominance in children who are simultaneous or sequential DLLs. For example, children who use additional languages 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. Bilingual children who are exposed to English prior to the age of 3 years develop reading skills similar to those of monolingual English speakers (Kovelman et al., 2008).

Phonological awareness skills tend to be better in bilingual children than in monolingual speakers (Kovelman et al., 2008; Páez et al., 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 the writing system in an individual’s first language may influence their reading and writing abilities in English. Orthography, phonology, and semantic units of the child’s home language will influence written English, particularly when languages share similarities. For example, English and Spanish share many cognate words (e.g., “club,” “mango,” “animal,” and “chocolate”), providing biliterate children with a cognate advantage (Lubliner & Hiebert, 2011). Additionally, transparent writing systems, such as Spanish, have more regular sound-to-letter correspondences than English and can facilitate reading and writing. In contrast, the writing system in Mandarin is made up of characters, and each character may represent a word or morpheme. Words consist of one or more morphemes and in spoken language, tones may differentiate morphemes (Comrie, 2009, pp. 703-723). Such differences between English and Mandarin reduce the opportunities to transfer skills across languages in early biliterate readers.

Variations in vocabulary and syntax across languages can influence reading comprehension in English. For example, some words may not have translation equivalents across languages. Differences in morphological and syntactic structures across languages can add to problems in reading comprehension.

For more information, see the ASHA Practice Portal page on Bilingual Service Delivery.

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; M. C. Brown et al., 2015). In a study comparing grammar and early spelling skills, children who spoke AAE did not differ from children who spoke Standard American English 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 Standard American English. Furthermore, 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).

More research is needed to examine the relationship between dialect use and literacy skills, particularly when social and environmental variables are known to impact the learning of reading and writing. For further information, please see the work of Washington and Seidenberg (2021).

Children Who Are Nonverbal or Have Limited Speech (Including Users of Augmentative and Alternative Communication)

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), it is necessary to modify these tasks so that verbal responses are not required (Barker et al., 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 et al., 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 corresponds to the initial phoneme within the word rather than speaking the initial phoneme (Fallon et al., 2004; Millar et al., 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 et al., 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.

For further information regarding intervention, please see the Intervention for Children With Complex Communication Needs section below.

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 the Individuals with Disabilities Education Improvement Act of 2004 (IDEA), 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 the National Joint Committee for the Communication Needs of Persons With Severe Disabilities (2002) report for information related to a priori criteria.

Eligibility for speech-language pathology services is documented in the child’s individualized education program, 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: Individualized Education Programs and Eligibility for Services, and Current IDEA Part C Final Regulations (2011).

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 (CCSS) and/or State Standards

Several states implement the CCSS (Common Core State Standards Initiative, 2010), which are internationally benchmarked learning standards. Other states use academic standards that they develop. In both cases, standards define what public school students are expected to learn in reading, math, and other subjects. These 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 or state standards because language skills are addressed across subject areas and 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.

See the Treatment section of the Written Language Disorders (School-Age) Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.

The goal of intervention is to improve language and communication in spoken and written language 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 Resources section of this page. 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.

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 African American English (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

It is important to design literacy intervention programs with a balanced focus on all areas of difficulty, which may include both sound-, syllable-, or word-level decoding or encoding (spelling) and sentence- or discourse-level comprehension and composition. Although the focus of intervention may 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

  • Print-to-speech word structure approaches focus on reading decoding. They are systematic and explicit approaches with lessons and instructional components such as syllable divisions and syllable types organized around the orthographic system. They 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.
  • Speech-to-print word structure approaches begin with the process of phonological encoding (spelling) to teach reading decoding and develop automatic word recognition. They are systematic and explicit approaches with lessons and instructional components such as syllable divisions and syllable types organized around the phonological system. They are designed to teach such elements as
    • phoneme–grapheme correspondences,
    • phoneme–grapheme mapping to establish robust lexical representations in long-term memory for automatic recognition and accurate spelling of all (regular and irregular) words, and
    • associations of morphological 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/or
    • the ability to make sense of words in context.

Writing

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

Spelling

  • Multilinguistic—instruction that functionally integrates phonological, orthographic, and semantic/morphological components at the lexical and sublexical levels, with application of skills to connected writing.
  • Multimodality—instruction that actively engages the student in the oral production and writing of words; students say the phonemes and simultaneously write the corresponding graphemes. With this process, they simultaneously see the letters and hear the phonemes.
  • Metalinguistic—explicit instruction that teaches students how to apply phonological, orthographic, and semantic/morphological knowledge to the spelling of unfamiliar words.
  • Developmental—instructional sequence that follows a developmental stage approach to facilitate acquisition of conventional spelling skills.
  • Rote memorization and testing of selected words in list format and in composition. Although memorization may be widely used, there is limited evidence to support its clinical utility (Galuschka et al., 2020).

Intervention Targets

The 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 each child’s goals, modifying them as necessary.
  • Provide intervention that is individualized, based on the nature of a child’s deficits and 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

See the Treatment section of the Written Language Disorders (School-Age) Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.

Below are brief descriptions of general and specific treatments for addressing disorders of reading and writing. Treatment targets (see Intervention Target Areas) guide the selection of treatment options. Clinicians may consider a variety of approaches and tools based on the needs of each individual.

SLPs and educators determine which methods and strategies are appropriate by taking into consideration

  • each individual’s language profile and learning style,
  • each individual’s cultural background and values,
  • the severity of the language disorder,
  • factors related to language functioning (e.g., hearing impairment and cognitive functioning),
  • each individual’s communication needs, and
  • available evidence (see the Written Language Disorders (School-Age) Evidence Map).

General Treatment Strategies and Methods

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 take notes and understand various text genres (e.g., Kim et al., 2004). They can also be used as part of a process to help students write meaningful descriptions (see, e.g., the video clip below; Montgomery, 2018) and to help students organize and cohesively link ideas for multi-paragraph essay writing.

Read-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 the 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 et al., 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 s, 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

  • echo reading (reading while listening),
  • choral reading (reading aloud in unison as a group), and
  • neurological impress or shadowing (fluent reader and student read aloud together).

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.

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.

Writing Lab Approach

The writing lab approach uses computers to support literacy instruction. 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 et al., 2001).

Specific Treatment Strategies and Methods

Cooperative Integrated Reading and Composition®

Cooperative Integrated Reading and Composition (e.g., R. J. Stevens et al., 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.

Lindamood Phoneme Sequencing®

Lindamood Phoneme Sequencing (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. Lindamood Phoneme Sequencing can be used with individuals (of all ages), in small groups, and in classrooms.

Orton–Gillingham (OG)-Based Interventions

The OG approach (e.g., Ritchey & Goeke, 2006) is an intensive, sequential, phonics-based system that teaches the basics of word formation over 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. Despite widespread use and some states even mandating the use of OG programs for students who have dyslexia, a recent meta-analysis of the research concluded the following regarding students with word-level reading disabilities (WLRD): “OG reading interventions do not statistically significantly improve phonological awareness, phonics, fluency, spelling, vocabulary or comprehension outcomes for students with or at-risk for WLRD. More high quality, rigorous research with larger samples of students with WLRD is needed to fully understand the effects of Orton–Gillingham interventions on the reading outcomes for this population” (E. A. Stevens et al., 2021).

Reading Apprenticeship®

Reading Apprenticeship (e.g., Schoenbach et al., 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 understand and regulate their own reading processes as well as develop strategies for overcoming reading obstacles and improving comprehension of texts from core academic disciplines.

Road to the Code

Road to the Code (Blachman et al., 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)

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 & Writing™

SPELL-Links to Reading & Writing (Wasowicz et al., 2012) is a speech-to-print multilinguistic word study curriculum that integrates phonological awareness, orthography, and semantics/morphology instruction at the word level and includes structured application of word study skills to reading and writing at the sentence and paragraph levels. It includes dynamic lessons, meta-cognitive reading and writing activities, and guided learning opportunities. Activities can be administered to individuals, small groups, or whole classrooms. The curriculum aims to teach critical word study strategies and promotes word study across the curriculum research. Please see the work of Wanzek et al. (2016) for further information on transcription writing interventions.

Stepping Stones to Literacy (SSL)

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.

SPELL-Links WordtivitiesTM

SPELL-Links Wordtivities (Wasowicz, 2019) is a collection of activities and materials that develop K–12 students’ literacy and language skills through active engagement with the sounds, letters, and meanings of words. Students learn to apply multiple components of oral and written language to improve their spelling, word decoding, reading fluency, and reading comprehension; build depth and breadth of vocabulary; and enhance oral expression and sentence-level writing performance (syntax).

Words Their Way™

Words Their Way (Bear et al., 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.

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, spelling, and decoding skills 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

The following list is not exhaustive. Treatment targets (see Intervention Target Areas) should guide the 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 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. The goal of this program is to enable 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.

SPELL-Links WordUP!TM

SPELL-Links WordUP! teaches K–12 students to attend to the phonological structure of spoken English words first and then to connect (map) the sounds they say and hear with the letters they see in the printed word and with the word’s meaning. This iPad app is designed for use as a clinical teaching tool and for student practice to improve reading, spelling, vocabulary, and oral language skills. Choose one of four game-play activities, adjust settings, and select words to support a student at the appropriate level.

WordQ®

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

Intervention for Children With Handwriting Difficulties

SLPs rarely work on the motoric aspects of handwriting, but they may collaborate with occupational therapists to help students develop self-talk strategies associated with performing the systematic, sequential movements required to form letters. Handwriting is not only a motor skill; it is also a written language skill, and handwriting instruction should be integrated with reading and writing instruction. 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; Wolf et al., 2017).

See Collaboration and Teaming and ASHA’s webpage 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 et al., 1991; Koppenhaver & Yoder, 1993; J. Light et al., 1994; J. Light & Kelford Smith, 1993; J. 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, augmentative and alternative communication devices) and other supports (e.g., scribes) to foster independent reading and writing. For example, augmentative and alternative communication 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 et al., 2002).

For further information, please see ASHA’s Practice Portal pages on Augmentative and Alternative Communication, Autism Spectrum Disorder, and Intellectual Disability as well as the section Children Who Are Nonverbal or Have Limited Speech (Including Users of Augmentative and Alternative Communication), above.

Intervention for Children Who Are Deaf or Hard of Hearing (DHH)

Children who are DHH traditionally demonstrate lower reading achievement levels when compared with their hearing peers (e.g., Holt et al., 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 et al., 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 (Tucci et al., 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 et al., 1994). Their background knowledge may also be less richly connected (McEvoy et al., 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 in Adults.

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

See the Service Delivery section of the Written Language Disorders (School-Age) Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.

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)

ASHA Resources

Other Resources

This list of resources is not exhaustive, and the inclusion of any specific resource does not imply endorsement from ASHA.

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Acknowledgments

Content for ASHA’s Practice Portal is developed through a comprehensive process that includes multiple rounds of subject matter expert input and review. ASHA extends its gratitude to the following subject matter experts who were involved in the development of the Written Language Disorders page:

  • Virginia W. Berninger, PhD
  • Lena G. Caesar, EdD, PhD, CCC-SLP
  • Barbara E. Culatta, PhD, CCC-SLP
  • Carol Scheffner Hammer, PhD, CCC-SLP
  • Elizabeth Ijalba, PhD, CCC-SLP
  • Alan Kamhi, PhD, CCC-SLP
  • Julie J. Masterson, PhD, CCC-SLP
  • Nichole A. Mulvey, PhD, CCC-SLP
  • Nickola W. Nelson, PhD, CCC-SLP
  • Rhea Paul, PhD, CCC-SLP
  • Elizabeth D. Peña, PhD, CCC-SLP
  • Celeste A. Roseberry-McKibbin, PhD, CCC-SLP
  • Elaine R. Silliman, PhD, CCC-SLP
  • Gary A. Troia, PhD, CCC-SLP
  • Jan Waskowicz, PhD, CCC-SLP

In addition, ASHA thanks the members of the Ad Hoc Committee on Reading and Writing, whose work was foundational to the development of this content. Members of the Committee were Nickola Nelson (chair), Hugh Catts, Barbara Ehren, Froma Roth, Cheryl Scott, Maureen Staskowski, and Roseanne Clausen (ex officio). Diane Paul-Brown, Kathleen Whitmire, and Susan Karr provided consultation. Alex Johnson, 2001–2002 vice president for professional practices in speech-language pathology, and Nancy Creaghead, 1997–1999 vice president for professional practices in speech-language pathology, served as monitoring officers.

Citing Practice Portal Pages

The recommended citation for this Practice Portal page is:

American Speech-Language-Hearing Association. (n.d.). Written Language Disorders. (Practice Portal). Retrieved month, day, year, from www.asha.org/Practice-Portal/Clinical-Topics/Written-Language-Disorders/.

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.

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