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:
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.
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:
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 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:
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 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:
The written product may be described in terms of the following components:
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, 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:
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).
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.
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.
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.
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.
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).
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 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.
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:
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 are environmental variables that can have a negative impact on the child’s reading acquisition. They include the following:
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).
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).
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).
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
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):
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 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
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
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:
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.
See the ASHA Practice Portal page on Cultural Responsiveness for guidance on taking a case history with all clients.
This is conducted if not completed during screening. See ASHA’s Practice Portal page on Childhood Hearing Screening.
See the Assessment section of the ASHA Practice Portal page on Spoken Language Disorders.
See the Assessment section of the ASHA Practice Portal page on Speech Sound Disorders: Articulation and Phonology.
This includes the following:
See the Assessment section of the ASHA Practice Portal page on Social Communication Disorder.
This includes basic and higher-level reading, writing, and spelling skills, listed roughly in developmental order.
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:
It is important to consider the following items to accurately assess a child’s spelling ability:
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).
It is important to consider the following abilities to accurately assess a child’s writing ability:
Assessment may result in one or more of the following:
For more information, see ASHA’s webpage on Interprofessional Education/Interprofessional Practice (IPE/IPP).
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:
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.
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.
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).
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:
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.
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.
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.
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).
The basic principles of effective intervention include the following (Roth & Worthington, 2015):
See Intervention Target Areas for a listing of target areas by developmental level.
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
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.
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 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
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 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
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).
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.
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 & 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.
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 (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 (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.
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 (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.
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 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 (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.
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 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 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 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 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 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 & 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! 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 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.
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).
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.
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):
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
See ASHA’s Practice Portal pages on Hearing Loss in Children and Hearing Loss in Adults.
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.
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.
This list of resources is not exhaustive, and the inclusion of any specific resource does not imply endorsement from ASHA.
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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:
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.
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/.
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