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Written Language Disorders

See the written language disorders evidence map for pertinent scientific evidence, expert opinion, and client/caregiver perspectives.


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 recognition (i.e., reading decoding and sight word recognition), reading comprehension, written spelling, or written expression (i.e., written composition; Ehri, 2000; Gough & Tunmer, 1986; Kamhi & Catts, 2012; Tunmer & Chapman, 2007, 2012). A word recognition disorder is also known as dyslexia.

Written language disorders, as with spoken language disorders, can involve any of the five language domains (i.e., phonology, morphology, syntax, semantics, and pragmatics). Problems can occur in the awareness, comprehension, and production of language at the sound, syllable, word, sentence, and discourse levels, as indicated in the table below (Nelson, 2014b; Nelson, Plante, Helm-Estabrooks, & Hotz, 2015). See ASHA's resource, disorders of reading and writing.

Sound-, Syllable-, And Word-level Difficulties Sentence- And Discourse-level Difficulties
  • Difficulty with phonological and morphological structure of words
  • Difficulty forming stable associations with the orthographic representations of words in print
  • Impaired reading decoding and written spelling skills
  • 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

The relationship between language disorders and learning disabilities is intricate, as indicated in the definition of specific learning disability below:

“The term ‘specific learning disability' means a disorder in one of 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 [IDEA], 2004)

Language disorders are typically diagnosed before learning disabilities and often affect the child's academic performance. Once academic struggles with reading and writing arise, a learning disability label may be used, 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 (ADHD)
  • emotional disability
  • intellectual disability (ID)
  • deaf or hard-of-hearing (DHH)
  • autism spectrum disorder (ASD)

Relationship Between Spoken and Written Language

The relationship between spoken and written language is well established (e.g., Hulme & Snowling, 2013; Kamhi & Catts, 2012). This relationship is underscored in the “simple view of reading” which “presumes that, once the printed word is decoded, the reader applies to the text exactly the same mechanisms which he or she would [apply to] its spoken equivalent” (Gough & Tunmer, 1986, p. 9). More specifically, the integration of word recognition, vocabulary, and oral language comprehension are important for the development of adequate reading comprehension skills (Tunmer & Chapman, 2012).

Children need strong knowledge of both the spoken and the written word in order to be successful readers and writers. Children with spoken language problems frequently have difficulty learning to read and write, and 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:

  • Reading decoding—the ability to transform orthographic patterns of alphabetic letters into phonological patterns of a corresponding spoken word
  • Word recognition—the ability to identify words when reading, either through word decoding or sight word identification, which may be called the “direct route” (i.e., automatic recognition of word as a whole without using strategies to decode)
  • Reading fluency—the ability to recognize and read words accurately, smoothly, and quickly, usually in context
    • Reading fluency is affected by reading automaticity—the ability to read a list of words accurately in a specified amount of time.
    • Reading fluency combines rapid decoding and sight word identification.
  • Reading comprehension—the ability to understand the meaning of written text
    • Comprehension is an integrated skill that includes having vocabulary knowledge, using cues (e.g., relational terms) to “unpack” complex syntax, and making sense of the different discourse structures (e.g., stories or expository text).
    • Comprehension also requires application of executive functions (e.g., the ability to use prior knowledge and make inferences and predictions; the ability to monitor one's 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 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 (i.e., “pre-writing”), 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). This process is iterative.
  • Written product—the end product of the writing process; it can be examined at the word level (e.g., word choice and spelling), sentence level (e.g., grammar and complexity), and text level (e.g., discourse structure, use of cohesive devices and coherence). The written product can also be described in terms of writing conventions (e.g., capitalization and punctuation), communication functions (e.g., to inform, to persuade), organizational structure (e.g., chronological, sequential, compare and contrast), and effectiveness in meeting the information needs of the audience (Nelson, 2014a; Puranik, Lombardino, & Altmann, 2007; Scott & Windsor, 2000).

Spelling

Spelling, also known as encoding, requires the ability to segment words into phonemes and map those phonemes onto graphemes (letters or letter combinations) in an acceptable sequence in written form. Words may be spelled “regularly,” which means that each grapheme is associated with a corresponding phoneme (e.g., cat), or “irregularly,” such that not all graphemes in a word are represented by one phoneme (e.g., right). However, irregularly spelled words may have predictable features based on their morphological makeup.

Spelling depends on semantic awareness; knowledge of phonological, orthographic, and morphological representations of words and their parts; and the ability to create mental models of their interrelationships (e.g., Apel & Masterson, 2001; Berninger, Nagy, Richards, & Raskind, 2008; Bourassa & Treiman, 2001; Ehri, 2000; Masterson & Apel, 2007).

There is a bidirectional relationship between spelling and word reading such that difficulty or progress in one area can influence performance in the other area.

Relationship Between Reading and Writing

Reading and writing are highly interrelated, and it is difficult to isolate any aspect of reading development that does not have a writing counterpart. For example, syntactic patterns that children read in texts also emerge in their writing (Scott, 1999), and children become fluent orthographic readers at about the same time that their spelling reflects similar orthographic sophistication (Ehri, 2000).

The interrelationship between reading and writing is also evident in the school setting. For example, kindergarten children are asked to “read” what they “write,” and secondary students “read to find out what to write and write to demonstrate that they understand what they read” (Scott, 1999, p. 224).

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, and diagnostic classification criteria within and across subtypes of written language disorder. As an example of how classification criteria may differ, cut-point scores for distinguishing typical learners from those with developmental dyslexia may be 1 standard deviation (SD) below the mean in one study and 1.5 SDs below the mean in another study.

Further, with regard to study design, although two studies may evaluate the same aspect of reading (e.g., reading decoding accuracy), one study may evaluate decoding words in isolation, whereas another focuses on decoding words in connected text, yielding different results. As such, the statistics that follow should be interpreted with these types of variations in mind.

Reading Disability

  • 7.6% of second and third grade children in the Connecticut Longitudinal Study were identified as having a reading disability, regardless of whether researcher- or school system–identification criteria were applied (Shaywitz, Shaywitz, Fletcher, & Escobar, 1990).

Writing Disability

  • A longitudinal study of a birth cohort born between January 1, 1976, and December 31, 1982, in Rochester, Minnesota, revealed that 6.9%–14.7% of participants had a writing disorder at age 19 years (Katusic, Colligan, Weaver, & Barbaresi, 2009).

Co-morbidities

  • Studies of elementary-age children from Iowa (Catts, Fey, Tomblin, & Zhang, 2002) and New Jersey (Flax et al., 2003) revealed a reading disability and specific language impairment comorbidity of 50% and 68%, respectively.
  • A longitudinal study of a birth cohort born between January 1, 1976, and December 31, 1982, in Rochester, Minnesota, revealed that among children with speech and language impairment, the cumulative incidence of a writing disorder was 61.4% for boys and 55.1% for girls at age 19 years (Katusic et al., 2009).
  • Prevalence of reading disability and ADHD co-morbidity from general population samples primarily from the United States ranged from 0.4% to 3.7% (Sexton, Gelhorn, Bell, & Classi, 2012).

Gender Considerations

  • A longitudinal study of a birth cohort born between January 1, 1976, and December 31, 1982, in Rochester, Minnesota, revealed that 10%–18.9% of boys and 3.6%–10.1% of girls had a writing disorder at age 19 years (Katusic et al., 2009).
  • Several studies (Badian, 1999; Flannery, Liederman, Daly, & Schultz, 2000; Katusic et al., 2009) have reported that boys are 2–3 times more likely than girls to have a literacy disorder.

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 exhibit difficulty with phonological awareness and phonics (Torgensen, 2002, 2004). This problem may continue as they struggle 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, Scarborough, & Rescorla, 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, Alonso, & Castilla-Earls, 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.

School-age children and adolescents with disorders of reading and writing are also likely to have spoken language difficulties. See spoken language disorders for a list of associated signs and symptoms.

The specific cause(s) of reading and writing disorders remain unknown. Disorders and difficulties with reading and writing have historically been associated with a number of external and internal causal factors and may be the result of an interplay of these factors. They are likely multifactoral, with no single cause that can account for all written language disorders (Silliman & Berninger, 2011). 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 with appropriate high-quality instruction (e.g., Justice, Chow, Capellini, Flanigan, & Colton, 2003; Justice, Mashburn, Hamre, & Pianta, 2008; Scanlon & Vellutino, 1996, 1997).

Children with written language disorders struggle with learning to read and write—often despite rich early literacy experiences and adequate learning opportunities—and they continue to struggle throughout their academic careers. These children with “unexpected” difficulties are the ones identified as having disorders of reading and writing (Pennington & Bishop, 2009).

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 (e.g., absent or limited early joint reading experiences and insufficient opportunity to draw/scribble with crayons) that affects exposure to vocabulary and advanced grammar and discourse and can, in turn, lead to further language problems (Stothard, Snowling, Bishop, Chipchase, & Kaplan, 1998).
  • 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).
  • Matthew effects (Duff, Tomblin, & Catts, 2015; Stanovich, 1986)—which are 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, in turn, affect written language development.

Internal Factors

Internal factors are those intrinsic to the child. They include genetic and neurological factors as well as spoken language deficits (see 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, Harlaar, Craig, Schalkwyk, & Plomin, 2008; Paracchini, Scerri, & Monaco, 2007).

    Studies comparing identical and fraternal twins report a higher co-occurrence of reading disabilities in identical twins than in fraternal twins (DeFries & Alarcon, 1996; 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)
    • Functional differences include the following:
      • Less left-hemisphere dominance than typical readers (see Bryden, 1982; Gerber, 1993)
      • Differences in activation (over- or underactivation) in various brain regions (e.g., Meyler, Keller, Cherkassky, Gabrieli, & Just, 2008; Paulesu et al., 1995; Salmelin, Service, Kiesilä, Uutela, & Salonen, 1996; Shaywitz et al., 1998)

Other Proposed Causes

Visually based deficits, auditory processing deficits, and attention-based deficits have often been proposed as causes for reading disabilities, but most are not supported by scientific evidence. (See Catts et al., 2012)

  • Visually-based deficits include reversal errors (e.g., reading/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). In spite of the popularity of this explanation in the past, there is no general support that visually based deficits cause reading disabilities. In fact, these observed visual phenomena may actually 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 with regard to the presence of auditory processing deficits in poor readers and whether or not these deficits, if present, 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 occur together, they appear to be distinct developmental disorders with different causes. When they co-occur, inattention may contribute to reading comprehension difficulties.

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 (i.e., phonology, morphology, syntax, semantics, and pragmatics) 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 have a reciprocal relationship;
  • children with spoken language problems often have difficulty learning to read and write; and
  • instruction in one modality (spoken or written) can result in 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, 2016a):

  • 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, 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 (reading and writing)
  • Understanding the influences of home language/dialect 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
  • 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 evidence map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.

Screening

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

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

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

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

Screening may result in

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

Comprehensive Assessment

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

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

Both formal and informal assessment activities are used:

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

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

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

Assessment may result in one or more of the following:

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

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

Cultural and Environmental Factors

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

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

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

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

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

Children Who Are Linguistically Diverse

Simultaneous And Sequential Dual Language Learners

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

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

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

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

Examples include the following:

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

Children Who Use Nonstandard American English Dialects

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

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

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

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

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

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

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

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

Children With Handwriting Difficulties

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

Eligibility For Services In The Schools

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

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

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

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

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

Common Core State Standards

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

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

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

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

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

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

Treatment Approaches

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

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

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

Reading

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

Writing

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

    Address both process and product simultaneously, when possible.

Spelling

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

Intervention Targets

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

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

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

Treatment Options

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

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

Comprehension Strategy Instruction

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

Cooperative Integrated Reading and Composition®

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

Dyslexia Training Program

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

Enhanced Proactive Reading

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

Graphic Organizers

Graphic organizers, also referred to as knowledge maps, concept diagrams, and cognitive organizers, are visual displays that show the relationships among facts, terms, and ideas. Examples of graphic organizers used for different tasks include problem–solution maps, sequential episode maps, comparison–contrast maps, and cause–effect maps. Graphic organizers can be used to support reading comprehension by helping students to take notes and to understand various text genres (e.g., Kim, Vaughn, Wanzek, & Wei, 2004). They can also be used as part of a process to help students write meaningful descriptions - see, for example, the video clip below (Montgomery, 2018).

Lindamood Phoneme Sequencing®

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

Orton-Gillingham–Based Interventions

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

Alphabetic Phonics

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

Barton Reading and Spelling System®

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

Wilson Reading System®

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

Reading Apprenticeship®

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

Reading-aloud Interventions

Dialogic Reading

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

Repeated Reading

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

Road to the Code

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

Self-regulated Strategy Development (SRSD)

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

SPELL-Links To Reading And Writing

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

Stepping Stones To Literacy (SSL)

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

Teaching Story Grammar

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

Words Their Way™

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

Writing Lab Approach

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

Computer-Based Technologies

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

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

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

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

ABC Phonics Word Family Writing

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

Co:Writer®

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

First Author

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

Lexia® Learning Systems

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

Read 180®

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

Read, Write & TypeTM

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

WordQ®

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

WriteAssist

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

Intervention For Children With Handwriting Difficulties

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

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

Intervention For Children With Complex Communication Needs

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

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

Intervention for Children Who Are Deaf Or Hard of Hearing

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

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

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

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

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

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

Transitioning Youth and Postsecondary Students

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

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

Service Delivery

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

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

ASHA Resources 

Other Resources

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

American Speech-Language-Hearing Association. (2016a). Code of ethics [Ethics]. Available from www.asha.org/policy/

American Speech-Language-Hearing Association. (2016b). Scope of practice in speech-language pathology [Scope of practice]. Available from www.asha.org/policy/

Anderson, R. C. (1980). Study strategies and adjunct aid. In R. J. Spiro, B. C. Bruce, & W. R. Brewer (Eds.), Theoretical issues in reading comprehension: Perspectives from cognitive psychology, artificial intelligence linguistics, and education (pp. 415–431). Hillsdale, NJ: Erlbaum.

Andrews, J. E., & Lombardino, L. J. (2014). Strategies for teaching handwriting to children with writing disabilities. Perspectives on Language Learning and Education, 21, 114–126.

Apel, K., & Masterson, J. J. (2001). Theory-guided spelling assessment and intervention: A case study. Language, Speech, and Hearing Services in Schools, 32, 182–195.

August, D., & Shanahan, T. (Eds.). (2006). Executive summary. In D. August & T. Shanahan (Eds.), Developing literacy in second-language learners: Report of the National Literacy Panel on Language-Minority Children and Youth (pp. 1–9). Mahwah, NJ: Erlbaum. Retrieved from http://www.bilingualeducation.org/pdfs/PROP2272.pdf

Badian, N. A. (1999). Reading disability defined as a discrepancy between listening and reading comprehension: A longitudinal study of stability, gender differences, and prevalence. Journal of Learning Disabilities, 32, 138–148.

Barker, R. M., Saunders, K. J., & Brady, N. C. (2012). Reading instruction for children who use AAC: Considerations in the pursuit of generalizable results. Augmentative and Alternative Communication, 28, 160–170.

Barton, S. E. (2000). Barton reading and spelling system. San Jose, CA: Bright Solutions for Dyslexia, LLC.

Bear, D. R., Invernizzi, M., Templeton, S. R., & Johnston, F. (2015). Words Their Way: Word study for phonics, vocabulary, and spelling instruction. Boston, MA: Pearson.

Beckham, P. B., & Biddle, M. L. (1989). Dyslexia Training Program books. Cambridge, MA: Educators Publishing Service.

Berninger, V. W. (2015). Interdisciplinary frameworks for schools: Best professional practices for serving the needs of all students. Washington, DC: American Psychological Association.

Berninger, V. W., Nagy, W., Richards, T., & Raskind, W. (2008). Developmental dyslexia: A developmental neurolinguistic approach. In G. Richheit & H. Strohner (Eds.), Handbook of communication competence (pp. 397­–440). Berlin, Germany: Walter de Gruyter.

Blachman, B. A., Ball, E. W., Black, R., & Tangel, D. M. (2000). Road to the code. Baltimore, MD: Brookes.

Blischak, D. (1994). Phonologic awareness: Implications for individuals with little or no functional speech. Augmentative and Alternative Communication, 10, 245–254.

Bourassa, D. C., & Treiman, R. (2001). Spelling development and disabilities: The importance of linguistic factors. Language, Speech, and Hearing Services in Schools, 32, 172–181.

Brown, M. C., Sibley, D. E., Washington, J. A., Rogers, T. T., Edwards, J. R., MacDonald, M. C., & Seidenberg, M. S. (2015). Impact of dialect use on a basic component of learning to read. Frontiers in Psychology, 6, 1–17.

Brown, W. E., Eliez, S., Menon, V., Rumsey, J. M., White, C. D., & Reiss, A. L. (2001). Preliminary evidence of widespread morphological variaitons of the brain in dyslexia. Neurology, 56, 781–783.

Bryden, M. P. (1982). Laterality: Functional asymmetry in the intact brain. New York, NY: Academic Press.

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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
  • 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

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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