Written Language Disorder: Causes, Signs, Treatment

Written language disorder is when someone has difficulty reading, writing, and understanding language. This can happen at different levels, like recognizing sounds and words or forming sentences and paragraphs. Dyslexia is one of the most well-known types of written language disorders. This disorder can involve different language domains and spelling systems and may be associated with learning disabilities. Interprofessional education and practice involving various specialists may be necessary for appropriate assessment and treatment. Written language disorders can occur with other conditions like spoken language disorder, ADHD, and an autism spectrum disorder.

Spoken and Written Language

The relationship between written and spoken language is crucial to developing reading comprehension skills, automatic retrieval for spelling, and automatic identification for reading. Children require a strong knowledge of both spoken and written language to become successful readers and writers. 

Components of reading include word recognition, phonological decoding, sight word identification, reading fluency, and reading comprehension. Writing consists of the writing process, the written product, writing conventions, communication functions, and organizational structure. The process of spelling, also known as phonological encoding, involves converting the sounds of spoken language into written symbols by mapping phonemes to graphemes.

Difficulty in spelling or foundational language knowledge areas that support it can affect word-level reading, reading comprehension, and writing composition.

How common are Written Language Disorders?

Written language disorders are quite common, affecting between 6.9% and 14.7% of children and adolescents by age 19. Reading disorders are also prevalent, with estimates ranging from 5.3% to 11.8%. Poor reading skills are often associated with language impairments and attention deficit/hyperactivity disorder (ADHD). Children with speech and/or language impairments have higher rates of writing disorders, with 50.1% of them experiencing both writing and reading disorders. Males are more likely to have reading problems and written language disorders than females, and children with ADHD have a greater risk of written language disorder and/or reading disability. Juvenile offenders also have high rates of reading disabilities, with phonological difficulties being a common issue.

What are the signs and symptoms?

Written language disorders can show different signs and symptoms in different people, depending on their age, severity, and language development stage. Young children at risk for reading disorders may struggle with phonological awareness and phonics, which can affect their ability to read accurately and fluently. Reading comprehension can be challenging for older children who have difficulty reading, as they may struggle with metacognitive awareness and strategies to comprehend the text. These challenges can be due to poor word-level reading skills that worsen with increased reading demands. It’s worth noting that cultural and linguistic differences may affect some symptoms and signs and may not necessarily indicate a disorder.

Here is one of the examples of child with dyslexia

What are the causes of Written Language Disorders?

Written Language Disorders are caused by internal, language-based factors, external environmental factors, and individual factors. Language-based factors include weaknesses in phonological processing skills, receptive and expressive vocabulary, and the use and comprehension of morphology and syntax. 

These weaknesses negatively impact the ability to read and comprehend texts. External factors include limited early literacy experiences, insufficient reading and writing instruction, and low socioeconomic status. These environmental variables can have a negative impact on a child’s reading acquisition. Internal factors include genetic and neurological factors, which have been associated with reading disabilities.

Developing successful reading skills relies on proper language development, which means that language difficulties can lead to reading challenges. However, the connection between language skills and reading skills is bi-directional, meaning that struggling with reading can also affect language development. Reading weaknesses can also result in language difficulties. 

Early literacy experiences and adequate high-quality instruction can support the development of written language skills in children with limited literacy experiences. Reading and writing difficulties can lead to negative consequences associated with low performance, such as poor motivation and little practice, which affect written language development.

How can Speech therapists help?

Speech-language pathologists (Speech therapists) can help patients with written language disorders in many ways. They have unique knowledge about the subsystems of language and metalinguistic skills required for reading and writing. They can provide prevention information and help prevent written language problems by fostering language acquisition and emergent literacy. They can also collaborate with teachers and other professionals to identify students at risk for or experiencing reading and writing disorders. 

SLPs can conduct assessments, diagnose disorders, including dyslexia, and develop culturally and linguistically appropriate treatment plans. They can also counsel patients and their families and advocate for them at local, state, and national levels. It is essential that intervention is collaborative, and the speech therapists can help in implementing Common Core State Standards in English Language Arts.

How to assess a patient?

When a child is suspected of having a reading or writing disorder, their written language skills are screened. This involves administering formal and informal screening measures and collecting information from teachers and parents. If further assessment is needed, a comprehensive assessment is undertaken, which involves the collaborative efforts of various professionals and takes into consideration the child’s developmental stage, expected literacy skills, and language(s) used. The assessment may include formal tests of written language and informal activities such as observations of the student’s engagement in literacy activities and assessment of writing samples. The assessment results may lead to recommendations for pre-referral intervention, comprehensive language assessment, speech sound assessment, audiology assessment, vision exam, assessments by physical or occupational therapists, and bilingual service delivery. A hearing screening should also be conducted to rule in or rule out hearing loss.

How to assess the literacy of a patient?

To assess a patient’s literacy with written Language Disorders, it is essential to evaluate their reading, spelling, and writing skills. Reading assessment should include print awareness, phonological awareness, alphabet knowledge, sound-symbol correspondence, phonemic decoding, word recognition, reading automaticity, and reading comprehension. It is essential to consider the language of reading instruction and oral reading discrepancies. Spelling assessment should include phonological awareness, orthographic pattern awareness, orthographic lexicon, semantic awareness, inflectional and derivational morphology, and spelling automaticity. Applying these skills to spell an unfamiliar word and understand the phonemic, morphological, and orthographic components of spelling in context is also essential.

Factors to consider 

Factors to consider in a patient with social communication disorder include:

• Cultural and environmental factors.
• Linguistic diversity.
• Use of nonstandard American English dialects.
• Limited speech or nonverbal communication.

Cultural norms and values can affect language development, including narrative discourse, topic maintenance, organizational structure, character, and creative elements. Children who use multiple languages in the home may have different oral and written language skills, while differences in vocabulary and syntax can affect reading comprehension in English. Nonstandard American English dialects may also impact decoding and word-level literacy skills, while limited speech or nonverbal communication can affect the assessment of literacy skills. It is essential to consider environmental variables and dynamic assessment procedures to identify a written language disorder.

Treatment

The primary objective in treating a patient with written language disorders is to enhance their written and oral communication abilities while also considering their overall educational curriculum. When evaluating a child’s language abilities, it is crucial to consider their performance in spoken and written language areas, such as hearing, cognition, and speech sound production.

The treatment approach should be balanced and cover all areas of difficulty, including sound-, spelling, sentence comprehension, and composition. There are different approaches to reading, writing, and spelling that can be used in combination, such as print-to-speech and speech-to-print word structure approaches, language comprehension approaches, and process-oriented and product-oriented approaches.

Intervention should be ongoing and individualized, based on the nature of the child’s deficits and learning style. Treatment goals should be tailored to promote a child’s knowledge, one step beyond their current level.

Treatment Options

When it comes to treating written language disorders, there are various options available based on the individual’s needs. Clinicians consider the person’s language profile, learning style, cultural background, the severity of the disorder, and communication needs when deciding on treatment strategies. Some available treatments include graphic organizers, read-aloud interventions, teaching story grammar, comprehension strategy instruction, and the writing lab approach. Graphic organizers help with note-taking and understanding text genres. Read-aloud interventions, like dialogic reading and repeated reading, increase fluency and enhance language skills. Teaching story grammar and comprehension strategy instruction aid in understanding and making predictions while reading. The writing lab approach uses computers to foster language growth through inclusive, curriculum-based writing instruction.

Specific treatment options

There are also several specific treatment options that can help people with this condition improve their communication skills.

Cooperative Integrated Reading and Composition

The program is created for students in Grades 2-6 and focuses on reading and writing activities, such as predicting story endings, discussing the main idea of a story, and practicing vocabulary and spelling.

Dyslexia Training Program

Dyslexia Training Program uses direct and systematic instruction to teach reading and spelling. It targets phonemic awareness, phonics, reading fluency, vocabulary, and reading comprehension and is most appropriate for Grades 2-5.

Lindamood Phoneme Sequencing

Lindamood Phoneme Sequencing is a multisensory program that uses systematic instruction to teach spelling, phonological awareness, decoding, and reading skills. The goal of this program is to develop fluent readers and competent spellers.

Orton-Gillingham

The Orton-Gillingham (OG) method is a rigorous, step-by-step approach that emphasizes phonics and word structure rather than meaning when teaching the fundamentals of word formation. This approach uses visual, auditory, and kinesthetic learning modalities and is used for students with spelling, reading, and writing difficulties.

The Reading Apprenticeship

The Reading Apprenticeship program is aimed at middle school, high school, and community college students and aims to enhance their involvement, fluency, and comprehension of content-related materials and texts. The program comprises a professional development component for teachers and students.

Road to the Code

Road to the Code is a program that enhances phonological awareness in young children by concentrating on phonemic awareness and letter-sound correspondence. The program offers developmentally sequenced lessons that provide repeated chances for students to practice and improve their initial reading and spelling skills.

Self-Regulated Strategy Development 

The Self-Regulated Strategy Development (SRSD) approach aims to assist students in acquiring and applying the writing strategies utilized by proficient writers. By combining strategy instruction with self-regulation, SRSD prompts students to assess, monitor, and refine their writing skills.

SPELL-Links to Reading & Writing

SPELL-Links to Reading & Writing is a comprehensive curriculum that teaches word-level skills by integrating phonological awareness, orthography, and semantics/morphology instruction. It also includes a structured application of these skills to writing and reading at the sentence and paragraph levels, with the aim of teaching critical word study.

Special treatment options

For children with handwriting difficulties, SLPs may work with occupational therapists to develop strategies for the motoric aspects of writing. For children with complex communication needs, interventions may include assistive technology and alternative communication systems to support both communication and literacy instruction. 

Children who are considered deaf or hard of hearing may need support with grapheme-phoneme acquisition and reading comprehension. Finally, transitioning youth and postsecondary students with written language impairments may need help with functional goals to facilitate their transition to young adulthood.