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Language impairment is often referred to as a “hidden disability”, but it may affect up to one in fourteen people. Individuals with impaired language skills, or Developmental Language Disorder (DLD), have difficulty learning, understanding, and/or using spoken language. However, the deficits can also extend to written language – reading, spelling, and writing – as well. These challenges typically emerge in early childhood and can persist into adulthood, but speech-language therapy is known to lead to positive outcomes.
Language impairment can co-occur with other disorders, including dyslexia and attention deficit hyperactivity disorder (ADHD). Additionally, students with impaired language skills are four times more likely to have difficulty with math and six times more likely to have difficulty with reading.
Students with impaired language skills may exhibit difficulty with:
Literacy – reading accuracy, spelling, reading comprehension, and written expression.
“Literacy is an achievement that rests on language competence at all levels, from the elemental sounds to the most overarching structures of text” (Moats, 2010, p. 2).
Literacy refers to the ability to access and use written language to communicate. It includes the ability to read and spell words accurately, comprehend what is read, and express oneself in writing. Impaired literacy skills can be attributed to various underlying factors and causes, which often have a complex interrelationship.
Skilled reading – i.e., reading with comprehension – is ultimately the outcome of language-based abilities. It occurs as a result of both accurate word recognition and adequate language comprehension.
Automatic recognition of written words requires integration of phonological awareness; knowledge of letter-sound correspondences, letter patterns, and spelling rules; awareness of affixes, base words, and word roots; semantic knowledge (meanings of words and phrases); and the development of robust mental images of words. As words are accurately read, our brains work to derive meaning from the written text.
How much meaning is extracted from a text depends on one’s background knowledge as well as one’s “receptive vocabulary, grammatical understanding, and discourse comprehension” (Catts, Adlof, & Weismer, 2006). Reading comprehension is, therefore, “is not easily taught” (Kamhi 2007) because it is not a single skill. Instead, it is highly dependent on specific content area knowledge, higher level processes (e.g., thinking, reasoning, imagining), and underlying language abilities.
Similarly, skilled writing is the product of adequate language expression (the ability to put background knowledge, thoughts, rationale, and notions into words) and adequate written word production. It requires seamless integration of many language components before or as the words are transcribed (i.e., handwritten or typed).
Dyslexia, which is sometimes referred to as Specific Learning Disorder with Impairment in Reading, has no relationship to intelligence. It is a general term for a neurodevelopmental disorder (i.e., the way the brain develops) that involves unexpected difficulties learning to read and spell even with appropriate classroom instruction. Individuals with dyslexia frequently struggle to accurately and/or fluently read and spell words. These challenges are often a result of deficits in the phonological component of language and/or retrieval of language-based information such as letter-sound correspondences.
Dysgraphia is a neurodevelopmental disorder that specifically affects writing and written expression. It falls under the category of specific learning disorders and has no correlation with intelligence. Symptoms vary by age, with some overlapping with dyslexia. Despite adequate exposure to appropriate instruction, individuals with dysgraphia experience greater difficulty with writing than expected for their age or grade level.
Individuals with dysgraphia experience significant challenges in transcription skills, including handwriting, typing, and spelling, which are essential for producing written content. Symptoms may manifest as slow and laborious writing with poor legibility as a result of difficulties with the physical act of writing, such as forming letters incorrectly or with atypical strokes, variable sizing of letters and numbers, inappropriate letter spacing within and between words, and difficulty writing in a straight line or situating writing in relation to the printed lines on paper. In addition to deficits in writing mechanics, the challenges in transcription may also hinder the transfer of ideas into written words.
While speech therapy is often associated with oral language and speech sound disorders, speech-language pathologists are uniquely positioned to address a child’s literacy skills because oral language skills are the foundation for literacy development. Language underlies all aspects of literacy whether one is thinking about the recognition of written words, decoding, spelling, reading comprehension, or written expression.
At Communicate & Connect Therapy, we love all things literacy! We specialize in the assessment, diagnosis, and treatment of language-based literacy disorders. Our associates evaluate the underlying abilities to determine the root causes of a student’s challenges. We then implement evidence-based interventions that lead to improved literacy outcomes.
Preliteracy skills, also known as early literacy skills, include the foundational knowledge and abilities that children develop before formal reading and writing instruction begins. These skills provide the building blocks for later literacy development and contribute to a child’s overall readiness for learning to read and write. Some important preliteracy skills include vocabulary, phonological awareness skills, letter-name knowledge and letter writing, print awareness and knowledge of print concepts, and narrative language skills. Because literacy aptitude is highly correlated with overall school achievement, these abilities pave the way for future academic success.
Individuals with dyslexia, developmental language disorder, and other neurodevelopmental disorders may also exhibit weak auditory/phonological processing skills.
Auditory processing refers to the brain’s ability to analyze and interpret auditory information in the presence of normal hearing acuity and are crucial for learning and communication.
Phonological processing is the use of the sounds of one’s language to process spoken and written language (Wagner & Torgesen, 1987) and includes phonological awareness, phonological working memory, and phonological retrieval. These skills are believed to play an important role in the development of mature speech sound production, oral language skills, and reading and spelling.
Phonological awareness refers to one’s conscious awareness of the sound structure of their oral language(s) and the ability to analyze and even manipulate units of sound (e.g., individual speech sounds, syllables, rhyme units).
Phonological memory, a component of working memory, involves retaining speech sound information in a temporary, short-term memory store. Research has shown an unmistakable link between working memory and reading comprehension.
Phonological retrieval involves the ability to recall the speech sounds in one’s oral language and is integral to phonological awareness. It has significant implications for literacy skills because it also includes the ability to call up the speech sounds associated with specific letters or letter teams (i.e., graphemes).
While it is expected that children will make speech sound errors as they learn to speak, all vowels and most consonant sounds are acquired by 90% of children by the age of 6. As such, a speech sound disorder can be defined either as when a child persists in making errors beyond the typical age of acquisition, when errors are atypical, or when errors on multiple sounds result in poor intelligibility compared to same-aged individuals. These disorders encompass both articulation and phonological disorders.
An articulation disorder involves challenges with the physical production of individual speech sounds. Children with articulation disorders may struggle with pronouncing with one or more specific sounds (e.g., /k/, /s/, /l/) leading to decreased intelligibility and issues with communicating effectively.
On the other hand, phonological disorders involve regular patterns of mistakes that often involve multiple sounds. Some examples include:
Executive function skills include working memory, inhibitory control (i.e., self-control), and cognitive flexibility, or the ability to think flexibly. Just like speech and language, we are not born with a set of developed executive function skills, but humans typically develop these skills slowly from infancy through early adulthood.
These mental skills operate like the air traffic control system at a busy airport, allowing us to set goals, plan, and get things done in our day-to-day lives because they are responsible for many other skills including:
Individuals with certain conditions such as Attention Deficit Hyperactivity Disorder (ADHD), autism, language disorder, and traumatic brain injuries may experience difficulties with executive functions. Deficits in these skills have repercussions on various aspects of life, including academics, work, social engagement, and other daily activities. However, these skills can also be developed and improved with practice and by applying strategies that target the specific areas of need. Speech-language pathologists (SLPs) can play a vital role in bolstering students’ executive function skills.
Pragmatic language skills are related to how people use verbal and nonverbal language to communicate with one another. They entail grasping and adhering to the “rules”, or social conventions, governing discourse and broader social contexts. Pragmatic language skills don’t only involve how we behave in social situations, they also involve using language in different ways for different purposes and how we interpret the verbal and nonverbal communication from others – whether the mode of communication is oral, written, or nonverbal language.
Strong pragmatic skills are necessary for:
Pragmatic language impairment can occur as a stand-alone condition but is often associated with other conditions such as autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), traumatic brain injury, intellectual disability and language disorders. Speech-language pathologists often work with individuals to develop and enhance social pragmatic skills through targeted interventions and social communication therapy.
