Disorder of Written Expression

Disorder of Written Expression may be a condition speech language pathologists (SLPs) treat as they continue to expand the scope of clients they treat. This diagnosis refers to a Specific Learning Disorder that includes an impairment in written language.

According to the American Speech-Language-Hearing Association (ASHA), SLPs play a critical role in developing literacy and in the assessment, diagnosis, and treatment of written language disorders. Speech therapy can effectively address an individual’s difficulties with spelling and writing (such as at the word or sentence level).

Let’s explore the role of speech therapy in improving skills within written expression. We’ll dive into ICD-10 coding, assessment, intervention, assistive technology and accommodations, and challenges to consider.

Definition and characteristics of Disorder of Written Expression

Disorder of Written Expression is a term that is used to refer to individuals who demonstrate abilities in writing that are not at the expected level for their cognitive level and age, despite exposure to adequate instruction. This is often used interchangeably with the term Dysgraphia. However, some use the term Dysgraphia to refer specifically to difficulties with handwriting.

Individuals with this disorder may struggle with various aspects of writing. This can include impairments in spelling and in the more conceptual aspects of writing, such organizing thoughts on paper to form a cohesive, organized message.

Spelling is the process of mapping from a phoneme to a grapheme in order to spell a spoken word in written form. This requires the ability to first segment words into phonemes, and then translate these phonemes into graphemes (units of letters) in both the correct order and written form.

Writing includes both the writing process and the written product. The writing process includes the ability for the individual to plan, organize, and edit written text. It also includes the ability to address a specific audience and convey a certain purpose.

The written product has several components, including: morphology, syntax (sentence level; content, complexity, punctuation), text level (coherence and cohesiveness), communicative functions, and organizational structure (including sequential/chronological order).

Speech therapy assessment for the Disorder of Written Expression

A comprehensive assessment is an essential component of successful intervention for clients with a Disorder of Written Expression.

An assessment will likely include:

• Standardized testing. Assessments such as the Oral-Written Language Scale - 2nd Edition (OWLS-II) provide normed measures of written language. Spoken language assessments and speech sound assessments may also be completed.

• Case History. The SLP should interview parents/caregivers and other professionals working with the child to obtain information about the child’s medical history, developmental milestones, and specific areas of concern.

• Phonological Processing Assessment. Assessment of the client’s phonological awareness, retrieval, memory, and production.

• Analysis of a writing sample. Clinicians can specifically analyze areas such as spelling, printing all letters of the alphabet, printing first and last name, and showing communicative intent in writing.

Other areas may also be included in the assessment, depending on the specific areas of concern for the client.

ICD-10 coding for the Disorder of Written Expression

F81.81 is the ICD-10 code for Disorder of Written Expression. This is a medical classification listed by the World Health Organization (WHO) under the range of Mental, Behavioral and Neurodevelopmental Disorders.

The official descriptor of F81.81 is: Specific Learning Disorder, with impairment in written expression. Attaching the accurate ICD-10 code to therapy notes and billing documentation can ensure compliance with HIPAA regulations and reimbursement from payers.

Speech therapy interventions for Disorder of Written Expression

Speech therapy intervention for Disorder of Written Expression focuses on improving the client’s written language skills by building on the reciprocal relationships between spoken and written language.

A process-oriented approach to writing focuses on the process involved, such as organizing and editing. A product-oriented approach focuses on the written form. This includes areas such as vocabulary, letter formation, spelling, and syntax.

It’s important to keep in mind that there are certain foundational language knowledge areas that support spelling, including:

• Phonological awareness

• Orthographic knowledge (the ability to understand how oral language is represented in writing)

• Semantic knowledge (how meaning affects spelling, as in using the correct form of “their” versus “there”)

• Morphological knowledge (the structure of words)

SLPs can incorporate evidence-based programs to improve a client’s spelling, such as the Barton Reading and Spelling System, which is a multisensory, Orton-Gillingham approach.