What is Literacy
Literacy is defined as the ability to produce and understand written language.  From birth, our brains are wired to learn language.  We go through developmental periods of rapid language growth where we learn to speak and understand spoken language.  
Unfortunately, our brains are not equally programmed to translate that spoken language to written language.  Children usually need years of instruction to transfer their knowledge of spoken language to written language and their literacy skills improve gradually over time.  Some children struggle with reading and writing more than others and require additional supports and resources.  These children are considered to have a literacy delay or disorder.  
But what about those children who struggled to learn speech and language skills in the first place?  Children with spoken language delays and disorders are more likely to struggle with literacy as their language foundations are not as solid as other children.  A 2009 study found clear evidence that speech sound disorder (SSD) is associated with persistent phonological deficits and that children with preschool histories of SSD have elevated rates of reading delays compared with both the general population and the control group. (Peterson et. al.)  We also know that language skills that are missing or used incorrectly in spoken language will also cause problems in written language.

How to Identify Children who need Help with Literacy
Our formal and informal assessments can identify children with reading and writing delays and disorders.  These children may be struggling to keep up in school or make progress on reading and writing skills that would be expected for their age.
However, due to the high interconnectivity between speech/language and literacy, all of our clients with speech/language delays and disorders can benefit from extra help with literacy.  This is especially true when we are working with younger children whom we don’t yet know if they will develop literacy problems later on.  The early supports and interventions that we can provide as speech-language professionals can go a long way to preventing future literacy problems.  
Now you may be thinking, “we can’t just add literacy goals to every child who crosses our doorstep” and I agree!  But there are many ways that we can build literacy supports into what we’re already doing to make our therapies more effective.  

How to Assess Literacy
Reading and writing skills should be evaluated as part of a full language and literacy evaluation.  As per the American Speech/Language Hearing Association (ASHA), a literacy evaluation can include both formal and informal assessment activities:

•    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.

How do you include curriculum-based assignments in literacy therapy?
The best way that we can help children with literacy delays and disorders is to make our therapy relevant to what is going on in the child’s life.  This may mean bringing in reading materials that relate to their interests or using their curriculum-based assignments as a foundation for our literacy therapy.
Speech-language pathologists are uniquely qualified to help our clients make the connection between spoken language and written language.  In therapy, we should focus on teaching the underlying language skills that are missing and then showing our clients how they apply to written language.  We can do this by teaching a skill and then immediately brining in assignments from their classroom to show them how that translates to what they’re working on in class.  We can work closely with classroom teachers to identify opportunities for this crossover to occur.
Another amazing benefit of using curriculum-based assignments is that you help your clients learn those language skills more quickly by applying them in multiple situations.  The more a child is exposed to a skill, the more likely they will be to retain it.  For example, if you’re working on the pronouns “he” and “she” in therapy, you might start by writing the words “he” and “she” on notecards and use that as you’re helping the child speak sentences with those words correctly.  After that, you might bring in a book from his/her classroom and point out where those pronouns are used.  Then, you can bring in a worksheet from class where he needs to write a sentence about the character in the book.  You can help him practice writing those pronouns correctly to complete the activity.  Now the child has multiple opportunities to see, hear, write, and use that word in multiple contexts.

Therapy and Carry-Over for Literacy
Before you begin literacy therapy, it is important to identify the resources that the child has available to him or her.  The child will likely be receiving regular literacy instruction from the classroom or educational placement.  In addition, some children will also have reading specialists or special educators on the team to support the child’s literacy development.  Knowing what services are already being provided will help you better understand your role on the team.  Work together with the child’s team to identify where your specialized training can be of the most help.
Keep in mind that of everyone on the team, you are the only one with extensive training in treating speech, phonological, and language disorders.  Identify which of those underlying conditions may be present for the child and focus on how you can help fix those underlying problems that may be impacting the child’s reading or writing.
Even if a child does not have specific goals for literacy, we can boost our clients’ literacy skills by incorporating reading and writing into our sessions.  Write the letters for the sounds you’re working on or write out the sentences that you want the client to speak.  Always present the child with the written representation of whatever you’re working on.  
Here some great literacy activities in you can do in therapy to help children with literacy based on their underlying speech/language difficulties:

Children with Speech Sound Disorders:
If the client you’re working with is struggling to produce certain speech sounds, you can help by teaching them the sounds along with the letters to spell them.  When you’re working on single words, make sure to present the text of the word first, then add the picture if needed.  Use letters and written language to supplement your work with sounds.  
If the child struggles with phonological processes, make sure to also work on phonological awareness (rhyming, syllabification, blending, etc.) along with the processes that you’re targeting.  Keep in mind that those phonological impairments can impact reading even once they have repaired the spoken aspects of their phonology.  Again, use literacy to target those processes.  For example, if the child is exhibiting final consonant deletion, take time to teach what letters/sounds are consonants and which are vowels.  Show the child the consonant on the end of the word in addition to saying it out loud.

Children with Vocabulary Delays:
Vocabulary delays can impact a child’s ability to read and write on grade level.  You can teach word-learning strategies to help them learn new vocabulary and understand new words when they encounter them in speech or reading.  One great word-learning strategy is teaching root words and affixes (prefixes and suffixes).  Talk about the difference between a root word, a prefix, and a suffix and teach them the meanings of some common affixes and roots that they may encounter in their reading.  Use examples from their curriculum-based assignments to help them understand how words derive their meanings from these common word parts.

Children with Grammar/Syntax Delays:
A child who struggles with grammar and syntax in spoken language is likely to have those same difficulties when translating that to written language.  Just as with children with speech sound disorders, make sure you incorporate written language into your sessions when teaching syntax and grammar.  Invest in a large stack of 3x5 notecards.  Write the words to a sentence on notecards and have your clients physically rearrange them to form the sentences (or add grammatical markers onto root words to change their meanings).  Pull in text from their classroom and help your client find where their target skill is being used in the text.  Help them edit their writing assignments for the target skill and re-write the assignment correctly.

Children with Attention/Organizational Problems:
As speech-language pathologists, we often work with children with executive functioning delays who need help with skills such as attention and organization. These factors can impact their reading and writing just as much as their spoken language.  When working with a child with attention problems, take time to help them develop strategies to stay on task during reading and writing assignments, such as using visual timers and chunking assignments to work on a little at a time.  When working with children with organizational problems, help them use graphic organizers to organize their writing before starting an assignment.

Children with Abstract Language Delays (Inferencing & Idioms):
Another common language difficulty that impacts reading is abstract language.  Our children with autism spectrum disorders can struggle with this as well as other children who take a more literal approach to understanding language.  
We can work on inferencing by starting with pictures.  Show the child a picture and then help them identify what background knowledge + clues from the picture they can combine to make an inference.  For example, let’s assume you show the child a picture of a woman in a wedding dress.  You could use the background knowledge that women wear big, white dresses when they get married (in American culture) and combine that with the observations that the woman is wearing a big white wedding dress in the picture.  From that, you could make an inference that this picture was taken on her wedding day.  After pictures, you can gradually work up to pictures with captions or speech bubbles and then to text without pictures.
We use figurative language and idioms quite a bit in our everyday speech.  Think about the most commonly heard ones in your area for the client you are working with.  Do teachers say “take a seat” or “hang on”?  These may make perfect sense to us but have a figurative meaning that our very literal clients may struggle with.  Help them identify these idioms and what they really mean.  To practice, have them read a passage where an idiom is used.  Then, give them options of what they think the idiom really means in that context.

Children with Difficulty Answering Questions:
Children who struggle with answering questions may have difficulty answering questions about a text or story that has been read in order to demonstrate comprehension.  You can help these children by explicitly teaching what each of the “wh-“ question words means (such as, “where means place”) and then by answering questions about stories and developmentally-appropriate texts.

Carry-Over into the Classroom:
One of the best ways to carry-over what you’re working on with literacy is to use the same or similar materials to the classroom.  When everyone is working on the same things, then carrying skills over from one setting to the next is a much less difficult task.  Pull the same reading passages and materials that the classroom is using or even push your therapy into the classroom during reading time.  If you have more than one child in the class, you can run a small group right there in the classroom while the teacher works with other students.  Use your literacy time to help older students with their reading and writing homework.  Any way that you can bring together what you’re doing with what is happening in the classroom will benefit the child.  
In addition to this, work closely with the classroom teacher to stay on the same page in terms of what skills are being addressed.  Give the teacher quick tips for how to incorporate what you’re addressing in speech into what he or she is doing in the classroom.

The Takeaways:
We as speech-language pathologists are uniquely positioned to help our clients boost their literacy skills.  We can incidentally include literacy throughout our sessions for all children to prevent further reading and writing difficulties and to increase the efficacy of our sessions.  For children who are already exhibiting literacy delays, we can support their overall language and literacy development by identifying the underlying language difficulties that are impacting their literacy skills and addressing those.  By integrating the spoken language skills with the written language skills, we can help our clients build a bridge between the two that will help them be more successful in school and in life.
Source:
American Speech-Language-Hearing Association. (n.d.). Written Language Disorders. (Practice Portal). Retrieved November 8, 2021, from www.asha.org/Practice-Portal/Clinical-Topics/Written-Language-Disorders/.

Peterson RL, Pennington BF, Shriberg LD, Boada R. What influences literacy outcome in children with speech sound disorder? J Speech Lang Hear Res. 2009 Oct;52(5):1175-88. doi: 10.1044/1092-4388(2009/08-0024). Epub 2009 Apr 29. PMID: 19403946; PMCID: PMC3608470.