SAJCD 87

Speech-language therapy for adolescents with
written-language difficulties: The South African context

D
Erasmus, B Communication Pathology;
L Schutte, B Communication Pathology;
M van der Merwe, B Communication
Pathology; S Geertsema, M
Communication Pathology

Department of
Communication Pathology, University of Pretoria, Gauteng,
South Africa

Corresponding author: S Geertsema
(salome.geertsema@up.ac.za)

Objective.
To investigate whether privately practising speech-language
therapists in South Africa are fulfilling their role of
identification, assessment and intervention for adolescents with
written-language and reading difficulties. Further needs
concerning training with regard to this population group were
also determined.

Method.
A survey study was conducted, using a self-administered
questionnaire. Twenty-two currently practising speech-language
therapists who are registered members of the South African
Speech-Language-Hearing Association (SASLHA) participated in the
study.

Results.
The respondents indicated that they are aware of their role
regarding adolescents with written-language difficulties.
However, they feel that South-African speech-language therapists
are not fulfilling this role. Existing assessment tools and
interventions for written-language difficulties are described as
inadequate, and culturally and age inappropriate. Yet, the
majority of the respondents feel that they are adequately
equipped to work with adolescents with written-language
difficulties, based on their own experience, self-study and
secondary training. The respondents feel that training regarding
effective collaboration with teachers is necessary to establish
specific roles, and to promote speech-language therapy for
adolescents among teachers.

Conclusion.
Further research is needed in developing appropriate assessment
and intervention tools as well as improvement of training at an
undergraduate level.

Keywords:
speech-language therapist, adolescents, written difficulties,
current practice, perceptions, needs, training, South African
context

S Afr J CD 2013;60:50-58
DOI:10.7196/SAJCD.87

Appendix A is available with the online PDF
of this article at http://dx.doi.org/10.7196/SAJCD.87

The International Reading Association’s
Commission on Adolescent Literacy (Moore, Bean, Birdyshaw &
Rycik, 1999) states that 21st century adolescents will be
required to read and write more when entering the adult world.
Future literacy needs of adolescents are complex and demanding;
therefore serious and continuing attention is needed in the
development of their reading, writing and language skills
(Kathard et al.,
2011).

With age, literacy difficulties increasingly affect
adolescents, which can lead to reduced competence and confidence
in adulthood. This compromises their life and work trajectories
(Harreveld, Baker & Isdale, 2008). A common concern is that
adolescents do not develop the adequate writing skills needed
for academic and vocational success and success in their
personal lives (Kathard et
al., 2011). The effect that reading and writing
disabilities have on students’ transition into adult life is
seldom addressed (Sitlington, 2008). Most adolescents who have
learning disabilities not only present with reading deficits,
but also with deficits in other academic areas such as writing
(Geertsema, Hyman & Van Deventer, 2011; Shumaker &
Deshler, 2003).

Owens (2010) further categorises written-language difficulties
into dyslexia (a disorder of reading characterised by poor
reading comprehension or word-recognition abilities), and
dysgraphia (difficulty in writing including spelling errors,
punctuation, word omissions, agrammatical sentences,
substitution and lack of organisation). Dyslexia and dysgraphia
are distinguished from non-specific reading disorders, on the
grounds of their characteristic problems with decoding and
encoding (Jantzen, 2010; Stark, 2010). These decoding and
encoding problems can be described in terms of dyslexia,
discalculia (a mathematical learning problem), and Gertsmann
syndrome (poor spatial orientation) (Stark, 2010). Non-specific
reading difficulties are differentially distinguished from
dyslexia on the basis of possible low intelligence, poor
motivation, perceptual and sensory problems, emotional problems,
social-cultural factors, educational deprivation, attention
deficit disorder (ADD), attention deficit hyperactivity disorder
(ADHD), or a second-language learning barrier (Stark, 2010).
Factors leading to non-specific writing difficulties may range
from difficulties with the execution and regulation of the
processes that underlie proficient composing to motivational
factors (Stark, 2010). Children experiencing these difficulties
display shorter written texts, are more prone to grammatical or
spelling errors, and have poor organisational skills (Owens,
2010).

Literacy skills are essential for people to achieve
maximum functional participation throughout their
foundation-phase school years into adulthood, and are
prerequisites for employment as well as quality of life (ASHA,
2001). Many children and adolescents, growing up in deprived
socioeconomic environments, are at risk of poor oral language
and general communication skills (Kathard et al., 2011). Spoken and written
language are strongly linked in terms of the physiology of the
reading (decoding) and writing (encoding) processes (Stark,
2010). Phonetic decoding abilities (word attack strategies) as
well as eidetic deciphering (look-and-say strategies) rely
strongly on an individual’s vocabulary. This poses a risk in
terms of second-language learning barriers, and cognitive
academic language proficiency in general. These risks are
aggravated by the current socioeconomic and educational
situation in South Africa (Kathard et al., 2011; Jordaan,
2011).

South Africa has one of the most diverse multilingual and
multicultural populations in the world (Seeff-Gabriel, 2003).
The language of learning and teaching (LoLT) in schools differs
in many cases from home languages spoken and understood by
learners. The term ‘additional language’ as opposed to ‘second
language’ is preferred, as many South African children are
exposed to more than one language in the home and community
(Jordaan, 2011). Many studies in South Africa have shown English
additional language (EAL) learners to display poorer
phonological awareness skills than those of their English first
language (EFL) peers (Seeff-Gabriel, 2003). These poor
phonological awareness skills impact on learners’ basic
cognitive academic skills. The result is poorer pronunciation,
and negative influences on their reading and spelling skills in
the class context, where the LoLT is English (Pijper, 2003).
Additional-language learning barriers can also mask the
differential diagnosis of dyslexia and non-specific reading and
writing problems, because of the many additional factors at play
(Stark, 2010). The education system in South Africa also poses
certain challenges. The discontinued outcomes-based education
system (OBE) is said to have contributed to the high school
failure rate. Naki (2010) stated that school pass rates have
dropped from a 60% average to about 40% average in rural areas,
since the onset of the OBE system. Literacy and numeracy skills
have been rated as some of the weakest in the world, as a result
of underqualified educators as well as a lack of learning
resources (Naki, 2010). However, these are not the only factors
contributing to the academic situation. The role of language in
education, peer-interaction as a social construct during
language learning, and content- and language-integrated learning
are often overlooked. Jordaan (2011) summarises these challenges
as limited language awareness, inadequate teaching methods, the
essentially positivist nature of OBE and weak integrated
learning contexts.

In addressing some of the challenges, the newly introduced
Curriculum and Assessment Policy Statements (CAPS) mark ‘an
important step to a basic education sector that is more unified,
accountable, better informed about itself and more focused on
workable solutions’ (Soobrayan cited in Department of Basic
Education; Notice 752 of 2010, p.4). The CAPS Action plan to
2014 acknowledges the need for improvement of all learning
outcomes and proposes to introduce quality early childhood
development, improve quality of teaching and learning, undertake
regular assessments to track progress, and ensure an
outcomes-focused planning and accountability system. More
compulsory time spent on English in the foundation-phase
classroom of the EAL learner, constant numeracy and literacy
progress tracking, attainment of minimum language and
mathematics competencies in grades 6 and 9, and eventually
increasing the number of grade 12 learners eligible for a
university Bachelor’s programme, are among the 13 proposed goals
looking at learning outcomes and coverage (Department of Basic
Education, 2010).

For a learner to access education, the ability to participate
in active and interactive communication with peers as well as
with adults in the classroom is necessary. Speech-language
therapists play a critical role in the development of literacy
when a child or adolescent displays communication difficulties.
This role is implemented in collaboration with other experts in
the field of the development of written language (ASHA, 2001).
The written-language component of literacy is not explored by
many speech-language therapists in the secondary school context.
A study by Ehren and Ehren (2001) indicated that many
speech-language therapists do not think that the assessment and
intervention of written language is their role at the secondary
school level. Speech-language therapists may be reluctant to
assume roles regarding reading and writing for a variety of
reasons such as their own perceptions, fear of change, and lack
of training (Ehren & Ehren, 2001). In addition to this,
standardised tests with adequate validity and norms are not
always available for adolescents (Adams, 2002). In a more recent
study Wellman (2006) of the University of Cincinnati (USA)
suggested that educator collaboration with speech-language
therapists exists in supporting secondary school learners with
reading problems, but many educators still hold a more
traditional view of speech-language therapists as working only
with speech sound production. Wellman (2006) suggested that
educators and speech-language therapists are not in agreement
regarding the roles of the school-based speech-language
therapist pertaining to literacy, as put forth by ASHA (2001).

In South Africa, very few tests are available to cater for the
11 official languages, and even if assessment material such as
the African receptive-expressive tests compiled in the South
African Language Assessments Manual (Bortz, 1997) are
administered, the examiner should preferably be a first-language
speaker of the test being administered. Only when assisted by a
first-language speaker, may an Afrikaans or English speaker
administer the test (Bortz, 1997). Specific diagnostic tests for
dyslexia are also much needed, and only recently has an
Afrikaans dyslexia test entered our system (Stark, 2010).

Although many locally relevant studies indicate a
willingness to collaborate, support and provide services to
primary schools (Kathard et al., 2011;
Moodley, Chetty, & Pahl, 2005), there is a dearth of
knowledge regarding the South African adolescent population.
To be a role player in the Department of Basic Education’s
immediate ‘Action
plan to 2014’ (Department of Basic Education,
2010), the speech-language therapist in South Africa has to
answer a few questions regarding expected competencies and our
role in the enhancement of language, learning and literacy in
Basic Education. Issues to consider are the type of service
delivery models, support in the development of all languages
(including English as an additional language), and leadership
and participation roles in social innovation (Kathard et al., 2011).

Therapy that addresses the underlying language problems
in adolescents should be the primary role of the
speech-language therapist at secondary school level. If
language disabilities persist beyond the age of 8 - 10 years,
it is no longer perceived to be the educator’s responsibility
to address the residual effects (Owens, 2010). Recent studies
indicate that many such residual and persistent effects can
occur into adolescence (Rescorla, 2008). According to
Geertsema et al.
(2011) written-language challenges, such as SMS (short message
system) language occurring in the adolescent age group, are
usually addressed by the educators themselves. However, the
educators in their study perceived the role of the
speech-language therapist to be one of assessment of and
intervention in spelling errors, and sentence length and
complexity. Learners should also be supported in the
application of specific skills in order to construct meaning
from spoken and written language (Staskowski & Creaghead,
2001). A greater focus on, and understanding of, the needs of
adolescents as they progress through their secondary school
education is needed for this support (Bercow, 2008).

There is currently an internationally increased focus on the
constant development of the language and communication skills of
adolescents throughout their secondary school education (Vance
& Clegg, 2010). If an educator notices a learner who shows
signs of poor academic performance due to a possible learning
difficulty, referral to a speech-language therapist should be
made (ASHA,

2001). However, Wellman (2006) suggested that there is no
significant relationship between the educators’ perceived roles
of the speech-language therapist working in USA schools and
their referral practices. Geertsema et al. (2011) found that
educators in the South African secondary school system perceive
the role of the speech-language therapist to be one of
addressing written-language difficulties in the adolescent age
group. This perception is in agreement with the roles and
responsibilities as set forth by ASHA (2001) and SASHLA (2013).
Furthermore, these educators represent the main source of
referral within a system of collaboration in the secondary
schools (Kathard et al.,

2011).

Evidence-based practice within a population that is often
neglected is warranted (Geertsema et al., 2011; Kathard et al., 2011; Rescorla,
2008). As school-based speech-language therapists in South
Africa are generally employed in schools for learners with
special educational needs (LSEN), and these populations exclude
learners with average to above-average IQs such as learners with
dyslexia, the current study focused on services provided to
learners in mainstream secondary schools by private-practising
speech-language therapists. Furthermore, the presence of many
EAL learners in the historical Model C schools in the
middle-class socio-economic group has increased the caseload of
these learners among private practices in suburban areas.

Methods

Objectives

The main aim of this study was to describe
the services provided to adolescents with written-language
disabilities by private-practising speech-language therapists in
South Africa.

The three objectives were to describe:

• Current practices of speech-language therapists
in South Africa regarding the assessment of and intervention in
written-language skills of adolescents

• Perceptions
of speech-language therapists in South Africa regarding
their role in assessment and intervention for written-language
difficulties in adolescents

• The nature of speech-language therapists’ needs
in future training, andspecific training skills needed for
assessment and intervention for this population.

Research design

This was a survey study which aimed to
develop hypotheses in such a manner that more accurate
investigation may occur at a later time. Within the exploratory
research design, a self-administered questionnaire was utilised
to research a larger population and more extended geographical
region, ensuring a high degree of freedom and anonymity (Leedy
& Ormrod, 2005).

Participants

The target population was speech-language
therapists in South Africa in private practice. A stratified,
purposive probability sampling technique was used. This study
only included those speech-language therapists currently in
private practice, and the group of respondents was further
divided into specific areas of practice. Respondents needed to
meet the criterion of being actively in private practice –
therefore registered with the Health Professions Council of
South Africa (HPCSA) – before being eligible for inclusion in
the sample. The SASHLA 2009 membership list was used to obtain
the names and contact details of all the currently
private-practising speech-language therapists in South Africa.
Each member on this list was invited to participate in the
study.

Biographical profile of respondents

Ten of the respondents (45%) indicated that
they graduated from the University of Pretoria, 23% from the
University of Cape Town, and 18% from the University of the
Witwatersrand. One respondent graduated from the University of
Stellenbosch, one from the University of KwaZulu-Natal, and one
from a university not situated in South Africa. Of the 22
respondents, 14 indicated that their highest qualification is an
undergraduate degree in speech-language therapy and they
represented 64% of the sample. Thirty-six per cent of the
respondents indicated that their highest qualification is a
master’s degree in speech-language therapy.

Twelve of the respondents (55%) have more than 15 years
experience in the field, and another 18% have between 10 and 15
years of clinical experience. This indicated that all the
respondents have sufficient knowledge and exposure in working
with speech and language difficulties. Eighteen of the
respondents’ caseloads are comprised of less than 25%, 3 of the
respondents’ caseloads are comprised of 25 - 50%, and only 1
respondent’s caseloads are comprised of 50 - 75% of adolescents
with written-language difficulties.

Ethics

The study abided by principles of research
ethics by obtaining informed consent, adhering to anonymity and
beneficence in terms of the research design, and ensuring the
competency of the researchers. Informed consent was granted
through submission of the questionnaire. Each questionnaire was
numbered and no names were requested. Ethical clearance was
obtained from the Faculty of Humanities, University of Pretoria,
South Africa.

Procedure

A self-administered questionnaire (Appendix
A) was chosen as the method of data collection. A pilot study
was conducted prior to the data collection. Based on the
feedback received from the respondents who participated in the
pilot study, refinements to the questionnaire were made. A
covering letter explaining the nature, content and aim of the
research study was attached to the questionnaire. Respondents
were informed that they were consenting to participate in the
research study by completing the questionnaire, and that
participation was voluntary.

A total of 100 questionnaires were distributed to all
speech-language therapists on the 2009 SASLHA membership list
via email. The SASLHA membership list is the most comprehensive
database available of private-practising speech-language
therapists in South Africa. However, it is recognised that not
all private-practising speech-language therapists are SASHLA
members, and therefore some amount of respondent bias could have
occurred. Twenty-two questionnaires were returned via email. A
response rate of 20 - 30% is seen as acceptable (Salkind, 2006).
The monitoring of returns via email was carefully recorded by
utilising a return rate graph, and follow-up mailings to
non-respondents was an additional encouragement to participate
(Irwin, Pannbacker, & Lass, 2005).

Analysis

Data were analysed quantitatively as
well as qualitatively. The study objectives were used to guide
the analysis, and data were presented in tabular and graphical
format using the computer spreadsheet program Microsoft Excel.
A descriptive statistical analysis was used to synthesise and
describe quantitative data (Irwin et al., 2005).
Qualitative data were analysed by means of a content analysis.
This process involved the categorising of responses obtained
and placing these in a specific context. A descriptive
statistical analysis was used to synthesise and describe
quantitative data (Irwin et al., 2005). The
objectives were used to determine which topics to include or
exclude during the analysis. The number of responses
associated with each theme was analysed statistically by
determining the frequency patterns for each theme.

Validity and reliability

The goals of the research project were
clearly specified in the cover letter. An in-depth literature
study was conducted consulting recent and relevant research on
assessment and intervention of isolated written-language
difficulties in adolescents as well as long-term outcomes when
disabilities are not addressed. Previous research questionnaires
were reviewed and compared with the questionnaire used in this
study, in order to ensure criterion validity. A range of
questions were included in the questionnaire, e.g. open- and
closed-ended questions, to ensure construct validity of a
well-planned questionnaire (Irwin et al., 2005).

Results and discussion

Current practice of speech-language therapists
in South Africa regarding the assessment and intervention of
adolescent written-language skills

Practice regarding assessment

Most of the respondents (95%) felt that
existing assessment tools for assessment of written-language
difficulties are insufficient. Furthermore, the respondents use
more informal assessment tools (64%) than formal tools (36%),
confirming this inadequacy. Examples of formal assessment tools
used by the respondents are the Test of Word Reading Efficiency
(TOWRE) (Torgesen, Wagner, & Rashotte, 1999), Test of
Written Language-2 (TOWL-2) (Hammill & Larsen, 1988),
Wechsler Objective Language Dimensions (WOLD) (Wechsler, 1996),
and the Test of Adolescent Language (TOAL-4) (Hammill, Brown,
Larson, & Wederholt, 2007). Informal assessment tools were
mainly indicated as informal written tasks, making use of the
adolescents’ school books and written class work and ability to
formulate and write down answers. A few of the respondents were
of the opinion that the existing assessment tools are not age
appropriate (8%) and many felt that they are culturally
inappropriate (44%).

A need exists for culturally valid and reliable developmental
assessment tools for children with written-language difficulties
that are able to accommodate multiple languages (Bornman,
Sevcik, Romski, & Pae, 2010). In South Africa the work of
authors such as Bortz (1997) and Stark (2010) is a step in the
right direction, but considerable work still needs to be done.
Furthermore, linguistic bias by the therapist who administers
the test, and bias toward life experience and social practices
(Laing & Kamhi, 2003) should be considered in a developing
country which requires innovative initiatives grounded in
knowledge of the challenges that characterise it.

Practice regarding intervention

Respondents mostly base their intervention on
experience and not on previous research (Figure 1). This
indicates that relevant literature and research on intervention
with adolescents of diverse linguistic and cultural backgrounds
are limited. Examples of the different programmes and techniques
used by a number of the respondents during intervention are
indicated in Table 1.

Fig. 1. Respondents’ (n=22)intervention bases.

Successful intervention

The respondents described the following
factors as necessary for successful intervention:

• The child’s motivation
and the parent’s support. Many respondents felt
that the adolescent’s will to succeed plays the biggest role
in successful intervention. When the adolescent has a positive
attitude and is willing to work with the therapist,
improvement is more likely to occur. It is also important that
parents provide support and understand the long-term
advantages of speech-language therapists’ services.

• Appropriate
and consistent therapy programmes. Respondents
commented that consistent intervention, that is relevant to
the adolescent’s curriculum, is important. A client-based
programme, which specifically meets the needs of the
individual, must be designed. One respondent commented that
activities need to be fun, and that computer-based activities
seem to interest adolescents. Another respondent commented
that it is important for adolescents to see visible signs of
their own progress in order to increase motivation.

• Improved
understanding of written-language deficits. It
is important that speech-language therapists understand and
identify underlying deficits of written-language disabilities.
One respondent mentioned that written-language difficulties,
which may not have been identified early, do not necessarily
resolve and therefore require the resumption of therapy in the
adolescent years when language demands increase. Research on
neural plasticity and central auditory processing has emerged,
and the speech-language therapist has to be knowledgeable in
these areas in order to make a correct diagnosis and treat
written-language difficulties effectively.

Challenges

The respondents described the following
challenges faced by the South African speech-language therapist:

• Lack of
awareness of the speech-language therapist’s role. A
lack of public awareness results in reduced referrals from
teachers and other professionals, as well as reduced
collaboration between professionals. A lack of knowledge among
teachers and parents exists in terms of how speech-language
therapy can help with adolescent language.

• Correct
identification and diagnosis. Respondents felt that
written-language difficulties are often identified at a late
stage. Some respondents are of the opinion that adolescents with
written-language difficulties are often labelled as having poor
cognitive abilities, and are then referred for remedial
education. Other respondents feel that written-language
difficulties are still diagnosed as a learning problem and
referred to remedial programmes where the focus is on grammar
and spelling, and not on the language used in writing.

• Limited
appropriate material. This is not only a challenge
during assessment, but also during intervention. Most of the
respondents (95%) were of the opinion that the available
treatment tools are culturally inappropriate. Some respondents
(82%) also felt that they have inadequate training and exposure
in the use of available tools for intervention. Respondents
mentioned an insufficient number of effective programmes and a
lack of intervention tools incorporating aspects of the school
curriculum. The ever-present additional-language challenge
impacting on effective treatment was highlighted.

• Adolescents
themselves. Motivation on the side of the client may
be the most apparent barrier. Clients’ lack of interest and lack
of self-confidence poses a problem during intervention. The
respondents identified numerous constraints, such as adolescents
having limited time to attend and follow through with the
intervention programmes, as well as limited financial resources.

The greatest challenge identified by the respondents regarding
intervention for this population was the lack of sufficient
assessment and intervention tools. The fact that speech-language
therapists are not adequately trained at undergraduate level in
this area was also mentioned. The respondents considered the
client’s motivation and parent support to be the most important
additional contributor to successful intervention. This
correlates with the self-determination theory which suggests
that students’ motivation for academic tasks varies in both
strength and quality, and both strength and quality predict
learning, achievement, and continuation to tertiary education
(Hardré & Reeve, 2003).

Perceptions of
speech-language therapists in South Africa regarding their role
in assessment and intervention of adolescent written-language
difficulties

A majority of the respondents (86%) indicated
that they felt that speech-language therapists are not
adequately involved when it comes to the identification,
assessment and intervention of written-language difficulties in
adolescents. However, they do feel they have a role to play in
these processes. Speech-language therapists may be reluctant to
assume roles regarding reading and writing for a variety of
reasons such as: their own perceptions, fear of change and lack
of training (Ehren & Ehren, 2001). According to our
findings, South African private-practising speech-language
therapists are aware that identification, assessment and
intervention of adolescents with written-language difficulties
are within the scope of practice of the speech-language
therapist.

Perception regarding assessment

A majority of the respondents (86%) felt that
speech-language therapists in South Africa are insufficiently
active and involved in the assessment of adolescents with
written-language difficulties. Fourteen respondents (64%)
indicated that they feel responsible for identification of
adolescents with written-language difficulties together with
other professionals. These professionals include: teachers,
occupational therapists, remedial teachers, neuro-psychologists,
educational psychologists and clinical psychologists.

Perception regarding intervention

A majority of the respondents (82%) reported
that speech-language therapists in South Africa are
insufficiently active in providing treatment to adolescents with
written-language difficulties. Only 18% of the respondents
indicated that they feel solely responsible. Twelve (55%)
indicated they are responsible as part of a multiprofessional
team. Six respondents (27%) felt that they had no role to play
during intervention in written-language difficulties in this
population.

Needs in future training
regarding assessment and intervention for adolescent
written-language difficulties

Ten (45%) respondents felt adequately
equipped to provide intervention to adolescents with
written-language difficulties. Some indicated they felt this way
because of experience, self-study and secondary training. On the
other hand, 8 respondents (36%) stated that they felt poorly
equipped to provide intervention to this population. Ten (45%)
respondents also felt that training in intervention of
written-language difficulties in adolescents should be taking
place at an undergraduate level. The respondents specifically
stated that training with regard to collaboration with teachers
is needed, as well as training in the provision of information
to educators in order for them to make appropriate referrals and
accommodations in the classroom. There is increasing awareness
of the need for collaboration between speech-language therapists
and professionals in the secondary educational setting (Vance
& Clegg, 2010). Most respondents also felt that the greatest
need in providing intervention to adolescents with
written-language difficulties lay in the area of assessment.
Training needs at different levels of education can be
summarised as follows:

Undergraduate

Of the 22 respondents, 14 (64%) indicated
that their highest qualification is an undergraduate degree in
speech-language therapy. One of these indicated that s/he did
not feel equipped to provide intervention, and another indicated
that s/he is well equipped. Half indicated that they feel
adequately equipped to provide intervention; however, 36%
indicated that they feel poorly equipped to do so.

Masters

Eight (36%) respondents indicated that their
highest qualification is a master’s degree in speech-language
therapy. Equal numbers of these respondents felt sufficiently
and insufficiently equipped to provide intervention for
written-language difficulties. Some of the respondents who
indicated feeling adequately equipped did not feel equipped
through primary training, but as a result of experience,
self-study and secondary training in the field of remedial
education.

Figure 2 indicates the respondents’ perceptions regarding the
expected level of training necessary for assessment and
intervention for adolescents with written-language difficulties.

Fig. 2. Respondents’

(n=22)
perceptions regarding necessary level of training.

In summary, most respondents (86%) indicated that they felt the
greatest overall need in written-language difficulties in
adolescents lay in the area of assessment by speech-language
therapists. The South African context, the need for standardised
tools in the various languages, and the need for culturally and
linguistically valid tools, as well as more affordable tools,
were stressed throughout. The need for specific guidelines when
working with adolescents with written-language difficulties was
mentioned, as well as a need for information on the curriculum
of secondary school students, and what is expected of them
academically.

A previous study reported that classroom teachers are the
team members who are most familiar with the educational
curriculum and are most responsible for ensuring that it is
presented (Geertsema et al., 2011). On
the other hand, speech-language therapists are also key role
players in the modification, adaptation, and individualisation
of this curriculum (Elksnin & Capilouto, 1994). It is
therefore essential that confidence and trust be established
among educators and speech-language therapists when educating
children in the classroom (Ferguson, 1992). The need for
information on the influence of language impairment on written
language was additionally identified as a possible
contributory factor to the uncertainty surrounding the
assessment and treatment of the adolescent population.

Summary and conclusion

According to ASHA (2001) and SASHLA (2013),
assessment of and intervention for adolescents with
written-language difficulties fall within the role of the
speech-language therapist. Educators agree that this population
is the responsibility of speech-language therapists (Geertsema et al., 2011). The
findings of the study indicate that the respondents are aware
that this is their role, and that they should be actively
involved in the identification of, assessment of and
intervention for adolescents with written-language difficulties;
however, they feel that speech-language therapists in general
are not actively involved in identification, assessment and
intervention in this population. The majority of the respondents
feel that they are adequately equipped to work with adolescents
with written-language difficulties; however, this is based on
own experience, self-study and secondary training. Training
regarding assessment of and intervention with adolescents with
written-language difficulties needs to take place at an
undergraduate level. There is also a need for training regarding
effective collaboration with teachers, including the provision
of information to teachers in the secondary educational setting
– which is a depicted role of the speech-language therapist
(Owens, 2010). The current practice of speech-language
therapists involves mostly assessment with informal assessment
tools, indicating that current assessment tools are not
sufficient, age-appropriate or culturally sensitive. The current situation
in South Africa is that school pass rates have dropped from a
60% average to about a 40% average in rural areas (Naki, 2010).
This highlights the importance of our role as speech-language
therapists in a collaborative relationship with educators
(Geertsema et al.,
2011). Further research is needed in developing appropriate
assessment and intervention tools, as well as improvement of
training at an undergraduate level.

Implications

The current study yielded a small sample size
and focused only on speech-language therapists in private
practice in South Africa. However, the preliminary results could
have long-term implications for undergraduate and postgraduate
degree studies, continuous professional development programmes,
and similar studies on a larger scale in South Africa. Should an
additional training programme be developed, the data obtained
could be used to address the perceptions and needs of
speech-language therapists regarding assessment and intervention
of adolescents with written-language difficulties, e.g. the
development of linguistically and culturally valid assessment
material, broadening the theoretical knowledge base on the
adolescent population in general, and collaborative practices
within the educational system. The adolescent population in the
current South African education system has been identified as
having extensive literacy problems within a system that seems to
have failed them (Naki, 2010). Optimal intervention should
therefore be provided by the South African speech-language
therapist as part of a team of professionals. Speech-language
therapists should be optimally equipped to provide intervention
for adolescents with written-language difficulties.

Recommendations for further research

The involvement and role of other
professionals working with adolescents with written-language
difficulties could be researched in the future. The
effectiveness of collaboration between different professionals
during assessment of and intervention with adolescents with
written-language difficulties should also be evaluated. In-depth
research focusing on the assessment and intervention materials
currently used by speech-language therapists should be
conducted. Specific assessment tools and programmes should be
evaluated regarding their appropriateness for the South African
context. There is currently a lack of research regarding
adolescents and adults with written-language difficulties and
how they cope in the educational and vocational settings. This
is a topic for future research.

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