Current Management for Word Finding Difficulties by Speech-Language Therapists in South African Remedial Schools 59 CURRENT MANAGEMENT FOR WORD FINDING DIFFICULTIES BY SPEECH-LANGUAGE THERAPISTS IN SOUTH AFRICAN REMEDIAL SCHOOLS Ingrid de Rauville, Sandhya Chetty and Jenny Pahl University o f Kwazulu-Natal a b s t r a c t Word finding difficulties frequently found in learners with language learning difficulties (Casby, 1992) are an integral part o f Speech- Language Therapists’ management role when working with learning disabled children. This study investigated current management for word finding difficulties by 70 Speech-Language Therapists in South African remedial schools. A descriptive survey design using a quantitative and qualitative approach was used. A questionnaire and follow-up focus group discussion were used to collect data. Results highlighted the use o f the Renfrew Word Finding Scale (Renfrew, 1972, 1995) as the most frequently used formal assessment tool. Lan­ guage sample analysis and discourse analysis were the most frequently used informal assessment procedures. Formal intervention pro­ grammes were generally not used. Phonetic, phonemic or phonological cueing were the most frequently used therapeutic strategies. The authors note strengths and raise concerns about current management for word finding difficulties in South African remedial schools, par­ ticularly in terms o f bilingualism. Opportunities are highlighted regarding the development o f assessment and intervention measures rele­ vant to the diverse learning disabled population in South Africa. Key words: word finding difficulties, learning disabled children, assessment, intervention. INTRODUCTION Learners with language learning disabilities frequently ex­ perience word finding difficulties (Casby, 1992; German, 1998) as cited by German, 2005) Word finding difficulties (WFDs) are an integral aspect o f the Speech-Language Therapist’s management practices when working with a learner who has a language learning disability (LLD). Using The Royal College o f Speech Therapists’ definition o f practice (1998), hereinafter, management refers to the assessment, formulating and implementing intervention pro­ grammes and decision making about discharge from therapy. Many factors impact on the complex management o f developmen­ tal WFDs by South African Speech-Language Therapists (SLTs), including: controversies about the nature and impact o f WFDs; the training o f SLTs in WFDs; the role o f the SLT in managing WFDs; the context in which services are provided; the model o f service delivery in use; policy issues including inclusive educa­ tion; outcomes based education and language issues. Furthermore, Speech-Language Therapists (SLTs) have experienced frustration with the outcome o f therapy for WFDs (Haynes, 1993). “Learning disability is a general term that refers to a hetero­ geneous group o f disorders manifested by significant difficulties in the acquisition and use o f listening, speaking, reading, writing, reasoning or mathematical abilities” (National Joint Committee on Learning Disabilities (1991, as cited by Owens, 2004). South Afri­ can learners with learning disabilities exhibit discrepancies be­ tween their intellectual potential (usually average to above aver­ age) and expected academic performance and are typically admit­ ted to remedial schools (S, Mohamed, personal communication, August, 24* 2004).Speech-language therapy services for learners with LLD and WFDs in the South African context are frequently provided in the context o f remedial education. Within the current educational system in South Africa, learners with LLD (and possi­ ble WFDs) are educated at long and short-term remedial schools or within mainstream schools. SLTs’ practice in different educational settings is shaped and influenced by current and changing educa­ tional policies such as Outcomes^ Based Education (Department o f Education, 2001). Another policy influencing the practice o f SLTs is inclusive education where the focus is on overcoming barriers in the system that prevent meeting learning needs by adapting the support systems in the classroom (Department o f Education, 2001). Policies like this impact on service delivery models for learners with LLD and possible WFDs viz. individual versus group therapy, traditional pull-out system or classroom-based therapy. WFDs in children with LD, who meet the criteria for ad­ mission into a remedial school, are pervasive in nature, and impact on their communicative and academic performance (Faust, Dimi- trovsky & Shacht, 2003; Lemer, 2000). This takes the form o f dif­ ficulties with confrontation naming, reading, and conversational discourse. Secondary behaviours such as hesitations, repetitions and re-formulations occur (Dockrell, Messer, George & Wilson, 1998) and may result in inaccurate messages being conveyed (Faust et al., 2003). It is therefore important for WFDs to be sys­ tematically identified, assessed and treated as early as possible in the learner’s educational career (Faust et al., 2003). Speech- language therapy interventions for WFDs have been reported to be ineffective (Dockrell et al., 1998), and have thus not enabled the learner to achieve the academic and communicative competence required for progress in education. The causes of Word Finding Difficulties There is no unequivocal explanation for the presence of WFDs (Casby, 1992). Within a psycholinguistic framework, lim­ ited processing resources, inadequate or ill-defined semantic repre­ sentations, inadequate phonological specifications and naming speed deficits are possible contributing causes o f WFDs (Dockrell et al., 1998). Within the processing view, the two inter-related compo­ nents o f the initial learning, organisation and storage o f informa­ tion that impacts on the learning o f vocabulary (Easton, Sheach & Easton, 1997), and the ability to retrieve words (Macgregor & Leonard, 1989, cited in Easton et al., 1997) may impact on WFDs. Thus storage strength (i.e. how well a word is learned) and re­ trieval strength (i.e. how easily a word is retrieved) are important. A debate exists about the types o f word-knowledge viz. semantic The South African Journal o f Communication Disorders, Vol. 53, 2006 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) 60 Ingrid de Rauville, Sandhya Chetty and Jenny Pahl and phonological features of a word and the link between them in relation to storage and retrieval strength (Easton et al., 1997). An additional view of the cause of WFDs is that of inade­ quate semantic specification (Easton et al., 1997). Semantic defi­ cits result in simple semantic networks, with limited options for associations for stimulus words, which may result in oral and writ­ ten WFDs (Casby, 1992). A further causal view is that WFDs are attributable to an inadequate phonological representation (Easton et al., 1997). In­ adequate phonological representation could, according to a proc­ essing model used by Chiat and Hunt (1993), indicate difficulty at an input (phonological representation) or output (phonological ac­ cess) level. Naming difficulties may suggest difficulties in phono­ logical storage (Webster, 1994). Deficits in phonological access may present as difficulties in the naming of familiar words such as colours, digits, letters or objects (Clark, 1988 as cited by Webster, 1994). However while it is not always easy to determine what the underlying cause of the child’s WFD is (Easton et al., 1997), it is important to assume an interaction between the two processes of semantic representation and phonological specification. Assessment for WFDs According to German (1989a), a comprehensive assessment for WFDs should incorporate naming tasks, a comprehension task and the identification of word finding characteristics. A thorough assessment of WFDs is needed for bilingual learners (German, 1989a), which is of particular importance in the South African context. Learners acquiring English as a second language, particu­ larly in the school setting, should have their abilities assessed us­ ing tools sensitive to their cultural and linguistic backgrounds (Cheng, 1994; Montgomery, 1999 as cited by Apel, 2001). The strategies for assessing WFDs may be formal and in­ formal (Wiig & Semel, 1984). Spontaneous language sample analysis is an informal tool suggested by Wiig and Semel (1984). A number of formal or standardised assessment procedures of Brit­ ish and American origin used by SLTs to assess word finding are highlighted in available literature, but may be of limited applica­ tion to the South African learner. Wiig and Semel’s (1984) guide­ lines for selection of procedures for assessing WFDs highlights the need to have a range of assessment contexts and procedures to diagnose or to determine the nature, severity and impact o f a WFD. To provide an in-depth assessment of word finding abilities and difficulties, one has to select multiple procedures with a num­ ber of tasks which require naming in a variety of contexts (Wiig & Semel, 1984), such as: • Rapid naming upon confrontation of visual stimuli (such as the Renfrew Word Finding Scale'Renfrew, 1972, 1995). • Rapid naming of automatic sequential series (such as the fa­ miliar sequences criterion referenced sub-test of the Clinical Evaluation of Language Fundamentals-Four, Semel, Wiig & Secord, 2003). • Rapid automatised naming (such as the rapid automatic nam­ ing task of the Clinical Evaluation of Language Fundamen­ tals-Four, Semel, Wiig and Secord, 2003). • Rapid naming of words in free or controlled association tasks. 'T h e R W FS as a standardised test nam e is used to rep resen t both the old version o f the test (R enfrew , 1972) and the new version o f the test (R enfrew , 1995), w hich has altered its nam e to the W ord Finding V ocabulary T est (W FV T). T his differentiation w as not m ade on the questionnaire. German and Simon (1991), also highlight the importance of as­ sessing children’s WFDs in discourse. While a battery of reliable and valid measures, which allow for the profiling of WFDs, is important, the limitations o f formal assessment tools applied to the South African context need to be acknowledged. Furthermore, a shift from standardised testing to criterion-referenced and educator-produced tests is recommended (Department of Education Directorate: Inclusive Education, 2002) Intervention Word finding intervention is complex with no single treat­ ment approach available that is known to address all WFDs. For storage difficulties, therapy should identify and elaborate semantic features of words. For retrieval difficulties, therapy should aim at semantic categorisation or visual imagery (Wiig & Becker-Caplan, 1984 as cited in German, 1992). When working with storage, one should aim to increase vocabulary, targeting common, frequent and meaningful words and those with concrete referents. The words should be taught in an orderly way, such as by using themes, and should highlight categorical and associative relation­ ships (Nippold, 1992). Aims of intervention for WFDs (Nippold, 1992) include hierarchically enhancing naming accuracy, improving retrieval strength and increasing the use of strategies by increasing meta- cognitive and meta-linguistic awareness of factors that affect word finding ability, such as looking at meaning changes across contexts (Nippold, 1992). The focus of intervention differs if a learner presents with WFDs in spontaneous language or discourse. Therapy should fo­ cus on increasing accuracy and fluency rate. A number of retrieval strategies, such as phonological, visual and semantic categories in discourse, need to be used and taught (German, 1992). Response to particular types of intervention also informs us of the nature of the learner’s problem in relation to reading difficulties. Learners with single phonological core deficits respond well to phonologically based therapy, which aims to increase phonemic awareness. Learners with single processing speed deficits or a double-deficit (a deficit in both areas) are typically only partially served by such intervention. They would require emphasis on building fluency in reading and building automaticity in lower level processes serving these skills (Wolf & Segal, 1992). From the above it is evident that working with learners with LLD and WFDs is a complex area, impacted on by factors such as changing educational policy. It is also an area where SLTs have experienced frustration with the outcome of therapy (Haynes, 1993). Since WFDs are frequently found in learners with LLD (Casby, 1992) and are an integral part of the SLTs’ management when working with LLD, the purpose of this study was to deter­ mine current management for WFDs in learners with LLD within the context of South African remedial schools, an undocumented area of investigation. Such investigation may highlight current strengths and difficulties in managing learners with WFDs and serve to guide SLTs toward the required shift in management within the South African educational setting. SLTs’ opinions on the management of learners with LLD and WFDs'currently used in the various remedial educational institutions were important to as­ certain how these management practices meet the current needs of therapists and learners. Die Suid-Afrikaanse Tydskrif vir Kommunikasieafwykings, Vol. 53, 2006 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) Current Management for Word Finding Difficulties by Speech-Language Therapists in South African Remedial Schools 61 METHODOLGY Aim The aim of the study was to determine SLTs’ current as­ s e s s m e n t and intervention practice for word finding difficulties in the language learning disabled population in South African reme­ dial schools. Critical questions needed to be asked in order to meet the aim of the study. These included: 1. What is the current practice in terms of assessment proce­ dures used for learners with word finding difficulties? 2. What is the current practice in terms of intervention pro­ cedures used for learners with word finding difficulties? Research design The nature of this research study was descriptive. The de­ sign employed could be further described as a descriptive survey as it allowed the researcher to describe characteristics of a sample at a particular point (Leedy, 1997). As it is important to collect data for qualitative research using a skilled individual rather than a single instrument, (Leedy, 1997), a questionnaire (quantitative) and a focus group discussion (qualitative) were used (McMillan & Schumacher, 2000). SLTs employed at remedial schools were par­ ticipants and it was their responses to the questionnaires that formed a significant basis of the research study. Participant selection criteria Participants needed to be SLTs working in South African government remedial schools. Furthermore, they needed to be reg­ istered with the Health Professions Council of South Africa and the South African Council of Educators. Participants needed to be willing to participate and learners with LLD and WFDs had to be part of their caseloads. Figure 1 summarises the process of obtaining approval to conduct research and of participant selection. Profile of participants A summary about the SLT participants is provided in Table 1. Table 1: Participant Selection Criteria Letters of approval to conduct research sent to Provincial Superintendent Generals of Education r APPROVAL from Gauteng Kwazulu Natal Western Cape Free State Province NOT APPLICABLE (No Speech Therapists) Northern Cape North West Province Criteria P articipants needed to be SLT s w orking in South A frican govern­ m ent, rem edial schools. P articip an ts had to be reg istered with the H ealth P ro fessio n s C ouncil of South A frica and the South A frican C ouncil o f E ducators. L earners with LLD and W FD s had to be part o f their caseloads. P articipants needed to be w illing to participate. Reasons T he focus o f the study w as the m an­ agem ent o f W F D s by S L T s in this p articu lar context and S L T s w ere to be th e participants. This was to ensure that the partici­ pant SLT s had the necessary qualifi­ cations and registrations to work in this area. T his population was the focus o f the resea rch study. T his is an im portant ethical consid­ eration. Data collection methods The data collection procedure involved two phases: ad­ ministration of the questionnaire (survey method) and follow-up focus group discussion. The focus group discussion is a strategy to obtain a better understanding of information obtained in the re­ search procedure (McMillan & Schumacher, 2000). Focus groups are unstructured interactions in a small group. Interactions are with group members and the group leader or researcher (Bowling, 1997). The questionnaire was administered following completion o f a pilot study using four qualified SLTs with relevant experience who were not part of the study sample. Data collection instruments Description o f the Questionnaire All questions were developed using the critical questions as a guide and were developed using relevant theory. A total of 23 questions were developed (refer to Appendix A). These questions were divided into three sections focussing on demographics, prac­ tice of WFDs and efficacy o f intervention for WFDs. Nineteen of APPROVAL from PRINCIPLES Gauteng: 8 from 9 Kwazulu Natal: 11 from 12 Western Cape: 5 from 5 Questionnaires Sent Gauteng 62 Questionnaires Sent KwaZulu Natal 22 NOT APPLICABLE (No Speech Therapists) Free State Questionnaires Sent Western Cape 16 NO RESPONSE Eastern Cape Limpopo I Figure 1: Process for participant selection The South African Journal o f Communication Disorders, Vol. 53, 2006 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) 62 Ingrid de Rauville, Sandhya Chetty and Jenny Pahl the questions were close-ended questions. The questions fol­ lowed a Likert Scale format (Bailey, 1991). A statistical pro­ gramme, Statistical Package for the Social Sciences (SPSS) (SPSS Inc., 1995), was used to explore patterns identified using frequency counts and percentages. Four open-ended questions were included in the questionnaire allowing for richer data to be obtained: The responses to the open-ended questions were quali­ tatively analysed. All questionnaires were coded using letters and numbers on questionnaires to ensure anonymity and confi­ dentiality. Focus Group Discussion Schedule Information obtained from the questionnaire needed to be explored further to improve the quality and richness o f the infor­ mation obtained (McMillan & Schumacher, 2000). This was achieved by developing a focus group discussion schedule which documented the open-ended questions to be investigated in an unstructured way (McMillan & Schumacher, 2000) using questions to probe further information where necessary. Participants in the focus group discussion were from Kwa-Zulu Natal which allowed ease o f access. Eight partici­ pants attended the single focus group discussion at which the researcher and a scribe were present. Data analysis Data analysis for this research embodied both quantita­ tive and qualitative analysis as the research tools used for data collection characterised both types o f research. According to Vithal and Jansen (1997) data analysis includes three steps, sum­ marised as ( 1) scanning and cleaning the data, (2) organizing the data and (3) representing the data. These steps and how they were applied to this study are presented in Table 2. Table 2: Description of the 70 Participant SLTs The research procedure involved a number of pivotal phases. Each phase was dependant on the completion o f the previous phase. A summary o f the research procedure, high­ lighting the phases is presented in Figure 2. P H A S E 1 • A list o f rem edial schools in SA w as obtained from SA U V SE . • P erm ission from regional S u p erin ten d en t G enerals to p erform the research w as obtained. P H A S E 2 • R em edial schools w ere co n tacted to determ in e i f S LTs w ere em ployed there. • P erm issio n from school prin c ip als to perform the research w as obtained. P H A S E 3 • P ilo t study • A lterations to the q u estio n n aire w ere m ade. P H A S E 4 • L etters w ere d istrib u ted to p otential p articipants inform ing th e m o f th e researc h aim. • L etters o f co n sen t to particip ate w ere s e n t to participants. • T h e revised q uestionnaire w as ad m inistered to S LTs in rem edial schools. • P articip a n ts w ere rem in d ed th a t questio n n aires w ere due for subm ission. P H A S E S • Q u estionnaires w ere scanned to determ in e i f they m e t the criteria fo r d ata analysis. • S tatistical d ata analysis w as com pleted. P H A S E 6 • R esponses on q u estionnaires w ere u sed to id e ntify trends to develop th e interview schedule. • A focus group discu ssio n w as held in a selected region. P H A S E 7 • R esearch and research findings w ere w ritten up. • F eed b a ck to ed u c atio n auth o rities and p articipants reg ard in g the research findings w as com pleted. Figure 2: Summary of Research Phases Ethical considerations Using guidelines outlined by Leedy (1997) certain ethical issues were considered for this research study. Potential partici­ pants were informed in writing about the research study. Informa­ tion included an ethical clearance number (03140A), who was un­ dertaking the research, why it was being undertaken and who fi­ nanced it. A letter to possible participants included a consent form, (informed consent) indicating willingness to participate! in the re­ search. Letters to participants highlighted that they could withdraw from the study at any time, or refuse to participate without any pen­ alty. Confidentiality in terms o f the participants, both SLTs and remedial schools, was guaranteed. All the information recorded in this research document was coded in order to uphold this. Further­ more, the participants were assured that once the study was com­ pleted, audiocassettes used for the recording o f the focus group discussions would be destroyed. Results o f this study were pro­ vided to the participants. A summary o f the findings and the impli­ cations thereof, were posted, faxed or e-mailed to the individuals, institutions, Superintendent Generals o f the provinces and all the relevant school principals that participated. Reliability and validity For the purpose o f this study, a pilot study was conducted to Parameter Summarised description Years o f Experience 60% o f SLTs: 10 years or less experience 17% o f SLTs: 11-20 years experience 23% o f SLTs: 21 years + experience Number of Years working with WFDs Mean number o f years: 7,24 years University Attended More than 80 % o f SLTs attended the former UDW ,W its or Pretoria Language of Therapy SLTs are guided by the language medium o f the school. The majority o f SLTs at dual medium schools provide therapy in English and Afrikaans. SLTs at single medium schools provide therapy in the language o f the school Procedure Die Suid-Afrikaanse Tydskrif vir Kommunikasieafwykings, Vol. 53, 2006 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) C urren t Management for Word Finding Difficulties by Speech-Language Therapists in South African Remedial Schools 63 refine the questionnaire, with the aim of increasing reliability. Ecological validity was evaluated by the extent to which find- jngs could be generalised beyond the find­ ings of the present study (McMillan & Schumacher, 2000). Strategies used to in­ crease validity in the context of this re­ search included varied data collection strategies (McMillan & Schumacher, 2000) (for this study, a questionnaire and focus group discussion). This resulted in the tri­ angulation of data across techniques, where consistency of findings by different data collection methods was checked (Bailey, 1991). It was important to be aware of the Hawthorne effect, where participants may have acted differently since they were par­ ticipants in a research project (McMillan & Schumacher, 2000). Furthermore, acknowl­ edging bias, particularly in descriptive re­ search, was important since it is inevitable (Leedy, 1997). Disciplined subjectivity and inter-personal subjectivity assisted in ac­ k n o w led g in g b ia s (M c M illa n & Schumacher, 2000). Therefore, a daily field log was kept, a field journal written and ethical decisions recorded. Finally, it is im­ portant to highlight that what was being researched was “reported practice”, i.e., what clinician’s said they did was not nec­ essarily what they may do in actual prac­ tice. RESULTS Results from the questionnaire, com­ pleted by 70 SLTs in South African reme­ dial schools, and from the focus group dis­ cussion, involving SLTs in the greater Dur­ ban area in KwaZulu Natal follow. The re­ sults are presented and discussed in two main sections: assessment and intervention practice. Current Assessment Practice, especially Procedures used for WFDs Assessment Procedures Results indicated that participant SLTs usually used both standardised and informal assessment procedures when as­ sessing for WFDs (question 13). “Other” assessment procedures used by only 8% of participants, included subjective measures, speaking to parents and other members of staff and observation. A summary o f re­ sults obtained is presented in Figure 3. Standardised Assessments Participants were asked to indicate which standardised assessment tools they used in assessing WFDs in learners with LLD (question 14). It was found that the Renfrew Word Finding Scale (Renfrew, 1972, 1995) was by far the most fre­ quently used test to assess WFDs. Eighty three percent of the partici­ pants who answered this question used either the Renfrew Word Finding Scale (RWFS) only or used it together with some other test(s). The results are summa­ rized in Figure 4. The use o f the RWFS as a tool for assessing WFDs was further explored in the focus group discussion to determine participants’ views o f this tool for identi­ fying WFDs. Participants at the focus group discussion offered views including that the RWFS depended on an intact vo­ cabulary, identified only severe WFDs, needed to be used with another tool and did not effectively test for WFDs, as indi­ cated by the following excerpt: “. . . I d o n ’t b eliev e i t ’s m ore effective than ju s t even a spon taneous language sa m p le ch arting the W F D .... ” Informal Measures Used In the Assess­ ment o f Learners with LLD and WFDs On the questionnaire, participants were asked to indicate which informal measures were used to identify WFDs (question 15). Language sample analysis (LSA) or discourse analysis (DA) was the most frequently used informal measure to identify WFDs. Thus 77 % of the partici­ pants in the sample who answered the question used either LSA or DA only or together with some other measure(s). These results are summarised in Figure 5. SLTs View o f Assessment Procedures fo r WFDs The results showed that 45 % of participant SLTs in the sample disagreed that assessment procedures were relevant to the South African population but 58 % agreed that the procedures assisted in identifying WFDs. Thirty four percent disagreed and 31 % remained neutral re­ garding assessment procedures providing sufficient detail to provide treatment goals. The results suggest that almost fifty percent of the participants working with WFDs in LLD were aware that the formal tools used were not relevant to the South African population. 3 0 i 25- 20 15 10- 5-/ / / / / / / / fZ a h h h 0- never sometimes usually aiways mean2) □ number using standardized tests °i 12 26 22 2.17 □ number using informal measures °l 19 19 16 1.94 □number using otheM) °l 2 2 2 Figure 3: Assessment procedures used by participant SLTs for learners with LLD and WFDs (n=60) ; 1. T he m easures listed under “other” include subjective m easures, speaking to parents and other m em bers o f staff, observation and a com bination o f standardised tests and inform al m easures. 2. T he calculation o f the m ean is based on allocating 0 fo r a “never” response, 1 fo r a “som e tim es” re­ sponse, 2 fo r a “ usually” resp o n se and 3 for an “ alw ays” response. Figure 4: Standardised tests used for identification of WFDs (TOLD-3 - T est o f L anguage D evelopm ent - 3, n o specific sub-test). The South African Journal o f Communication Disorders, Vol. 53, 2006 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) 64 Ingrid de Rauville, Sandhya Chetty and Jenny Pahl Figure 5: Informal measures used for assessment o f WFDs (Key: L SA = language sa m p le analysis. D A = discourse analysis) Figure 6: Formal programmes used in intervention (Key: L S= L ingui System s) Figure 7: Therapeutic strategies used by participant SLTs in intervention for WFDs Figure 8: Number of participant SLTs who reported providing both individual and group therapy (n=59) Die Suid-Afrikaanse Tydskrif vir Kommunikasieafwykings, Vol. 53, 2006 Current Intervention Practice, espe­ cially Procedures Used for Learners with WFDs The second area of focus was cur­ rent management practice in terms of in­ tervention procedures used for learners with LLD and WFDs (question 16). More than 60% of the participants in the sample did not use any formal interven­ tion programme. Of those who did use a formal programme, a variety of pro­ grammes were given, with no particular one being used by the majority of schools in the sample. The results obtained are summarized in Figure 6. The findings suggested that pho­ netic cueing combined with some “other” strategy was the informal therapeutic strategy most used in working with LLD children with WFDs (question 17). Ninety one percent of the participants who answered the question used either phonetic cueing only or together with some other strategy or strategies. Other informal strategies included for example: categorizing, associations, mind map­ ping, cloze tasks and visual cueing. A summary of the results indicating the therapeutic strategies used in interven­ tion, is presented in Figure 7. Administering Therapy Participants provided either group, individual or both individual and group therapy to learners with LLDs and WFDs (question 10). A summary of results is presented in Figure 8. Using the Chi Square Test of Association, no significant differences between the provision of individual ver­ sus group therapy were noted.'However, qualitatively, some differences were identified. This issue was explored dur­ ing the focus group discussion and re­ vealed the following about intervention for learners with WFDs. Three I variables were identified as influencing' whether SLTs provided intervention for WFDs individually or in a group. These vari­ ables were the SLT’s caseload, the popu­ lation of learners at the school, and deci­ sions of school management. Participants in the focus group discussion - indicated that the greater the caseload, the more likely group intervention was provided. Further, the more severe,a learner’s diffi­ culty the less likely they were to receive group therapy. In terms o f caseload, two thirds of the participants in the sample saw 10 or--less learners with LLD and WFDs per week. These results are sum­ marized in Figure 9. R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) Current Management for Word Finding Difficulties by Speech-Language Therapists in South African Remedial Schools 65 21 -i- per vseek 13% 1 -5pervsfcek 50% TOTAL NUMBER OF RESPONSES = 60 Figure 9: Number of learners with learning disabilities as well as with WFDs seen per week SLTs’ Views on Intervention Procedures Used fo r WFDs An equal number of participants in the sample (36 %) agreed or were neutral in terms of intervention procedures being relevant to the South African population of learners with WFDs and LLDs (question 21). Sixty one percent of the participants agreed that intervention pro­ cedures were useful in addressing WFDs. Continuing Professional Development in the Area o f WFDs There was an overwhelming re­ sponse (100%) where all participant SLTs in the sample wanted WFDs to be covered in continuing professional development programmes. Due to this overwhelming response, continuing professional develop­ ment as an issue was further explored dur­ ing the focus group discussion. The results are discussed in the discussion of current practice in terms of intervention proce­ dures. DISCUSSION I Current Assessment Practice for WFDs in Learners with LLD An in-depth and thorough assess­ ment for WFDs in learners with LLD with multiple procedures and a number of tasks in a variety of contexts is recommended (Wiig & Semel 1984, Wolf & Segal 1992, German, 1989a). Despite this, the RWFS as a single tool was by far the most fre­ quently used standardised assessment tool for identifying WFDs. A number of possi­ bilities for this assessment practice exist. These include training in WFDs, knowl­ edge bases, available resources and poli­ cies. Knowledge from undergraduate training may be related to limited choice of assessment procedures for WFDs since two-thirds of participant SLTs responded that word finding was not an area covered in training. On the other hand, the avail­ ability of resources in the South African context could impact on the choice of assessment tools used. SLTs may be re­ stricted in purchasing standardised proce­ dures specifically for WFDs like the Test of Word-Finding (TWF) (German, 1989b) due to availability, high costs or other practical reasons. Standardised assess­ ment tools are generally expensive. The RWFS is relatively cost effective. It is also quick to administer (Renfrew, 1995), making it functional for SLTs in the re­ medial school environment with large caseloads (Stockman, 2000). In assessment, the literature stresses the importance of identifying the type and possible cause of the WFD. This influences the intervention selected. While some participant SLTs described WFDs according to semantic deficits, retrieval deficits and general characteris­ tics of WFDs, the descriptions did not seem to match their assessment practices. These focussed mainly on assessing ex­ pressive vocabulary using the RWFS. The purpose of the RWFS is to identify if a child is able to name a word (Renfrew, 1995), not to assess word finding specifi­ cally. The use of the RWFS could there­ fore impact on service delivery, since it provides limited information about WFDs. In comparison German’s Test of Word Finding (1989b), assesses accuracy of word finding, word comprehension, speed of naming, use of gestures and extra verbalizations. Augmenting assessment with qualitative observation of how the learner responds (as recommended by Renfrew, 1995), provides additional, valuable but partial information about WFDs. Furthermore, Renfrew (1995), when commenting on studies informing revisions to the RWFS test, notes that its use with a South African population is problematic (Pahl & Kara, 1992). Using tests not standardised on the population with which you work impacts on the va­ lidity of findings (Apel, 1999). SLTs in South African remedial schools need to be aware of this limitation regarding the in­ terpretation of formal test findings when assessing WFDs. Using vocabulary tests, such as the RWFS, with multicultural populations often provides a negatively biased view of linguistic competence (Stockman, 2000). Using standardised tests not normed for our population highlights ethnocentricity. With the shift in South African educa­ tional policies, criterion-referenced and educator-produced tests are recommended by the Department of Education (Department of Education Directorate: Inclusive Education, 2002). Consistent with the Department of Education’s rec­ ommendation for criterion-referenced tests, Terrell and Terrell (1993) suggest the use of criterion-referenced assess­ ments with individuals from diverse cul­ tural backgrounds. SLTs assessing WFDs should consider devising criterion- refer­ enced and educator-produced tests for use in the context of South African remedial schooling. The most frequently used informal assessment procedures for identifying WFDs in learners with LLD were lan­ guage sample analysis (LSA) or discourse analysis. The use of LSA as an informal assessment procedure to determine how WFDs create difficulties for the learner with a LLD is recommended by Wiig and Semel (1984). Using LSA with the learner with LLD is particularly relevant when formal tests are not relevant to the popula­ tion with whom we work (Pahl & Kara, 1992). However, it is important to bear in mind whether the LSA is in the learner’s first language. Apel (1999) suggests that SLTs use context- based assessment methods such as assessing communication skills in the classroom. Such an approach would be consistent with a more consulta­ tive or collaborative role (Schoeman, 2003). Current Intervention Practice, espe­ cially Procedures Used for WFDs in Learners with LLD The findings of the study revealed that most participant SLTs in the sample did not use formal programmes for inter­ vention. This is consistent with the lim­ ited availability of specific programmes The South African Journal o f Communication Disorders, Vol. 53, 2006 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) 66 Ingrid de Rauville, Sandhya Chetty and Jenny Pahl for WFDs (German, 1992). Possible reasons for predominant use o f informal programmes are similar to those discussed under as­ sessment for WFDs namely: knowledge o f available pro­ grammes, limited training, and limited resources. It is possible that even if resources were not limited, intervention programmes developed in other countries using unfamiliar stimulus material would be inappropriate to South African learners with WFDs. Using informal programmes may be an advantage in that SLTs can plan and develop appropriate interventions for the South Af­ rican context. Most participant SLTs agreed that the formal intervention procedures they used for WFDs in learners with LLD were use­ ful. Although participant SLTs found the programmes useful, the programmes were not specifically developed for targeting WFDs. Therefore, a very specific aspect o f WFDs, which may not be the learner’s area of difficulty in word finding, may be addressed, raising questions about the effectiveness o f intervention. The most frequently used informal therapy strategy for WFDs was phonetic, phonemic or phonological cueing. These findings are supported by literature recommending these strate­ gies for intervention with WFDs (Wiig & Semel, 1984). How­ ever, SLTs need to be aware that response to a specific type o f intervention informs us o f the nature o f the learner’s problem. For example, if the response to phonological based therapy is good, the difficulty is phonologically based (W olf & Bowers, 2000). Adopting such an approach to treatment implies that diag­ nostic therapy is relevant for WFDs. Intervention strategies would need to change if the child does not respond to selected strategies. SLTs in remedial education in South Africa should also incorporate into intervention for WFDs a number o f other skills. These include: phonological segmentation and imagery (Wing, 1990), self-cueing, semantic intervention and phonologi­ cal awareness intervention (Wittmann, 1996), combined semantic and phonological treatment approaches (Easton et al., 1997) and discourse based intervention (Stiegler & Hoffman, 2001). How­ ever, since there is little evidence to support the efficacy o f treat­ ment approaches for learners with WFDs (Casby, 1992), SLTs need to monitor the effects o f their treatment (Wittmann, 1996). This will assist in determining the most appropriate treatment for the learner with LLD and WFDs. The predominant languages in which intervention for WFDs was p ro v id ed were English and Afrikaans. A concern arises for learners who speak other official languages of South Africa and for whom the language o f instruction is English or Afrikaans. When working with learners who use more than one language, a differential diagnosis is necessary. The aim is to de­ termine if the difficulties are related to a first language learning problem, a problem with acquiring a second language or if the learner is in a normal process o f learning an additional language (Miller, 1984). SLTs should question which the optimal lan­ guage to provide therapy for WFDs in, is (Miller, 1984). Consistent with the findings o f Haynes (1993), participant SLTs in South African remedial schools seem to be providing strategies for WFDs but it did not appear that consideration was given to the general aims o f intervention outlined by German (1992). Since therapy for WFDs is complex and there is no single intervention approach that addresses all WFDs, the general aims o f intervention as outlined by German (1992) can be used to guide such intervention. These aims are to enhance naming accu­ racy, improve retrieval strength and develop meta-cognitive and meta-linguistic strategies to improve WFDs and to increase accu­ racy and fluency in spontaneous language. Consistent with the findings o f Haynes (1993), SLTs in South African remedial schools need to extend their understanding o f language process­ ing so that therapy for WFDs can be addressed in a broader man­ ner. The issues raised by participants about institutions’ demands and experience for example, become secondary to providing the most effective and accountable service (Baum, 1998), for learn­ ers in remedial schools. Caseloads of SLTs for Learners with LLD with WFDs It is difficult to account for the low caseload o f learners with LLD and WFDs reported by the participants. Compared to the prevalence figure of 49 % of all grade four and five learners with LD having WFDs (German, 1998 cited by German, 2005), this low caseload o f less than ten learners with LLD and WFDs is of concern. As WFDs are the domain of the SLT, this may imply that the WFDs of some learners are not being identified. If the WFDs o f learners in remedial schools which focus on reducing barriers to learning (Schoeman, 2003), and aim to return learners to mainstream schools, are not being identified and treated, these learners are possibly not receiving the help that they need. Other possible reasons for this low caseload o f learners with WFDs receiving intervention from SLTs may be low priori­ tisation given to WFDs in comparison to other difficulties experi­ enced by learners in remedial schools. Furthermore, limited availability o f procedures appropriate to the South African con­ text may be another reason for small caseloads o f learners with WFDs for SLTs in remedial schools. Limitations of the Study A number of limitations in both the implementation and results o f this study are noted. Since the sample was limited to SLTs in South African remedial schools, the results obtained provide information specific to this population. This means that the findings cannot be generalised to other populations of SLTs. The focus group discussion was only completed in KZN for logistical reasons. If these focus group discussions had been extended to other regions, the results may have provided a valu­ able comparison o f findings. Some responses on the focus group discussion differed from the findings o f the questionnaire, possi­ bly because participants were given more opportunity to explain or expand on certain issues. The questionnaire used a predominantly close-ended ques­ tion format with SLTs ticking the appropriate response. Such a format was selected to facilitate quick completion of; the ques­ tionnaire (Bailey, 1991). However, in selecting such a', question­ naire format, more detailed responses were limited to i questions posed in the focus group discussion. This may have had an im­ pact on the quality o f the information obtained. It is recommended that biased or leading questions be avoided (Leedy, 1997). Although this was a criterion used for developing the questionnaire for this study, examples o f tests were provided for specific questions. Generally the responses to those specific questions used the examples provided. Richer in­ formation may have been obtained with open-ended questions. CONCLUSION From this study, the following conclusions can be drawn. In terms o f assessment of WFDs in South African remedial schools, there were concerns, strengths and opportunities for change. It seems that the vast majority o f participant SLTs in South African remedial schools who typically assess WFDs use Die Suid-Afrikaanse Tydskrif vir Kommunikasieafwykings, Vol. 53, 2006 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) C u r r en t Management for Word Finding Difficulties by Speech-Language Therapists in South African Remedial Schools 67 standardised tests. This is despite the tests b e in g b ia sed against our population and limited in their application for comprehensive a ssessm en t of WFDs in learners with LLDs. Reasons for this concerning assessment practice may include limited training in WFDs and limited resources. It is however encouraging that some participant SLTs in remedial schools were incorporating informal assessment measures into their standard test battery. Us­ ing informal strategies reduces test bias but the manner of o b ta in ­ ing the language sample and the mother tongue of the learner are crucial considerations. Using LSA, for example, is a useful strat­ e g y to observe WFDs in discourse, but LSA used with another tool such as the RWFS is not enough. Furthermore, SLTs need to include teachers in the assessment of WFDs. Teachers can pro­ vide information about the impact of WFDs on classroom per­ formance. As SLTs follow policy changes in education and shift from standardised testing to criterion-referenced and educator- produced tests (Department of Education Directorate: Inclusive Education, 2002), assessment practices for WFDs will become more applicable to our context. In terms of intervention for WFDs by SLTs in South Afri­ can remedial schools, there were also concerns, strengths and op­ portunities for change. O f concern was the finding that, consis­ tent with Haynes (1993), some participant SLTs were only pro­ viding strategies for WFDs. While this is an important interven­ tion principle, it is not sufficient (German, 1989a, German, 1992, Wiig & Semel, 1984, Wolf & Bowers, 2000). It seems that cur­ rent service delivery models typify a “pull out” model with lim­ ited collaboration with teachers. This is problematic in that it is not in line with changes in educational policy. Other concerns include small caseloads for WFDs in learners with LLD and the language of instruction differing from the mother tongue of the learner receiving intervention. The predominant use of informal programmes in intervention for WFDs may be an advantage in that SLTs can plan and develop appropriate interventions for the South African context. Again, in the context of changing educa­ tional policy, an opportunity exists for reviewing and extending current intervention practices for WFDs. With the changing education system for learners in reme­ dial schooling, SLTs face many challenges. One of these is to re­ visit the management of WFDs in learners with LLD. SLTs in remedial education should embrace the challenges by reviewing and improving existing management practices. They should be encouraged to build on existing J strengths to serve the learners with LLD whom they serve. J ACKNOWLEDGEMENTS i This article embodies the culmination of a thesis submit­ ted to the University of KwaZulu-2Natal by the first author, in partial fulfilment of the requirements for the degree, Master of Communication Pathology (Speech-Language Pathology), under supervision of the second and third authors. REFERENCES Apel, K. (2001). D eveloping evidence based practices and research col­ laborations in school settings. Language Speech and Hearing Services in Schools, 32, 149-152 (Prologue). Apel, K. (1999). Checks and balances: Keeping the science in our pro­ fession. Language Speech and Hearing Services in Schools, 30, 98-107. 2 The U niversity o f D urban-W estville and the U niversity o f N atal m erged in 2004 to becom e T h e U niversity o f K w aZ ulu-N atal Bailey, D.M. (1991). Research fo r the health professional: A practical guide (2 nd ed.). Philadelphia: F. A. Davis Company. Baum, H.M. (1998). Overview, definitions, and goals for A sha’s treat­ ment outcomes and clinical trials activities. (What difference do outcome data make to you?). Language Speech and Hearing Ser­ vices in Schools, 29, 246-249. Bowling, A. (1997). Research methods in health: Investigating health and health services. Buckingham: Open University Press. Casby, M.W. (1992). An intervention approach for naming problems in children. American Journal o f Speech Language Pathology, 1, 35-42. Chiat, S., & Hunt, J. (1993). Connections between phonology and se­ mantics: An exploration o f lexical processing in a language im­ paired child. 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Language assessment and intervention fo r the language learning disabled. (2nd ed.). Columbus: Charles E. Merrill Publishing Company. Wing, C.S. (1990). A preliminary investigation o f generalisation to un­ trained words follow ing two treatments o f children’s word- finding problems. Language Speech and Hearing Services in Schools, (21) 151-156. Wittmann, S. (1996). A case study in word finding. Child Language Teaching and Therapy, 12 (3), 300-311. W olf, M., & Bowers, P.G., (2000). Naming speed processes and devel­ opmental reading disabilities. An introduction to the special issue o f the double deficit hypothesis. Journal o f Learning Disabili­ ties, 33 (4), 322-324. W o lf, M., & Segal, D. (!992). Word finding and reading in the develop­ mental dyslexias. Topics in Language Disorders, 51-23. Die Suid-Afrikaanse Tydskrif vir Kommunikasieafwykings, Vol. 53, 2006 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) Current Management for Word Finding Difficulties by Speech-Language Therapists in South African Remedial Schools 69 APPENDIX A Q u estion n aire fo r S p eech -L an gu age T h erap ists (S L T s) to In vestigate P ra ctice w ith W ord F in d in g D ifficu lties in C h ild ren w ith L a n g u a g e L ea rn in g D isab ilities. Dear Colleagues, I would appreciate your time in completing the follow ing questionnaire to investigate practice in dealing with children with word finding difficulties. I would like to assure you that you are fr e e to withdraw from this research programme at any time and that all information will remain anonymous. Should you have a query about the language o f the questionnaire, please contact the researcher. Thanks fo r yo u r time. SECTION A - TICK the appropriate box. 1. How many years is it since you graduated as a SLT 1 1-5 years 2 6 - 1 0 years 3 11-15 years 4 16-20 years 5 2 1 + years 2. Which University did you attend? 1 University o f *Durban-Westville 2 University o f the Witwatersrand 3 University o f Pretoria 4 University o f Cape Town 5 University o f Stellenbosch 6 Other * T he U niversity o f D urban-W estville a n d the U n iv ersity o f N atal m erged in 2004 to becom e T he U niversity o f K w aZ ulu-N atal I If other, please specify: _________________________________________________________________________________ 3. How many years have you been in practice as a SLT? 1 i 1-5 years 2 6-10 years 3 11-15 years 4 16-20 years 5 21+ years 4. What is (are) the language (s) of instruction at your school? 7 XiTsonga 8 IsiShangaan 9 IsiNdebele 10 SePedi 11 SiSwati 12 Other 1 English 2 Afrikaans 3 IsiZulu 4 IsiXhosa 5 SeTswana 6 TshiVenda I f other, please specify: The South African Journal o f Communication Disorders, Vol. 53, 2006 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) 5. During your training did you specifically cover word-finding difficulties as a topic in your course on learning disabilities? 7 0 Ingrid de Rauville, Sandhya Chetty and Jenny Pahl YES NO 6. How many years have you worked specifically with language learning disabled children with word finding difficulties? 1 Never 2 1-5 years 3 6 - 1 0 years 4 11-15 years 5 16-20 years 6 21 + years 7. If you responded never for question 6, please give a reason 1 Lack o f skill in the area o f word finding therapy 2 Lack o f awareness o f the presence o f word finding difficulties 3 Limited assessment tools for the identification o f word finding difficulties 4 Limited therapy programmes for word finding therapy 5 Low prioritisation in terms o f intervention for word finding difficulties 6 Other If other, please specify: ______________________________________ 8. What language (s) do you provide therapy for word finding difficulties in? 7 XiTsonga 8 IsiShangaan 9 IsiNdebele 10 SePedi 11 SiSwati 12 Other 1 English 2 Afrikaans 3 IsiZulu 4 IsiXhosa 5 SeTswana 6 TshiVenda If other, please specify: SECTION B 1 I The following section need only be completed if you presently manage word-finding difficulties in children with language learning disabilities. TICK the appropriate box(es) 9. Who refers language learning disabled children to you? Most Referrals Some Few None 1 Psychologists 2 SLTs / 3 Occupational Therapists 4 Remedial Teachers 5 Other If other, please specify: ___________________ D ie Suid-Afrikaanse Tydskrif vir Kommunikasieafwykings, Vol. 53, 2006 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) C u rren t Management for Word Finding Difficulties by Speech-Language Therapists in South African Remedial Schools 10. H ow do you adm inister therapy to language learning disabled children w ith word finding difficulties? 71 Always Usually Sometimes Never 1 Individual therapy only 2 Group therapy 3 Both 11. How many language learning disabled children with word finding problems do you see per week? 1 None per week 2 1-5 years 3 6-10 years 4 11-15 years 5 16-20 years 6 2 1+ years 12. How many children are there in your caseload for whom the language of instruction is different to their mother tongue? 1 None 2 1-5 years 3 6-10 years 4 11-15 years 5 16-20 years 6 2 1+ years 13. What assessment measures do you use? Always Usually Sometimes N ever 1 Standardised tests 2 Informalj 3 Other If other, please specify: I 14. Please list the standardised tests you use to identify word finding difficulties in language learning disabled children. Please list in order of frequency o f use e.g. 3. Renfrew Word Finding Scale. Most frequently used Name o f standardised test used 1 2 3 4 ' 5 6 The South African Journal o f Communication Disorders, Vol. 53, 2006 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) 72 Ingrid de Rauville, Sandhya Chetty and Jenny Pahl 15. Please list the informal measures you use to identify word finding difficulties in language learning disabled children. Please list in order o f frequency o f use, e.g. 1. Language sample analysis. Most frequently used Informal measure used 1 2 3 4 5 6 16. What formal programmes/ and or activities do you use in your work with word finding difficulties in language learning disabled children. Please list in order o f frequency o f use e.g. 4. Lingui Systems Auditory Association Activity Booklet. Most frequently used Name o f Programme or Activities Used 1 2 3 4 5 6 17. what therapeutic strategies do you use in your work in language learning disabled children with word finding difficulties? E.g. 5. Phonetic cueing. Please list in order o f frequency. Most frequently used Name of Therapeutic Strategy Used 1 2 3 4 5 6 18. What role do other team members play in your management of word finding difficulties in the language learning disabled children that you treat? J Always Mostly Some­ times Hardly ever Never 1 Teachers are involved in the management process by observing SLT classroom based therapy to gain insight into strategies used. 2 Teachers are involved in the management process by providing strategies for word finding difficulties in the classroom 3 Occupational therapists are involved in the management process by providing strategies for word finding difficulties in their interac­ tions during their therapy sessions / 4 Psychologists are involved in the manage­ ment process by providing strategies for word finding difficulties in their interactions during their therapy sessions 5 Staff are aware o f the impact o f WFD on their assessment. Die Suid-Afrikaanse Tydskrif vir Kommunikasieafwykings, Vol. 53, 2006 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) Current Management for Word Finding Difficulties by Speech-Language Therapists in South African Remedial Schools 73 SECTION C - TICK the appropriate box. 19. Do you feel that your therapy for word finding difficulties in language learning disabled children is effective? Always Usually Sometimes Never 20. How do you measure the effectiveness of your therapy? Strongly agree Agree Neutral Dis­ agree Strongly disagree I feel my therapy for word finding difficulties in children with language learning disabilities is effective I feel the effectiveness o f m y therapy is based on m y theoreti­ cal knowledge related to word finding difficulties in language learning disabled children There is a strong degree o f carry-over o f skills developed during therapy for word finding difficulties in children with language learning disabilities in terms o f accuracy, fluency and word retrieval There is a strong degree o f carry-over o f skills developed during therapy for word finding difficulties in children with language learning disabilities in terms o f an increase in read­ ing fluency I feel the effectiveness o f m y therapy is based on the assess­ ment measures I use to identify word finding difficulties in children with language learning disabilities I use assessments or re-assessments to measure therapy out­ comes for word finding difficulties in children with language learning disabilities I use teacher checklists to measure the effectiveness o f my therapy for word finding difficulties in children with lan­ guage learning disabilities I use parent checklists to measure the effectiveness o f my therapy for word finding difficulties in children with lan­ guage learning disabilities 21. What is your opinion on the management procedures used for word finding difficulties in children with language learning disabilities? 1 Strongly agree Agree Neutral Disagree Strongl y dis­ agree Assessment procedures are relevant to the South African Context Assessment procedures are useful in identifying such difficulties Assessment procedures provide sufficient detail to facili­ tate the formulation o f treatment goals Intervention procedures are relevant to the South African Context Intervention procedures are useful in addressing word finding difficulties Therapy outcome measures are useful in identifying the benefit o f therapy The South African Journal o f Communication Disorders, Vol. 53, 2006 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) Ingrid de Rauville, Sandhya Chetty and Jenny Pahl 22. Did your training prepare you to adequately manage language learning disabled children with word finding difficulties? Strongly agree A gree N eutral D isagree Strongl y dis­ agree My training in word finding difficulties in language learning disabled children was indepth and relevant M y training in word finding difficulties in language learning disabled children was limited M y training in word finding difficulties in language learning disabled children focused on theory M y training in word finding difficulties in language learning disabled children focused on clinical experi­ ence M y training in word finding difficulties in language learning disabled children was a balance o f theory and clinical experience M y training in word finding difficulties in language learning disabled children adequately prepared me for practice in this area 23. Is word finding an area that you would like to be addressed for Continuing Professional Development? YES NO Die Suid-Afrikaanse Tydskrif vir Kommunikasieafwykings, Vol. 53, 2006 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) C u rre n t Management for Word Finding Difficulties by Speech-Language Therapists in South African Remedial Schools 75 APPENDIX B Focus Group Discussion Interview Schedule Thank you for participating today. My role is as facilitator to discuss some o f the responses to the questionnaires on practice for WFDs. The discussion is informal. Based on the responses obtained, I would like to explore a few issues. It is important for me to briefly discuss some o f the reasons why I selected WFDs as a topic to research: • It has always been a significant part of my caseload within a remedial school environment • I have not always been sure which assessments, interventions, strategies or therapy outcome measures to use when dealing with WFDs and have sometimes experienced frustration at the benefit o f intervention • With the proposed changes for service delivery in education, I have queries about how practice for WFDs will be af­ fected 100 questionnaires were sent to remedial schools in South Africa. 73 were returned and 69 were used for analysis. (Four were not analysed as the therapists did not work with WFDs or had no experience in the area). 1. I would like to start by asking how you define WFDs? (Depending on responses, use this as adjusted probe ques­ tion: Do you for example consider it to be a processing deficit or a storage deficit? 2. In terms o f caseload, it was found that all o f you provide therapy for WFDs in English. Some of the children with WFDs in your caseloads speak English as a second language. What impact does this have on your assess­ ment and intervention. What patterns do you encounter, if any? 3. In terms o f formal assessments, the RWFS was by far the most frequently used tool for identifying WFDs. How do you feel about the use of the RWFS? What do you feel about its “fit” to your definition of WFDs? How do you feel about its appropriacy and effectiveness in the assessment of WFDs? 4. Differences were noted in terms o f practice specifically regarding individual versus group therapy. Based on your experience in schools, what information can you provide about this pattern? 5. Do you find intervention needs change from year to year? Can you explain this? 6 . Within a school, the various SLTs differed as to whether they used standardised versus informal assessment pro­ cedures and in' their assessment and treatment approaches. Can you provide possible reasons for this? 7. Participants frequently responded that their undergraduate training in WFDs was inadequate but generally thera­ pists said WF therapy is sometimes or usually effective. Why do you think this is? 8. Every participant said “Yes” to WF being a topic of interest for CPD. Why is this? What other solutions for in­ creasing knowledge in this area do you have? Who would you like to see doing a WFD workshop and how do you think it could be done to be o f most value to you? i 9. Many therapists seemed to have a small caseload for WFDs and some gave it low priority in terms of interven­ tion. How significant do you think the impact o f WFDs is on academic performance? 10. How do you see WF therapy fitting into the proposed changes in education such as an increased role for the therapist as consultant and less role in providing intervention to children? 11. Are there any other issues you would like to raise? The South African Journal o f Communication Disorders, Vol. 53, 2006 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) INFORMATION FOR CONTRIBUTORS NATURE OF PUBLICATION The South African Jo u rn a l o f Com m unication Disorders publishes reports and papers concerned with research, and critically evalua­ tive theoretical and philosophical conceptual issues dealing with aspects o f human com m unication and its disorders, dysphagia, service provision, training and policy. The Journal will accept the following three types of articles: • Research articles defined as reports based on qualitative or quantitative research. • Original general articles which are reports of work usually, but not exclusively, theoretical in nature and regarded as provid­ ing a significant, critically evaluative contribution to the field of human com m unication and its disorders and/or dysphagia. • Review articles which are usually written by authors invited by the Journal's editorial team to com m ent, express opinions and or critically evaluate a topic. The Journal will not accept material which has been published else­ w here or that is currently under review by other publications. M AN U SCR IPT SU BM ISSIO N & STYLE R EQ UIR EM EN TS • All articles may only be subm itted electronically using the online manuscript subm ission, review and tracking system via the following website: w w w .saslha.co.za. • MS Word must be used for the text. 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REFEREN CIN G • References must be cited in the text by author's name and the date, e.g. Van Riper (1971). • W here there are more than two authors, after the first occur­ rence, et al. may be used. • The names of all authors must appear in the Reference List which must be listed in strict alphabetical order in triple spac­ ing at the end of the article. • All references must be included in the List, including secondary sources. • Only acceptable abbreviations of journals may be used, (see DSI-1 ABSTRACTS, October; or The W orld List o f Scientific Periodicals). • Author(s) should use references that reflect an international diversity among authors of both source articles and cited arti­ cles. • The num ber of references should not exceed 30, unless specifi­ cally warranted. Examples Locke, J.L. (1983). Clinical Psychology: The explanation and treat­ m ent of speech sound disorders. J. Speech H ear Disord., 48 339- 341. Penrod, J.P. (1985). Speech discrim ination testing. In J. Katz (Ed.), H andbook o f clinical audiology (3rd ed.). Baltimore: Williams & Wilkins. Davis, G. & W ilcox, M.J. (1985). Adult aphasia rehabilitation: Ap­ p lied pragm atics. San Diego, CA: College-Hill. EDITING • Articles must be corrected for gram m ar and style prior to sub­ mission. • Only articles com plying with the above requirem ents will be accepted for review. REVIEW ING SYSTEM • The double-blind peer review system is em ployed as a method of quality control of this publication and ensures that author (s) and reviewers do not know each others' names. • Each article is sent to two independent reviewers, selected according to their area of expertise, to assess the quality of the m anuscript's scientific and technical content. • Author(s) m ust ensure that the m anuscript does not contain inform ation/clues as to the identity of the author(s). • The Editor in Chief retains the final responsibility for decisions regarding revision, acceptance or rejection of the manuscript. 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A uthor's Responsibility: The South African Journal of C om m uni­ cation Disorders is not responsible for authors' views and does not endorse any of the products or m aterials advertised in the Journal. * Copyright: The copyright of all articles printed in The South Afri­ can Journal of Com m unication Disorders is reserved by The South African Speech-Language-Hearing Association (SASLHA). 2006 Editorial Board Editor in Chief: Dr Mershen Pillay Editors: Prof Harsha Kathard, Dr Elsie Naude and Prof Eleanor Ross Technical Editor: Ms Carm en Milton R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) http://www.saslha.co.za mailto:admin@saslha.co.za