Scielo RSS <![CDATA[South African Journal of Communication Disorders]]> vol. 65 num. 1 lang. en <![CDATA[SciELO Logo]]> <![CDATA[<b>First-language raters' opinions when validating word recordings for a newly developed speech reception threshold test</b>]]> BACKGROUND: The purpose of this study was to consider the value of adding first-language speaker ratings to the process of validating word recordings for use in a new speech reception threshold (SRT) test in audiology. Previous studies had identified 28 word recordings as being suitable for use in a new SRT test. These word recordings had been shown to satisfy the linguistic criteria of familiarity, phonetic dissimilarity and tone, and the psychometric criterion of homogeneity of audibility. OBJECTIVES: The aim of the study was to consider the value of adding first-language speakers' ratings when validating word recordings for a new SRT test METHOD: A single observation, cross-sectional design was used to collect and analyse quantitative data in this study. Eleven first-language isiZulu speakers, purposively selected, were asked to rate each of the word recordings for pitch, clarity, naturalness, speech rate and quality on a 5-point Likert scale. The percent agreement and Friedman test were used for analysis. RESULTS: More than 20% of these 11 participants rated the three-word recordings below 'strongly agree' in the category of pitch or tone, and one-word recording below 'strongly agree' in the categories of pitch or tone, clarity or articulation and naturalness or dialect. CONCLUSION: The first-language speaker ratings proved to be a valuable addition to the process of selecting word recordings for use in a new SRT test. In particular, these ratings identified potentially problematic word recordings in the new SRT test that had been missed by the previously and more commonly used linguistic and psychometric selection criteria. <![CDATA[<b>Intervention for bilingual speech sound disorders: A case study of an isiXhosa-English-speaking child</b>]]> BACKGROUND: Bilingualism is common in South Africa, with many children acquiring isiXhosa as a home language and learning English from a young age in nursery or crèche. IsiXhosa is a local language, part of the Bantu language family, widely spoken in the country. AIMS: To describe changes in a bilingual child's speech following intervention based on a theoretically motivated and tailored intervention plan. METHODS AND PROCEDURES: This study describes a female isiXhosa-English bilingual child, named Gcobisa (pseudonym) (chronological age 4 years and 2 months) with a speech sound disorder. Gcobisa's speech was assessed and her difficulties categorised according to Dodd's (2005) diagnostic framework. From this, intervention was planned and the language of intervention was selected. Following intervention, Gcobisa's speech was reassessed. OUTCOMES AND RESULTS: Gcobisa's speech was categorised as a consistent phonological delay as she presented with gliding of/l/in both English and isiXhosa, cluster reduction in English and several other age appropriate phonological processes. She was provided with 16 sessions of intervention using a minimal pairs approach, targeting the phonological process of gliding of/l/, which was not considered age appropriate for Gcobisa in isiXhosa when compared to the small set of normative data regarding monolingual isiXhosa development. As a result, the targets and stimuli were in isiXhosa while the main language of instruction was English. This reflects the language mismatch often faced by speech language therapists in South Africa. Gcobisa showed evidence of generalising the target phoneme to English words CONCLUSIONS AND IMPLICATIONS: The data have theoretical implications regarding bilingual development of isiXhosa-English, as it highlights the ways bilingual development may differ from the monolingual development of this language pair. It adds to the small set of intervention studies investigating the changes in the speech of bilingual children following intervention. In addition, it contributes to the small amount of data gathered regarding typical bilingual acquisition of this language pair. <![CDATA[<b>Adapting and translating the Mullen Scales of Early Learning for the South African context</b>]]> BACKGROUND: South African speech-language therapists have identified the need for culturally valid and sensitive assessment tools that can accommodate multiple languages and cover a reasonable age range. The Mullen Scales of Early Learning (MSEL) extend from birth to 68 months, contain five separate subscales including receptive language, expressive language, gross motor, fine motor and visual reception scale, are straightforward to administer and have been successfully used in other African countries, such as Uganda. It also identifies a child's strengths and weaknesses and provides a solid foundation for intervention planning. OBJECTIVES: This research aimed to demonstrate the appropriateness and usefulness of the translated and culturally and linguistically adapted MSEL across four South African languages (Afrikaans, isiZulu, Setswana and South African English) through two sub-aims: (1) to describe differences, if any, in MSEL performance across language groups and (2) to describe differences, if any, in MSEL performance between age groups. METHOD: A total of 198 typically developing children between the ages of 21 and 68 months spread across the four language groups were individually assessed with the culturally and linguistically adapted and translated MSEL. RESULTS: A one-way analysis of variance (ANOVA) showed no statistically significant differences between the four language groups for total MSEL scores. A Welch's one-way ANOVA showed that the total MSEL scores were significantly different between age groups. CONCLUSION: The translation and adaptation of the MSEL was successful and did not advantage or disadvantage children based on their home language, implying that linguistic equivalence was achieved. The MSEL results differed between age groups, suggesting that the measure was also successful in differentiating the performance of children at different developmental levels. <![CDATA[<b>Male students' perceptions about gender imbalances in a speech-language pathology and audiology training programme of a South African institution of higher education</b>]]> BACKGROUND: The professions of speech-language pathology and audiology (SLPA) are characterised by occupational gender segregation. Reasons given by men are a lack of awareness of SLPA; a perception of poor salaries; a perception of poor working conditions; a stereotype that the profession is a female occupation; and a perception that working with children is feminine. OBJECTIVES: The aim of this study was to describe the perceptions of male students in a specific SLPA training programme regarding gender imbalances. The objectives were to describe the influences of gender on the career orientation of students, the factors shaping students' career choices and the experiences of students during their undergraduate training. METHOD: This study followed a quantitative descriptive survey design. Thirty-one conveniently sampled male SLPA students, across different years of study, completed a self-administered questionnaire. RESULTS: Participants indicated that they did not believe in the gendered nature of occupations and that SLPA are not 'female only' professions. They (65%) recorded that they considered salary and career prospects for choosing a career, and 74% specified that they chose SLPA because of a desire to help people. The perception of male students regarding their training appears to be positive as participants are comfortable with the clinical (71%) and learning (77%) activities. However, barriers were reported and some lecture information may be more obvious or applicable to female students. A need was identified to address the issue of working alone with paediatric clients and pertains to the societal awareness regarding sexual harassment of children, which may impact spontaneity in engagements. CONCLUSION: The recruitment of male students should be prioritised to better reflect the client population served by the professions. Recommendations include career counselling in rural schools, recruitment campaigns to identify interested students, public awareness regarding the professions and guidance regarding working with paediatric clients. <![CDATA[<b>Evaluating a smartphone digits-in-noise test as part of the audiometric test battery</b>]]> BACKGROUND: Speech-in-noise tests have become a valuable part of the audiometric test battery providing an indication of a listener's ability to function in background noise. A simple digits-in-noise (DIN) test could be valuable to support diagnostic hearing assessments, hearing aid fittings and counselling for both paediatric and adult populations.j OBJECTIVE: The objective of this study was to evaluate the South African English smartphone DIN test's performance as part of the audiometric test battery. DESIGN: This descriptive study evaluated 109 adult subjects (43 male and 66 female subjects) with and without sensorineural hearing loss by comparing pure-tone air conduction thresholds, speech recognition monaural performance scores (SRS dB) and the DIN speech reception threshold (SRT). An additional nine adult hearing aid users (four male and five female subjects) were included in a subset to determine aided and unaided DIN SRTs. RESULTS: The DIN SRT is strongly associated with the best ear 4 frequency pure-tone average (4FPTA) (r s = 0.81) and maximum SRS dB (r = 0.72). The DIN test had high sensitivity and specificity to identify abnormal pure-tone (0.88 and 0.88, respectively) and SRS dB (0.76 and 0.88, respectively) results. There was a mean signal-to-noise ratio (SNR) improvement in the aided condition that demonstrated an overall benefit of 0.84 SNR dB. CONCLUSION: The DIN SRT was significantly correlated with the best ear 4FPTA and maximum SRS dB. The DIN SRT provides a useful measure of speech recognition in noise that can evaluate hearing aid fittings, manage counselling and hearing expectations. <![CDATA[<b>Skydiving: The audiological perspective</b>]]> BACKGROUND: Skydiving is a popular recreational sport for the young and old. There is minimal research pertaining to skydiving and its relation to the audiological system. The risks of skydiving in relation to the auditory system should be explored further. AIMS: The main aim of this study was to explore the relationship between skydiving and audiology in South Africa. The sub-aims of the study focused on determining if skydivers were provided with safety precautions before they commenced with the dive, determining the middle ear pressure before and after the skydive and identifying the audiological symptoms that were present post-dive. This study also aimed at scrutinising the South African sports and recreation policy. METHOD: A mixed-method descriptive research design was utilised. Qualitative information pertaining to audiology was identified and recorded from the scrutiny of South Africa (SA) policy and the dropzone consent forms at two skydiving schools. Thirty-one skydivers were purposefully recruited to undergo a pre- and post-dive tympanometric assessment. RESULTS: There is no information within the clearance forms that pertain to the audiological risks related to skydiving. There was a lack of information related to the risks of skydiving in the clearance forms at both dive schools. A statistically significant pressure change was noted in regular skydivers, regardless of the ability to equalise effectively during the skydive. CONCLUSION: This study identified the gaps in policy and clearance forms, highlighting the need for the inclusion of safety measures and risks in the documentation and legislation that governs the sport. Audiologists, sportspeople and medical advisors should be cognisant of the negative consequences that may be evident within the auditory system of skydivers. <![CDATA[<b>Exploring the efficacy of melodic intonation therapy with Broca's aphasia in Arabic</b>]]> BACKGROUND: Even though the efficacy of melodic intonation therapy (MIT) with persons with aphasia (PWA) has been explored in different languages, the efficacy of MIT with Arabic-speaking PWA has never been explored. AIMS: To explore the efficacy of MIT, adapted to Arabic, in promoting the expressive abilities of a 70-year-old Jordanian Arabic-speaking male subject with severe Broca's aphasia 3 months post-onset. METHODS: An 8-week MIT therapy programme with tapping (1.5 h daily, 6 days a week) was used in a multiple baseline design across two types of trained phrases (i.e. automatic and self-generated phrases). Outcome measures included accuracy of production of trained (at the end of each session) and untrained phrases (at the end of each week). Pre- and post-treatment measures used, were the bilingual aphasia test, the American Speech-Language Hearing Association Functional Assessment of Communicative Skills, the communicative effectiveness index and the American Speech and Hearing Association Quality of Communication Life Scale. Accuracy of production for the trained and untrained phrases was also measured 2 weeks and 4 weeks after the treatment programme was finished. RESULTS: The patient, (MK), improved his expressive productions post-treatment in automatic and self-generated phrases. Automatic phrases exceeded the established 75% accuracy criterion, whereas the self-generated phrases reached criterion and remained constant at follow-up. Moreover, MK gradually started improving on the generalisation stimuli, once the treatment on the self-generated phrases started and maintained the gains 2 weeks and 4 weeks post-treatment. CONCLUSION: MIT appears to be a viable treatment option for Jordanian Arabic-speaking persons with Broca's aphasia. However, more research is needed with larger groups of Jordanian Arabic-speaking persons with Broca's aphasia to provide more support to the present findings. Moreover, future studies might focus on the efficacy of MIT with persons with Broca's aphasia from different Arab countries and from countries where Arabic is part of the multicultural structure like South Africa and other countries on the African continent. <![CDATA[<b>Early hearing detection and intervention: Reflections from the South African context</b>]]> For researchers and clinicians in developing contexts like South Africa, the establishment of universal newborn hearing screening (UNHS) programmes is something which we have strived to achieve. However, we need to ask the question as to whether we have attempted to view our ultimate goal of achieving mandated UNHS programmes from the perspective of the South African healthcare system as a whole. The current manuscript is aimed at providing an overview of audiological services within a broader context, with reflections from a South African perspective, and a suggestion to consider alternatives to UNHS, particularly in the South African public health care sector. <![CDATA[<b>Erratum: Wideband acoustic immittance for assessing middle ear functioning for preterm neonates in the neonatal intensive care unit</b>]]> For researchers and clinicians in developing contexts like South Africa, the establishment of universal newborn hearing screening (UNHS) programmes is something which we have strived to achieve. However, we need to ask the question as to whether we have attempted to view our ultimate goal of achieving mandated UNHS programmes from the perspective of the South African healthcare system as a whole. The current manuscript is aimed at providing an overview of audiological services within a broader context, with reflections from a South African perspective, and a suggestion to consider alternatives to UNHS, particularly in the South African public health care sector. <![CDATA[<b>A pilot study: Considering spirituality in an inclusive model of practice in clinical audiology</b>]]> BACKGROUND: A patient-orientated approach in medical clinical practice is emerging where patients and practitioners are considering and including the spiritual, emotional and psychosocial aspects of the individual. This practice is an important change in health care, specifically in the field of audiology as a holistic view of the patient now alters the perspective on the management of individuals with hearing impairmentsOBJECTIVES: This article explored the experiences of a participant who reported supernatural healing of his sensorineural hearing loss (SNHL). Hence, this study focuses on the consideration of spirituality in the inclusive model of careMETHOD: An exploratory, qualitative narrative inquiry was used to obtain data from a single pilot case study of a 27-year-old man who reported healing of his permanent profound hearing lossRESULTS: Four themes were identified within the narrative obtained: prayer and faith, deaf culture, identity and purpose. The participant stated that he believed that he was partially healed to fulfil his purpose in life. The partial healing allowed him to belong to the deaf community and the hearing world simultaneouslyCONCLUSION: South Africans live in a diverse society where most people accept spirituality as part of their search for meaning in life. Health care for individuals should therefore consider the person as a holistic being more than a medical entity. The exploration of narratives of individuals who report supernatural healing of a SNHL will assist health care practitioners and audiologists in managing individuals in an inclusive manner. This pilot study thus has implications for policy and practice in health care contexts <![CDATA[<b>The internal and external consistency of a speech reception threshold test for isiZulu speakers with normal hearing sensitivity</b>]]> BACKGROUND AND OBJECTIVES: This study investigated reliability, particularly the internal and external consistency, of a new isiZulu speech reception threshold (SRT) test. METHODS: To examine internal consistency, 21 adult isiZulu speakers with normal hearing sensitivity completed the SRT test using the first and second halves of the SRT wordlist in the same test session. To examine external consistency, a separate 23 adult isiZulu speakers with normal hearing sensitivity completed the SRT test, using the whole word list on two occasions 4 weeks apart. Consistency of SRT test scores in these test conditions was measured using intraclass correlation coefficient analyses (a measure of the consistency or reproducibility of different observations of the same quantity) and Bland and Altman analyses of agreement (a comparison of measurement error with the expected variation amongst subjects. RESULTS: Intraclass correlation coefficient values ranged from 0.69 to 0.79, showing the isiZulu test scores were highly consistent between the test and retest conditions used in this study. Bland and Altman analyses showed that isiZulu speakers with normal hearing sensitivity can be expected to return isiZulu SRT test scores that differ by no more than 7.5 dB HL - 8.7 dB HL between original and repeat assessments. CONCLUSION: The isiZulu SRT test was reliable, showing high internal and external consistency, when used to assess first-language speakers of isiZulu with normal hearing sensitivity. These findings warrant continued development of the isiZulu SRT test for eventual clinical use. This development should include validating this test on first-language speakers of isiZulu with and without hearing loss. <![CDATA[<b>Caregivers' reading practices to promote literacy in a South African children's home: Experiences and perceptions</b>]]> BACKGROUND: Exposure to social trauma influences the psychosocial experiences of vulnerable children. This affects their positive development, consequentially resulting in poor scholastic progress. South Africa's history of inequality and injustice has compounded the current social, educational and economic situation, highlighting the need for research on children in care. A paucity of published studies exists on caregiver facilitation of literacy skills among vulnerable populations in South African children's homes. The purpose of this paper is to describe the reading practices that caregivers in one children's home (orphanage) used to promote literacy developmentMETHOD: An exploratory, descriptive contextual design was implemented, using inductive and interpretative approaches. Semi-structured interviews and focus group discussion were conducted. Ten caregivers, who supervised children aged 9-10 years at the home, consented to be participants. Applied content thematic analysis was used to interpret the data obtainedFINDINGS: The caregivers at the children's home were implementing some reading strategies, but they did not engage sufficiently in self-reflection on the reading processes. The caregivers used relevant reading strategies, such as asking questions to develop understanding and memory recall. They encouraged dialogue through characterisation, where the children acted out the roles of the main characters. These reading strategies demonstrate the quality of the mediationCONCLUSIONS: Speech-language therapists have a role in prevention and promotion programmes in children's homes. They should advocate for, collaborate on and support caregivers' facilitation of early literacy skills in these homes, as the link between literacy and language cannot be ignored. Providing guidelines and sharing knowledge on reading instruction for the children are essential in improving the literacy rates in vulnerable populations. Language and literacy interventions are only effective and meaningful if the social and cultural contexts are considered. Such interventions would add value and constitute a step towards redressing past inequalities in South Africa. These results contribute to our understanding of context when developing literacy programmes. The sample size was a limitation. However, the aim was not about generalisation but to gain an insight into caregiver reading practices so that literacy programmes are built on these strengths <![CDATA[<b>Assessing the efficacy of asynchronous telehealth-based hearing screening and diagnostic services using automated audiometry in a rural South African school</b>]]> BACKGROUND: Asynchronous automated telehealth-based hearing screening and diagnostic testing can be used within the rural school context to identify and confirm hearing lossOBJECTIVE: The aims of the study were to evaluate the efficacy of an asynchronous telehealth-based service delivery model using automated technology for screening and diagnostic testing as well as to describe the prevalence, type and degree of hearing lossMETHOD: A comparative within-subject design was used. Frequency distributions, sensitivity, specificity scores as well as the positive and negative predictive values were calculated. Testing was conducted in a non-sound-treated classroom within a school environment on 73 participants (146 ears). The sensitivity and specificity rates were 65.2% and 100%, respectively. Diagnostic accuracy was 91.7% and the negative predictive values (NPV) and positive predictive values (PPV) were 93.8% and 100%, respectivelyRESULTS: Results revealed that 23 ears of 20 participants (16%) presented with hearing loss. Twelve per cent of ears presented with unilateral hearing impairment and 4% with bilateral hearing loss. Mild hearing loss was identified as most prevalent (8% of ears). Eight ears obtained false-negative results and presented with mild low- to mid-frequency hearing loss. The sensitivity rate for the study was low and was attributed to plausible reasons relating to test accuracy, child-related variables and mild low-frequency sensory-neural hearing lossCONCLUSION: The study demonstrates that asynchronous telehealth-based automated hearing testing within the school context can be used to facilitate early identification of hearing loss; however, further research and development into protocol formulation, ongoing device monitoring and facilitator training is required to improve test sensitivity and ensure accuracy of results <![CDATA[<b>Language and culture in speech-language and hearing professions in South Africa: The dangers of a single story</b>]]> BACKGROUND: Speech-language and hearing (SLH) professions in South Africa are facing significant challenges in the provision of clinical services to patients with communication disorders from a context that is culturally and linguistically diverse because of historic exclusions of black and African language speaking candidates in higher education training programmes. Over 20 years post the democratic dispensation, minimal changes have been noted in terms of the training, research as well as clinical service provision in these professions, although the demographic profile of students is seen to be transforming graduallyOBJECTIVES: We offer this viewpoint publication as a challenge to the professions to interrogate their academic and clinical orientation in respect of African contextual relevance and responsivenessMETHOD: We do this by identifying gaps within the higher education context, highlighting the influencing factors to the provision of linguistically and culturally appropriate SLH training and clinical services in South Africa, while asking questions about what SLH students and practitioners need to carefully considerRESULTS: We make recommendations about what needs to happen within the SLH professions in South Africa in order to stay safe from the dangers of a single storyCONCLUSION: We invite debate in order to allow for constructive engagement with this complex issue within the South African SLH professions <![CDATA[<b>Mixed-methods research: A tutorial for speech-language therapists and audiologists in South Africa</b>]]> BACKGROUND: Mixed-methods research (MMR) offers much to healthcare professions on clinical and research levels. Speech-language therapists and audiologists work in both educational and health settings where they deal with real-world problems. Through the nature of their work, they are confronted with multifaceted questions arising from their efforts to provide evidence-based services to individuals of all ages with communication disorders. MMR methods research is eminently suited to addressing such questionsOBJECTIVE: The aim of this tutorial is to increase awareness of the value of MMR, especially for readers less familiar with this research approachMETHOD: A literature review was conducted to provide an overview of the key issues in MMR. The tutorial discusses the various issues to be considered in the critical appraisal of MMR, followed by an explanation of the process of conducting MMR. A critical review describes the strengths and challenges in MMRRESULTS: MMR is less commonly used or published in the fields of speech-language therapy and audiologyCONCLUSION: Researchers working in teams can draw on the strengths of different disciples and their research approaches. Such collaborative enterprises will contribute to capacity building. Researchers, SLTs and audiologists are encouraged to make use of MMR to address the complex research issues in the multicultural, multifaceted South African context. MMR makes an important contribution to the understanding of individuals with communication disorders, and in turn, researchers in the two disciplinary fields of speech-language therapy and audiology can contribute to the development of this research approach. MMR is well suited to the complexity of South African contexts and its populations, as it can provide multiple perspectives of a topic <![CDATA[<b>A comparison between video otoscopy and standard tympanometry findings in adults living with human immunodeficiency virus (HIV) in South Africa</b>]]> BACKGROUND: Literature suggests that there is a correlation between video otoscopy and standard tympanometry findings. However, there is limited evidence on whether these two measures are comparable in the identification of middle ear pathologies in adults living with human immunodeficiency virus (HIVOBJECTIVE: This study aimed to determine the correlation between video otoscopy and standard tympanometry with 226 Hz probe tone in the identification of middle ear pathologies in adults living with HIV in Limpopo, South AfricaMETHOD: A prospective, non-experimental, comparative design was employed on HIV-positive adults aged 18 years and older. All participants underwent basic audiological assessment including case history interviews, video otoscopy, tympanometry with a 226 Hz probe tone and pure tone audiometry. Two ear, nose and throat (ENT) specialists independently analysed video otoscopic images and provided their reports to the researcher, and these were compared to the tympanometry results. The IBM SPSS v.24 was used for data analysis, including the use of Cohen's kappa to determine the agreement between the two procedures. Pearson's correlation coefficient was used to determine the strength of the correlation between tympanometry and video otoscopyRESULTS: A total of 87 adults (N = 161 ears) took part in the study. Middle ear pathology was observed in 8% (n = 13) of the sample when tympanometry was used, and this increased to 10.6% (n = 17) when video otoscopy was utilised. Kappa statistics found a good agreement (k = 0.7) between the diagnoses made by two ENTs. However, there was poor agreement (k = 0.2) between the diagnoses by video otoscopy and tympanometry. Pearson's correlation coefficient indicated weak correlation between video otoscopy and tympanometry (r = 0.195CONCLUSION: Findings from this study suggest that video otoscopy may be more accurate in the identification of middle ear pathologies in adults living with HIV when compared to tympanometry. These findings have training implications in the use of video otoscopy to ensure accuracy and reliability. Clinical implications of current findings include the use of both video otoscopy and tympanometry in a complementary manner for more sensitive identification of middle ear pathologies in this population. Lastly, tele-audiologic implications of the use of video otoscopy to increase access in resource-constrained contexts are raised <![CDATA[<b>Towards the preferred stimulus parameters for distortion product otoacoustic emissions in adults: A preliminary study</b>]]> BACKGROUND: Although distortion product otoacoustic emissions (DPOAEs) are useful in evaluating cochlear outer hair cell function, determining the optimal stimulus parameters could result in a more reliable, sensitive and specific diagnostic tool across the range of DPOAE applications. OBJECTIVES: To identify which stimulus parameters warrant further investigation for eliciting the largest and most reliable DPOAEs in adult humans. METHOD: A single group, repeated measures design involving a convenience sample of 20 normal-hearing participants between 19 and 24 years of age. RESULTS: Descriptive statistics and mixed model analyses suggested L1/L2 intensity levels of 65/65 dB sound pressure level (SPL) and 65/55 dB SPL, and f2/f1 ratios of 1.18, 1.20 and 1.22 elicited larger and more reliable DPOAEs in both ears. CONCLUSION: Further investigation of the 65/65 dB SPL and 65/55 dB SPL intensity levels and the 1.18, 1.20 and 1.22 f2/f1 ratios is warranted to determine the stimulus parameters for eliciting the largest and most reliable DPOAEs in adult humans across the range of DPOAE applications. <![CDATA[<b>A pilot study to determine the feasibility of a cluster randomised controlled trial of an intervention to change peer attitudes towards children who stutter</b>]]> BACKGROUND: While randomised controlled trials (RCTs) are considered the gold standard of research, prior study is needed to determine the feasibility of a future large-scale RCT study OBJECTIVES: This pilot study, therefore, aimed to determine feasibility of an RCT by exploring: (1) procedural issues and (2) treatment effect of the Classroom Communication Resource (CCR), an intervention for changing peer attitudes towards children who stutter METHOD: A pilot cluster stratified RCT design was employed whereby the recruitment took place first at school-level and then at individual level. The dropout rate was reported at baseline, 1 and 6 months post-intervention. For treatment effect, schools were the unit of randomisation and were randomised to receive either the CCR intervention administered by teachers or usual practice, using a 1:1 allocation ratio. The stuttering resource outcomes measure (SROM) measured treatment effect at baseline, 1 and 6 months post-intervention overall and within the constructs (positive social distance, social pressure and verbal interaction RESULTS: For school recruitment, 11 schools were invited to participate and 82% (n = 9) were recruited. Based on the school recruitment, N = 610 participants were eligible for this study while only n = 449 were recruited, where there was n = 183 in the intervention group and n = 266 in the control group. The dropout rate from recruitment to baseline was as follows: intervention, 23% (n = 34), and control, 6% (n = 15). At 1 month a dropout rate of 7% (n = 10) was noted in the intervention and 6% (n = 15) in the control group, whereas at 6 months, dropout rates of 7% (n = 10) and 17% (n = 44) were found in the intervention and control groups, respectively. For treatment effect on the SROM, the estimated mean differences between intervention and control groups were (95% Confidence Interval (CI): -1.07, 5.11) at 1 month and 3.01 (95% CI: -0.69, 6.69) at 6 months. A statistically significant difference was observed at 6 months on the VI subscale of the SROM, with 1.35 (95% CI: 0.58, 2.13 CONCLUSION: A high recruitment rate of schools and participants was observed with a high dropout rate of participants. Significant differences were only noted at 6 months post-intervention within one of the constructs of the SROM. These findings suggest that a future RCT study is warranted and feasible <![CDATA[<b>Learning new words from an interactive electronic storybook intervention</b>]]> BACKGROUND: Children who enter school with limited vocabulary knowledge are at risk for reading failure. This study investigated the efficacy of an interactive e-book, implemented as a mobile application, to facilitate vocabulary learning in Grade 1 isiXhosa-speaking children (n = 65 OBJECTIVE: The purpose was to measure if an e-book intervention, specifically developed for use in the South African context, could facilitate the acquisition and retention of new words at different levels of lexical representation. METHOD: A randomised pre-test and/or post-test between-subject design was used where an experimental group that received the e-book intervention was compared to a control group before the control group received a delayed intervention. Follow-up testing was performed to measure retention of the new vocabulary after eight weeks. Mixed-model repeated-measure Analysis of Variance (ANOVAs) were used to determine differences between the participants in the experimental and control groups. RESULTS: The short-term e-book intervention not only facilitated fast-mapping of new words but enabled participants to develop more robust lexical representations of the newly acquired words. Follow-up assessment showed that they retained their newly acquired word knowledge CONCLUSION: Multimedia technology can be used to provide explicit and embedded vocabulary training to young children at risk for academic failure. These findings are particularly relevant for South African environments where there is limited parental support and lack of educational resources to promote vocabulary learning in young children. <![CDATA[<b>Gestational age and birth weight variations in young children with language impairment at an early communication intervention clinic</b>]]> BACKGROUND: South Africa presents with high preterm birth (PTB) and low birth weight (LBW) rates (14.17%). Numerous conditions characterised by language impairment are associated with LBW and/or PTB. Speech-language therapists may fail to identify older children whose language impairment may have originated from LBW and/or PTB. OBJECTIVE: To describe the frequency of LBW and/or PTB, in comparison with full-term birth, and associated conditions in children at an early communication intervention (ECI) clinic. METHODS: Retrospective data of 530 children aged 3-74 months were analysed, with 91.9% presenting with language impairment. RESULTS: Almost 40% had LBW and/or PTB, and late PTB was the largest category. Factors associated with LBW and/or PTB were prenatal risks, including small-for-gestational age, perinatal risks, including caesarean section, and primary developmental conditions. Secondary language impairment was prevalent, associated with genetic conditions and global developmental delay. CONCLUSION: The frequency of LBW and/or PTB was unexpectedly high, drawing attention to the origins of language impairment in almost 40% of the caseload at the ECI clinic. <![CDATA[<b>Audiological follow-up in a risk-based newborn hearing screening programme: An exploratory study of the influencing factors</b>]]> BACKGROUND: Follow-up return rate in Early Hearing Detection and Intervention (EHDI) programmes is of specific importance as it ensures that benchmarks are met and that no child with suspected hearing loss is left unidentified. OBJECTIVES: The aim of this study was to determine the factors influencing audiological follow-up of high-risk infants in a risk-based newborn hearing screening programme. METHOD: A non-experimental, exploratory, qualitative research design was employed. Purposive sampling was used. The study was conducted at a secondary level hospital in the public health care sector in South Africa. Participants comprised 10 caregivers (age range 26-40 years) of infants who had been enrolled in a risk-based newborn hearing screening programme, and returned for follow-up appointments. Data were collected using semi-structured interviews. Responses were recorded by the researcher and a colleague to ensure rigour and trustworthiness of findings. Data were analysed using thematic analysis for open-ended questions and descriptive statistics for the closed-ended questions. RESULTS: The most common positive contributors that facilitated participants' attendance at follow-up appointments were: having friendly audiologists; a clear line of communication between caregiver and audiologist and a reminder of the appointment. The most significant perceived challenge that participants described in returning for the follow-up appointment was living in far proximity from the hospital. CONCLUSION: Findings of the study revealed that influencing factors on follow-up return rate are demographic, socio-economic, and interpersonal in nature and further suggested the need for an all-inclusive appointment day. It may be of importance to not only look at what is being done to improve the follow-up return rate but also howit should be done in terms of professional-to-patient communication and interactions.