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How to cite this thesis Surname, Initial(s). (2012) Title of the thesis or dissertation. PhD. (Chemistry)/ M.Sc. (Physics)/ M.A. (Philosophy)/M.Com. (Finance) etc. [Unpublished]: University of Johannesburg. Retrieved from: https://ujcontent.uj.ac.za/vital/access/manager/Index?site_name=Research%20Output (Accessed: Date).

Learning with a central auditory processing disorder: Phenomenological case studies exploring pupils’ experiences by ELISE MELISSA LEVIN

DISSERTATION

Submitted in fulfilment of the requirements for the degree MAGISTER EDUCATIONIS in INCLUSIVE EDUCATION in the FACULTY OF EDUCATION at the UNIVERSITY OF JOHANNESBURG

SUPERVISOR: Mrs J. V. Fourie

October 2016

ABSTRACT This study explored the perceptions that five learners with central auditory processing disorder (CAPD) displayed about this disorder throughout their schooling careers, with a view to improving insight into the ways in which they interacted with their school environment. The literature review included consideration of current issues of inclusive education in which the characteristics, symptoms, and treatment of CAPD were contextualised. Bronfenbrenner’s eco-systemic theory was employed for determining how the children interacted with their school environment, and a phenomenological, multiple case study design was used for exploring and describing the unique characteristics of each learner’s school experiences in managing their CAPD. Data were gathered using individual reading and spelling diagnostic tests, semi-structured interviews with the learners, as well as classroom observations and documents such as school and medical reports. Data sets were analysed using interpretative phenomenological analysis (IPA). From the coding of raw data, patterns and themes were determined and interpreted using Bronfenbrenner’s model as a framework. The first theme focused on learners’ self-awareness and how increased personal knowledge of CAPD and coping strategies improved their ability to fulfil their academic potential. The second theme, which related to family and friends, indicated that these immediate relationships of continuous, helpful parental support and positive peer group influences directly affected the learners’ perceptions and experiences of academic success. A third theme, relating to the school environment, elucidated the significance of the learners’ relationships with, perceptions of, and expectations from educators and other professionals in this environment. It appeared that learners’ understanding of CAPD and of the school’s expectations, and a reciprocal understanding of learners’ situation by the school, were conducive to positive perceptions and the attainment of academic success. The fourth theme highlighted the importance of stronger community networking in supporting learners’ perception of their academic work. The final theme covered rules, policies, and systemic determinants that exert an effect on learners’ ability to function successfully in their schooling careers. The study indicated that school and home environments with open communication supported learners in maintaining a more positive perception of their academic life, and that activities in iii

which learners achieved success, such as sports, improved their self-esteem, friendships, and their perception of school. Implications for schools and educators were that innovative strategies that took account of the social and emotional intelligence of the learners were required in the classroom. Dynamic classrooms promoted learners’ problem-solving skills by encouraging them to bring all their skills, resources, and senses to bear on the learning process. A team approach by educators, assistive professionals, parents, and learners themselves was fundamental to academic success and conducive to promoting a truly inclusive education system. Key words Central auditory processing disorder; inclusive education; learning problems; learning support; longitudinal case study; qualitative research.

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ACKNOWLEDGEMENTS I would like to express my sincere thanks to the following people who assisted me in completing this study: To my supervisor, Mrs Jean Fourie, for her continued support, constructive criticism, patience, understanding, and guidance. To my parents, who have never stopped believing in me and who are my heroes. To my husband, Derek (my rock and springboard), and four children, who had to be understanding, loving, and see the funny side more often than not. To Donna and Raymond, my miracles. To my nieces and nephew, who always challenge me and spur me on. To the children and parents that I work with and who inspire me, and to G_d who is ever present in my heart, work, and life.

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TABLE OF CONTENTS AFFIDAVIT ...........................................................................................................................ii ABSTRACT ......................................................................................................................... iii  ACKNOWLEDGEMENTS ................................................................................................... v  LIST OF FIGURES................................................................................................................ x  LIST OF TABLES ................................................................................................................ xi  ABBREVIATIONS AND ACRONYMS ............................................................................xii  CHAPTER 1

ORIENTATION TO THE RESEARCH..................................................... 1 

1.1 

INTRODUCTION ....................................................................................................... 1 

1.2 

RATIONALE .............................................................................................................. 2 

1.3 

RESEARCH QUESTION AND AIMS ...................................................................... 5 

1.4 

PERSONAL MOTIVATION ...................................................................................... 5 

1.5 

CONTEXTUAL ORIENTATION: CENTRAL AUDITORY PROCESSING DISORDER ....................................................................................... 6 

1.6 

CONCEPT CLARIFICATION ................................................................................... 8 

1.6.1 

Recommended professional approaches and terminology ................................... 8 

1.6.2 

Auditory processes ............................................................................................... 9 

1.6.3 

Auditory processing disorder ............................................................................. 10 

1.6.4 

Learner and learning .......................................................................................... 10 

1.6.5 

Experience.......................................................................................................... 11 

1.6.6 

Perception .......................................................................................................... 11 

1.6.7 

Assessment ......................................................................................................... 11 

1.6.8 

Remediation or treatment ................................................................................... 11 

1.6.9 

Management ....................................................................................................... 12 

1.6.10  Paradigms ........................................................................................................... 12  1.7 

PROGRESSION OF THE INVESTIGATION ......................................................... 12 

1.8 

CHAPTER SUMMARY ........................................................................................... 13 

CHAPTER 2

LITERATURE REVIEW .......................................................................... 14 

2.1 

CHAPTER PREVIEW .............................................................................................. 14 

2.2 

BRONFENBRENNER’S THEORY OF HUMAN DEVELOPMENT .................... 15 

2.2.1 

Aims of the ecological systems theory .............................................................. 15 

2.2.2 

Microsystem....................................................................................................... 17 

2.2.3 

Mesosystem........................................................................................................ 17 

2.2.4 

Exosystem .......................................................................................................... 18  vi

2.2.5 

Macrosystem ...................................................................................................... 18 

2.2.6 

Chronosystem .................................................................................................... 19 

2.3 

THE ECOLOGICAL SYSTEMS THEORY IN RELATION TO INVESTIGATING CAPD ........................................................................................ 20 

2.4 

AUDITORY PROCESSING..................................................................................... 21 

2.4.1 

Definition and description of typical auditory processing ................................. 22 

2.4.2 

The role of the brain in auditory processing ...................................................... 23 

2.4.3 

The peripheral auditory system (outer ear) ........................................................ 25 

2.4.4 

The central auditory nervous system ................................................................. 27 

2.4.5 

Central auditory processing disorders: definition and discussion...................... 28 

2.4.6 

DSM-5 criteria for specific learning disorder and comorbidity of CAPD......... 32 

2.4.7 

Aetiology of CAPD............................................................................................ 37 

2.4.8 

Incidence of CAPD ............................................................................................ 39 

2.4.9 

Behavioural indications and symptoms of CAPD in children ........................... 40 

2.4.10  Remediation, treatment, and management of CAPD ......................................... 43  2.5 

STAGES AND MANIFESTATIONS OF CAPD..................................................... 47 

2.5.1 

The infancy and early childhood phase (3 months to 2 years) .......................... 47 

2.5.2 

The preschool phase (2–3 years)........................................................................ 48 

2.5.3 

The nursery school phase (3–6 years) ................................................................ 48 

2.5.4 

The grade, primary school phase (6–13 years) ................................................. 50 

2.5.5 

The high school phase (13–18 years)................................................................. 53 

2.5.6 

Adults with CAPD ............................................................................................. 53 

2.5.7 

Prognosis of CAPD ............................................................................................ 54 

2.6 

INCLUSIVE EDUCATION: DEFINITION AND DESCRIPTION ........................ 55 

2.7 

CHAPTER SUMMARY ........................................................................................... 58 

CHAPTER 3

RESEARCH METHODOLOGY............................................................... 60 

3.1 

CHAPTER PREVIEW .............................................................................................. 60 

3.2 

RESEARCH DESIGN AND THEORY ................................................................... 60 

3.3 

RESEARCH PARADIGM........................................................................................ 63 

3.4 

PARTICIPANT SELECTION .................................................................................. 64 

3.5 

DESCRIPTION OF THE First RESEARCH INSTRUMENT ................................. 65 

3.5.1 

Submission of checklist to the Human Research Ethics Committee ................. 66 

3.5.2 

Pilot study .......................................................................................................... 66 

3.6 

DATA COLLECTION METHODS ......................................................................... 66 

3.6.1 

Interviews ........................................................................................................... 67  vii

3.6.2 

Interview guiding questions ............................................................................... 67 

3.6.3 

Documents and artefacts .................................................................................... 68 

3.6.4 

Data recording .................................................................................................... 69 

3.6.5 

Data analysis ...................................................................................................... 69 

3.6.6 

Formulation of categories .................................................................................. 72 

3.7 

TRUSTWORTHINESS ............................................................................................ 74 

3.8 

ETHICAL CONSIDERATIONS .............................................................................. 76 

3.9 

CHAPTER SUMMARY ........................................................................................... 77 

CHAPTER 4

CASE NARRATIVES ................................................................................. 78 

4.1 

CHAPTER PREVIEW .............................................................................................. 78 

4.2 

FRIK .......................................................................................................................... 78 

4.3 

GREG ........................................................................................................................ 80 

4.4 

PAUL ........................................................................................................................ 81 

4.5 

ELIZA ....................................................................................................................... 82 

4.6 

SAM .......................................................................................................................... 83 

4.7 

LINKING THE CASE NARRATIVES TO SPECIFIC LEARNING DISORDERS AS DEFINED IN THE DSM-5 ......................................................... 84 

4.7.1 

DSM-5 criteria for Frik ...................................................................................... 85 

4.7.2 

DSM-5 criteria for Greg..................................................................................... 85 

4.7.3 

DSM-5 criteria for Paul ..................................................................................... 86 

4.7.4 

DSM-5 criteria for Eliza .................................................................................... 86 

4.7.5 

DSM 5 criteria for Sam ...................................................................................... 86 

4.7.6 

Summary of DSM-5 diagnosis for case studies with CAPD ............................. 87 

4.8 

CHAPTER SUMMARY ........................................................................................... 88 

CHAPTER 5

ANALYSIS AND INTERPRETATION OF FINDINGS........................ 89 

5.1 

CHAPTER PREVIEW .............................................................................................. 89 

5.2 

RESEARCH AIM ..................................................................................................... 89 

5.3 

THEMES ................................................................................................................... 89 

5.4 

THE SELF ................................................................................................................. 90 

5.4.1 

Frik’s self-awareness of learning limitations ..................................................... 91 

5.4.2 

Greg’s self-awareness of learning limitations.................................................... 92 

5.4.3 

Paul’s self-awareness of learning limitations .................................................... 92 

5.4.4 

Eliza’s self-awareness of learning limitations ................................................... 93 

5.4.5 

Sam’s self-awareness of learning limitations .................................................... 94 

5.4.6 

Concluding remarks on self-awareness of learning limitations ......................... 94  viii

5.5 

MICRO- AND MESOSYSTEMIC SUPPORT: FAMILY, EDUCATORS AND FRIENDSHIPS ................................................................................................ 95 

5.5.1 

Frik: Micro- and mesosystemic support ............................................................ 97 

5.5.2 

Greg: Micro- and mesosystemic support ........................................................... 98 

5.5.3 

Paul: Micro- and mesosystemic support ............................................................ 98 

5.5.4 

Eliza: Micro- and mesosystemic support ........................................................... 99 

5.5.5 

Sam: Micro- and mesosystemic support .......................................................... 100 

5.5.6 

Conclusion about micro- and mesosystemic support....................................... 101 

5.6 

FOSTERING SUCCESS AT SCHOOL ................................................................. 102 

5.6.1 

Frik: Fostering success at school ..................................................................... 103 

5.6.2 

Greg: Fostering success at school .................................................................... 106 

5.6.3 

Eliza: Fostering success at school .................................................................... 107 

5.6.4 

Paul: Fostering success at school ..................................................................... 107 

5.6.5 

Sam: Fostering success at school ..................................................................... 108 

5.6.6 

Conclusion: Fostering success at school .......................................................... 109 

5.7 

COMMUNITY NETWORKING............................................................................ 109 

5.7.1 

Frik: Community networking .......................................................................... 110 

5.7.2 

Greg: Community networking ......................................................................... 111 

5.7.3 

Paul: Community networking .......................................................................... 111 

5.7.4 

Eliza: Community networking ......................................................................... 111 

5.7.5 

Sam: Community networking .......................................................................... 112 

5.7.6 

Conclusion: Community networking ............................................................... 112 

5.8 

EFFECTS OF MACRO- AND CHRONOSYSTEMIC CHANGES ...................... 113 

5.8.1 

Frik: Macrosystemic influences ....................................................................... 116 

5.8.2 

Eliza: Macrosystemic influences .................................................................... 116 

5.8.3 

Paul: Macrosystemic influences ..................................................................... 117 

5.8.4 

Sam: Macrosystemic influences ...................................................................... 117 

5.8.5 

Conclusions: Macrosystemic influences .......................................................... 118 

5.9 

EXPERIENCES OF PARTICIPANTS AND INTERACTIONS OF SUBSYSTEMS ................................................................................................. 122 

5.10 

CHAPTER SUMMARY ........................................................................................ 123 

CHAPTER 6 CONCLUSIONS AND RECOMMENDATIONS .................................. 125  6.1 

CHAPTER PREVIEW ............................................................................................ 125 

6.2 

SUMMARY OF THE STUDY ............................................................................... 125 

6.3 

THEORETICAL AND PRACTICAL IMPLICATIONS ....................................... 128  ix

6.4 

LIMITATIONS OF THE STUDY .......................................................................... 129 

6.5 

STRENGTHS OF THE STUDY............................................................................. 130 

6.6 

RECOMMENDATIONS FOR FURTHER STUDY .............................................. 131 

6.7 

CONCLUDING REMARKS .................................................................................. 131 

REFERENCES..................................................................................................................... 134  APPENDICES ...................................................................................................................... 155 Appendix A: Ethics clearance and permission forms ............................................................ 155  Appendix B: Consent letters .................................................................................................. 156  Appendix C: Screening instrument ........................................................................................ 160  Appendix D: Screening of participants .................................................................................. 162  Appendix E: Reading and spelling ESSI answer sheets, Grades 1 and 2 .............................. 167  Appendix F: NFER-Nelson reading comprehension test, Grades 1 and 2 ............................ 183  Appendix G: Field note examples about screening and rating scale ..................................... 199  Appendix H: Extracts from field notes by participants ......................................................... 201  Appendix I: Extracts from field notes by researcher ............................................................. 209  Appendix J: IEB application field notes ................................................................................ 210  LIST OF FIGURES Figure 2.1. Mind map to the literature review ......................................................................... 15 Figure 2.2 Systems theories: Bronfenbrenner’s ecological system ........................................ 16 Figure 2.3 Structure of the ear ................................................................................................ 22 Figure 2.4 Basic structure of the outer ear .............................................................................. 25 Figure 2.5 Basic structure of the inner ear .............................................................................. 26 Figure 2.6 Schematic representation of the neural auditory pathway ..................................... 28 Figure 3.1 Codes-to-theory model .......................................................................................... 71 Figure 3.2 Formulation of categories ...................................................................................... 73 Figure 3.3 Categories for analysis as in Bronfenbrenner’s model .......................................... 74 Figure 5.1 Bronfenbrenner’s bio-ecological model – the self in the microsystem ................. 90 Figure 5.2 Bronfenbrenner’s bio-ecological model – the mesosystem................................... 96 Figure 5.3 Photographs of pages written by Frik .................................................................. 104 Figure 5.4 The exosystem – community networking............................................................ 110 Figure 5.5 The macrosystem ................................................................................................. 114

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LIST OF TABLES Table 2.1 Path of sound through the auditory system ............................................................. 26 Table 2.2 DSM-5 criteria for SLD .......................................................................................... 33 Table 2.3 CAPD with co-occurrence of other impairments ................................................... 37 Table 2.4 Observable behaviours indicating CAPD ............................................................... 42 Table 2.5 Medical codes for CAPD ........................................................................................ 46 Table 2.6 Language development norms ................................................................................ 49 Table 3.1 Interview data for coding ................................................................................................... 72 Table 5.1 Test results corroborating learners’ and teachers’ perception of learners’ being weak at spelling and reading ....................................................................... 103

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ABBREVIATIONS AND ACRONYMS ACLD: Association of Children and Adults with Learning Disabilities (later the LDA) APA: American Psychiatric Association APD: Auditory processing disorder ASD: Autistic spectrum disorders ASHA: American Speech-Language-Hearing Association CANS: Central auditory nervous system CAPD: Central auditory processing disorder CAPS: Curriculum and Assessment Policy Statement CVC: Consonant-vowel-consonant DANIDA: Danish International Development Assistance DDT: Dichotic digits test DSM-5: Diagnostic and statistical manual of mental disorders, 5th edition EILBRD: Early identification of language-based reading disabilities FM: Frequency modulation HPCSA: Health Professions Council of South Africa ICD-10: International statistical classification of diseases and related health problems, 10th revision IEB: International Examination Board IPA: Interpretative phenomenological analysis LDA: Learning Disabilities Association of America LI: Language impairment xii

RD: Reading disorder SASLHA: South African Speech-Language-Hearing Association SCOPE: South African/Finnish Cooperation Programme in the Education Sector SIAS: Screening, identification, assessment, and support SLD: Specific learning disorder SLI: Specific language impairment SRD: Specific reading disorder

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CHAPTER 1 ORIENTATION TO THE RESEARCH

1.1 INTRODUCTION Central auditory processing disorder (CAPD), also referred to as auditory processing disorder (APD) (Jerger & Musiek, 2000), arises from deficiencies in the neural processing of auditory stimuli and may lead to various cognitive and communication difficulties. As an auditoryspecific perceptual disorder in children, it was first identified by the American researcher Helmer Myklebust in the 1950s (Musiek & Chermak, 2014). Since then, a fragmented approach has appeared to be evident to the researcher when assessing CAPD and the strategies required to assist learners diagnosed with it. The present study explored the experiences of such learners throughout their schooling careers in order to gain an overview of their perspectives on their learning difficulties and the impact that the disorder has had on their lives. A phenomenological research design was used as the most appropriate research method as recommended by Schostak (2002), since it focused on the lived experiences of several participants in order to gain a general sense of the experience of various individuals. Interpretative phenomenological analysis (IPA) was employed as the primary method of data analysis, since it firstly allowed for a detailed exploration of the way in which the participants made sense of their personal experiences, and secondly facilitated engagement with interview transcriptions in order to find themes and concepts within them (Smith & Osborn, 2015; Willig, 2008). This chapter is aimed at introducing the rationale for the research, the research questions and aims arising from the rationale, as well as the personal motivation that steered the research. The rationale was rooted in the perception that an information gap existed in the literature about the role and significance of treatment of CAPD in improving learners’ progress and academic achievement as viewed over the continuum of their schooling careers. The research questions were formulated from this awareness in order to direct the research, while the personal motivation for the research provided the contextual orientation within which the investigation was conducted.

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1.2 RATIONALE The reasons for learners’ struggling with learning tasks through their schooling careers are many and varied, but the researcher, in her capacity as speech, language, and remedial therapist, has observed that parents tend to hold the school system primarily responsible for failing their children. The school system, whether private or state controlled, is often accused of mismanagement or poor teaching, and even legislation such as the Basic Education Laws Amendment Act, No. 15 of 2011, for example, which was introduced to help children with special educational needs, does not seem to benefit these children. Among the various groups of children with specific needs is the group affected by CAPD (a deficit defined more extensively in section 1.5.1). The rationale for this study is to improve understanding of the school experience of learners with CAPD from their perspective, particularly since the current academic pressure on schoolchildren is much greater than it was a generation ago. Almost two decades ago Cogburn (1998) already observed that knowledge had become a factor of production in new information-intensive economies in the era of globalisation. The education and learning paradigm worldwide was under pressure to cope with the demands posed by this new knowledge and information-intensive global economy. New technological realities held particular challenges for African countries in having to decide what adjustment strategies suited their specific circumstances best in the allocation of scarce resources. (Beyers, 2009; Cogburn, 1998). Against this background, the demands for success at school, in higher education, and in the corporate setting for employment opportunities are considerable, and possession of a Grade 12 certificate – as one of the most important milestones of the young adult’s career path – is essential to opening doors to children’s futures (Campbell, Kibler, & Weisman, 2009). Learners with learning deficits are doubly at a disadvantage since they have to cope not only with their learning difficulties but also with intensified educational demands in a new globalised societal environment (Beyers, 2009). An important aspect of this study is to investigate whether parents, educators, schools, and policy-makers (in the Bronfenbrenner systemic perspective) can be empowered with information that will facilitate efforts aimed at assisting learners in coping better with their school experience and passing Grade 12. Other important justifications for the research are that investigations reflected in the literature do not always link the various manifestations of auditory processing disorders in young children or follow the progression of these disorders from nursery school into high school and adulthood. Furthermore, parents often mistakenly assume that once auditory processing 2

problems have been treated by a speech therapist, such difficulties will disappear. The degree to which an individual child’s auditory deficits will improve with therapy cannot, however, be determined in advance. Whereas some children with CAPD experience significant amelioration of their difficulties or seem to “grow out of” their disorders (a dubious assumption in any event), others may exhibit some residual degree of deficit forever (Bellis, 2002a). In recent years, as described by Hasson and Honey (2012), scientists have developed new ways to study the human brain through imaging, which is a powerful tool that allows the monitoring of brain activity without any physically invasive techniques such as surgery. Imaging studies have already provided researchers with new insights into normal auditory processing, which also encouraged further investigations into the disorders associated with auditory processing (Rosen 2005). A major advantage of imaging is that it provides an objective, measurable view of a process, which offers a sound basis for standardisation of research terms and methodology, considering that many of the symptoms described as related to CAPD are described differently by different investigators and thus lead to confusion in the research field (Jerger & Musiek, 2000; Maggu & Yathiraj, 2014; Musiek & Chermak, 2013). In the extended field of remedying child language disorders, much specialised research is still needed to improve understanding of auditory processing problems, related disorders, and the most appropriate interventions for each child or adult. Especially in the case of children, who are going through critical developmental and formative phases, remedial strategies have to be suited to the needs of the individual child and must be continually evaluated for effectiveness. The standard for determining such effectiveness is that a patient can reasonably expect to benefit from the intervention (Bellis & Bellis, 2015; Jerger & Musiek, 2000). This study is also aimed at discovering whether the benefits that learners derived from intervention can be demonstrated and that the information obtained can be applied in a school setting. The relative recency of professionally focused attention on CAPD is reflected in the Consensus Conference on the Diagnosis of Auditory Processing Disorders in School-Aged Children held in Dallas, USA, in 2000, which was attended by 14 senior scientists and clinicians in the field (Jerger & Musiek, 2000; Musiek & Chermak, 2013). These researchers and professionals noted the high importance of establishing solid efficacy in the treatment of CAPD at various ages, specifically the relationship between test outcomes and management strategies, outcomes of early intervention, and the relative efficacy of intervention 3

approaches. Gaining further insight into this relationship between professionals’ assessments and intervention or treatment programmes, the eventual outcomes of such interventions, and learners’ perceptions of such endeavours, constituted another fundamental motivation for this study. The five participants in this study were specifically selected. They were learners who at an early age displayed reading disabilities due to language-related learning problems associated with auditory processing. The study sought to illustrate how auditory processing difficulties influenced their learning requirements through consideration of their schooling careers from reception year to Grade 12 in order to extract essential information, thus providing a holistic, guiding overview for professionals in assessing positive and negative strategies that influence learners’ careers. By specifically investigating the “reality” (Hansen, 2006, p. 48) experienced by participants with central auditory processing disorders, this study was aimed at indicating ways for ameliorating the frustration experienced in the school setting by the learners themselves, their educators, and their parents. With appropriate intervention, all children with CAPD can learn to become active participants in their own listening, learning, and communication success, rather than remain hapless (and helpless) victims of an insidious impairment. Thus, when the journey is navigated carefully, accurately, and appropriately, there can be light at the end of the tunnel for the millions of children afflicted with CAPD (Bellis, 2005). Corriveau, Goswami, and Thomson (2006) showed that children who exhibited CAPD at the age of six years fell far behind their peer group in language development over time. These children were also at risk for becoming classified in groups diagnosed with specific learning difficulties such as ADD, ADHD, and dyslexia not applicable to them at the time. However, individuals identified with CAPD in their preschool years are often diagnosed with learning disabilities or language-based reading difficulties later on in their schooling careers (Aram, Ekelman, & Nation, 1984). Longitudinal studies show that CAPD generally does not disappear or dissipate over time, but that many children diagnosed with it make up the majority of learners identified as having learning disabilities or displaying reading difficulties (Catts, 1997; Scarborough, 1998). Since CAPD seems to persist into later life and causes linguistic and learning challenges, it can affect all areas of a person’s life from childhood to adulthood. Alleviating these difficulties and finding strategies to manage them can allow

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children and teenagers to flourish, reach their full potential, and develop into independent, well-adjusted, and capable adults. 1.3 RESEARCH QUESTION AND AIMS The above rationale formed the basis for the formulation of the research question: "What were the experiences of five learners with CAPD in an inclusive education system during their schooling careers from their reception year through to Grade 12?" The primary aim of this study was to explore and describe the experiences and perceptions of five learners with CAPD during their schooling years with a view to achieving a better understanding of supporting such leaners within inclusive classrooms. Derived from the descriptions of the primary aim, the secondary aim was to identify strategies that would help these learners effectively and support them in the classroom throughout their schooling careers. 1.4 PERSONAL MOTIVATION This study was also actuated by the researcher’s personal observations in her capacity as a speech and hearing therapist in mainstream high schools in which children with learning difficulties struggled to matriculate with an International Examination Board (IEB) certificate. The high levels of anxiety and stress that educators, parents, and learners experienced had a negative effect on school success, but the researcher often noted that even small constructive variations in attitude or actions of the school management could make a significant positive difference in results and outcomes. Such observations impelled the researcher to investigate and highlight some assistive strategies for educators, parents, and learners in cases in which auditory processing difficulties were at issue. Auditory processing has a direct effect not only on sensory integration attributes such as speech and language, attention and concentration, learning and memory, but also on social skills (Lund & Duchan, 1988). As a therapist, the researcher noticed that although children with auditory processing difficulties received therapy and treatment in their younger nursery and junior school phases, assistive techniques such as speech therapy or occupational therapy were frequently not carried over into remedial therapy when these learners entered Grade 4. They were often left to cope on their own until their school marks reflected that they were struggling, and it was only at this belated stage that extra lessons and other assistive methods were advised. By then, however, feelings of frustration and negative emotions about school 5

and academic work had already taken firm root among the learners. Since the break in continued monitoring and assistance appeared to be the cause of stress and anxiety especially in high school, this study was aimed at gaining insight that might serve professionals and caregivers in assisting children and adolescents with these learning difficulties. 1.5 CONTEXTUAL ORIENTATION: CENTRAL AUDITORY PROCESSING DISORDER As a term, “central auditory processing disorder” (Banai & Kraus, 2014) can simply be defined as “a disorder that is marked by a deficit in the way the brain receives, differentiates, analyzes, and interprets auditory information and that is not attributable to impairments in peripheral hearing or intellect” (p. 193). Individuals with CAPD usually have normal structures and functions of the ear and peripheral hearing, but they are unable to process the information they hear adequately because of a dysfunction in the central nervous system. This incapacity leads to difficulties in recognising and interpreting heard speech sounds (Torgesen, 2000). Auditory processing refers to the conversion process that sound information undergoes in the ear (Nicolosi, Harryman, & Kresheck, 2006). Sound waves travel through the air and are collected by the outer ear, also anatomically termed the auricle, auricula or pinna (see Figure 2.3). These sound waves then travel down the ear canal, causing the eardrum to vibrate, which in turn causes the bones of the middle ear to vibrate. As Nicolosi et al. (2006) describe further, this vibration causes the fluid in the cochlea to move. Inside the cochlear system nerve cells convert the information into electrochemical signals. These signals pass along various nerve systems from the ear into the auditory cortex of the brain where the sound is consciously “heard” or interpreted. This engages the cortex and all other areas and functions of the brain that are responsible for processing the sound information, a process that explains the way in which the act of listening occurs (Nicolosi et al., 2006). The auditory pathway is described in greater detail in Chapter 2. Various brain systems and subsystems are involved in the processing of auditory information. They include systems involved with attention, memory, and executive cognitive functions (Nicolosi et al., 2006). Auditory processing cannot therefore be regarded as consisting only in the ability to hear. Many people with auditory processing difficulties have perfect hearing, as tested by audiologists, but will show deficits in the processing of the heard message. Some children at risk of CAPD will display early signs of comprehension problems and expressive 6

language delays, and can often be suspected of having a hearing loss in their early developmental stage if it appears that they are not hearing well, while other children may have difficulty with reading (Catts, 1989; Torgesen, 2000). Moreover, children with CAPD will frequently exhibit trouble in following directions, expressing themselves, or coping in social situations because of difficulty in grasping meanings or understanding conversations (Bellis & Beck, 2000). It should not be assumed, however, that auditory processing difficulties are strictly limited to the sense of hearing. Children can experience CAPD in other ways as well. These signs and symptoms indicate how auditory processing difficulties involve various areas of the brain, and therefore also areas of cognitive functioning (Katz, 2000). Auditory processing difficulties can also extend to reading and writing, serving as contributory factors to dyslexia in some children (Shipley & McAfee, 2009). As Kamhi (2011) observed, in the area of listening (which is another auditory skill), the inability to filter out extraneous, unimportant information is also a significant indicator of CAPD in some children. In a classroom situation, such children are unable to focus on what an educator is saying, as their attention is constantly being drawn away from the educator’s voice to inconsequential sounds such as chairs scraping on a floor, coughing, or a classmate rummaging through a bag. These children’s auditory processing systems are equally aroused by unimportant information as it is by vital information, and they consequently appear to be slow in grasping what has been said to them (Kamhi, 2011) This inattentiveness may be diagnosed as ADD by some professionals since the symptoms and behaviour are very similar. Children with CAPD experience a delay in auditory processing: the message they hear is taking longer to get to its destination in the brain for processing than it does for their classmates. Often these children will say “What?” when someone has asked them something, but then provide an answer just as the question is about to be repeated, which demonstrates that the message took just a little longer than normal to be processed (Lund & Duchan, 1988). These findings motivated the researcher to study the education and support of learners with CAPD from their perspective. During the researcher’s work as a speech and language therapist, all the Grade 0 learners in a primary school were screened for CAPD in 1999. Five learners displayed signs of severe CAPD on standardised screening tests (Early Identification of Language-Based Reading Disabilities checklist by Catts, 1997; ESSI reading and spelling test by Esterhuyse and Beukes, 1997; Nelson test of reading comprehension, 1999). These 7

learners were provided with supportive interventions at the school. For the initial study, which was begun in 1999, the researcher received ethical clearance from the University of the Witwatersrand’s Human and Ethics Committee, the children’s parents, and the school governing board. The initial study had to be suspended because of data-processing difficulties relating to bilingualism policies at schools at the time, as well as a change in the researcher’s place of employment. However, she retained the data she had collected and realised a few years later that the five learners concerned would be taking their Grade 12 examinations in 2014. A new study, as embodied in the present one, would provide them an opportunity to reflect on their schooling careers and the effect of CAPD on their learning and general academic progress. The researcher consequently investigated the experiences of these learners regarding their schooling careers and the challenges they faced in completing their schooling, as formulated in the research question in section 1.2. 1.6 CONCEPT CLARIFICATION Concept clarification is necessary to demarcate and delineate what is discussed in the research, especially in view of the diverging opinions and approaches about terminology. 1.6.1

Recommended professional approaches and terminology

At the Consensus Conference on the Diagnosis of Auditory Processing Disorders in SchoolAged Children (Jerger & Musiek, 2000) mentioned above, Khan (2006) and other scientists and clinicians, led by Jerger and Musiek (2000), met at the University of Texas in Dallas from 27 to 29 April 2000 to achieve professional consensus on the definition of auditory processing disorders. At the time, children presenting with these disorders were referred to as presenting with a central auditory processing disorder (CAPD). Because the word “central” carried the implication of anatomical loci and did not denote the interaction between disorders at both central and peripheral sites, the conference decided to retain CAPD as an operational (currently functional) definition so as not to cause terminological confusion (Jerger & Musiek, 2000). It may be noted here that “a peripheral process is one which occurs outside the brain, whereas a central process is one which occurs within the brain” (Tatham & Morton, 2011, p. 131). However, the conference deemed it more appropriate to refer to the disorder as an auditory processing disorder (APD), which they broadly defined as a “deficit in the processing of information that is specific to the auditory modality,” which “may be associated with difficulties in listening, speech understanding, language development, and learning” (Jerger & Musiek, 2000, p. 468). 8

In addition to redefining the disorder, the conference formulated guidelines in the areas of screening and differential diagnosis of APD, and offered recommendations regarding a minimum test battery. However, not all clinicians practising in the area of APD agreed with the consensus report issued by Jerger and Musiek (2000). A group of 13 audiologists, led by Katz (2002), challenged the merits of the recommendations outlined in the report. They were of the opinion that APD required an educational rather than a medical (diagnostic) model, which implied that the most valuable role of the speech-language therapist and audiologist was to guide the management of the child with APD, instead of merely diagnosing APD (Katz, 2002). Regarding management of the disorder, Katz (2002) noted that the 1996 guidelines of the American Speech-Language-Hearing Association (ASHA, 1996) on auditory processing offered a comprehensive and a more appropriate goal to develop an APD intervention programme. ASHA consequently convened a working group to review its 1996 guidelines, and its executive board approved the technical report developed by the working group in March 2005 (ASHA, 2005). The working group considered the use of the term “auditory processing disorder”, but agreed to use the term “central auditory processing disorder” for the purpose of the report. The working group acknowledged that there had been a fair amount of confusion and controversy regarding the use of the term “auditory processing disorder” without the qualifying word “central”, particularly as most current definitions of the disorder focused on the central auditory nervous system (CANS). The group consequently resolved that the terms CAPD and APD were to be considered synonymous (ASHA, 2005). Locally, the Health Professions Council of South Africa’s (HPCSA; 2003) competency profiles that outline standards and guidelines in terms of practice for both speech-language therapists and audiologists in the area of APD, favoured the term CAPD (HPCSA, 2003). In light of the preceding debates in which both the terms APD and CAPD were sanctioned, the researcher resolved to use the latter term. For the purposes of this study, the most important definitions below were garnered from the above authorities in the field whose definitions enjoy general acceptance. 1.6.2 Auditory processes Auditory processes are specific skills such as discrimination, localisation, auditory attention, auditory figure-ground, auditory closure, auditory discrimination, auditory blending, auditory 9

analysis, auditory association, and auditory memory-sequential memory (Nicolosi et al., 2006). These skills fulfil a crucial function in the perception of speech (Moore, 2008). 1.6.3

Auditory processing disorder

APD is the impaired ability to attend, discriminate, recognise, or comprehend auditory information even though hearing and intelligence are within normal limits. APD is more pronounced with distorted or competing speech in noisy or poor acoustic environments. Auditory processing abilities develop parallel with language, and children with auditory processing disorders are a subset of those with receptive and/or expressive language disorders (Nicolosi et al., 2006). As mentioned above, the terms APD and CAPD have been sanctioned as interchangeable in the field of auditory processing research, and use of the latter term will predominate in this study. 1.6.4 Learner and learning In the South African Schools Act (Republic of South Africa, 1996b), a learner is simply defined as “any person receiving education or obliged to receive education in terms of this Act” (p. 4). A learner may therefore be any age, but for the purposes of this study a learner is a person who is learning, whether considered a student or pupil, and who is being educated in the school system with the appropriate age limitations applying to it. The Act furthermore defines a uniform system for governing schools and provides structured laws for governance and funding of schools. The Act acknowledges that a new national system for schools is needed to remedy past social and educational injustices, thus supporting the rights of learners, educators, and parents, while also setting out the duties and responsibilities of the state. Learning in turn can be defined as “the process of acquiring new and relatively enduring information, behavior patterns, or abilities, characterized by modification of behavior as a result of practice, study, or experience” (VandenBos, 2013, p. 327). This definition is particularly apt for this study, since it sums up the experience of the participants in having continually to acquire new information and skills, and adjust their behaviour accordingly. They are required to use these skills, behaviour, and knowledge in test or examination situations and are assessed according to their ability to succeed in the testing situation and move on to a higher level of learning.

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1.6.5 Experience Experience, as defined in the APA Dictionary of Clinical Psychology (VandenBos, 2013), may firstly be “a conscious event: an event that is lived through, or undergone, as opposed to one that is imagined or thought about,” or, secondly, “the present contents of consciousness” (p. 221). In other words, experience can be regarded as practical contact with and observation of facts or events that leave a personal impression on individuals, in this case the impression of events or occurrences on learners during their schooling careers. 1.6.6

Perception

Perception involves not only the ability to see, hear, or become aware of something through the senses, but also the way in which something is regarded, understood, or interpreted. Different people may derive meaning or obtain an impression from the same situation in a different way (Corriveau et al., 2006). More importantly, it is through perceptional activities such as “recognizing, observing, and discriminating” that people are enabled “to organize and interpret the stimuli received into meaningful knowledge” (VandenBos, 2013, p. 423). Particularly in the field of hearing, Tatham and Morton (2011) point out, perception needs to be distinguished from the physical experience of hearing. The latter is not influenced by thinking about the sound heard, whereas perception is a largely an active process in that it is dominated by cognitive processing (in which subconscious processes may also be involved). In brief, “perception is the cognitive process of assigning labels to the incoming signal. This is the case whether the signal is auditory or visual, or derived using any other modality for sensing events in the world outside the human organism” (Tatham & Morton, 2011, p. 126). 1.6.7 Assessment For the purposes of this investigation, “assessment” involves the use of formal and informal procedures to collect data and gather evidence from the five learners and important people in their environment. The term includes evaluation, i.e. the interpretation of assessment data, evidence, and related information (ASHA, 2005). 1.6.8

Remediation or treatment

“Remediation” or “treatment” refers to procedures aimed at the elimination or management of impairment (ASHA, 2005).

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1.6.9

Management

“Management” refers to intervention for the purpose of remediating a disorder or disease, as well as compensatory approaches, e.g. strategies and technologies, aimed at reducing the effect of deficits resistant to remediation (Musiek, Chermak, Weihing, Zappulla, & Nagle, 2011). 1.6.10 Paradigms Paradigms in terms of how people think can be defined as accepted general truths or principles characterised by their differing set of assumptions about the phenomena into which they are designed to inquire (Guba & Lincoln, 1982). 1.7 PROGRESSION OF THE INVESTIGATION This study has been arranged as follows: Chapter 1 serves to present the background, aims and objectives, and rationale for this study. Chapter 2 provides a theoretical framework for the study, which entails an in-depth discussion of the literature consulted and reviewed. Its purpose is to form a sound theoretical foundation to inform and ground the investigation. Chapter 3 deals with the research design and methodology of the study, which is a phenomenological, multiple case study. The methods of data collection and analysis are elucidated. The chapter concludes with an assessment of the ethical measures taken within the study and a review of the validity and trustworthiness of this qualitative inquiry. Chapter 4 is an in-depth description of the case studies and subsequent findings. This is expounded in a qualitative narrative, presenting the views of the participants, and exploring their perceptions of the inclusive-classroom practices. Chapter 5 discusses the analysis of the findings based on IPA. It also explores various strategies to support children with CAPD. Chapter 6 concludes the study and provides recommendations for schools, parents, and future research within the same field.

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1.8 CHAPTER SUMMARY This chapter served to clarify and orientate the study, briefly contextualising the research into CAPD. The rationale, research question, and aims for the study were explored, as well as the personal motivation that impelled the investigation. A concept clarification of CAPD was provided in terms of its relation to APD, and other related concepts were briefly outlined. A synopsis of the study progression was also provided. The following Chapter is devoted to a literature review aimed at contextualising the topics covered by this study.

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CHAPTER 2 LITERATURE REVIEW

2.1 CHAPTER PREVIEW The researcher Slavin (1996) made use of the following parable to illustrate an essential point: Once upon a time, there was a town whose playground was at the edge of a cliff. Every so often, a child would fall off the cliff. Finally, the town council decided that something should be done about the serious injuries to children. After much discussion, however, the council was deadlocked. Some council members wanted to put a fence at the top of the cliff, but others wanted to put an ambulance at the bottom. (p. 4)

Slavin (1996) notes that the foolishness of stationing an ambulance at the bottom of the cliff verges on the cruel and inhumane since the children would be exposed to danger that could easily and cheaply be prevented. Yet, Slavin continues, such an approach is paralleled by longstanding policies in special education, especially for children with learning disabilities. Whereas schools may generally provide sound assistive programmes in early years of schooling and even beyond, they already know beforehand that a number of these children will fail to stay the course. Among these will be a group with normal intelligence but who will fail to learn to read because of CAPD, and they will not be provided with early assistance appropriate to the disorder. Thus, in context of the metaphor of the ambulance at the bottom of the cliff, by the time that services are rendered, most of these children will themselves be aware of having failed at the crucial task of learning to read and will be significantly impeded in positive motivation for their schooling careers (Slavin & Corwin, 2009). This study is aimed at providing information and formulating strategies that will function as the fence in the story. Against the above background of inadequate and belated approaches to aid learners with CAPD, this chapter will first focus on a theoretical overview of Bronfenbrenner’s (2009) theory of development. An understanding of this theory will facilitate clarification of the relevant issues in current literature regarding CAPD and auditory processing, including its definition, incidence in levels of schooling, causes and aetiology, remediation, intervention, and prognosis. How CAPD is sometimes described by some professionals in the educational and medical field is also discussed. Inclusion and its premise in the current education system are explored. The ideal framework for support and collaborative efforts to accommodate the 14

children are expanded upon. The following diagram (Figure 2.1) illustrates the conceptual approach taken to the literature review in this chapter.

Figure 2.1 Mind map to the literature review

2.2 BRONFENBRENNER’S THEORY OF HUMAN DEVELOPMENT 2.2.1

Aims of the ecological systems theory

The bio-ecological perspective had particular value in shifting the traditional research focus away from the individual’s intrinsic problems only, towards a broader assessment of the systems that affect that individual (Hay, 2003), which in the case of this study included the barriers to learning that learners experience. Bronfenbrenner (1994) argued that in order to understand human growth and development properly, it was necessary to understand the ecological system (holistic environment) in which such maturation occurs. He identified four social subsystems arranged hierarchically from the microsystem of a person’s immediate environment up to the macrosystem of institutional patterns of culture (later adding the fifth chronosystem (Gray, Midgley, & Webb, 2012). The paradigm that Bronfenbrenner employed is characterised as ecological, since it involves the course of human development throughout life, in actual living environments, and taking into account the processes and conditions 15

acting not only on but also between these environments (Bronfenbrenner, 1994). The research approach taken was also referred to as a bio-ecological theory, generally because of the effects that organisms in a community have on one another by not existing in isolation and being subject to interaction between themselves and the environment, and specifically because of its emphasis on the reciprocal biopsychological interaction between developing human beings and all aspects of their environments (Bronfenbrenner, 1994). Thus, Bronfenbrenner’s ecological perspective was brought to bear on human development, particularly for this study on child and family, as well as education practice. Consequently, his paradigm correlated exceptionally well with observations on the development of children in an education system, especially because of the links between the individual learner in the microsystem, the education system in the mesosystem, the policy-makers in the exosystem, as well as specific cultural dimensions in the macrosystem (Bronfenbrenner 1994, 2009). The chronosystem may be regarded as the “historical” system of changes over long periods (Gray et al., 2012). Bronfenbrenner’s (2009) chief aim with developing the ecological systems theory (see Figure 2.2) was to explain how everything within individual children and their environment affected their growth and development in either a large-scale or small-scale manner as all elements are shown to be interlinked in his theory.

Figure 2.2 Systems theories: Bronfenbrenner’s ecological system (Yingst, 2012)

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In relation to the innate factors (such as psychological factors or genetic makeup) in children in their interaction with various environments during their development, Bronfenbrenner identified different aspects and consequently different levels of the environment influencing development. These include the microsystem, mesosystem, exosystem, macrosystem, and chronosystem. 2.2.2

Microsystem

Formally, the term “microsystem” is defined as follows: A microsystem is a pattern of activities, social roles, and interpersonal relations experienced by the developing person in a given face-to-face setting with particular physical, social, and symbolic features that invite, permit, or inhibit engagement in sustained, progressively more complex interaction with, and activity in, the immediate environment. Examples include such settings as family, school, peer group, and workplace (Bronfenbrenner, 1994, p. 36).

This means that the microsystem is the small, immediate environment in which children live, and which will usually include their immediate family or caregivers and their school or day care (Bronfenbrenner, 2009). How these people, organisations and small environments interact with the child will have an effect on how the child grows. The researcher believes that the more encouraging and nurturing these relationships and places are, the better the child will be able to grow. Furthermore, how a child acts or reacts to these people in the microsystem will affect how the child is treated in turn and how the child reacts to others in the system. Each child’s specific genetic and biologically influenced personality traits, otherwise known as temperament (or innate factors as refered to above), will have an effect on the child’s view of the self, the child’s view of others, and also on the view that others will develop about the child, according to Bronfenbrenner (2009). In relation to this study, the microsystem is of particular importance since the innate perception that learners with CAPD have of themselves may affect the way in which they cope with successfully acquiring knowledge, completing academic tasks, controlling their behaviour, and forming relationships. The mesosystem builds from the microsystem. 2.2.3

Mesosystem

This system is defined as comprising 17

the linkages and processes taking place between two or more settings containing the developing person (e.g., the relations between home and school, school and workplace, etc.). In other words, a mesosystem is a system of microsystems (Bronfenbrenner, 1994, p. 40).

The mesosystem involves different aspects of a child’s microsystem working together for the sake of the child; for example, if a child’s caregivers take an active role in the child’s schooling, it will help the child’s overall growth (Bronfenbrenner, 2009). The difference between the micro- and mesosystems is that the microsystem engages with the child, whereas the mesosystem serves as the linking process between two systems. Research has shown that two-way communication between parents and educators and their participation in decisionmaking had a positive developmental impact on children (Bronfenbrenner, 1994). This is another aspect of particular relevance to the present study in the exploration of the ways that learners with CAPD and their families and educators, for example, modify and construct their academic environment to cope with school demands. 2.2.4 Exosystem The exosystem in turn comprises the linkages and processes taking place between two or more settings, at least one of which does not contain the developing person, but in which events occur that indirectly influence processes within the immediate setting in which the developing person lives (e.g., for a child, the relation between the home and the parent's workplace; for a parent, the relation between the school and the neighborhood peer group) (Bronfenbrenner, 1994, p. 40).

More simply expressed, the exosystem level includes other outside people and places that children themselves may not encounter, but that still affect them (Bronfenbrenner, 2009). For example, as regards the parents’ workplace, if the parents are retrenched, the financial consequences may affect the child negatively. A promotion for the parents, on the other hand, may affect the child negatively or positively. Such effects should be viewed, as in this research, in terms of children’s perceptions of events or experiences. A move to a new environment may be viewed as positive by a family, but as negative by a child who may be losing an established circle of friends (as happened with one of the participants in this study). 2.2.5

Macrosystem

The macrosystem 18

consists of the overarching pattern of micro-, meso-, and exosystems characteristic of a given culture or subculture, with particular reference to the belief systems, bodies of knowledge, material resources, customs, life-styles, opportunity structures, hazards, and life course options that are embedded in each of these broader systems. The macrosystem may be thought of as a societal blueprint for a particular culture or subculture (Bronfenbrenner, 1994, p. 40).

Because this system involves comprehensive overarching components, it is also the most remote set of circumstances and people in relation to children, but has a great influence over their lives. The macrosystem includes things such as freedoms allowed by the government, cultural values, the economy, wars, and political stability (Bronfenbrenner, 2009). The crucial importance of the macrosystem is that what takes place in it ultimately affects “the particular conditions and processes occurring in the microsystem” (Bronfenbrenner, 1994, p. 40). In recent years, especially the changes in the political macrosystem have led to vast changes in the education-related exo- and mesosystems, which in turn impacted significantly on the microsystems experienced by all learners in South Africa. This also relates to the effects of the chronosystem as affecting learners in South African society in the most recent generation. 2.2.6 Chronosystem The chronosystem was a later component that Bronfenbrenner added to his ecological systems model to take account of changes occurring in the external environment of all systems over time (Gray et al., 2012). This includes events that transpire in a person’s life. The aspect of time in human development studies was traditionally treated in terms of chronological age, but since the 1970s time has also come to be treated as an aspect of the surrounding environment. In other words, time has come to be considered not only as lifecourse time in an environment, but also as changes occurring over historical time (Bronfenbrenner, 1994). Thus, a chronosystem encompasses change or consistency over time not only in the characteristics of the person but also of the environment in which that person lives (e.g., changes over the life course in family structure, socioeconomic status, employment, place of residence, or the degree of hecticness and ability in everyday life) (Bronfenbrenner, 1994, p. 40).

This could be viewed as the individual’s experiences in a particular socio-historic setting (see Figure 2.2). It may be said that politically, economically, and socially the macrosystem and 19

the chronosystem in South Africa have in tandem undergone far-reaching changes that have affected the educational landscape in particular with specific reference to special education needs. 2.3 THE ECOLOGICAL SYSTEMS THEORY IN RELATION TO INVESTIGATING CAPD Bronfenbrenner’s (2009) ecological systems theory holds great value for an inquiry into the experiences of learners with CAPD. It facilitates consideration of various aspects of children’s growth and development in terms of not only interactions among various systems, but also changes over the course of time. It can help to identify obstacles and indicate ways of overcoming such obstacles. For example, if a learner fails to master counting in sequence from zero to ten, then more anxiety problems may develop and carry over into ordinary lifeskills such as buying tuck because of anxiety to calculate the required amount of money. A teenager who cannot get a date may later encounter other, more complex social issues. According to the ecological theory, if a breakdown of relationships occurs within their microsystem, children will not develop the skills to explore other parts of their living and learning environment. Developmental insufficiencies may also be exacerbated by negative personal and social attributes, since learners with CAPD may, especially in adolescence, exhibit antisocial behaviour, lack of self-discipline, and the inability to provide self-direction (Lounsbury, 2000). In view of the deleterious effects that personal microsystemic insufficiencies may have, it follows that ecological systems theory has important implications for the practice of teaching and learning in general and the South African situation in particular. The history of the concept of inclusiveness, as outlined by Donohue and Bornman (2014), serves as an excellent example of positive effects that initiatives in the chrono- and macrosystems had on all the other systems. Familiarity with the child’s chronosystem or knowing about incidents that may have affected the child helps one deal with the environment of the overarching macrosystem. A thread can be followed from the international community’s Education for All initiative in 1990, the publication of the Salamanca Statement in 1994, the South African Constitution of 1996, UNESCO’s educational Millennium Development Goals in 2000 (signed by South Africa), and the implementation of Education White Paper 6 in 2001 (Donohue & Bornman, 2014), as well as all subsequent educational initiatives in South Africa that worked through to the microsystems of all learners in the country (see section 2.6). 20

Thus, seen from a chronosystemic perspective, these initiatives were aimed at countering the negative effects of shortcomings in social and economic circumstances by focusing on poverty alleviation, training teachers about inclusive education, and providing after-school care and meals for learners with working parents. Such efforts affect the meso-, exo-, and macrosystems, which in turn exert a critical impact on microsystems. Learners with CAPD are one of several at-risk groups for whom schools and educators need to provide stable, long-term management strategies. However, as will be illustrated by the literature assessment in the remainder of this chapter, such initiatives should first be rooted in learners’ microsystemic environments and can only be fostered by persons within learners’ immediate sphere of life experience, namely parents (Winebrenner, 1996). In addition to providing for their children’s physical and psychological needs, parents should set aside time and a quiet space for them to study and complete their homework. Schools and educators fulfil an important secondary role in equipping learners with various kinds of information and problem-solving skills, but they cannot provide in the full complexity of interactions that can only be undertaken by primary-sphere adults. Nevertheless, educators should work towards supporting the primary relationship in creating an assistive environment for children with auditory processing difficulties. From the researcher’s experience, to ensure the success of all learners, it is imperative that the school– home connection should be strong and that all individual stakeholders should understand their role in learners’ educational success. Parents or guardians need to work cooperatively with the school staff. Before the literature on the nature, origin and effects of such difficulties can be considered, it is necessary to pay attention to the mechanisms of auditory processing. 2.4 AUDITORY PROCESSING As noted in section 1.5.2, hearing speech cannot summarily be equated with understanding speech. Dalebout (2009) observes that only the brain can make sense of sound: although the ears pick up and convert vibrations in the air into mechanical energy, hydraulic energy, and neural energy, it is the brain that integrates information into a meaningful whole. The most important function of auditory processing is to enable in particular the understanding of words. It is the ability to obtain meaning from what one hears. Other additional functions relating to such processing include short-term memory, working memory, executive functioning, conceptual thought, and language development as defined below (Kamhi, 2011). 21

2.4.1

Definition and description of typical auditory processing

Anatomically, hearing is primarily dependent on the peripheral hearing mechanism, which includes the outer ear where sound waves are collected, the middle ear where sound is converted to mechanical energy, and the inner ear containing the cochlea where sound is converted to neural energy (Dalebout, 2009). (Some aspects will be discussed in more detail below.) Traditional hearing tests such as pure tone tests, as well as many others such as bone conduction tests which are plotted on audiograms and tympanograms that measure the pressure in the middle ear, can assess the integrity of this system. If this system is intact and functioning well, then hearing should function within the normal average decibel range (Katz, 2000).

Figure 2.3 Structure of the ear

From the inner ear, the signal received travels along the auditory nerve through the brainstem and reaches the brain. Auditory processing, simply defined, is what happens along this neural pathway and what the brain does with the auditory signal from the ears. It has a number of different aspects that are listed and enumerated differently by different authors (Nicolosi et al., 2006). ASHA, the American Speech-Language-Hearing Association, has defined specific components of auditory processing that have been found to be relevant to children with CAPD (Kamhi, 2011): 

Auditory attention is the ability to focus on auditory input. 22



Auditory discrimination is the ability to distinguish between different sounds or words.



Auditory sequential processing is related to auditory memory and is often tested using the number of digits one can remember, i.e. how many pieces of information one can receive, store, recall, and use.



Auditory memory is the ability to store and recall auditory information.



Auditory tonal processing is the correct processing of sounds or tones related to auditory discrimination.

All of the above abilities have a significant effect on language function. Other aspects as defined by ASHA (Kamhi, 2011; Nicolosi et al., 2006) are as follows: 

Auditory sensitivity refers to the perception of sound loudness; hyposensitive individuals have a reduced response to sound in their environment, even when their hearing is considered to be normal. Hypersensitive individuals, on the other hand, over-respond to “normal” sounds, often perceiving typical environmental sounds as bothersome or too loud).



Auditory figure-ground discrimination refers to the ability to pick out important sounds from a noisy background.



Language processing refers to the way humans use words to communicate ideas and feelings, and how such messages are processed and understood. This is the way in which the brain creates and understands language.



Temporal processing relates to the “time” aspect of the auditory signal, namely the rate of processing (Kamhi, 2011; Nicolosi et al., 2006).

2.4.2

The role of the brain in auditory processing

The adult brain weighs around 1 kg (Bamiou, Luxon, & Musiek, 2001). It can be divided into three main parts called the cerebrum, cerebellum, and brainstem. The cerebrum consists of two hemispheres whose outer layer, the cortex, plays an important function in consciousness (Bellis, 2003). Although the cerebral hemispheres are symmetric, each has certain dominant specialised functions. A simplistic explanation in respect of communication abilities is that language is usually dominated by the left hemisphere function and the right hemisphere is more associated with facial expression, emotion, and facial recognition, as well as allocation of attention (Bamiou et al., 2001). Moreover, the left hemisphere, especially the temporal lobe, appears to be more oriented toward auditory processing abilities and skills than the right 23

hemisphere (Bellis, 2003). This type of explanation is simplistic in the sense that it fails to take account of much cross-lateral processing that takes place. Each cerebral hemisphere consists of four primary lobes, namely the frontal, parietal, temporal, and occipital lobes. The temporal lobe is considered to be the main area of the brain for auditory processing, but auditory responsive regions are found throughout the brain and subcortical structures (Bellis, 2002b). The brainstem, situated in the posterior of the brain and connecting with the spinal cord, contains the midbrain, which consists largely of the reticular formation. A principal function of the reticular formation is to contribute to auditory-evoked potentials (Bellis, 2003). Each cerebral hemisphere also contains an external and an internal capsule of white matter composed of the axons communicating to and from the cerebral cortex (Bellis, 2003). Although the external capsule also carries auditory information, it is the internal capsule that primarily serves as the pathway through which the auditory information is inputted to the auditory cortex (Bellis, 2003). Since the brainstem is able to respond to electrical stimuli and can provide an objective biological index of auditory speech processing, future research should yield further information about auditory function in both typical and atypical populations. Recording brainstem response to sound is a reliable way to assess the integrity of the neural transmission of acoustic stimuli. Transient acoustic events induce a pattern of voltage fluctuations in the brainstem, resulting in a familiar waveform, yielding information about brainstem nuclei along the central auditory pathway leading up to the brain (Kraus & Nicol, 2005). The auditory nerve and brainstem structures are often explained as a relay station that passes information along from ear to brain, but this is regarded as an oversimplified typification of inadequately understood neural mechanisms that underlie the encoding and speed of complex auditory signals (Kraus & Nicol, 2005). Researchers consider themselves to be on firmer ground in their understanding of the science of auditory processing in relation to the auditory pathway. In sum, Dalebout (2009) states: We make sense of sound with our brains, not with our ears. Let’s consider our “ears” to be all the parts of the auditory system leading up to the brain (this is known as the peripheral auditory system; peripheral meaning distant from the brain). It’s the responsibility of our ears to pick up and change vibrations traveling through air into mechanical energy – then into hydraulic energy – and finally into neural energy [electric energy] that can be interpreted by

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the brain as meaningful sound. In addition to making these energy conversions, our ears pass critical information about the frequency and intensity of incoming vibrations along to the brain. But our ears can't integrate tiny bits and pieces of information into a meaningful whole; only the brain is capable of accomplishing that miracle. (p. 27)

2.4.3

The peripheral auditory system (outer ear)

The outer ear (see Figure 2.4) has two components, the pinna (or auricle), and the ear canal (Dalebout, 2009). They assist in collecting sound waves.

Figure 2.4 Basic structure of the outer ear (Dalebout, 2009, p. 29)

When a sound wave reaches the pinna, the energy travels via the ear canal and causes the tympanic membrane (eardrum) at the end of the canal to vibrate. This vibration is carried over to three small bones or ossicles in the middle ear (see Figure 2.5), known as the malleus, incus, and stapes, which form a mechanical connection between the tympanic membrane and the oval window of the inner ear (Zwislocki, 2002). The inner ear contains two sensory systems, namely the cochlea concerned with hearing, and the vestibular system concerned with balance and posture (see Figure 2.6). (The vestibular system falls beyond the scope of this discussion.) When the stapes of the ossicular system is activated by the motions of the malleus and incus, it moves/vibrates the oval (Dalebout, 2009). However, as Dalebout (2009) remarks, since the brain can make sense only of neural energy, the inner-ear structures are responsible for converting the energy into neural/electric

25

energy through a highly complicated process, of which only a basic overview can be provided here. Thus, when air-pressure changes (sound waves) enter the outer ear, are amplified by the mechanisms of the middle ear, and arrive at the entrance of the cochlea, it is the function of the latter to convert sound energy into neural impulses that can be transmitted via the nerve to the auditory cortex of the brain (Tatham & Morton, 2011).

Figure 2.5 Basic structure of the inner ear (Dalebout, 2009, p. 34) Table 2.1. Path of sound through the auditory system (adapted from Tatham & Morton, 2011, p. 132)

Outer ear

Anatomical Pinna → structure Ear canal →

Function

Collecting and directing the audio signal/sound waves to the tympanic membrane

Middle ear

Inner ear

Neural transmission

Central nervous system

Ossicles (malleus, incus, stapes) →

Cochlea →

Auditory nerve →

Auditory cortex

Amplifying and transmitting sound wave vibrations from the tympanic membrane to the oval window

Converting analogue vibrations of the oval window to an electrical neural representation of the audio signal

Transmitting the multichannel digital analysis from the cochlea to the brain, and projecting it onto the auditory cortex

Receiving the digital, parametric representation of the wave form and preparing it for cognitive processing

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2.4.4

The central auditory nervous system

Where the eighth cranial nerve joins the brainstem, the central auditory nervous system (CANS) comes into operation (Dalebout, 2009). In the brainstem, the neural code of the auditory information undergoes analysis and modification in nuclei that can be described as processing stations (see Figure 2.8). These stations process inter alia information coming from both ears in order to locate where sounds originated and to sift out extraneous noise. Dalebout (2009) concludes: The brain is able to synthesize and interpret the coded information contained within many neurons, resulting in the perception of sound. There are many alternative and overlapping pathways within the central auditory system. Ultimately, they all lead to specialized auditory areas located in the temporal lobes of the brain (just above the ears). Because there's so much duplication, damage to the central auditory pathways does not always result in a hearing loss, at least in the conventional sense. Instead, central auditory disorders tend to be more subtle (for example, an inability to locate the source of sounds) and may not be revealed without special auditory tests. (p. 38)

Bamiou et al. (2001) provide a basic outline of the anatomy of the CANS, which extends from the cochlear nucleus in the brainstem to the auditory cortex. Important relay stations along this pathway include the superior olivary complex, the lateral lemniscus and inferior colliculus, the medial geniculate body, and the reticular formation. It is important to understand what parts and pathways of the brain are involved in the auditory processing system for the identification of systems that lead to disabilities and disorders in its functioning. The cortical and subcortical areas of the brain associated with auditory processing are known as Heschl’s gyrus and the Sylvian fissure. The corpus callosum that connects the two hemispheres of the brain is also involved in the processing of auditory information as a relay station (Bamiou et al., 2001). The characteristic plasticity of young children’s brains supports the argument for the implementation of earlier intervention strategies for children showing signs of CAPD. As myelination and maturation continue in children until age 10–12 years, sensory representations in the child’s brain may change in response to altered receptors, a stimulating sensory environment, and learning (Bamiou et al., 2001).

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Figure 2.6 Schematic representation of the neural auditory pathway (Bristol University, Department of Anatomy, 2000)

Speech and language are mainly attributed to parts of the cerebral cortex. Motor portions of language are attributed to Broca's area within the frontal lobe. Speech comprehension is attributed to Wernicke's area at the temporal-parietal lobe junction. These two regions are interconnected through a large white-matter tract, the arcuate fasciculus. Damage to Broca's area results in expressive aphasia (non-fluent aphasia), which is the inability to say words. A person with such damage knows what he or she wants to say, but cannot articulate the words. Damage to Wernicke's area, on the other hand, results in receptive aphasia (also called fluent aphasia), which means that a person can hear the language or read it but cannot understand it (Penn, Frankel, Watermeyer, & Russell, 2010). 2.4.5

Central auditory processing disorders: definition and discussion

CAPD is an impaired ability to attend to, discriminate, remember, recognise, or comprehend auditory information in individuals who typically exhibit normal intelligence and hearing (Nicolosi et al., 2006). Children and adults identified with CAPD are a heterogeneous group 28

of individuals who have difficulty using auditory information to communicate and learn. CAPD is not a specific disability; it is a set of problems occurring in different types of listening tasks. Often children with CAPD are initially diagnosed with attention deficit hyperactive disorder (ADHD) or learning disorders, with a diagnosis of CAPD usually given only later (Owens, 2008). Symptoms of CAPD can range from mild to severe and can take many different forms. In the main, children diagnosed with CAPD can experience an inability to process verbal information, failing to interpret what is being said to them. They may repeat sentences word for word but still not succeed in registering the semantic message of the verbal communication. They have a disability in processing the auditory information within the brain, not within the anatomical ear system (Kamhi, 2011). Other factors that could affect auditory processing include hearing difficulties, neurological organisation problems that could compromise the efficiency with which the brain carries out its operations, weaknesses in the sequencing of information, developmental issues, brain injuries, autism, and sound sensitivity. These can have an impact on the brain’s ability to receive and process input to various degrees (Lund & Duchan, 1988). As Bishop and Snowling (2004) have observed, the organisation of the brain determines the efficiency with which it carries out its operations. The more appropriate and specific the input, the more efficiently the child’s brain functions, and the better the brain’s neurological organisation becomes. This organisation, or lack of it, affects all aspects of brain functioning, including the critically important ability to process and interpret sound and language (Bishop & Snowling, 2004). Developmental difficulties such as Down syndrome or autism have a negative effect on the brain’s ability to receive and process input to a certain degree, and consequently also on its neurological organisation and function. Snowling, Gallagher, and Frith (2003) state that any child who has not received the necessary stimulation and opportunities that permit the brain to organise itself appropriately runs the risk of being affected in significant developmental areas. Developmental consequences may include learning disabilities, ADD, ADHD, and dyslexia, which may adversely affect the ability of the brain to process and interpret sound and language (Snowling et al., 2003).

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Both hyposensitivity and hypersensitivity to sound are pertinent problems that can have detrimental effects on the development of auditory processing skills. Children who exhibit a decreased awareness of sound may have great difficulty in attending to language, whereas many hyper-auditory children find it an effort to cope because of being overwhelmed by too much auditory input. They also tend to avoid situations and interactions that they know could cause them difficulty (Hulme & Snowling, 2009). After a number of earlier studies in which investigators claimed that no correlation existed between ear infections and delayed language development, recent studies have confirmed the contrary, namely that reduction in hearing associated with chronic ear-fluid or middle-ear infections has a negative effect on the development of the auditory cortex in the brain. Even short-term hearing loss may lead to a “weakening” in the ability of the brain to process sound (Hulme & Snowling, 2009). These authors continue that neuroplasticity is fortunately such that intervention can reorganise and accelerate the development and organisation of the brain at any point in the child’s development. They agree that children can learn to work around challenges that they face when dealing with auditory processing difficulties. Some of the difficulties include clarity of speech; for example, children may drop the ends of words and syllables that are not emphasised. They may also confuse similar sounds (free instead of three) long after their peers have learned to correct themselves. Furthermore, their development in reading, spelling, and writing skills may be affected. Learning vowels and developing phonemic awareness—the building blocks for reading—can be especially difficult. Understanding spoken instructions is often challenging. Expressive language can be delayed. They may have trouble in telling stories or jokes. They may avoid conversations with peers because it may be hard for them to process what is being said and to think of an appropriate response. Such barriers often have a detrimental effect on their social skills (Rosen, 2005). As stated above, other characteristics associated with auditory processing problems like inattention, distractibility, frequently asking “What?” or “Huh?”, mis-hearing words, misunderstanding meaning, exhibiting poor social interaction, and misinterpreting social cues (Rosen, 2005). Reading difficulty, and comprehension difficulty is evident in the presence of background sounds. Often there are also indications of a global immaturity, language delay, and poor conceptual thought (Rosen, 2005).

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Professionals in the field of education and learning disabilities have long been aware of the effect of CAPD on academic performance and learning. It has been identified as one of the primary deficits identified in the study field of learning disability (Williams & Lind, 2013). In 1967, the South African National Advisory Committee on Handicapped Children described specific learning disability as “a disorder, which may manifest itself in an imperfect ability to listen, think, speak, read, write, spell, or do mathematical calculation” (Khan, 2006, p. 6). The National Joint Committee for Learning Disabilities subsequently revised this definition to read as “a generic term that refers to the heterogeneous group of disorders manifested by significant difficulties in the acquisition and use of listening, speaking, reading, writing, reasoning, or mathematical abilities” (Khan, 2006, p. 59). Difficulty with listening ability (auditory processing problems) is clearly recognised as being a significant part of learning disability (Kamhi & Catts, 2012). With the growing body of literature on how children learn to read, and the knowledge that phonemic and phonological awareness (also referred to as auditory components of reading) is a fundamental skill used when learning to read, the importance of auditory processing has taken on a new significance (Blair & Razza, 2007; Catts, 1997; Moore, Rosen, Bamiou, Campbell, & Sirimanna, 2013). This emphasis has fairly recently been affirmed when ASHA determined that a diagnosis of CAPD falls under the scope of the practice of audiology (Desroches, Newman, Robertson, & Joanisse, 2013). Therefore, it is important to understand what the audiological diagnosis means. Audiologists make a diagnosis of CAPD through standardised testing of specific auditory skills through sophisticated, calibrated equipment used in carefully controlled acoustic environments. Research has shown that auditory testing is a sensitive procedure which can produce scattered results if it is not administered under well-controlled conditions (Desroches et al., 2013). People with CAPD can detect pure tones that are delivered one by one in a very quiet environment, such as a sound-treated room, as Desroches et al. (2013) point out, but they also note that the ability to detect the presence of sounds is only one part of the processing that occurs in the auditory system. In other words, people with CAPD do not have a loss of hearing sensitivity, but they do not process heard sounds normally or effectively. If these auditory deficits are not identified and managed early in life, many children with CAPD may develop speech and language delays, as well as academic problems (Desroches et al., 2013). Professionals in the education and medical fields may have taken different approaches to describing and discussing CAPD in the past, but the disability is currently well documented 31

in research and clearly recognised as a problem for many adults and children (Catts 1997; Howland & Liederman, 2013). It affects language learning and contributes to reading disorders and dyslexia (Snowling, 2015). Often, children diagnosed with CAPD will have received another diagnosis before being referred to an audiologist. An initial misdiagnosis, as well as the disorder itself, can be confusing for parents, educators, and other professionals working with the child. Musiek and Chermak (2013) state that identifying children with CAPD requires the combined efforts of speech-language pathologists, audiologists, and other professionals such as teachers. For this reason, psychologists, physicians, and educators should be included in the assessment and treatment team as well. Educators can find auditory processing disorders such as CAPD difficult to understand or deal with because the symptoms often overlap and can be labelled incorrectly. Psychologists and educators may recognise anomalies in children’s behaviour such as poor listening comprehension, problems with short-term auditory memory, or difficulty in following directions. However, these professionals may not attribute such characteristics to weakness in auditory sequencing, auditory memory, and auditory closure due to auditory- or languageprocessing disorders as a speech-language therapist or audiologist would. On the other hand, an audiologist cannot be in the classroom to watch the child’s behaviours constantly in order to be able to attribute symptoms to CAPD. Therefore, a multi-professional team is needed for accurate assessment, diagnosis, and effective treatment of CAPD. For effective treatment and support for children with CAPD in the inclusive education structure, it is important to show how the auditory difficulties develop and amalgamate or fit into the specific learning disorder (SLD) diagnosis in the DSM-5 (see section 2.4.6). The benefit of this collaboration is that learners can gain access to the resources of support from the different medical and educational boards. These boards grant extra examination time, or assistance by scribes or readers during examinations, as well as access to medical aids that pay for certain therapies, for example language therapy. The IEB as well as the Gauteng Department of Education grant formally diagnosed learners this type of support. 2.4.6

DSM-5 criteria for specific learning disorder and comorbidity of CAPD

The Diagnostic and statistical manual of mental disorders, fifth edition (DSM-5), of the American Psychiatric Association (APA, 2013a), is a mental health classification system of disorders in children and adults. It is the standard guide to US psychiatric practice and has a global influence on how disorders are described and diagnosed. However, because it is based 32

on a medical model, controversy exists about its use in education (Eriksen & Kress, 2005). The latest edition of the DSM-5 (APA, 2013a & 2013b) has made significant changes to the way in which learning disorders, and hence, reading disorders, are classified. Within DSM-5 (APA, 2013a), “learning disorder” is the generic term used for describing those disorders with onset in childhood that are characterised by difficulties in learning and that affect academic achievement significantly. Learning disorders are grouped together with communication disorders; both are described as neurodevelopmental disorders to reflect their early onset (Hulme & Snowling, 2009). It falls to theoreticians and practitioners alike to recognise the interrelationships between spoken and written language (Snowling, 2015). The APA’s (2013a) diagnostic criteria for SLD are set out in Table 2.2. Table 2.2 DSM-5 criteria for SLD (APA, 2013a, p. 72) Criteria for diagnosing SLD A. Difficulties with learning and using academic skills, as indicated by the presence of at least one of the following symptoms that have persisted for at least six months, despite the provision of interventions that target those difficulties: l. Inaccurate or slow and effortful word reading (e.g., reads single words aloud or slowly and hesitantly, frequently guesses words, has difficulty sounding out words). 2. Difficulty with understanding the meaning of what is read (e.g., may read text accurately but not understand the sequence, relationships, inferences, or deeper meanings of what is read). 3. Difficulties with spelling (e.g., may add, omit, or substitute vowels or consonants). 4. Difficulties with written expression (e.g., makes multiple grammatical or punctuation errors within sentences; employs poor paragraph organisation; written expression of ideas lacks clarity). 5. Difficulties with mastering number sense, number facts, or calculation (e.g. has poor understanding of numbers, their magnitude and relationships; counts on fingers to add singledigit numbers instead of recalling the math fact as peers do; gets lost in the midst of arithmetic computation and may switch procedures). 6. Difficulties with mathematical reasoning (e.g. has severe difficulty applying mathematical concepts, facts, or procedures to solve quantitative problems). Children with CAPD often have several, if not all of the symptoms. B.

The affected academic skills are substantially and quantifiably below those expected for the individual's chronological age, and cause significant interference with academic or occupational performance, or with activities of daily living, as confirmed by individually administered standardised achievement measures and comprehensive clinical assessment. For individuals age 17 years and older, a documented history of impairing learning difficulties may be substituted for the standardised assessment [which is a full education assessment by an educational

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Criteria for diagnosing SLD psychologist]. C.

The learning difficulties begin during school-age years but may not become fully manifest until the demands for those affected academic skills exceed the individual's limited capacities (e.g., as in timed tests, reading or writing lengthy complex reports for a tight deadline, excessively heavy academic loads).

D. The learning difficulties are not better accounted for by intellectual disabilities, uncorrected visual or auditory acuity, other mental or neurological disorders, psychosocial adversity, lack of proficiency in the language of academic instruction, or inadequate educational instruction. Note: The four diagnostic criteria are to be met based on a clinical synthesis of the individual's history (developmental, medical, family, educational), school reports, and psychoeducational assessment. Coding note: Specify all academic domains and subskills that are impaired. When more than one domain is impaired, each one should be coded individually according to the following specifiers. Specify if: 315.00 (F81.0) with impairment in reading:   

Word reading accuracy Reading rate or fluency Reading comprehension

Note: Dyslexia is an alternative term used to refer to a pattern of learning difficulties characterised by problems with accurate or fluent word recognition, poor decoding, and poor spelling abilities. If dyslexia is used to specify this particular pattern of difficulties, it is important also to specify any additional difficulties that are present, such as difficulties with reading comprehension or math reasoning. 315.2 (F81.81) with impairment in written expression:   

Spelling accuracy Grammar and punctuation accuracy Clarity or organisation of written expression

315.1 (FBI.2) with impairment in mathematics:    

Number sense Memorisation of arithmetic facts Accurate or fluent calculation Accurate math reasoning

Note: Dyscalculia is an alternative term used to refer to a pattern of difficulties characterised by problems processing numerical information, learning arithmetic facts, and performing accurate or fluent calculations. If dyscalculia is used to specify this particular pattern of mathematic difficulties, it is important also to specify any additional difficulties that are present, such as difficulties with math reasoning or word reasoning accuracy.

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Since the symptoms of CAPD fit into the criteria set for the identification of SLD, and because learners with CAPD usually underperform academically, they are more often than not referred to assistive programmes for SLD. Such assistive programmes may include speech or reading therapy, as well as a suggestion to move to smaller classes. CAPD as an even more specific difficulty is only identified when learners in SLD programmes can no longer compensate for their difficulty even when equipped with certain new skills. There is consequently a need for the early identification of CAPD as such (Rosen, 2005). From the researcher’s experience, SLDs can be viewed on a continuum of early to late diagnosis of visual processing issues or auditory processing issues. It is possible to identify such barriers in an early stage, as it is often done in the private schools, even in the nursery school phase (Sapon-Shevin, 2008). As noted in the literature, just as each person has unique characteristics, so do the specific learning difficulties (Snowling, 2015). An SLD can be explained as a neurodevelopmental disorder with a probable genetic basis that generally affects more boys than girls. Its core features are problems with word decoding, visually or auditory, which in turn affect spelling performance and the development of reading fluency in childhood and adolescence (Snowling, 2015). If these problems persist into adulthood, the outcomes differ across the board: whereas many learners with SLDs leave school with minimal qualifications, some of them succeed in proceeding to a university education. However, most such adults complain of slow reading, problems with spelling, and difficulties with written expression. In addition, problems with working memory, attention, and organisation are frequently reported (Snowling, 2015). From the above information, it appears that CAPD slots well into the DSM-5 criteria for SLD. This is demonstrated by a literature that is replete with references to similarities between the presenting symptoms of CAPD, ADHD, specific language impairment (SLI), dyslexia (sometimes known as specific reading disorder (SRD), and autistic spectrum disorders (ASD), particularly in children (Dawes & Bishop, 2008). Symptoms of CAPD that overlap with other disorders include: 

poor attention and high distractibility (ASHA, 2005; Ghanizadeh, 2009; Jerger & Musiek, 2000; Riccio, Cohen, Garrison, & Smith, 2005);



language difficulties (ASHA, 2005; Bamiou et al., 2001; Jerger & Musiek, 2000; Miller & Wagstaff, 2011; Sharma, Purdy, & Kelly, 2009);

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reading difficulties (ASHA, 2005; Dawes, Sirimanna, Burton, Vanniasegaram, Tweedy, & Bishop, 2009; Jerger & Musiek, 2000; Sharma, Purdy, Newall, Wheldall, Beaman, & Dillon, 2006; Sharma et al., 2009);



difficulty following oral instructions (ASHA, 2005; Jerger & Musiek, 2000); and



ASD behaviours, poor social skills, difficulty with participating in group work, and language and listening delays (Dawes & Bishop, 2008; Goswami et al., 2009).

This co-occurrence of symptoms or comorbidity has led to doubts and debates in literature as to whether CAPD may exist as a coherent disorder in its own right (Dawes & Bishop, 2008). Summarising all the studies that indicate comorbidity between developmental disorders is unfeasible because of their large numbers. The brief outline above does not indicate the cooccurrence sufficiently, but it may be observed that during diagnosis, different professionals tend to focus on symptoms primary to their specific field of expertise. For example, audiologists are hearing-centric, and the identification of difficulty listening in a situation with background noise is considered one of the main symptoms of CAPD, which would undoubtedly encourage a CAPD diagnosis. On the other hand, paediatricians may not be inclined to leap to such a conclusion since the general nature of their work requires them to take a more general view of child health, with hearing being just one of a multitude of components. Nevertheless, the results of a study by Chermak, Tucker, and Seikel (2002) indicated that both groups of professionals (paediatricians and audiologists) showed a high degree of correlation and overlap between diagnoses of CAPD and ADHD-related disorders. This overlap was consistent with findings by Riccio and colleagues who reported that 50% of consecutive referrals of 12 children with CAPD also had ADHD (Riccio, Hynd, Cohen, Hall, & Molt, 1994). Furthermore, these children also exhibited significant language problems, which prompted the authors to conclude that a need existed for multidisciplinary assessment of children with CAPD. Sharma et al. (2009) assessed a group of 68 children with suspected CAPD according to reports of parents, educators, or healthcare professionals such as audiologists, speechlanguage therapists, or educational psychologists (see Table 2.3). The children underwent a large battery of tests to assess auditory processing such as the dichotic digits test (DDT), frequency pattern test (FPT), random gap detection test (RGDT), compressed consonantvowel-consonant (CVC) words, and masking level difference reasoning ability, language, reading, phonology, auditory memory, and sustained auditory and visual attention. The 36

authors found that 71% of the children had CAPD, 76% had language impairment (LI), and 73% had reading disorder (RD), with a further 10–12% having two disorders, and 47% having all three. Only 4% had “pure” CAPD. Table 2.3 CAPD with co-occurrence of other impairments (Sharma et al., 2009)

Percentage

CAPD

4%

X

Language impairment

Reading disorder

10% - 12%

Three of the three disorders

X

47%

X

73% 76%

Two of the three disorders

X X

 

Therefore, Sharma et al. (2009) concluded that language impairment and reading difficulties commonly co-occurred with CAPD, with more children showing symptoms of two or more disorders rather than only one disorder. Because the interpretation could be made that the tests were not sufficiently sensitive or adequate to identify the clinical groups differentially, the authors emphasised the need for professionals to cooperate in the assessment of children with listening, language, or reading difficulties. They suggested that the CAPD deficits might constitute part of a wider multifactorial learning disability, rather than being a specific diagnostic category. As Pennington and Bishop (2009) affirmed, better understanding of the comorbidity of CAPD with other disorders might be achieved by considering the different types of models of CAPD comorbidity with speech, language, and reading disorders that have been examined in other investigations. 2.4.7

Aetiology of CAPD

As noted above, the diagnosis of CAPD may be controversial because it is often associated or bracketed with comorbid disorders such as ADHD, learning disabilities, speech-language impairments, developmental dyslexia, pervasive developmental disorder, or developmental delays in general. The diversity of signs and symptoms associated with this disorder also makes the aetiology difficult to pinpoint (Jerger & Musiek, 2002). King, Lombardino, Crandell, and Leonard (2003) investigated the extent of comorbid CAPD in a group of adults with developmental dyslexia. They concluded that although it was highly improbable that all 37

persons with developmental dyslexia would have comorbid CAPD, the data suggested the need to be alert to possible comorbidity and co-occurrence of dyslexia with auditory processing deficits. Billiet and Bellis (2011) hypothesised that the underlying defect in CAPD was an auditory variation of a general disorganisation of forebrain systems, arising from mutations in genes and affecting brain development, conferring susceptibility on the constellation of developmental learning and language disorders. Diagnoses misapplied to an individual with CAPD could be an alternative manifestation or alternative diagnosis of the same underlying cause. Multiple brain regions and mechanisms are known to affect the recognition of sounds (Banai & Kraus, 2014). It is reasonable to hypothesise heritable predispositions in brain structure or functions underlying individual patients’ ability to process sound (Moore, 2006). Family clustering has been reported, but the genetics of auditory processing are not well understood (Billiet & Bellis, 2011). The presence of CAPD indicates that something is adversely affecting the processing or interpretation of sound within the brain (Nicolosi et al., 2006). Multiple mechanisms could be said to affect the recognition and processing of sound. It is likely that multiple genes contribute to sound interpretation, and that there is variability in the expression of the underlying genetic defect in different individuals (Billiet & Bellis, 2011). Furthermore, while on the one hand other members of a family may sometimes exhibit similar processing weaknesses, on the other hand these weaknesses may be caused by birth trauma or common childhood problems such as ear infections (Williams & Lind, 2013). The aetiology of CAPD is not well understood, but the devastating effect it has on children’s ability to learn language and consequently on their educational performance, particularly learning to read, has remained a cause of concern for parents, educators, and professionals. Confronted with an inadequately understood disorder, professionals in particular are intensely aware of the need to implement interventions even though they lack sufficient aetiological knowledge. Therefore, they follow new research in the field with keen interest. For example, contributions from neuroscience have indicated that some language disorders and dyslexia may be secondary to deficits in the central auditory processes (Nicolosi et al., 2006). Gunarson and Finitzo (as cited in Wallace & Gravel, 2000) undertook an investigation into recurrent otitis media (middle-ear infection) in children between the ages of four and five 38

years. These children exhibited abnormal responses on auditory brainstem tests, indicating a relationship between recurrent otitis media and CAPD. However, several studies have also reported abnormalities of the speech-evoked auditory brainstem response associated with a variety of learning problems that included impaired auditory perception (Hornickel, Zecker, Bradlow, & Kraus, 2012). Wallace and Gravel (2000) reported a study in which they followed children with and without early otitis media from the first year of life through to nine years of age. They found that the children in the group who had experienced the mild, fluctuating hearing loss associated with otitis media had had long-term problems with higher-order auditory processing skills and learning, unlike the group who had not experienced otitis media. Therefore, not only do more children have auditory learning impairments from CAPD than from hearing loss, but the impairments associated with CAPD may be a “hidden” deficit because hearing impairments are usually recognised more easily and associated more directly with a marked effect on speech and language. The above research highlights the hidden factor of CAPD (Gersons-Wolfensberger & Ruijssenaars, 1997; Weihing, Chermak, & Musiek, 2015). 2.4.8

Incidence of CAPD

Even in developed countries, the exact prevalence of CAPD in the adult and paediatric population has not been firmly established for several reasons. Firstly, the lack of standard definitions of CAPD symptoms has caused difficulty in establishing accurate data, leading to a variance in prevalence estimates (Kamhi & Catts, 2012; Keith, 1988). According to the Association of Children and Adults with Learning Disabilities (ACLD; now known as the Learning Disabilities Association of America (LDA) (n.d.)), mild cases of auditory processing disorders may be inconspicuous in children because affected individuals may learn to compensate in various academic and social situations (Nicolosi et al., 2006). Approximately 5% of American school-age children have some type of auditory processing disorder according to the National Institutes of Health (Auditory Processing Center, 2017). Jerger and Musiek (2002), too, have observed that the incidence of CAPD in the USA has been estimated at 3–5% and is more common than the incidence of hearing loss. Owing to the high incidence of CAPD and the language and learning problems associated with it, such as a high incidence of comorbidity with ADHD, researchers have focused 39

special attention on determining the aetiology of CAPD (Kamhi & Catts, 2012; Ricco et al., 1994). Then, too, CAPD is not necessarily restricted to the young. Aside from children, many adults in the population may also be experiencing CAPD symptoms, considering that a high incidence of central auditory nervous system involvement has been discovered among adults with aphasia and with certain neurological diseases such as multiple sclerosis and Parkinson’s disease (Billiet & Bellis, 2011; Ricco et al. 1994). Individuals who have experienced closed head trauma often have central and auditory damage or deficits. In South Africa, the incidence of CAPD is not exactly known and its diagnostic status within the local context places further constraints on reliable statistics. What can be said with a measure of certainty is that 1 802 audiologists and STAs registered with the HPCSA in 2013 provided services to a diverse population, both culturally and linguistically, of approximately 54 million people (Statistics South Africa, 2014). Another challenge is that the majority of audiologists in South Africa speak English or Afrikaans (or both), but not one of the country’s other official languages (Pascoe & Norman, 2011). This creates a mismatch between audiologists and their clients in terms of language, which has a further impact not only on service delivery but also on determining the actual incidence of CAPD (Pascoe, Rodgers, & Norman, 2013). Thus, appropriately diagnosing and managing children presenting with CAPD and arriving at a realistic determination of the incidence of CAPD remain a challenge. 2.4.9

Behavioural indications and symptoms of CAPD in children

A task force of ASHA (1996) suggested that difficulties experienced in one or more of the following auditory abilities, skills, or tasks may serve as indications of CAPD (Nicolosi et al., 2006): 

Sound localisation and lateralisation, which refer to the ability of an individual to know where a sound has occurred in space. This is an important survival skill since localisation is used to identify the source of a sound and from which direction it is coming, such as a moving car or a barking dog.



Auditory discrimination, which refers to the ability to distinguish one sound from another. The term is most often used when referring to distinguishing speech sounds such as phoneme /p/ from phoneme /b/.

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Auditory pattern recognition, which refers to the ability to determine similarities and differences in patterns and sounds.



Temporal aspects of auditory processing, which refers to the ability to sequence sounds, integrate a sequence of sounds into words or other meaningful combinations, and perceive sounds as separate when they follow one another rapidly.



Auditory performance decrements, which refer to the ability to perceive speech or other sounds when another signal is present. The other signal may be noise or another similar speech signal, and may be either loud or soft.



Auditory performance with degraded acoustic signals, which refers to the ability to perceive a signal in which some of the information is missing. A degraded signal may be one in which parts of the sound spectrum have been deleted, or the highest or lowest frequency components of the sound have been removed, or the sound has been compressed in time (Nicolosi et al., 2006).

As can be seen from the above descriptions, these auditory tasks are not easily observable by an educator in the classroom or a parent at home. An educator may note that a child is unable to listen well when there is a great deal of noise in the classroom, and a parent may become aware that the child is easily distracted when two people are talking simultaneously. Such observations may indeed serve as important indicators, but cannot compare with the professional determination of auditory problems by scientific means. Even so, these functional behaviours are still difficult to test objectively, and because they may be symptoms of other problems not related to the auditory system, an audiologist, for example, must use objective measures to test skills that may not directly correspond to the real-life function of these observable behaviours (Young, 2001). An example of objective testing is auditory brainstem function, which may serve as a key biological indicator of auditory processing disorders. Hornickel and Kraus (2011) have shown that reliability of responses within an individual’s auditory brainstem function tests and cognitively-based communication skills assessments is essential for any CAPD testing battery. It is still, however, possible for educators to look out for identifiable, observable behaviours that may indicate that the child is exhibiting CAPD-related symptoms. As seen in Table 2.4, these observable behaviours can be divided into categories, each of which includes typical, specific, or observable characteristics or actions that the child may exhibit or perform, indicative of CAPD (Young, 2001). 41

Table 2.4 Observable behaviours indicating CAPD (Adapted from Young, 2001) Category of behaviour

Characteristics exhibited by child

Oral communication

 Preferring written communication. Difficulty remembering information presented orally. Better understanding of visually presented information.

Difficulty following directions

Difficulty following multi-step directions. Better handling and understanding when directions are given step by step.

Processing information

Needing much more time than classmates for processing new information.

Poor listening skills

Needing that people speak slowly. Difficulty hearing in noisy places or in places with background noise, such as social locations.

Multimodal presentation of information

Preferring that information be presented in one mode at a time.

Academic difficulties

Failure/difficulty to learn to read. Falling behind classmates.

Distractibility

Easily distracted in classroom.

Inattentiveness

Difficulty focusing in class

The link between reading disabilities and language or learning disorders underlies the need to identify affected children in order to facilitate the implementation of appropriate strategies that may reduce the risks of later learning disabilities (Catts, 1989; Torgesen, 2004). It is generally agreed that regarding the identification of communication and language disorders, earlier is better. Such identification should be considered independent of the causes or aetiology of CAPD; in other words, irrespective of its being due to either genetic or environmental agents (Nicolosi et al., 2006), or a combination of both. Support for the efficacy of early intervention is corroborated by research studies demonstrating that development during the prelinguistic period in children is crucial to the acquisition of linguistic competence (Nicolosi et al., 2006). Research interest in early language intervention stemmed from the recognition that individuals identified as having language disorders in preschool years were often diagnosed as having learning disabilities

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later on in their schooling careers (Aram et al., 1984; King et al., 2003; Nicolosi et al., 2006). The topic of remediation, treatment, and management of CAPD can now be addressed. 2.4.10 Remediation, treatment, and management of CAPD Frequently, the suggestions offered to parents to help their children with auditory processing problems are compensatory tactics, or rather short-term ways to help the children cope. While these “fixes” may be useful in helping the children as learners to deal with day-to-day situations, they are not intended to remedy the problem strategically over the long term. Some of these tactical suggestions include speaking to learners using a slower than typical rate of speech to give them more processing time, obtaining their attention before speaking to them, and providing visual cues as needed, especially when giving instructions (Snowling, 2015). In spite of this, it should not be assumed that the information or instruction was understood. Follow up is essential, as well as repetition with these learners and preferential seating in the classroom (i.e., having them sit in front). It needs to be noted that tactical modi operandi do have advantages in conjunction with remediating programmes aimed at addressing auditory processing difficulties therapeutically and strategically. Such programmes may include Targeted Sound Intervention (TSI) with TSI: Boost: TSI: Focused Attention; and TSI: Individualised for Frequency Normalisation (National Association for Child Development, n.d.); the Listening Programme (Advanced Brain Technologies, n.d.); and Fast ForWord (Scientific Learning, n.d.). Equipment such as frequency modulation (FM) units for aiding auditory processing may also be used (Phonak Communications, 2010). These units are most commonly found in schools where the educator wears a microphone and a learner listens to the educator’s voice either through headphones or through a speaker on the desk. Some programmes put together appropriate equipment in packages that could be used by families at home. The person speaking wears a microphone and the child listens through headphones, allowing for a direct, intense auditory signal, free of competing background sounds. This is especially helpful when doing specific activities to remediate auditory processing problems or speech/language problems. A fairly recent study by Johnston, John, Kreisman, Hall, and Crandell (2009) showed that children with auditory processing disorders who used FM devices for home and classroom settings demonstrated improved speech perception scores over the course of the school year. In fact, after prolonged FM use, their speech perception performance improved even when they were not using the device. 43

Remediation for children with CAPD generally falls into three categories, namely 

compensatory training to strengthen perceptual skills,



management of the environment, and



cognitive therapy in which the clinician assists the children in learning strategies for dealing with their disorder (Keith, 1988).

These may be effective remediation strategies for various reasons. During perceptual skills strengthening and phonemic training, children receive positive reinforcement for any improvements. Keith (2002) is of the opinion that children may develop a clearer understanding about speech sounds because the phonemes are repeated, blended, analysed, as well as synthesised. Children are thus assisted to establish more concrete phoneme maps and also to learn that words are made up of units that can be manipulated. As Hulme and Snowling (2009) have pointed out, improvement in processing will likely expand to decoding new words, which in turn improves reading and spelling skills. In the early grades, Hulme and Snowling continue, educators can do a number of things that help children with CAPD, for example by inserting pauses between statements, repeating key phrases frequently, using visual cues and aids routinely in instruction, and seating the children in the front of the class. Musiek et al. (2011) have reported extensively on various techniques and procedures for clinical management of CAPD. Hall (2000) emphasises the importance of classroom modifications for children diagnosed with CAPD. These recommendations include education of educators and other school personnel about specific teaching strategies, modification of the environment, and recognising at-risk children. Modification of the environment includes various strategic actions such as giving the children preferential seating so that they can see the educator and the board easily, distancing the children from distracting noise, and reducing classroom noise levels and echoes by means of acoustic ceiling tiles, soft furniture, and wall panels (Hall, 2000). A personal FM and amplifier system is also an effective tool for children with CAPD, especially those who have particular difficulty in listening to and understanding speech in the presence of background noise (Johnston et al., 2009). Young (2001) describes four metacognitive approaches (metacognition being “awareness of one’s own cognitive processes, often involving a conscious attempt to control them”, as defined by VandenBos (2013), p. 355) found to be useful in managing CAPD, namely

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attribution training, cognitive behaviour modification, reciprocal teaching, and assertiveness training: 

Attribution training targets motivation. Owing to their chronic listening problems, academic failures, and social frustrations with friends or family, learners with CAPD are at high risk of developing motivational problems. Essential to attribution therapy is the provision of feedback during auditory testing. Every incorrect or correct response is recognised as respectively an inadequate or satisfactory effort, but with positive acknowledgement of hard work and encouragement towards greater effort so as to improve performance (Young, 2001).



The goal of cognitive behaviour modification is to promote active, self-controlled listening and learning. The first phase of this type of therapy is self-instruction, followed by problem-solving and self-regulation during which learners are encouraged to analyse the situation they are in and generate a variety of potential solutions or responses. Subsequently, the implementation and conscious maintenance of the chosen productive response receive attention. In the final phase, namely cognitive strategy training, learners are made more aware of the specific productive strategy underlying effective performance (Young, 2001).



Reciprocal teaching involves alternating the roles of learners and therapists to facilitate learning (perhaps more appropriate for older learners). This approach is likely to boost self-esteem and self-efficacy, thereby increasing motivation. Furthermore, the therapist and the learner each have opportunities to share their metacognitive processes by verbalising their uses of various strategies (Young, 2001).



Finally, the goal of assertiveness training is for learners to attain personal effectiveness via verbal communication. Self-confidence and self-esteem are prerequisites to assertiveness. Daily affirmations are helpful in conjunction with these therapy types (Kamhi, Masterson, & Apel, 2007; Young, 2001).

In addition to modifications and efforts on the part of educators to improve the success of learners with CAPD, it is equally important for the learners to learn to self-advocate and create an optimal learning environment (Williams & Lind, 2013). Efforts made in the classroom by educators and learners should extend into the home and extracurricular activities. Skills are more likely to be generalised and learned by practising remediation strategies throughout the entire day (Kamhi & Hinton, 2000). 45

Counselling techniques used by therapists before, during, and after the diagnosis of CAPD or any type of auditory deficits are very important. Learners and parents are likely to experience various negative reactions while the learners are being tested and assessed, and after they have been diagnosed. These reactive feelings may include but are not limited to some degree of grief, fear, anger, guilt, and vulnerability (Aro, Eklund, Nurmi, & Poikkeus, 2012). The following techniques may be useful in dealing with the parents’ feelings. Attentive listening enables the parents to resolve their confusion within a supportive framework. Sensitive and reflective listening elicits feelings that can be acknowledged and validated in order to move towards acceptance of realities (Silverman, Kurtz, & Draper, 1998). A significant way in which parents may feel involved in their child’s diagnosis and treatment is by obtaining more knowledge about CAPD. In addition to providing information to parents, therapists may suggest that parents research the disorder on the internet, or get in touch with parents who are in a similar situation, and perhaps start a support group or network (Silverman et al., 1998). Management of CAPD cases usually falls on the speech pathologist who has not conducted the original assessment and may not have all the information about the learner to guide a treatment plan. Better collaboration, communication, and delineation of the problem need to precede treatment (Kamhi, 2011). Knowing which techniques work best for which types of problems is paramount, which requires assessment of post-treatment and outcome measures as advocated in this study. Treatment of CAPD can be expensive, but speech pathologists in South Africa are registered with the HPCSA and patients may claim expenditure on therapy sessions back from their medical aid associations if a proper diagnosis is made and the correct medical codes are used. In the diagnosis of the disorder and application the medical codes, speech pathologists must identify all academic domains and sub-skills that are impaired. When more than one domain is impaired, each one should be coded individually according to the specifiers listed in Table 2.5. (South African Speech-Language-Hearing Association [SASLHA], 2010). Table 2.4 Medical codes for CAPD Code and specifier

Domains impaired   

315.00 (F81.0), with impairment in reading

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Word reading accuracy Reading rate or fluency Reading comprehension

Code and specifier

Domains impaired

315.2 (F81.81), with impairment in written expression:

315.1 (FBI.2), with impairment in mathematics

  

Spelling accuracy Grammar and punctuation accuracy Clarity or organisation of written expression

   

Number sense Memorisation of arithmetic facts Accurate or fluent calculation Accurate math reasoning.

A difference between diagnostic and procedural codes has to be clarified: whereas diagnostic codes are used to identify what went wrong, procedural codes are used to describe what is to be done. Both code types must be reflected on accounts submitted to medical aids (SASLHA, 2010). Moreover, in addition to the current procedural codes. use must be made of the ICD10, which stands for International statistical classification of diseases and related health problems, 10th revision, as used by the World Health Organisation (2016). The ICD-10 is an international standard employed for collecting health statistics data in order to create links between diagnoses, treatments, and products, while reducing administrative costs. The more specific the diagnosis, the easier it is to find the correct code. If a limited number of digits are used, the claim may be rejected, as the diagnosis will be too general (SASLHA, 2010). Correct coding is essential in helping parents of children with CAPD to claim for therapy from their medical aid associations instead of paying from their own pocket. 2.5 STAGES AND MANIFESTATIONS OF CAPD Recognising the symptoms of CAPD is frequently problematic since the disorder may present differently at various developmental stages in an individual’s life. The following sections will discuss which signs are most common in infancy, the preschool phase, nursery school phase, grade (junior) school, high (senior) school, and adulthood. 2.5.1

The infancy and early childhood phase (3 months to 2 years)

CAPD in children can manifest itself in early childhood. Parents whose children are identified as having CAPD report that as infants their children did not readily alert or respond to voices and seemed to “tune out” even when still being in the cot (Young, 2001). At the other end of the spectrum are infants who appear alert and attend to sounds, but in a manner that makes them appear to be hypersensitive. The latter group often develops difficulty with 47

sound sensitivities and problems in understanding speech in noisy places, which interferes with peer socialisation, group functioning, and learning in large classes. When infants approach 12 months of age, parents might observe that they are talking less than their peers do, become worried about the infants’ hearing, and take them to the paediatrician to have their hearing tested. Often, these children have multiple hearing tests that all show normal results (Young, 2001). When children experience recurrent otitis media, however, their poor listening and auditory attention ability may be attributed to residual effects of the ear infections. Because 30% of children have at least one episode of otitis media during their first year of life, listening problems may be attributed to fluid in the ear or so-called stiff middleear systems, when in fact the listening problem may be a red flag signalling a developing processing problem (Young, 2001). 2.5.2

The preschool phase (2–3 years)

As children enter preschool, they begin to learn nursery rhymes and childhood songs. Children with CAPD may like music but appear to have difficulty in learning the words. In preschool, educators identify these toddlers as having difficulty in sitting still for story time or requiring repetition of oral direction, and needing tactile or visual cues to attend when spoken to. Young (2001) states that such children may be described as “daydreamers” or “selective listeners” even in the preschool years. She further notes that parents may find that these youngsters often do not like to be read to, prefer puzzles, and would rather watch television and videos. Parents and educators often perceive children with CAPD as seeming to be “in a world of their own” (Young, 2001). Some children who seem to be hypersensitive to noise, covering their ears or avoiding noisy situations, such as birthday parties or loud unstructured play activities, are often considered immature or attention seeking. Others may present as inattentive to people, or overfocused on television or visual activities, and it is difficult to get their attention when talking to them. Because of the different and varying behaviours of children with CAPD, these characteristics can often be misinterpreted as behaviour problems, adjustment difficulties, and immaturity. While some maturational delays can exist, it is not a defining characteristic of CAPD (Nicolosi et al., 2006). 2.5.3

The nursery school phase (3–6 years)

In nursery school, children must learn to follow longer and more linguistically complex oral directions. They acquire pre-reading skills, learn letter names, and begin to associate sounds 48

with letters. Phonemic-awareness skills, such as knowing that /t/ and /p/ are different sounds and knowing that the word “cat” is composed of the sounds /k/, /æ/, and /t/, require the accurate discrimination of individual phonemes. Phonological awareness tasks, such as identifying the beginning, middle, and ending sounds of words, are tasks that children in nursery school usually learn without difficulty. These skills, which create the foundation for learning to read (Lyon, 1995), are very important for pre-reading since children who do not auditorily process phonemes with accuracy find them extremely difficult to master. Therefore, children with CAPD can be identified at the start of schooling, more specifically in the beginning stages of learning to read, because of their struggling with pre-reading tasks and possibly falling behind their peers in academic progress (Lyon, 1995; Torgesen, 2000). Table 2.6 presents normative data for speech and language development. Table 2.6 Language development norms (Columbia University Medical Center, 2015) Ages

2–3 years

Symptoms of Identification          

  

   

Groups objects such as foods, clothes, etc. Identifies colours. Uses most speech sounds but may distort some of the more difficult sounds such as l, r, s, sh, ch, y, v, z, th – these sounds may not be fully mastered until age 7 or 8. Uses consonants in the beginning, middle, and ends of words – some of the more difficult consonants may be distorted, but attempts to say them. Strangers are able to understand much of what is said. Able to describe the use of objects such as “fork”, “car”, etc. Has fun with language – enjoys poems and recognises language absurdities such as “Is that an elephant on your head?” Expresses ideas and feelings rather than just talking about the world around him/her. Uses verbs that end in “-ing”, such as “walking” and “talking”. Answers simple questions such as “What do you do when you are hungry?” Repeats sentences.

  

Understands spatial concepts such as “behind”, “next to”. Understands complex questions. Speech is understandable but makes mistakes pronouncing long, difficult, or complex



3–4 years

4–5 years

Knows some spatial concepts such as “in”, “on”. Knows pronouns such as “you”, “me”, “her”. Knows descriptive words such as “big”, “happy”. Vocabulary of 250 to 900 words. Uses three-word sentences. Speech is becoming more accurate but may still leave off ending sounds – strangers may not be able to understand much of what is said. Answers simple questions. Begins to use more pronouns such as “you”, “I”. Uses question inflection to ask for something such as “my ball?” Begins to use plurals such as “shoes” or “socks”, and regular past tense verbs such as “jumped”.

  

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Ages

5 years

Symptoms of Identification      

words such as “hippopotamus”. Vocabulary of about 1 500 words. Uses some irregular past tense verbs such as “ran”, “fell”. Describes how to do things such as painting a picture. Defines words. Lists items that belong in a category such as animals, vehicles, etc. Answers “why” questions.

        

Understands more than 2 000 words. Understands time sequences (what happened first, second, third, etc.). Carries out a series of three directions. Understands rhyming. Engages in conversation. Sentences can be eight or more words in length. Uses compound and complex sentences. Describes objects. Uses imagination to create stories.

Young (2001) has observed that some children’s listening or auditory attending difficulties go unnoticed through the preschool years. They use compensatory skills, such as being alert to visual cues, noticing body language, and anticipating what will be said. These children exert more energy listening and have to be visually alert. They are sometimes mistakenly thought to be better listeners than other students because they try so hard. Children with CAPD usually have difficulty in carrying out telephone conversations, hearing announcements over loudspeakers, or understanding tape-recorded speech, presumably due to the lack of visual cues and mild distortion of sound in transmission. As mentioned above, activities with visual cues and less listening are preferred; for example, videos being preferred to audiotapes, and action games to listening to stories (Young, 2001). 2.5.4

The grade, primary school phase (6–13 years)

Children have to go to school to learn new information presented in a predetermined style and manner not of their choosing. They also have to learn to develop classroom language, which can be extremely difficult when burdened with severe CAPD (Raskind, Peter, Richards, Eckert, & Berninger, 2013). Grade 1 is usually the first time that children encounter education in large, formally arranged classrooms in which oral instruction is the primary method of teaching. In this grade, phonics is introduced and words must be separated into their individual phonemes or sounds. It is a difficult task for children with CAPD and they are usually slower than other children (Torgesen, 2000). One of the most compelling findings 50

from recent reading research is that children who get off to a poor start in reading rarely catch up; the poor first-grade reader almost invariably continues to be a poor reader (Torgesen, 2000). The consequences of a slow start in reading become monumental as they accumulate exponentially over time. As Stanovich (1986) and Young (2001) pointed out regarding Merton’s well-known paper on the "Matthew effect" (the “rich” getting richer and the “poor” getting poorer in skills acquisition) in respect of failure to acquire early word reading skills, such consequences may vary. They may entail negative attitudes towards reading, reduced opportunities for vocabulary growth (Nicolosi et al., 2006), missed opportunities for development of reading comprehension strategies, or less actual practice in reading than other children receive (Torgesen, 2000). It should be noted that the “Matthew effect” could by extension also serve as an apt metaphor for material, economic systemic support (touched upon in sections 2.8.4 and 2.8.5). Unless masked by the child’s extra efforts in being eager to please (as mentioned above) or by supplemental work at school or home (Young, 2001), a child who experiences significant CAPD difficulties in Grade 1 may begin falling behind, misinterpret oral directions, and fail to master sound-symbol relationships. However, children with CAPD often excel at mathematics until word problems appear (Gabay, Thiessen, & Holt, 2015). Learning problems are not all alike and have inconsistencies, but difficulty with learning to read and growing frustration usually lead to these children being noticed, identified, assessed, and helped. For other children with less severe signs and symptoms, the years between first and third grade act as a sort of grace period, when they manage to get by with eagerness to please and attention to non-verbal cues and gesture (Agus, Carrión-Castillo, Pressnitzer, & Ramus, 2014). Children who have CAPD often watch other learners when they have not heard what is said, and, by using compensation methods, they avoid being noticed and their difficulties go untreated. These children’s listening problems are associated with stereotypes and notions such as “boys will be boys” or “she listens only when she wants to” (Miller, 2011). When children cannot filter out background speech and noise, they may seem to have “selective hearing”. The redundancy or repetition often used in the teaching techniques of early schooling years, helps to hide signs of CAPD until senior primary school years. At this point, listening demands and pressures climb significantly and fewer picture cues may be used in textbooks and lessons (Young, 2001; Gabay et al., 2015). As the pace of oral instruction 51

increases, CAPD becomes more recognisable. The child can be frustrated, which can lead to lowered self-esteem, feelings of helplessness, and fear or failure (Young, 2001). Unfortunately, although parents and educators may perceive that some children are not strong auditory learners, these children’s inconsistent listening and auditory attending abilities make them seem wilful in their listening habits. There are factors that contribute to this perception: 

Fluctuations of ambient noise levels in the classroom vary considerably, causing children with CAPD to appear more easily distracted at times, compared with other learners (Gabay et al., 2015).



Educators’ voices may range from being 20 decibels louder or softer than ambient noise in the classroom, and learners’ ability to hear instructions is complicated by factors such as the distance between them and the educator, and the amount of reverberation in the room. The amount of reverberation depends on the size of the room and the number of reverberation surfaces such as hard floors, walls, and the flat surfaces of desks and chalkboards (Young, 2001).



Other factors that contribute to the degradation of speech presented in the classroom include the pace and pitch of the educator’s voice, the direction that the educator faces when talking, and the number of learners in the room (bodies absorb sound). Reverberation may also be exacerbated by the proximity of the classroom to noisy areas such as hallways, cafeterias or playgrounds, and the placement of the child in that room (Hazan, Messaoud-Galusi, & Rosen, 2013).

Because the compensatory techniques that learners use require a great deal of energy, they become fatigued easily. Fatigue further contributes to their processing dilemmas and can increase their frustration (Hazan et al., 2013). Some educators and parents may recognise the fatigue and will be able to deal with the core issue, while other children with CAPD feel overwhelmed. They may lose interest and divert their attention, making it seem to parents or educators as if they have ADHD. Children who experience CAPD may tend to be less able to process spoken language when they are tired, stressed, excited, or in transitions such as changing class or switching from one subject to another (Young, 2001). With all the above fluctuations affecting each learner and the learning environment, it is not difficult to understand the adverse effects of CAPD on a child’s education, particularly learning to read.

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For children with normal auditory processing abilities, the central nervous system effectively fills in missing parts of speech sounds or processing functions. This phenomenon is called language closure and the children have little difficulty in noisy situations (Catts, 1997; Catts, Fey, Tomblin, & Zhang, 2001), unlike children with CAPD who struggle to listen and attend, and who have to use coping and compensatory skills. 2.5.5

The high school phase (13–18 years)

Teenagers can experience CAPD in a number of ways. The written word is an extension of language information; it is the visual representation of auditory communication. Therefore, auditory processing difficulties can extend to reading and writing. It is in this way that CAPD can contribute to difficulties related to dyslexia (Young, 2001). Reading and learning difficulties have been identified primarily based on hearing problems (Torgesen, Roshotte, Alexander, Alexander, & McPhee, 2003). Therefore, teenagers with auditory difficulties may already have experienced feelings of struggle, panic, and other negative emotions associated with reading difficulties. Catts et al. (2001) report that preadolescent learners who encounter early reading problems often become less motivated, develop lowered expectations of their abilities, and gain less practise in reading than those who have good reading skills. Consequently, in their adolescence they may fall even further behind their peers in reading and academic achievement. Some teenagers are unable to filter out extraneous information and are therefore easily distracted. This leads them to miss much of what the educator is saying, become unable to follow along with the class, and quickly lose track of the information given out as the class progresses (Kamhi, 2011). Since they are constantly a few steps behind the class, they have to expend extra energy and focus trying to catch up. As in the primary school situation, fatigue sets in and reduces energy to deal with new information. Scarborough (1998) has also indicated that catching up with peers may take longer than learners expect. Feelings of frustration and hopelessness may then give rise to problematic behaviour requiring supportive intervention. 2.5.6

Adults with CAPD

That much less research information is published about adults than children with CAPD may be ascribed to the assumption that the problems children face are generally more severe than those confronting adults (Wijnen, Kappers, Vlutters, & Winkel, 2012). Although the processing abilities of adults with CAPD may never reach the level of those who do not have 53

this disorder, these individuals can ameliorate their difficulties to some extent by choosing life paths and environments enabling them to maximise their strengths. This is not to say that they completely overcome their auditory processing problems, but the linguistic demand is generally lessened with increased language use and well-considered career choices (Raskind et al., 2013). 2.5.7

Prognosis of CAPD

Among academics such as Catts et al. (2001), Kamhi (2011), Jerger and Musiek (2000), Torgesen (2000), and Khan (2006), opinions differ and varied emphasis is placed on issues relating to the exact nature, implications, diagnosis, and treatment of CAPD. Because it is internationally agreed that CAPD is problematic to define and that there are no universal guidelines for its assessment and management (Jerger & Musiek, 2000), a discussion of its prognosis is difficult. The lack of consensus on the assessment and management of this disorder can lead to over- or underdiagnosing its pathology, to inappropriate management, and consequently to unreliable prognoses. A study conducted by Khan in 2006 regarding the training of speech-language therapists in South Africa revealed significant shortcomings in linguistically and culturally appropriate instruments for CAPD assessment and management. Poverty was identified as the primary cause for the inappropriateness of instruments because of inadequate socioeconomic and educational resources – specifically for support of speech, language, and hearing development – which were even further depleted by the effects of the HIV/AIDS pandemic (Khan, 2006). Khan identified a cardinal need for the development of standardised assessment and management practice to ensure that the unique needs of the South African population would be fully addressed. Saleh, Campbell, and Wilson (2003), too, identified a critical need for a framework and guidelines that would facilitate a well-founded prognosis for individuals with CAPD in South Africa. It is evident from Khan’s study (2006) that speech-language therapists in South Africa are not receiving standardised education in the area of CAPD, which may be partly attributable to the international controversy about definitions and approaches. Abroad, Lewis et al. (2006) have referred to the need for a “gold standard” of research that could serve for academic seeding in universities to equip speech-language therapists with the necessary expertise to address CAPD. This would also aid in the capacity to frame a reliable prognosis.

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Irrespective of the controversy about the nature and prognosis of CAPD, there appears to be little doubt about the link between academic success (or failure) and reading skills both in normally developing children and in children with speech and language delays such as CAPD (Aaron, 1995; Kamhi & Catts, 2012). If this premise is accepted as plausible, it is highly significant that findings from studies of young children with language disorders have consistently indicated that the majority of them were still showing signs of language disorders, CAPD, or additional problems with learning in later life (Aaron, 1991; Kamhi & Catts, 2012). Such conclusions cast serious doubt on the hypothesis that the majority of children outgrow their early language disabilities. The question on how to provide schooling treatment and management strategies for these children leads to the topic of inclusive education. 2.6 INCLUSIVE EDUCATION: DEFINITION AND DESCRIPTION In 1990, the international community laid the groundwork for an initiative called Education for All with a view to ensuring inter alia the provision of free and compulsory education for all children of school-going age (Donohue & Bornman, 2014). Shortly afterwards, the establishment of democracy in South Africa in 1994 led to fundamental political and socioeconomic changes that had far-reaching effects on inter alia the important field of education. A cornerstone of the framework for providing services to all South Africans on an equitable basis was the development of an inclusive education system and the provision of education for all, including learners with disabilities, as reflected in the Constitution of the Republic of South Africa, Act No. 108 of 1996 (Republic of South Africa, 1996a). In the same year that South African became a democracy, the United Nations Educational, Scientific and Cultural Organisation (UNESCO, 1994) issued the Salamanca Statement in which the principle of inclusive schools for all children was endorsed. This was envisaged for all children despite individual differences, but also with the aim of providing support to learners who had special learning needs (UNESCO, 1994). Consequently, from the outset, the concept of inclusivity in South African education was deeply influenced by ideas and support from abroad, as will be explained below. Section 29 of the Bill of Rights in the South African constitution (Republic of South Africa, 1996a) rules on the fundamental right to education for everyone, but the detailed framework for an inclusive education system is set out in “Education White Paper 6: Special needs education: Building an inclusive education and training system” (Department of Education 55

[DOE], 2001). Broad in its scope, the policy attempted to address the diverse needs of all learners who experience barriers to learning and called for a significant conceptual shift based on the premise that all children, youth, and adults have the potential to learn, given the necessary support. This had to be achieved, as Donohue and Bornman (2014) noted, within an undivided education system for all learners, including those with disabilities, without a division between special and ordinary schools. Several initiatives have been embarked upon to facilitate the effective implementation of an inclusive education system in South Africa in recent years, particularly through two international donor funded pilot projects: The South African Finnish Cooperation Programme in the Education Sector (SCOPE), and the Danish International Development Assistance (DANIDA) programme. The SCOPE and DANIDA pilot projects were viewed by the Department of Education as experimental. They offered a field-testing learning experience that was to inform the implementation of Education White Paper 6 (DOE, 2001a). Through these projects, inclusive education was implemented from 2000 until 2003 in KwaZulu-Natal, the Eastern Cape, the North West, the Northern Cape, and Mpumalanga provinces. The SCOPE and DANIDA pilot project evaluation revealed that while inclusive education policy was considered the appropriate strategy for addressing the diverse needs of all learners in South Africa, the implementation of this policy and its complex reports (Da Costa, 2003; DOE, 2001) resulted in organisational turbulence inter alia because of the varied ways in which different schools approached implementation (i.e. in the mesosystem). For example, although an estimated 5% of the South African population had a disability, there was no consensus about how disabilities should be classified, while most school-going learners with disabilities were still in “special” schools – more than a decade after the publication of White Paper 6 (Donohue & Bornman, 2014). However, instead of seeking the reasons for this among schools, Donohue and Bornman (2014) argued that lack of significant movement on inclusive policy was due to lack of clarity in the policy itself, as well as poor implementation because of insufficient funding, guidance, and support provided by the DOE to provincial education departments (macrosystem). White Paper 6, for example, provided broad strategies with little guidance about effective policy implementation, and Donohue and Bornman noted research indicating that “some South African policies are enacted for their political symbolism rather than their practicality; thus, vague policies often get passed but no one is held accountable for their implementation” (DOE p.8). These difficulties can therefore also 56

be viewed from a systemic perspective regarding cascading effects from the macrosystem to the exo-, meso-, and microsystems, from policy level to the impact that policy has on the individual learner. Subsequently, the Department of Basic Education (DBE; one of the new divisions of the restructured previous DOE) adopted an implementation strategy consisting of two guiding components. The first was the “National strategy on screening, identification, assessment, and support” (SIAS) (DBE, 2014), which guided inclusive education policy by defining the process of identification, assessment, and enrolment of learners in special schools, thus curbing the unnecessary placement of learners in such schools. The SIAS strategy provided guidelines on early identification and support, the determination of the nature and level of support required by learners, and identification of the best learning sites for support. The strategy also provided guidelines on the central role of parents and educators in implementing the strategy (DBE, 2014). The second component of the implementation strategy was the “Guidelines for responding to learner diversity in the classroom through curriculum and assessment policy statements” (DBE, 2011), which provided practical guidance to school managers and educators on planning and teaching to meet the needs of a diverse range of learners. This document has recently been redrafted to incorporate curriculum changes in the CAPS (CAPS orientation programme for teachers and education officials in the provinces, 2014.) The Salamanca Statement (UNESCO, 1994) declared that an inclusive education system should “recognise and respond to the diverse needs of students, accommodating different styles and rates of learning and ensuing quality education to all through appropriate curricula, organisational arrangements, teaching strategies, resources, and partnership with their communities” (UNESCO, 1994, pp. 11–12). Despite the enabling policy described above, the implementation of inclusive education in South Africa was slow and only partial (Wildeman & Nomdo, 2007). The reasons for this were numerous, but related mainly to problems that affected the education system as a whole, the role of special schools and other support structures, and conditions of poverty (Donohue & Bornman, 2014; Engelbrecht, 2006; Stofile & Green, 2006). Viewed in the international context, Vaughn, Bos, and Schumm (2003) state that “the onus no longer rests on the student to ‘fit’ into the systems, but the educational systems to 57

transform so as to be able to accommodate and address the diverse needs of all the students so that each individual student receives an educational experience that ‘fits’” (p. 9). This view is corroborated in South African context by Donohue and Bornman (2014), who emphasise that [c]ontemporary teacher education in South Africa trains teachers how to accommodate diverse learners in a single classroom . . . This is in line with the social model of disability that views disability centrally as a social construct created by an ability-oriented environment. Disability, in this sense, sees the problem as located not in the individual, but in a societal, economic, political (and educational) system and culture that fail to meet the needs of these individuals . . . The social model is rooted firmly in the human rights paradigm, arguing for inclusion and the removal of all barriers that hinder full participation of individuals with disability. (p. 4)

These principles relate directly to this study in its investigation into the perception of five individuals with CAPD of their schooling careers, and whether they were of the opinion that such a “fit” had been achieved in their educational experience. Any “fit”, however, can only be interpreted meaningfully if viewed in the context of Bronfenbrenner’s (2009) bioecological model, as will be done later in this study. 2.7 CHAPTER SUMMARY This chapter provided a literature overview of the main themes relevant to this study. Bronfenbrenner’s (2009) theory was discussed for its value as a bio-ecological systems theory providing guidance for research into human development and growth, as well as its function in investigating the specific issue of CAPD. Normal auditory processing was then considered in terms of the peripheral auditory system and auditory neural pathways, after which SLDs and CAPD’s relation to them were taken into account. The literature on CAPD itself was surveyed regarding criteria for identification, aetiology, incidence, behavioural aspects, remediation, treatment management, stages, and manifestations of the disorder. Finally, inclusive education was touched upon to provide brief background on current sociopolitical and socioeconomic issues in South Africa in terms of their impact on education and learners with special needs. From the literature overview it could be inferred that CAPD is a highly complex phenomenon not only in terms of its physiological and psychological aspects, but also regarding the psychosocial ecosystemic attributes as set out by Bronfenbrenner. Controversy about 58

CAPD’s identification and aetiology makes clear-cut approaches to remediation all the more difficult, which points to an essential need for further research.

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CHAPTER 3 RESEARCH METHODOLOGY

3.1 CHAPTER PREVIEW This chapter discusses the research paradigm and design of the investigation. The selection of participants, the data collection approach, and the data analysis method are explained. Issues of trustworthiness and ethical considerations are outlined. The exploration of the experiences of five individuals with CAPD in an inclusive education system during their schooling careers from Grade 0 to Grade 12 was aimed at elucidating better ways of support for such learners within inclusive classrooms. Since various investigative approaches may be selected for a study of this nature, the use of a phenomenological perspective is explained. 3.2 RESEARCH DESIGN AND THEORY Because this study dealt with the analysis of personal perceptions of participants, an interpretative phenomenological research approach was indicated for the following reasons: The aim of interpretative phenomenological analysis (IPA) is to explore in detail how participants are making sense of their personal and social world, and the main currency for an IPA study is the meanings particular experiences, events, states hold for participants. The approach is phenomenological . . . in that it involves detailed examination of the participant’s lived experience; it attempts to explore personal experience and is concerned with an individual’s personal perception or account of an object or event, as opposed to an attempt to produce an objective statement of the object or event itself. At the same time, IPA also emphasizes that the research exercise is a dynamic process with an active role for the researcher in that process (Smith & Osborn, 2015, p. 53).

These principles will be related below to the approaches taken in this investigation. A phenomenological, multiple case study model was selected as a research design because of the appropriateness and flexibility of such a design for explaining social phenomena (Merriam, 2015). The phenomenological approach is not concerned with explaining causal relationships, but rather attempts to describe first-hand experiences of participants’ everyday world (Willig, 2008). Phenomenological research provides a richly detailed description of human experience as data, instead of facts that are constricted by statistical analysis (Pringle, Drummond, McLafferty, & Hendry, 2011). Therefore, the strength of a phenomenological study is that the results emerge from the participants’ own descriptions in the data (Willig, 60

2008). The benefit of a qualitative case study design is the emphasis on the uniqueness of each case, and the participants’ subjective experience (Stake, 2000). According to Creswell (2013), the disadvantages of using a phenomenological research approach are that the subjectivity of the data may lead to difficulties in establishing reliability and validity of approaches and information. It is difficult to detect or to prevent researcherinduced bias. There can be difficulty in ensuring pure bracketing, which can lead to interference in the interpretation of the data. Furthermore, Creswell notes, the qualitative nature of data in phenomenological research makes presentation of results difficult because such data are often not easy to display and explain in a manner that is usable by practitioners. When analysing the data, the researcher has to live with the uncertainty that clear patterns may not emerge, yet the voice of the participant is powerful and clear. It is often labelled as less credible research by non-researchers. The contention is that phenomenology does not produce generalisable data for a number of reasons, mostly because the samples are generally very small. It is argued that the researcher cannot be certain that the experiences investigated are typical. The advantages of phenomenological studies are that they facilitate the understanding of how and why an event is being lived or experienced. It aids researchers in being flexible and sensitive to changes that occur while the research is unfolding, and provides a good understanding of the social process (Creswell, 2013). Phenomenology entails the study of lived experience (Willig, 2008). As a research design, a phenomenological approach hopes to explore and describe the unique, qualitative phenomena of human experiences. A phenomenological study asks not only what the experience consisted of or how it can be described, but also how it felt to go through those experiences. It studies “the individual’s experience of the world” (Willig, 2008, p. 85). Literally, phenomenology is the study of “phenomena”, appearances of things, or things as they appear in experience, or the ways in which things are experienced, and is thus aimed at discovering the meanings that things have in experience. In brief, phenomenology studies conscious experience as experienced from the subjective or first-person point of view (Corbin & Strauss, 2015). Because the viewpoint taken by five specific participants was the subject of investigation, the case study method was employed. A case study is one type of observational data collection technique in which an individual is studied in depth in order to identify behavioural, emotional, and/or cognitive qualities that are universally true, on average, of others. Case 61

studies often include face-to-face interviews, paper and pencil tests, and other methods such as questionnaires (Creswell, 2013). Because it is aimed at individual participants, the casestudy method is highly compatible with phenomenological analysis. IPA is a method of data analysis that also allows exploration of the researcher’s own views while interpreting experiences in order to engage with scripts and findings, and to find themes and concepts within these findings (Willig, 2008). A strong subjective component is therefore involved in qualitative phenomenological research as an endeavour to describe a “lived experience” phenomenon (Taylor, Bogdan, & DeVault, 2015). Such qualitative analysis of narrative data differs considerably from the more traditional or quantitative methods of research. As Hara (1995) observed aptly: Quantitative and qualitative research approaches in education have arisen from different research needs. The quantitative research approach endlessly pursues facts while the qualitative research approach recognizes that the researcher’s viewpoint is central. The quantitative research approach is used when the researcher desires to obtain entire trends or statistical truth in the research while the qualitative research approach is used if the researcher wants to observe in detail by his/her own research viewpoint. (p. 351)

In this study, participants described their lived experience in non-directive interviews, unlike surveys or questionnaires that may have directed or suggested certain types of response. The participants were encouraged to attempt a full description of their experience, including their thoughts, feelings, images, sensations, and memories (Hansen, 2006; Smith & Osborn, 2015). The researcher tried to obtain their stream of consciousness and their perception of their schooling careers. The first principle of analysis of phenomenological data is to use an emergent strategy to allow the method of analysis to follow the nature of the data itself. This precipitates an understanding of the essential meaning of the experience and allows the researcher to use a common approach that forms the themes (Smith & Osborn, 2015). In the theme analysis, meanings rely on socio-cultural and linguistic or artistic context. This is one way to describe the participants’ lived experiences. By analysing the data, emergent themes can be formed (Smith & Osborn, 2015). Another way is to include the participants’ lived experiences into an existing theory such as Bronfenbrenner’s (2009) model.

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Bronfenbrenner (2009) provides a valuable framework to the researcher for the formulation of themes after the analysis of findings and the discovery of recurrent concepts as common threads. He argues that in order to understand human development, one must consider the entire ecological system in which growth occurs (Bronfenbrenner, 1997). As explained in section 2.2, the system is composed of five socially organised subsystems that help support and guide human growth. They range from the microsystem, which refers to the developing relationship between a person and the immediate environment such as school and family, to the macrosystem, which refers to the institutional patterns such as the economy, customs, culture, and bodies of knowledge, with the chronosystem representing changes occurring over historical time. Schostak’s (2002) description of qualitative research may be useful in underscoring the relevance of Bronfenbrenner’s approach because of the emphasis on the principle of a web (system) of interrelatedness: A qualitative research project explores the ways through which a “self” and its “world” are constituted and coordinated through an imaginative grasp in relation to experiences of “Reality”. What “ties” them together are the intricate web of purposes, motives, interests, needs, demands, feelings and so on structured by the language we use to express ourselves to others and by which we orient our behaviour with theirs and they with us in a world of material structures (Schostak, 2002, p. 18).

This principle also forms a valuable bridge with the research paradigm. 3.3 RESEARCH PARADIGM This study used a qualitative, interpretative, phenomenological research paradigm whose purpose can be summed up as an endeavour to understand social worlds from within (Fuchs, Fuchs, Mathes, & Simmons, 1997; Taylor et al., 2015). The essence of qualitative research lies within the interpretative tradition (Creswell, 2013) in that a qualitative study provides the opportunity for the use of rich descriptive narrative (see section 4.1) to interpret the words and nuances of participants’ responses and reflections during an investigation (Taylor et al., 2015). This research correlates with the qualitative, interpretative phenomenological research paradigm in having been aimed at the exploration of the experiences and perceptions of five learners with CAPD throughout their schooling careers. The interviews held with the learners, now young adults, enabled the researcher to view their experiences of struggling academically and not feeling confident in their academic abilities, and also provided the

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researcher with a detailed view of how the participants adapted in order to cope with their disorder. It is often said that qualitative techniques appear from phenomenological and interpretative paradigms, with the emphasis being on constructivist approaches where no clear-cut objectivity or reality needs to be investigated (Cassell & Symon, 1994). According to Cassell and Symon (1994), qualitative research is “less likely to impose restrictive a priori classifications on the collection of data”, and thus, research is “less driven by very specific hypotheses and categorical frameworks, and more concerned with emergent themes and idiographic descriptions” (p. 2). 3.4 PARTICIPANT SELECTION Working as a private practice speech-language therapist renting rooms at a government preparatory school in Johannesburg in 1999, the researcher enrolled at the University of the Witwatersrand for master’s research aimed at validating a checklist she found herself using often while screening all the reception-year learners in the school for CAPD. The research, which eventually came to involve 191 participants from five different schools, had to be suspended at that stage because of complications with statistical variables relating to bilingualism in the schools, and also because of a change in the researcher’s employment and personal circumstances. Five learners from one of the schools showed signs of severe CAPD on standardised screening tests and were provided supportive interventions at the school which the researcher had changed to. The standardised tests included the Early Identification of Language-based Reading Disabilities checklist, which will be described in detail below, the ESSI reading and spelling test, and the Nelson test of reading comprehension (Catts, 1997; Esterhuyse & Beukes, 1997; Nelson, Jones, & Griffin, 2003). For this initial study, ethical clearance was received from the University of Witwatersrand’s Human Research Ethics Committee, the children’s guardians, and the schools’ governing boards. Once settled in her new professional life and continuing her career, the researcher became aware that these five learners had completed their schooling careers and the current study was aimed at providing them, now as young adults, with an opportunity to reflect on their school performance, and the effects of CAPD on their learning and general academic progress. Purposive sampling is defined as choosing the sample for a specific reason (Leedy & Ormrod, 2010). Whereas random sampling is mostly used for surveying large groups with statistical generalisation in mind, purposive or purposeful sampling is aimed at the selection 64

of information-rich sources (DeMarrais & Lapan, 2004). For this study, participants were purposefully selected with the criteria of manifesting with severe CAPD on the Catts screening checklist in their reception year (Catts, 1997). Five of the 120 students who seemed to present with language-based barriers to learning in the Catts screening checklist were chosen. All five of the participants were reported by their educators to have the following or similar difficulties: 

speech-sound awareness problems, defined as difficulty rhyming or recognising beginning sounds;



word retrieval difficulties, including poor memory for names or problems retrieving verbal sequences;



auditory memory difficulties, such as difficulty following instructions or directions;



comprehension issues, resulting in difficulty in understanding questions or ageappropriate stories; and



expressive language issues, which cause stories or events to be related in a disorganised or incomplete manner.

3.5 DESCRIPTION OF THE FIRST RESEARCH INSTRUMENT A two-page checklist consisting of 39 questions was used. This checklist, designed by Hugh W. Catts (1997), University of Kansas, is aimed at identifying children who are at risk for language-based reading disabilities. Sections B, C, and D in particular are focused on important auditory processing skills. The checklist is intended for use with children at the end of nursery school and the beginning of Grade 1. Therapists or educators completing the checklist are required to consider each of the descriptions carefully and check those that characterise the child’s behavioural history. The checklist is made up of the following sections: A: Demographic questions B:

Descriptors of the child’s speech-sound awareness

C:

Descriptors of the child’s word retrieval skills

D:

Descriptors of the child’s verbal memory skills

E:

Descriptors of the child’s speech production skills 65

F:

Descriptors of the child’s comprehension skills

G: Descriptors of the child’s expressive language skills H: Descriptors of the child’s family history 3.5.1

Submission of checklist to the Human Research Ethics Committee

In accordance with the Code of Ethics for Research on Human Subjects, the checklist, together with the covering letter and consent forms, were submitted to the relevant University Committee to ensure that the participants’ physical, social, and psychological welfare would be protected and their dignity and privacy respected. 3.5.2

Pilot study

Creswell (2009) recommends that the feasibility of a research project and related practicalities should first be assessed in a pilot study, along with concept correctness, adequacy of method, and measurement instrument. For this investigation, the questionnaire was submitted to a class in the first term of Grade 1 (with the educator and class being excluded as participants in the field study to ensure greater objectivity). The purpose of the procedure was to assess the appropriateness of the checklist and to ascertain whether it did indeed test the concepts and theories concerned. The pilot study related to the original part of the research and added information to the five-case study research as it provided in-depth knowledge of the original screening tool. It yielded information such as the length of time required to complete the profile and the training needed to complete the questionnaire. Informed by the pilot study, the researcher decided to have an initial interview with each educator concerned. An introductory interview to explain the questionnaire was therefore held with each educator involved in filling out the checklist on participants in the final research. 3.6 DATA COLLECTION METHODS The primary method of data collection for this study involved semi-structured in-depth interviews with each of the five learners and their parents. This method of data collection was complementary to a phenomenological case study research design (Stake, 2000; Willig, 2008). Anecdotal data from teachers, the participants, the parents of the participants, and the researcher in the form of documents and artefacts were used to supplement and support the interview content. These documents dated from the period when the participants were at 66

school and were part of a previous research study. Field notes were kept of all the researcher’s reflections. Tests were also done on four of the participants in Grade 1 and again in Grade 2 (but not on the fifth participant, whose remedial school did not approve of extra tests). These tests were used for two reasons: Firstly, it allowed the researcher to establish a working relationship with the educator and, secondly, it gave the researcher a quantitative baseline of the participants’ reading and spelling skills to determine whether the educator’s perception of these skills corroborated the test scores. 3.6.1

Interviews

As Radnor (2001) observes, interviews as research tools may assume four main forms: structured (content organised in advance with predetermined sequence and wording), unstructured (open situation with greater flexibility), non-directive (minimum direction and control), and focused (concentrating on subjective responses to a known situation). Radnor recommends a semi-structured format primarily aimed at active listening by the researcher in an atmosphere that encourages free talking. To ensure that the participant has been clearly understood and to elicit rich data from the interview, the researcher should encourage the participant to give feedback and provide concrete examples (Radnor, 2001). In this study, interviews were held with each of the participants as young adults. These interviews were semi-structured, as recommended by Radnor (2001), to obtain participants’ perspective on and experience of the subject matter (Corbin & Strauss, 2015). The questions were shaped to a large degree by the interactions between the researcher and the participants (Radnor, 2001). Comments made in passing by the participants or their parents, while setting up and explaining the interview process, were also noted. Parents were granted time and opportunity to speak informally with the researcher to ask questions and explain their feelings and viewpoints. Mostly open-ended questions were used as they allowed for a free flow of information from participants and enabled the researcher to obtain in-depth narrative data (Leedy & Ormrod, 2010; Radnor, 2001). 3.6.2

Interview guiding questions

The following questions served to guide the interview: 1. The term “perception” is used in the title of this study. Perception is your view of a situation. What was your perception of your academic career? 67

2. What emotions and feelings do you associate most with about you schooling career? 3. Explain the manner in which you handled these emotions. 4. Did your behaviour change because of your perceptions of school in high school? 5. Were you told you had auditory processing problems? 6. Describe the manner you found out about your difficulties. 7. Would you have preferred another manner? 8. What plan or support did your parents or school give you because of your diagnosis or emotions? 9. Did you have questions about your difficulties and school? 10. Elaborate. 3.6.3 Documents and artefacts A portion of the data consisted of documents and artefacts, also known as anecdotal data. These are written data sources that are accessible by the researcher (Merriam, 2015). Examples of such documents are class speeches, tests, reports, class workbooks, and memos. The tests included in this data set were the ESSI reading and spelling test (Afrikaans and English), which was developed to replace the well-known UCT reading and spelling test standardised in 1944 (Esterhuyse & Beukes, 2002). The ESSI reading test (Esterhuyse & Beukes, 2002; see Appendix C) was used for assessing the formal oral reading abilities of the research participants in this investigation. Based on single-word reading, this test was originally developed for South African children from former model C schools (inclusive educational settings). A list of 20 to 25 single words is provided for each grade from Grade 1 to Grade 7; for example, the R2 list is specifically for Grade 2 learners and the R1 list for Grade 1 learners. It needs to be noted that the school at which the current research was conducted used no formal tests to assess reading ability, putting into question the accuracy of the educators’ subjective evaluations of learners’ literacy ability. Research was mainly directed at single-word reading or at reading comprehension (Catts et al., 2001), but not at both. Oral reading was selected, as errors may escape notice when learners read silently to themselves (Young 2001). The ESSI spelling test (Esterhuyse & Beukes, 2002) was used to assess the participants’ written spelling abilities. Similar to the list for the reading test, a spelling list of 20 to 25 words is provided for each grade. Permanent records of tests that the school’s learners wrote 68

weekly on Fridays was thus available for qualitative analysis. Researchers such as Hulme and Snowling (2009) have utilised written spelling measures in their test battery. A spelling assessment was included in the current assessment protocol because there was clear evidence that phonological awareness, auditory processing, and spelling performance were linked (Hulme & Snowling, 2009). The NFER-Nelson (also abbreviated as nferNelson) group reading test (forms A and B) is a popular short screening and monitoring test that allows one to measure the reading comprehension of children and compare their performances to those of their peer group. Employing everyday language and situations, it is easy and quick to use and has alternative forms to prevent copying and allow retesting (Nelson & Griffin, 2003). 3.6.4

Data recording

The researcher carefully recorded the data obtained on the five learners’ subtests during the testing period, using specified formats. A separate form was utilised for each individual participant on each individual assessment measure using the formats as discussed below. Responses to the ESSI R1 and R2 reading list (Esterhuyse & Beukes, 2002) were noted on the record form supplied in the test manual (Appendix B). Recording of responses was conducted as suggested by the test manual and a note was made of the word that was read. The researcher later calculated the participants’ scores out of 20. Participants recorded their responses in pencil to the items in the ESSI 2 spelling list on the record form supplied in the test manual (Esterhuyse & Beukes, 1997; see Appendix B). The responses for the NFER-Nelson comprehension test were also recorded in pencil on the form supplied. It was scored according to the test manual and calculated out of the number of items the learner completed (Appendix D). 3.6.5

Data analysis

The primary aim of IPA as a research design and paradigm was explained in section 3.2. Here more attention will be paid to IPA as a data analysis method that is aligned with interpretative phenomenology and qualitative interpretation. Analysis requires close interaction between analyst and text: the analyst seeks to comprehend the presented account while concurrently making use of his or her own “interpretative resources” (Smith et al., 1999, p. 223). Smith

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(2004) argues that the quality of the final analysis is determined by “the personal analytic work done at each stage of the procedure‟ (p. 40). Smith and Osborn (2015) have remarked that IPA emphasises sense-making by the researcher, using in-depth qualitative analysis – rather than quantitative and experimental methodology – to examine how people think about what they are experiencing. As also recommended by Willig (2008), the researcher processed and interpreted data collected from qualitative interviews in order to identify patterns and categories from which overarching themes relating to the research question could be grouped and clarified. Zhang and Wildemuth (2009) provide a valuable overview (only outlined here) of the sequential steps that should ideally be taken in qualitative content analysis to condense raw data into themes: 

The data are prepared, usually through transcription.



The unit of analysis is defined; in other words, it is decided what type or unit of text should be used for classification during content analysis. Any word, phrase, sentence, paragraph or document may serve as coding unit to work towards a theme.



Categories and coding schemes are developed from raw data, using inductive content analysis.



The coding text is tested by coding a sample of data and checking for coding consistency. The coding rules are revised if the consistency level is low.



If the consistency is found to be satisfactory, all the text is coded.



It is ascertained that new codes have not been added and that categories and coding rules have not changed (consistency checking).



Now conclusions can be drawn from the coded data to make sense of the themes or categories identified. This is the critical step in the analysis process.



The methods and findings are reported, which in qualitative content analysis should not be about producing counts and statistical significance, but about uncovering meaningful patterns, themes, and categories as relating to a social reality. (Zhang & Wildemuth, 2009.)

Thus, IPA served in this study as a data analysis method aimed at describing the phenomena of CAPD throughout the five participants’ schooling careers. Through qualitative analysis of the content of the learners’ thoughts and feelings, themes could be identified within the data sources (Corbin & Strauss, 2015). The process was divided into three steps:

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The scores obtained by remaining learners/participants who did not leave for another school were calculated for ESSI reading as well as ESSI spelling tasks (Esterhuyse & Beukes, 1997), and the researcher collected and noted all the information given in the narrative data that had been derived from the interviews.



The information was then sorted into categories by grouping the data into manageable units with a similar theme.



These groups were then analysed and compiled into meaningful themes.

Figure 3.1 (Saldaña, 2009) shows that codes can be categorised and that categories can be mapped into themes or concepts and fitted within theory. As presented by Saldaña (2009), the model shows an inductive process where theory is developed from code.

Figure 3.1 Codes-to-theory model (Saldaña, 2009, p. 12)

This research explored the participants’ educational environment and their perception of their schooling careers. It consisted of a set of interpretative, material practices that made the participants’ world visible. Through interpretation of the raw material, including field notes, interviews, conversations, photographs, recordings, and self-reminding memos, the researcher tried to turn the participants’ world into a series of representations. At this level, qualitative research involves an interpretative, naturalistic approach to the world. This means that qualitative researchers study things in their natural settings, attempting to make sense of, or to interpret, phenomena in terms of the meanings people bring to them (Saldaña, 2009). Pursuing the same avenue of investigation, the researcher strived to arrive at 71

phenomenological assumptions that brought meaning to the information in the form of themes and categories (Mayring, 2003). Table 3.1 is an example of raw interview data used for “unit” analysis (significant words, sentences, ideas) to formulate concepts and codes for the establishment of categories. Table 3.1 Interview data for coding

…also not great too, because when I left and had to start Afrikaans it was ... mmm ... really bad. 15. I

Ok good. Did you pass?

16. S I thought I would never pass, I think I like just made it in matric. 17. I

Anything else?

18. S Well mmm. [laughs] My friends were much better in high school. It was hard at [name deleted] because my friends, my family, were with, were all at [name deleted] and Jewish holidays, were different, I felt like I missed out on my friends. 19. I

When you see these books in front of you what do you think?

20. S I think these? (Thank God, I don’t have to see them anymore) I don’t have to do this or read this. Maybe I should have worked harder but school did not understand me and I did not understand what was so important about school. Most of school I felt was a waste of my time. I suppose I could have work harder. 21. I

Now that you…

The strength of qualitative content analysis is that it is strictly controlled methodologically and that the material is systematically analysed (Denzin & Lincoln, 2011). The core tool of any content analysis is its system of categories: every unit of analysis must be coded and allocated to one or more categories. The researcher was able to formulate categories as colour-coded in Figure 3.2, which will be explained in Chapter 5 under discussion of results (compare also Figures 3.3, 5.1, 5.2, 5.4, and 5.5). 3.6.6 Formulation of categories A major challenge of the education system is to understand the complexity, influences, interactions, and interrelationships between the individual learner and multiple other systems. There is continuous, dynamic interaction between the multiple contexts that has an influence on learners’ development (Donald, Lazarus & Lolwana, 2002). In the field of inclusive education and in this research, Bronfenbrenner’s (2009) ecological model has special 72

relevance because of the interaction between the development and growth of an individual with CAPD and the general social context as expressing itself in systems. An important aspect of Bronfenbrenner’s model is the understanding that individuals are also active participants in their own development and that environmental effects do not merely leave their imprints on passive individuals.

Figure 3.2 Formulation of categories

Learners’ perceptions of their living and learning context are central to understanding how they interact with the environment (Swart & Pettipher, 2005). To uncover key patterns in participants’ perception for the development of a category system, it was necessary to rely on two procedures: inductive category development and deductive category development (Mayring, 2003). With the former, the theoretical background and the research question are used to define a criterion for the relevant aspects of the textual material that should be taken into account. The text is perused according to this criterion and categories are “constituted” tentatively and systematically. Within a feedback loop, the categories are revised, eventually reduced to main categories, and checked for reliability (Mayring, 2003). With deductive category development, categories may with equal validity be derived from theory that is formulated beforehand and tested against the text (Mayring, 2003). The researcher used the inductive system of summary and coding with the deductive categories from 73

Bronfenbrenner’s theory. From the above procedures, the researcher was able to categorise the information as illustrated in Figure 3.3.

Figure 3.3 Categories for analysis as reflected in Bronfenbrenner’s model (Adapted by the researcher for the purpose of this study from Bronfenbrenner, 2009)

The coding of data that was synthesised both in an inductive and deductive manner strengthened the trustworthiness of the research. 3.7 TRUSTWORTHINESS Trustworthiness refers to the degree to which the results of a study can be generalised to other contexts (Denzin & Lincoln, 2011) because of the reliability of the findings. Trustworthiness strengthens the validity of a study’s argument (Corbin & Strauss, 2015), as well as its credibility and objectivity. A sound research definition of trustworthiness considers it to be “[d]emonstration that the evidence for the results reported is sound and when the argument made based on the results is strong” (Lincoln & Guba, 1985, p. 330). Taylor et al. (2015) suggest four criteria to ensure valid interpretation of data, namely truthvalue, applicability, consistency, and neutrality. In the qualitative approach, truth-value is measured by credibility, which means an adequate engagement in the research setting so that recurrent patterns in data can be properly identified and verified. Applicability, these authors continue, is established by transferability, which allows readers to apply the findings of the study to their own situations. Since the perspective of qualitative researchers is naturally biased because of their close association with the data, sources, and methods, various audit strategies can be used to confirm findings (Creswell, 2009). Therefore, trustworthiness of 74

interpretations and findings are dependent on being able to demonstrate how they were reached (Taylor et al., 2015). Trustworthiness in this study was obtained by using Lincoln and Guba’s (1985) model of credibility, transferability, confirmability, and dependability. Triangulation of multiple data sources, member checking, audit trails, and the researcher’s reflective journal were used to ensure trustworthiness of this study (Taylor et al., 2015). Triangulation entailed the collection of data from different sources and also involvement with the participants over an extended period of time. Member checking required feedback from the participants on the information collected and the conclusions drawn by the researcher (Grinnell & Unrau, 2005). As recommended by Grinnell and Unrau (2005), a journal with the researcher’s field notes was kept and discussions within the tutor groups were held about interesting incidents. The journal also served as a means for recording an audit trail, which showed prolonged engagement and rich descriptions of observations. Peer debriefings, interviews, and discussions were also conducted to supplement any insights. Credibility refers to establishing that the results are believable from the perspective of the participants in the research (Taylor et al., 2015). Hansen (2006) notes that credibility relates to internal validity through assessment and examination of findings and interpretations to see whether they cohere in a form of “truth” (p. 49). In this study, it was pursued through prolonged engagement with the participants, namely reports on their 12 years in the schooling system. Member checks were done by submitting the results to the participants for approval once the study had been completed. The results were discussed with the participants, who expressed their satisfaction that the researcher had understood their perception of their schooling careers correctly. Transferability concerns generalisability of the findings, which is rarely possible in qualitative studies, as Hansen (2006) points out: The results from qualitative research are rarely generalisable. To be generalisable, quantitative projects require significant statistical power and large, often randomised samples. However, the results from qualitative research are derived from relatively small purposeful samples and presented as interpretation and description. Therefore, they cannot be described as generalisable. Nevertheless, the results from qualitative research may be transferable. They should be understandable by others and recognisable. If the study context, methods, sampling and results are clearly outlined, it is possible for the reader to decide if the results are relevant to other similar situations. (p. 48)

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Because this study was conducted over an extended period, its findings should be applicable to similar cases concerning small sampling groups of learners in private schools. Confirmability refers to the degree to which the results can be corroborated by others, and it is considered to be high when findings in research can be confirmed by other sources in the literature (Taylor et al., 2015). According to Hansen (2006), confirmability also concerns the difficult question of neutrality in research, which can be strived after through the avoidance of distortion and maintaining a reflexive analysis. In this investigation, the researcher endeavoured to follow these guidelines consistently. Dependability emphasises the need for the researcher to account for the ever-changing context within which the study occurs and how these changes affected the way in which the researcher approached the study. This is usually done with the use of an audit trail or logbook (Taylor et al., 2015). In this study, the researcher strived to observe Hansen’s (2006) recommendation to provide a clear account of the research process followed, which will enable readers to judge research dependability. The researcher recognises limitations in the study methods and their potential effects on the investigation. In this study, the long-term observation of the learners and perceptions needed to be identified by the researcher, and the researcher’s own beliefs and assumptions needed to be bracketed (Corbin & Strauss, 2015). Peer scrutiny and debriefing, defined as a discussion of the researcher’s interpretations and conclusions with other peers (Taylor et al., 2015), were also carried out. 3.8 ETHICAL CONSIDERATIONS Ethical clearance for this investigation was obtained from the Research Ethics Committee of the Faculty of Education at the University of Johannesburg (Appendix A, 2013-2015). In accordance with the Code of Ethics for Research on Human Participants, the checklist, together with the parents’ letters and consent forms, were submitted to the Ethics Committee to ensure that the participants’ physical, social, and psychological welfare would be protected and their dignity and privacy respected. The principles of ethics covered the concepts of informed consent, voluntary participation, right to withdraw, no form of payment, and explanation of any risks or benefits of being involved in the study (Babbie, 2004). The participants’ anonymity was respected throughout, and they clearly understood that their participation in the study was voluntary and that they had the right to withdraw at any time 76

(Corbin & Strauss, 2015). Confidentiality was followed and pseudonyms were used in reference to the participants in all documentation arising from the investigation. Extra support was provided to all participants if requested. The interview time did not extend beyond an hour and the tests did not last more than half an hour. All data will be kept in a safe place and will not be accessible to any unauthorised persons. Once the research has been completed, all relevant material will be destroyed. Information sheets and consent forms (Appendix A) were hand-delivered to the potential participants, whose parents or legal guardians signed the consent forms as proof of willingness to participate in the study. Open communication was taken into account and participants could contact the researcher directly (Babbie, 2004). 3.9 CHAPTER SUMMARY This chapter outlined the research design and methodology of the study in detail, with special emphasis on the function of IPA in qualitative investigations such as this. The purpose of an interpretivist research design was elucidated and linked with the specific aims of this study. The useful role of case studies was touched upon, and the relation between participant selection and purposive sampling was explained. A discussion of the research methods detailed the data collection and analysis approaches, entailing interviews, documents, artefacts, and recording. Special note was taken of qualitative content analysis as a guiding framework. The elements of trustworthiness were specified, and compliance with the necessary ethical requirements for a study of this nature was confirmed. In the following chapter, the researcher will give a narrative summary of each participant.

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CHAPTER 4 CASE NARRATIVES

4.1 CHAPTER PREVIEW This chapter presents the case narratives that resulted from the interviews with the five participants in the study regarding their perspectives of their schooling careers. The narratives were structured from the raw data of the interviews as also reflective of the interaction between the researcher and the participants. The raw data are kept in a secure, tamper-free environment in sufficient detail to enable any expert to address queries related to the data or the research. Since qualitative research entails investigation into a social world, stories as narratives assume fundamental importance in leading to insight and understanding of the phenomena being considered, as Hansen (2006) has observed. Narrative analysis enables researchers to mine the richness of qualitative data about the values and perceptions of participants from their own perspective. As in studies explicitly aimed at employing narrative to explore the experience and understanding of others (Hansen, 2006), this study features a collection of information that should lead to the better accommodation and support of learners with CAPD in the inclusive classroom. Pseudonyms have been used to ensure anonymity. 4.2 FRIK At the age of five and a half, Frik was in reception year in 1999. He scored poorly on the early identification of language-based reading disabilities screening checklist (EILBRD), which was graded by his educator. Frik presented with sound-letter recognition difficulties, auditory blending, auditory analysis and synthesis difficulties, as well as problems with auditory memory, poor receptive and expressive vocabulary, and weak sentence structure. These skills were found to be below average compared with those of his peers. Frik’s educators and speech therapist, who worked privately at the school, recommended intensive therapy for language and auditory processing issues, as well as a full assessment. Frik was fully assessed by a private educational psychologist. It was recommended that he leave his current school and attend a school that specialised in helping children with learning disorders. He was accepted at a private, remedial institution where he continued his schooling career until Grade 7. Frik was diagnosed with ADHD by a well-known psychiatrist in Johannesburg who prescribed Ritalin. 78

At the remedial school, the pace of work was slower than in a mainstream school. It was recommended to Frik’s parents that extramural activities be kept to a minimum, and that school hours include therapies such as occupational and speech therapy. The occupational therapist worked on his motor output for writing and the multiple processing skills needed for tasks such as spelling, creative writing, and dictation. The speech therapist and remedial therapist focused on auditory processing, letter recognition, and sound blending from gross to finer levels of spelling in the classroom. Frik’s parents, educators, and therapists worked closely together and understood his needs and abilities. In Grade 7, Frik returned to a mainstream school where he stayed until Grade 12. He stated that at the remedial school he felt inadequate about his schoolwork but was not afraid to attempt academic tasks. While attending the remedial school, Frik realised he was not at the same school as his brother, but understood that it was necessary for him to attend a school that suited his abilities. Frik also felt that while at the remedial school, he was not able to attend some of the Jewish holiday and social events offered at his initial school. Frik considered high school more pleasant than primary school, as he was reunited with his friends. The greatest difficulty in high school for Frik was to tackle Afrikaans as a second language for the first time, as it was not a primary school subject for him. The academic work in high school was also more demanding and more difficult for Frik than that of primary school. Frik felt that he did not understand what was important about school. He was misunderstood academically in high school and felt labelled as lazy, naughty, or uninterested. In primary school, Frik felt understood, while high school made him feel irritated and gave him feelings of regret and shame. He passed matric without university entrance. Frik felt some relief when he decided he wanted to go to Israel and join the Israeli Defence Force. In Israel, Frik experienced the same feelings of shame, fear, and irritation because he was to write a Hebrew language examination in order to gain admission to the army. His Hebrew skills were inadequate and he failed the examination. Frik had to come back to South Africa but was later informed that he could return to Israel in order to rewrite the examination. This time around, he passed through using resources such as a personal supervisor, doing verbal work instead of written assignments, as well as recording lessons instead of taking notes. Frik applied the techniques and strategies that he acquired in school and he felt that he was finally able to understand his difficulty with focusing, attending, and

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processing. Frik was allowed a special dispensation for spelling, as well as extra time for his Hebrew examination. 4.3 GREG Greg was screened in Grade 0, at the age of six, using the EILBRD checklist. It was noted that he had various difficulties. The school recommended that he attend speech and occupational therapy and discussed the possibility of his repeating the reception year. Not repeating the year, he continued to Grade 1 in a mainstream school but still attended both speech and occupational therapy. Greg was diagnosed with low muscle tone, which caused him to fidget because of physical fatigue during learning. However, no attention deficits were identified. Other difficulties diagnosed were auditory difficulties, including poor auditory skills such as rhyming, recognition of sound–letter correspondence, and poor memory for names. Greg’s receptive and expressive language was also below average for his age level. Poor expressive sentence structure and vocabulary as well as articulation errors, such as a lateralised “s” sound, were cited on the checklist by teachers and later in formal assessments by professionals. Greg experienced high stress in Grade 1, and in Grade 3 he moved schools twice. He was eager to change schools because he felt he did not fit in at the school he was. He tried the second school, but was only there for three days, finally settling in at the third school. This new school allowed him to experience a few days in Grade 2 and a few days in Grade 3, then gently encouraged him to repeat Grade 2. Greg remembers this as being his choice and feeling empowered by it. He continued with extra lessons and therapy that focused on building auditory and language skills, as well as writing practice. Greg felt very cared for and understood in his new school, and experienced no further problems in primary school. Greg moved schools again for high school because both he and his parents wanted him to attend an all-boys school where he could have more sports opportunities, as well as gain a sense of tradition, community, and camaraderie. Greg became very involved and talented at sports despite his low muscle-tone diagnosis. He played cricket and rugby, and practised tae kwon do. He enjoyed the sense of solidarity and companionship that sports provided. Greg did feel, however, that at the all-boys school, classes were noisier and that there was less focus on academic subjects and more on sports. He was very happy until he sustained an incapacitating rugby injury, which stopped him playing for at least a year.

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Greg felt very unsettled. His previous routine fell into disarray; he had too much “down time” and no longer felt like a part of the school. Greg changed schools one last time at the beginning of Grade 11 to a small, private, co-ed school. Although he missed the school spirit and tradition of the all-boys school, Greg enjoyed the family-like atmosphere of the new school and was able to benefit from the one-on-one teaching in the smaller classrooms. At the end of Grade 11, his self-perception altered and he realised he was capable of a university pass, and possibly some distinctions. Greg matriculated with a university pass and a distinction in mathematical literacy; he also obtained 78% for English and was delighted at this result. Greg confessed that he was never sure if he was capable of achieving a good Grade 12, as he understood that he had spelling and reading difficulties. He did not recognise it as an auditory processing disorder. Greg stated that it was of utmost importance to find a school that fits your personality, otherwise school can feel like a prison sentence. 4.4 PAUL At the age of six, in reception year, Paul was recognised as having barriers to learning. He was tested in Grade 1 and again in Grade 2 by means of the ESSI and NFER-Nelson (Appendices C & D), which confirmed that he had reading and spelling difficulties. Paul attended speech, occupational, and remedial therapy that included work on auditory processing, including sound–letter recognition, sequencing, and blending of sounds. It was recommended that he stay behind in his reception year. His parents disagreed however, as they intended to emigrate to Perth, where the school year started in June, so Paul would repeat the first half of the year regardless of what year he was in. Paul continued with therapy for the first three years of primary school, focusing on reading and writing skills. Paul knew he was not as good at reading as his classmates and was constantly called out of class for reading supervision, which focused on sounding out and citing words, but also techniques such as visual closure, language closure, and cues. Paul presented with auditory processing difficulties and many other symptoms of specific learning difficulties. Paul was found to have poor organisational skills and often needed to be reminded when it came to organising his uniform, homework, or things that needed to be brought to class. Paul’s parents were encouraged to help him prioritise and organise himself for the next day. This is a strategy he claims to still be using as an adult. Paul’s family emigrated at the end of his Grade 3 year to Australia. Paul had many negative feelings about his ability and his past schooling career. He started school in Australia feeling 81

fearful and “not very grounded”. Paul was afraid to move in the middle of the year and he compared it to coming into a movie halfway through: “You never get the whole picture”. However, after a month at the new school, he felt fortunate because he started his third-grade school year again and therefore felt as if he had not missed anything. The teachers were supportive and caring, they understood that he had learning barriers, and helped him manage his timetables. The school in Perth made much use of technology. Paul’s parents consistently received emails and texts that enabled them to help him complete work on time, plan for tests, and remember academic and social events. Paul did not have to take as many notes, as notes were printed and given out, and he was granted spelling dispensations in all of his subjects, except for English. The school held many writing workshops throughout his schooling career and he learned how to structure essays. Paul made a good group of friends and played sports. He enjoyed school and felt that he was supported and understood. Paul matriculated with good results and is currently pursuing a law degree at university. He acknowledges that he still has a problem with written self-expression but feels that he is still able to achieve academically because he focuses on completing the tasks and is not concerned with achieving maximum marks. 4.5 ELIZA Eliza was the only female in the case study group. She was recognised to be at risk for reading problems on the EILBRD checklist in her reception year at the age of six. After a full psychological assessment, it was recommended that she attend speech and occupational therapy. Eliza was identified as having auditory processing difficulties relating to auditory memory for words and numbers, auditory blending, auditory analysis and synthesis, and visual processing, visual-spatial, and visual sequencing abilities. A family history from her father and paternal grandfather indicated similar difficulties, but her paternal grandmother was a retired teacher who had a positive and understanding influence on her academic life. Although it was recommended that Eliza use Ritalin, she never took it. Losing her grandmother in her matriculation year, Eliza credited her successes to her grandmother’s support of her during her school years. Her grandmother was very involved in her life and understood her learning barriers. Her grandmother put strategies and coping methods in place that allowed Eliza to cope with her difficulties. The strategy her grandmother focused on was an organised, disciplined, and habitual routine. Automation of

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processing tasks, such as multiplication tables, blending sounds, and sight-word reading skills formed the foundation of Eliza’s Grade 1 and 2 years. The evidence of the improvement in her reading and spelling is noted in Eliza’s tests in these grades, as well as the ESSI reading and spelling tests and NFER-Nelson reading comprehension test in both grades. Eliza had a highly structured homework schedule. On Mondays, she and her grandmother would plan their schedule for the week. Time was made for a routine, intensive academic reading and homework period. Understanding of a task, task completion, and the confidence to ask for help was a major focus in their time together when doing schoolwork. Eliza obtained a university pass. She is currently studying at university to become a physical education teacher as she enjoys sports. Eliza believes that her grandmother made school easier for her because every time she felt “stuck” her grandmother would lift her out and help her move on. Eliza believes that no one should suffer alone and that it is important to surround yourself with people who can help and support you. 4.6 SAM Sam was tested in his reception year at the age of six with the EILBRD checklist. He exhibited many markers on the checklist. His main difficulty was with sound–speech awareness, including difficulty understanding rhymes, initial sound recognition in words, counting syllables spoken in words, and word retrieval. Expressive language difficulties were also identified, as his sentence structure was short and vague. The school recommended a full assessment and speech and occupational therapy. Sam stated that he found school “amazing”. He played soccer in primary school and rugby in high school. Sam had many friends and he was not focused on academic learning. He always disliked reading. In primary school, he had many extra reading lessons, although to no avail. Sam’s mother would read books to him, which would cause tension and fighting. His mother reported that she was not sure what to do with a child that was clearly not performing at school, whom she believed was more capable than his marks demonstrated. Sam’s mother said that she was not successful at school herself and preferred the more practical work, but that she believed her son was more intelligent than she was. Sam’s mother followed up on all of the school’s recommendations, sending Sam to therapy, but there was very little progress.

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Sam’s father is a medical practitioner who was not married to Sam’s mother. However, he paid for medical aid and school fees. Sam only saw his father on the odd occasion, and his father never became involved in his schoolwork. Sam never felt that others expected him to achieve anything, so he “never bothered about schoolwork”. Sam enjoyed the social interaction at school and reported that he was part of a “rebel group” who drank alcohol and smoked cigarettes. Sam went to see a psychologist after failing Grade 12. Six months out of school, he regrets not having taken schoolwork more seriously, mixing with the wrong crowd and being involved in substance abuse, not taking to heart the advice that people gave, and not obtaining a university pass. Sam is a very talkative, likeable young man who is uncertain of his career direction. Sam stated that he blamed the school and his teachers, but admitted to often giving his mother false or no information about what the school needed or wanted in terms of assignments, meetings, or marks. Sam is trying to take responsibility for his life at present. He wants to be independent and realises how important school is in opening the doors to financial independence. 4.7 LINKING THE CASE NARRATIVES TO SPECIFIC LEARNING DISORDERS AS DEFINED IN THE DSM-5 The fifth edition of the APA’s (2013a) Diagnostic and statistical manual of mental disorders (DSM-5) takes a different approach to SLDs from that of previous editions by broadening the category. This was undertaken to increase diagnostic accuracy and to target care effectively. SLD is now a single, overall diagnosis, incorporating deficits that affect academic achievement. Rather than limiting learning disorders to diagnoses that are particular to reading, mathematics, and written expression, the current criteria describe shortcomings in general academic skills and provide detailed specifiers for the areas of reading, mathematics, and written expression (APA, 2013a). In the United States, the Individuals with Disabilities Education Act (IDEA; US Department of Education, 2004) defines a specific learning disability as “a disorder in one or more of the basic psychological processes involved in understanding or in using language, spoken or written, that may manifest itself in the imperfect ability to listen, think, speak, read, write, spell, or to do mathematical calculations” (n.p.). This disability category includes conditions such as perceptual disabilities, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia. At the start of the present study, all five participants were identified 84

(according to the Catts (1997) checklist) in their reception year as having a language-based reading disorder that fell primarily into the area of poor auditory processing skills. After they all matriculated, they were interviewed by the researcher. 4.7.1

DSM-5 criteria for Frik

Frik presented with several of the symptoms as described in the DSM-5 diagnostic criteria (APA, 2013a). His academic skills were substantially and quantifiably below those expected for his chronological age, and caused significant interference with academic or occupational performance, as confirmed by individually administered standardised achievement measures and comprehensive clinical assessment. Frik’s mathematical abilities were not very strong but did not affect his academic performance as he chose to do mathematical literacy rather than higher grade mathematics. According to the DSM-5 (APA, 2013a), Frik fits into the criterion for learning disorder since his condition persisted for more than six months despite appropriate intervention. He worked only with effort and was slow in reading and spelling. His academic skills were quantifiably below those expected for his chronological age. These difficulties began during school-age years, and were not better accounted for by intellectual, visual, or hearing difficulties. His self-esteem was negatively affected by his CAPD and poor academic achievement. He was tested at the ages of 5, 9, 12, and 15 years. He attended speech therapy and occupational therapy at a remedial school. When he was assessed at the age of 12 (using the Wechsler intelligence scale for children, Fourth UK Edition, WISC–IV), significant weaknesses in his working memory and processing subtests were indicated, and both these areas scored below his age level. He was also hampered by anxiety and attention difficulties, which may well have had a detrimental effect on his cognitive functioning as a whole. (He was prescribed Cipralex for anxiety and also Concerta, a Ritalin-related medication.) Cognitive difficulties were indeed found during reassessment at 15 years. Concessions were made to allow him a reader for examinations, the use of a computer for class work, and to condone spelling difficulties. A short-term study skills course was recommended. 4.7.2

DSM-5 criteria for Greg

Greg had no significant difficulty with mathematics, which he passed at higher-grade level, but other academic problems correlated with the DSM-5 (APA, 2013a) criteria for specific learning difficulties. These were difficulties with processing speed, reading, and spelling that 85

persisted for over six months with scores well below average for his age. Greg’s mother took him for many educational assessments. His strengths and weaknesses remained similar, which was to be expected. However, after repeating his Grade 2 year, he was able to cope with all scholastic tasks with greater confidence and speed. He stated that he felt as good academically as his class mates, and the management of his difficulties led him to succeed in completing Grade 12 with a university pass. 4.7.3

DSM-5 criteria for Paul

Paul’s case also correlated with the DSM-5 (APA, 2013a) criteria for specific learning difficulties that persisted for over six months. Similar to Greg’s situation, the management of Paul’s difficulties – despite persistent problems with reading, spelling, and mathematics – did not bar him from obtaining the Grade 12 results needed to enter into university. Since Paul lived in Perth, it was difficult to obtain test results of any full assessments that he had during his school career. Most of his testing was done in South Africa during the junior school to primary school phase. Once his family had emigrated, the system did not call for educational assessments. 4.7.4

DSM-5 criteria for Eliza

Eliza presented as a learner with specific learning difficulties according to the criteria of the DSM-5 (APA, 2013a). She possessed great dedication and self-discipline, but her struggle to focus in spite of using medication did not resolve her learning difficulties with reading accuracy, comprehension, and writing. She tended to decode and encode phonetically and did not have a strong visual memory, undermining her reading speed and comprehension of content. Using her strengths, she obtained a matric certificate and could move forward in her areas of passion –a career in exercise and sports – without feeling that she had failed. She did not experience the regrets and low self-esteem that troubled Frik. 4.7.5

DSM 5 criteria for Sam

Sam’s difficulties also correlated with the DSM-5 (APA, 2013a) criteria. Professional assessments since Grade 2 indicated that Sam functioned on an average level but with a significant discrepancy of 15 points between his scores on the verbal and the non-verbal scales, indicating that his language was better developed than his visual abilities. He experienced frustration by his variance of skills during his schooling career. It was 86

recommended that Sam have his eyes tested and go for occupational therapy for his poor visual spatial skills. His level of activities in class (the Conners rating scale) was assessed by his Grade 4 teacher and it was pointed out that Sam left many tasks half completed but for behavioural rather than purely attentional reasons. Sam was reported to be a sensitive, needy boy who felt somewhat abandoned by his parents, felt insecure in his peer group, and was vulnerable to criticism. It was recommended that he go for therapy and that schoolwork and tasks be broken down into manageable chunks, and that he should be praised frequently on the accomplishment of tasks. However, the management of his difficulties did not lead to significant academic improvement and he did not obtain a university pass at matric level. He continued to display difficulty with reading, spelling, and mathematics, and acted out at school, falling in with a peer group that misbehaved and used illegal substances. His motivation, because of his peer group’s influence and his own self-esteem and frustration level, was low. This is often typical of teenagers who present with specific learning difficulties. 4.7.6 Summary of DSM-5 diagnosis for case studies with CAPD Perhaps the single most important indication that could be derived from the participants’ narratives was that they showed identifiable signs of having a learning disability or CAPD in their school reception year. For example, difficulties learning the alphabet, problems with following directions, and trouble with transforming thoughts into long sentences are all indicators of CAPD but also symptoms of a learning disability. Even a cursory reading of the narratives reveals that individuals with learning disabilities face a number of potentially traumatic educational challenges with equally potentially serious effects throughout their lives. In all five cases, the diagnosis of CAPD seems to have been conflated with a diagnosis of SLD as classified by the DSM-5 (APA, 2013a). All five participants showed difficulties with word reading (inaccurate, slow, or effortful), understanding the meaning of what is read, spelling, and written expression. These difficulties affected their academic skills, which were substantially and quantifiably below those expected for the chronological age, and caused significant interference with academic performance. This can be seen in school reports and tests done by the researcher in Grade 1 and Grade 2, as well as confidential assessments to which the researcher was allowed access.

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4.8 CHAPTER SUMMARY This chapter presents the participants’ perspectives, as expressed in interviews, regarding the effects that their learning difficulties had on their schooling careers and personal lives. It also presents their histories as augmented by information provided by parents, educators, and school archival sources. Their symptoms as identified by therapists and clinicians were linked with the diagnostic criteria of the DSM-5. Each case can be outlined as follows: 

Frik, who was identified like all the pupils at the age of five years to have CAPD, first attended a remedial school and then a mainstream high school, where he found school difficult and uninspiring.



Greg changed schools often. He attended five schools in his academic career. He appeared to change schools each time the school no longer met his needs. He matriculated well and was positive about school.



Paul remained at the same school until he emigrated. He enjoyed his new school and was positive about his schooling career in general.



Eliza remained at the same school throughout her schooling. She was good at sports and her family, especially her grandmother, was very involved with the school and supported her academically.



Sam remained at the same school throughout his academic career. He did not enjoy reading and found school pointless, except for enjoying time with his friends. He finished school with regrets about his low marks.

These outlines can be considered the bare bones of the narratives. The significance of meanings of experiences will be fleshed out in the following chapter; in other words, their richness will be explored.

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CHAPTER 5 ANALYSIS AND INTERPRETATION OF FINDINGS

5.1 CHAPTER PREVIEW The analysis of these five case studies is intended to help parents, learners, and therapists obtain a greater understanding of the difficulties experienced by learners with CAPD, and it will highlight intervention strategies aimed at supporting these learners during their schooling careers. In this chapter, the five case studies are analysed against the backdrop of Bronfenbrenner’s (2009) bio-ecological systems theory, which explains how learners are affected by everything in their environment during their growth and development. The IPA approach was used to analyse, interpret, and discuss the influences on and perspectives of the participants in this study, and by means of qualitative data analysis certain themes were extracted from the data in response to the research question. 5.2 RESEARCH AIM The research question for this study is, “What were the experiences and perceptions of five learners with CAPD in an inclusive education system during their schooling careers from their reception year through to Grade 12”? The primary aim was to explore and describe the experiences of the learners in order to gather rich data for identifying strategies that supported such learners in inclusive classrooms. 5.3 THEMES The categories extracted from the data via qualitative analysis approaches were related to Bronfenbrenner’s (2009) bio-ecological systems theory (Oswalt, 2011). The self is congruent to the microsystem (in personal interaction with the “nuclear” social environment of immediate family, friends, and school, for example); family and peers to the mesosystem; the school to the exosystem; and the community to the macrosystem. The chronosystem can be seen as historical changes affecting all systems over longer periods of time (Gray et al., 2012), for example the far-reaching political and socio-economic changes in South Africa since 1994 as affecting the educational landscape. Bronfenbrenner’s bio-ecological model is one of the significant theories that can be used to analyse case studies. As noted in section 2.2.1, the bio-ecological perspective had particular value in shifting the traditional focus on only the individual’s intrinsic problems to a broader assessment of all the systems that affect 89

the individual (Hay, 2003). It could be suggested that this “shift” or “move” of focus may be better explained as a “widening”, since attention to the individual is not displaced, but widened to a richer, more inclusive perspective (see Figure 5.1). Bronfenbrenner’s model was particularly fruitful for exploring the main aim of this study, namely to gain deeper insight into the barriers that learners with CAPD experience in their learning, and thus also the various systems that they encounter in their “learning life”.

Figure 5.1 Bronfenbrenner’s bio-ecological model – the self in the microsystem (Adapted from Bronfenbrenner, 2009)

5.4 THE SELF The microsystem is the small environment in which children live, grow, and develop. Their microsystems will include any immediate relationships in which they are involved, such as their family or caregivers. The interaction of children and their environment will have an effect on how they perceive their schooling careers, and this environmental interaction will reflect the way in which the different parts of their microsystem work together (Kail & Cavanaugh, 2010) In the inclusive education setting, the differences of every individual are treasured, accepted, and respected (Tutt, 2011). No child is discriminated against. The hope for each individual, both on a physical and psychological level, is to stay healthy, stay safe, enjoy their time, and achieve while at school. This desideratum envisages that every learner will attain economic self-sufficiency and make a positive contribution to society; in other words, work towards becoming a healthy, happy, and independent adult (Tutt, 2011). 90

Two main determining psychosocial forces can be identified in any individual’s life, namely intrapersonal and external influences (Donald et al., 2002). The intrapersonal system encompasses the individual’s physical and psychological characteristics, whereas the external influences include the individual’s close interpersonal connections and interactions with other individuals and the surrounding environment in daily life. As was evident from the narratives of the participants in this investigation, the dynamic interactions between intrapersonal and external forces exerted a profound influence on their perceptions of their experiences in the ecosystemic environment of schooling and education. It needs to be considered that they would view their experiences through the lens of awareness of learning disabilities. Specific significant elements were selected for discussion in each case, serving as rich examples of meaningful perceptions. 5.4.1 Frik’s self-awareness of learning limitations Frik’s external close connection to his brother affected his perception of how he saw himself: Yes, my brother took like nine subjects for matric. He is studying accountancy now. He has always been very clever from when we were babies.

Frik also stated that he knew he was not as clever as his brother, but he had physical strength. His self-esteem at school was hampered by his poor academic achievement but his physical strength and good looks helped him: He is two years older than me … life has been hard for him, even though he was clever at school. So, I kind of accepted we were different. I often had to fight for him. He got teased; now people are nicer and accept him. He is clever and eccentric, and I am more rough and simple [laughs]. (Appendix E)

Frik often stated during the interview, “Maybe I should have worked harder.” He expressed his feeling of regret that he did not work hard enough. With regard to this statement, the vision of inclusion is that learners are in an environment that promotes an educational practice that engenders feelings of worth and belonging, and not this feeling of inadequacy and regret expressed by Frik. He showed that he understood his vulnerability or weakness in his schoolwork and that he was grateful for his physical stature and strength in comparison with those of his brother. This helped his self-worth, but he still had regrets concerning his academic achievements.

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5.4.2

Greg’s self-awareness of learning limitations

There is much research showing that children who have learning disabilities are at risk of having lower self-esteem and self-worth than their peers (Kamhi, 2011). From an early age, children compare themselves with others in areas such as academic abilities, but such comparisons and subsequent self-judgement can be simplistic (Lyon, 2012). Whether simplistic or not, such self-assessment may be either positive or negative effects, with a positive approach more likely to have a positive impact. For example, Greg’s perception of himself was expressed as follows: I always thought I was average or less than average. I never thought I could get an A and I was ecstatic with a B. My perception of myself changed at the end Grade 11 with final results. I saw what I was capable of if someone guided me to help me reach my potential. (Appendix E)

Greg thought he was not capable of achieving high marks and was very happy and surprised by the marks he accomplished at the co-ed school. He attributes this change in marks to his attitude to the relationship he had with the teachers, how they made him feel about his abilities, as well as their expectations of his abilities (Appendix E). This external environmental relationship with his teachers and their behaviour towards him altered his selfperception and lifted his self-worth. 5.4.3

Paul’s self-awareness of learning limitations

At approximately seven years of age (and possibly even younger) children are able to compare their skills and abilities with those of others around them, such as classmates (Kamhi, 2011). Once this happens, their perceived abilities or weaknesses compared with those of similar-aged children or siblings become an important contributing factor to their self-esteem. The self-esteem of many children is threatened when they start school and have to cope in an unfamiliar situation with many other new children and new rules to learn. Difficulties with language and auditory processing skills result in children’s falling behind their peers in many cognitive activities (Kamhi, 2011). Paul realised towards the end of Grade 1 that his reading skills were not as good as those of his peers. He relates in his interviews that he disliked reading, a difficulty that assumed greater proportions in Grade 2 because of longer passages to read and questions to answer. He also had to learn the Hebrew alphabet, which was written and read in the opposite direction to the Latin one. He later 92

recalled how embarrassed he felt because he was taken out of the “big” class for Hebrew and sent to the slower-paced “small” class. He asked his mother if he could leave school and be home schooled. Reading problems adversely affect self-esteem. As children progress through school, selfesteem wanes. During preschool and the early primary years, children are typically confident as evidenced by their curiosity and eagerness to learn. As they move into higher grades, they become increasingly aware of how their performance compares with that of their peers and they become more realistic about their capabilities (Kamhi, 2011). Once a child has low selfesteem, it can be very difficult to reverse their feeling of worthlessness and they enter a cycle that perpetuates and enhances their negative feelings. Paul knew that he was different from his friends, but this did not matter to him. He stated, “From Grade 1, I knew I was different from my friends, but that that was just fine with me.” In spite of this apparent bravado, Paul in fact displayed low self-esteem about his reading skills (Appendix E). Later in the interview, he stated that he did not like to be noticed and as an adult abided by the cliché “to rather be silent and let them think you are a fool than open your mouth and let them know you are a fool”. Paul is currently studying law, and when asked whether he felt limited in his studies, he replied that he was always highly prepared and even “pedantic”. It appeared to the researcher that because Paul was sensitive about his reading difficulties, he expended much energy and used various strategies to overcome or mask these difficulties. 5.4.4

Eliza’s self-awareness of learning limitations

Similar to Paul, Eliza had poor self-esteem about reading (Appendix E). All children’s selfesteem should be actively dealt with by teachers. Children who experience learning difficulties find their self-esteem being constantly challenged by negative messages about their own efficacy and the experience of failure. Parents and teachers play a significant role in shaping their child’s opinion of themselves and they need to employ strategies actively to enhance self-esteem where possible. Eliza’s grandmother was an active facilitator Eliza’s self-perception and schooling career by ensuring that Eliza experienced as much success as possible. She provided organisational strategies and academic support, and aided Eliza in awareness and utilisation of her strengths (Appendix E). Eliza’s perceived schoolwork as difficult because of a feeling of disorganisation, but her positive attitude to sports made it generally easier for her to cope:

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I was really good at sports. I spent high school on the sports field with friends or working. Everyone expected me to do well but I really struggled with English, Afrikaans, and Hebrew. My maths was fine and I went for extra lessons; my history and geography was fine. Primary school, I carried on. It was hard because of the homework. I am not an organised person. Later, I learnt I had something similar to dyslexia. Studying is not for me. I loved and still love sports and my friends, but I am not a big reader. (Appendix E)

5.4.5

Sam’s self-awareness of learning limitations

Sam had feelings of regret about his behaviour at school and admitted that he should have taken heed of what his parents and teachers were telling him (Appendix E). Sam’s regret after he matriculated allowed him to be reflective about his schooling mistakes and learn from them. He observed: My standard was consistently low; I was almost expected to fail. I was a bad reader and writer even though on a personal level I thought maybe I could do it. I wanted good marks; got better marks on computer stuff than writing tidy … I am at college now and work really hard. (Appendix E)

5.4.6

Concluding remarks on self-awareness of learning limitations

Shame differs from regret as it wears away self-esteem because of embarrassment about the mistakes made (Oswalt, 2011). Self-esteem is defined as individuals’ overall opinion of themselves – how they feel about their abilities and limitations. Healthy self-esteem leads to perceptions of being deserving of the respect of others, whereas low self-esteem leads to placing little value on own opinions and ideas. Persons displaying healthy self-esteem are able to acknowledge both virtues and faults in the self, and yet remain able to continue loving themselves (Erikson, 1963). Many children with learning difficulties have low self-esteem, and this was also evident to a greater or lesser degree among the five participants in this investigation. Eliza, for example, achieved a self-esteem balance by accepting her reading limitations and acknowledging her sporting abilities. Paul recognised his differences and seemed to accept himself from a very early age. Further in the interview, it was evident how his mother’s guidance, structure, and support seemed to play an important role in his perception of himself and his self-acceptance. The need of inclusion is to keep children positive about themselves, as was evident in Eliza’s and Paul’s case. Like parents, educators have a special placement in 94

social systems that enable them to assist learners who have low self-esteem. Greg seemed to move from school to school until he found a school where he felt he belonged, and this increased his self-esteem. Unlike Paul, Greg, and Elize, Frik did not accept his academic limitations and experienced remorse and regret about his inadequate efforts in schoolwork. Among the participants, Frik appeared to be the least self-aware. Sam was more self-aware than Frik, but felt rebellious, frustrated, and found schooling pointless. In comparison with them, Greg appeared to be more eager to please and was consequently more anxious; his self-esteem varied in accordance with his ability to please his teachers or mentors in his environment. To help ameliorate low self-esteem and unhappiness, school environments should be structured to create successful experiences. One method involves boosting self-determination or making learners active participants in designing their educational experiences and monitoring their own successes. This can be done by teaching self-awareness and self-advocacy skills (Bauer & Bennett, 2003). Self-determination is a foundational component of inclusion. Bauer and Bennett (2003) describe self-determination as the ability to define and reach goals based on a foundation of knowing and valuing oneself. For example, Greg’s surprise at his achievement and change in his perception of himself influenced his self-determination, and in her turn Eliza displayed self-determination in concentrating on the positive aspects of what she knew was her strength, namely sports. An individual is self-determined if his or her actions reflect four essential characteristics: autonomy, self-regulation, psychological empowerment, and selfrealisation (Torgesen, 2004). The participants who were able to perceive their learning difficulties as only one aspect of themselves, like Greg and Eliza, were not defined by them. One’s inner reality can guide one’s destiny, as Torgesen (2004) aptly expressed it. 5.5 MICRO- AND MESOSYSTEMIC SUPPORT: FAMILY, EDUCATORS AND FRIENDSHIPS Around the microsystem in which the self functions (Bronfenbrenner, 2009), the various subsystems also interact in the mesosystem (see Figure 5.2).

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Figure 5.2 Bronfenbrenner’s bio-ecological model – the mesosystem (Adapted from Bronfenbrenner, 2009)

In other words, children interact with their surroundings in the microsystem via immediate relationships with their families, caregivers and educators, but the surrounding subsystems also have reciprocal effects on one another. In other words, as mentioned previously, “a mesosystem is a system of microsystems” (Bronfenbrenner, 1994, p. 40) that involves different aspects of a child’s microsystem working together for the sake of the child; for example, if a child’s caregivers take an active role in the child’s schooling, it will help the child’s overall growth (Bronfenbrenner, 2009). For example, if children’s caregivers take an active interest in school activities going to parent-teacher meetings and attending sporting events, it will help ensure the children’s overall growth (Kail & Cavanaugh, 2010). Familyschool participation can occur in many formats, including communicating with educators or other school personnel, attending school functions, and volunteering in the classroom. Not only does family-school involvement assist parents in understanding the school community and monitoring their children’s participation, but it also conveys to children the importance of the school (Dukes & Smith, 2006). Resilience in children and coping methods are built by supportive structures in the social network of the family and peer community. Regarding this study, the researcher has noticed a gradual decrease in support from the social network in the local area since more single families, or families with no relatives in the 96

country, were encountered with no connection to their community. Linkage to family and friends are important factors for coping, and when parents are involved in schools, they are more likely to obtain support from the schools when assistance is needed (Anderson-Butcher & Ashton, 2004). There are many by-products of family-school collaboration: for example, learners and their families are supported; feel appreciated, valued, and empowered; gain necessary coping and management skills and strategies; gain access to working alliances with school personnel; and derive benefit from knowledge-sharing between all concerned (Anderson-Butcher & Ashton, 2004). 5.5.1

Frik: Micro- and mesosystemic support

Children’s microsystem environment affects them daily and greatly determines the way in which they perceive their schooling careers. Frik stated that his mother was supportive and helped him as much as she could to fit into the remedial school. His father and mother were getting divorced when he was 11 years old and he remembered them fighting about his enrolment at a remedial school. His father considered it unimportant and this made Frik feel confused (Appendix E). Parental support, communication, and understanding directly affect learners’ perspective of their academic careers, either positively or negatively. Parents and inclusive schools need to be aware that as children grow, their developmental capacities increase but so does the level of work at school. Many educators believe that by the time learners enter adolescence, they should take responsibility for their own schoolwork and parental involvement should decrease (Bruning, Schraw, Norby & Ronning 2004). However, because of the difficulties that learners with CAPD experience with following direction, sequencing, organisation, and other cognitive weakness, the parent-educator team should maintain support for them. As children develop, social connections outside the immediate family environment, such as with peers, become increasingly important to them (Bruning, Schraw, Norby, & Ronning, 2004). Special attention needs to be paid to the influence that peer groups may have on the experiences and perceptions of children with CAPD (Marlowe, Trance, Kerstin, & Flores, 2014), since children in peer groups may be competitive or nasty because of immaturity, and positive support may not always be forthcoming. Frik reported that he was lonely and missed his old friends while at the remedial school, where it took time to make new friends as his parents did not have social contact with the 97

other parents. Once he returned to the mainstream school, however, he could resume his former friendships, which remained in good standing in the family’s familiar social circle. He felt happy and secure among his friends, and enjoyed sports and his social life (Appendix E). Constructive friendships in high school made Frik’s school experience more positive, as opposed to the primary school period when he was separated from his friends and had a significantly lower perception of school (Appendix E). It is important to note that even though his academic achievement was poorer in high school than in primary school, he felt happier at school being with his friends. Peer group systems can therefore be considered to play an important role in positive perceptions of schooling careers. 5.5.2

Greg: Micro- and mesosystemic support

Children can frequently feel different or lonely, and from the evidence of Greg’s narrative it appeared that sports, especially team sports, could serve as a positive strategy to aid learners with CAPD to feel part of a group and give them a sense of accomplishing goals. Professionals who work with children with learning disabilities have important roles in helping them recognise both their areas of difficulty and their areas of strength. If the learners are good at sports, pointing this out may help providing them with meaning, goals, and a social connection. This had a positive effect on Greg’s perception of his schooling career: Well, ma’am, yes friends … and it all depends on the children of the school ... Friends at the all-boy’s school … it’s the brotherhood. It helped because you focused because we had a schedule; no time for procrastination. My mind was more focused. No negativity because you all so busy and we played sports six days a week, especially rugby. Saturday always with friends, so did not matter. I went to the all-boys’ school; it was great. I was there two years but then had a bad rugby injury so then the next year I could not do sports. I never saw my friends and was frustrated, so my mom and dad moved me to private co-ed school. My last two years at that school I excelled at sports without much effort. Compared to the all-boy’s school, the teachers loved me and really wanted me to do well in matric. We would often spend weekend afternoons or mornings, even some evenings at the English, maths, or Afrikaans teachers’ houses, working together after a match. (Appendix E)

5.5.3

Paul: Micro- and mesosystemic support

Paul had to endure great change when his family emigrated. He stated,

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All my friends from school in South Africa were lost to me. I was sad. My mother and father’s family had already emigrated and we had spent lots of December holidays and family celebrations in Perth, so at least I had lots of cousins and I knew their friends. We were similar ages and I quickly made a lot of friends, but I still think of one or two special friends in South Africa. (Appendix E)

In this case, Paul’s loss of a circle of friends was partly compensated for by a close, caring, and supportive family who functioned as a supportive community by also being involved in Paul’s school (Appendix E). Paul’s experience serves as an excellent example of the way in which perceptions of loss can be overcome by taking recourse to other positive aspects in the environment, even though such alternatives cannot be perfect replacements. 5.5.4

Eliza: Micro- and mesosystemic support

Eliza’s narrative illustrates the decisive role that a single individual in the learner’s microsystem may fulfil in providing quality support. Eliza was fortunate to have a grandmother with a teaching background: Gran was always helping with homework. I was either playing tennis, soccer, running, swimming, or I was with my Gran doing homework. My friends also liked to sit with her to do homework. Work with her was always easy. When we were stuck, she always knew the answers. (Appendix E)

The importance of sports, especially team sports, has already been mentioned as a positive strategy to help learners feel part of a group and gaining a sense that they are accomplishing goals. As Elize remarked, I was really good at sports. I spent high school on the sports field with friends or working. Everyone expected me to do well but I really struggled with English, Afrikaans, and Hebrew. My maths was fine and I went for extra lessons; my history and geography were fine. (Appendix E)

It is interesting that Eliza’s acceptance and self-awareness of her limitations contradicted the expectations of peers and certain educators in her environment. Her strong self-awareness of strengths and weaknesses in her abilities did not equate with “the reality” that unsympathetic people may have ascribed to her, but she was aware of this and seemed to accept it and deal with it. Her approach serves as a good example that other peoples’ expectations do not necessarily have to be accepted and influence personal perception negatively. 99

5.5.5

Sam: Micro- and mesosystemic support

In Sam’s case, where his father was not present and his single mother did not feel she was academically skilled, Sam’s academic efforts were not fully supported. Sam related, My mom tried to help me but the work just got too hard for both of us. My mom was stressed and kept screaming at the school and asking my dad for help and saying she could not do it on her own. (Appendix E)

The sense of being overwhelmed is common among parents, as CAPD has a genetic predisposition and often the parents themselves have not acquired the skills to achieve academically (Oswalt, 2011). It is also common for learners with CAPD to turn to underachieving peers for acceptance because they do not feel judged. Negative peer influences involving substance abuse and other delinquent behaviours are factors that already overstressed parents may have to cope with, and it is important for the school and parents to remain alert to such difficulties, as in Sam’s case. He started missing classes, an even bigger drop in his marks became evident, and he socialised with friends who smoked, drank, and stayed out late with no parental supervision: I was smoking [illegal substances] and having a huge party in Grade 10. The therapists said I had decreased productivity. I had many lectures and teachers one-on-one. Never got a varsity pass. I realised that the smoking was a chilled crutch, so school would not bother me, and I would not feel worthless (Appendix E).

Sam’s coinage of the phrase “chilled crutch” was particularly apt for describing his perceptions and behaviour, since “crutch” referred to an artificial means of support and “chilled” to drug-induced euphoria. The meaning was that smoking marijuana was a “chilled crutch” that allowed him to cope through his higher grades. Sam wished that he taken his tutors and teachers more seriously when he was struggling with schoolwork, but he felt that they had made schoolwork the entire focal point of life without leaving time for anything fun or interesting; he was bored, dissatisfied, and rebellious (Appendix E). This is often the outcome for many teenagers who feel misunderstood at school and experience academic failure.

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5.5.6

Conclusion about micro- and mesosystemic support

It is common for teenagers with learning disabilities to have friendship problems (Gordon, Feldman, & Chiriboga, 2005), such as those mentioned in Sam’s case. Some learners may have a hard time reading social cues, for example knowing when to speak and when to listen. Most teenagers struggle with their self-image, and those with learning disabilities such as CAPD have more concerns because they know that they also have learning difficulties to cope with. Feelings of embarrassment, failure, low self-esteem, and anxiety about the future are common for them. According to Gordon et al. (2005), peer influence peaks between 11 and 14 years of age. By high school, teenagers have developed a stronger sense of self and can resist the temptation to do anything to fit in. It is therefore important for parents to keep the lines of communication open for replacing negative influences with positive ones. Maturation establishes a sequence of cognitive stages, but the environment contributes to learners’ experiences, which in turn dictate how they develop (Gargiulo & Kilgo, 2005). The environmental contribution is affirmed by Piaget’s theory, which suggests that development does not just take place but is based on active engagement and exploration of the physical and social world. Consequently, if the learning process is to be optimised, learners need to be given the opportunity to experiment and discover things for themselves (Gordon et al., 2005). It stands to reason though that learners with special learning difficulties will need guidance in their exploratory efforts. To a greater or lesser extent, all five participants in this study received support, assistance, or opportunities from others over the course of their lives. Guidance, extra experimentation, individualised programmes, and encouragement came from family members, friends, mentors, teachers, therapists, and later in their lives also co-workers. The people who provided support to the learners generally held clear and realistic expectations regarding life goals and outcomes, guiding them to identify and achieve realistic goals without being harsh or critical. They were also able to help them change directions in attempting to achieve goals, or modify the goals, if necessary. They were consistent and steadfast in their functioning as sounding boards for reality testing. Eliza, Greg, and Paul all revealed in their interviews that they actively sought and used the support of others, and were willing to accept help when it was offered. By contrast, Sam and Frik were more resentful of help and saw it as extra work and negative judgement. They were not as likely to actively seek support or accept it when 101

offered. Both these participants expressed their regret at not having worked harder or using their resources better, which reflected on their understanding and acceptance of their strengths and weaknesses and feelings of self-worth. Previously, both had felt comfortable with friends who did not prioritise schoolwork and both were influenced by their peers. Sports in Greg’s and Eliza’s cases helped maintain a feeling of belonging and a sense of selfworth, motivation, and a positive social attitude. Motivation is the fuel that propels individuals’ performance and encourages them to expend effort or engage in a task (Sands, Adams, & Stout, 1995). According to Oswalt (2011), motivation is optimised through high self-regard; when individuals perceive themselves as being effective at a particular task, their motivation increases. Motivation, in turn, leads to attention to tasks, persistence, and increased effort. Motivation theorists believe that individuals expend effort if they expect to succeed at a task and if they value the outcomes of the task (Covington, 2009). Motivation can be promoted externally through activities, such as those seen in Greg’s, Paul’s, and Eliza’s cases. Sam and Greg did not expect to succeed at the task of “school” and they did not place much value on the outcome of finishing school with high marks. This affected their focus and motivation. Parents and friends can send strong messages to learners about the value of school and about what is expected of them. In both Frik’s and Sam’s cases, the parents were not working as a team and both participants seemed to feel unempowered and were apathetic in their early attitudes about the “reason for school”. 5.6 FOSTERING SUCCESS AT SCHOOL Schools are the instrumental place for educating children and yet at times are involved in constructing some of the barriers to learning (Torgesen, 2000). The early school environment places much emphasis on the acquisition of core literacy and numeracy skills, as indeed it should (Torgesen, 2000). (See Figure 5.2, which also reflects the place of the school in the micro- and mesosystemic environments as proposed by Bronfenbrenner (2009).) For the participants in this study, reading was not easy. All of them expressed in their own words that learning to read, write, and spell was difficult for them. The test-scores of the ESSI Grade 1 and Grade 2 spelling and reading, as well as the test-scores of the NFERNelson reading comprehension done in Grade 1 and Grade 2, reflect the pupils’ perception and help in the triangulation of the data validity of a concept as abstract as “perception of 102

reading, writing, and spelling abilities” (see Table 5.1). Only Frik was not tested, as he moved schools. Table 5.1 Test results corroborating learners’ and teachers’ perception of learners’ being weak at spelling and reading

Name

Paul percentile Eliza percentile Greg percentile Sam percentile

Percentile

Reading scores ESSI (4th term)

Grade 1 10 60-77% 8 40-60% 11 9 40-60%

Grade 2 12 60-77% 13 60-77% 15 60-77% 9 40-60%

Spelling scores ESSI (4th term)

Grade 1 10 60-77% 7 23-40% 11 77-89% 10 40-60%

Grade 2 12 60-77% 11 60-77% 12 60-77% 11 60-77%

Reading comprehension NFER-Nelson (4th term) Grade 1 8 40% 13 45% 16 48% 9 40%

Grade 2 31 50% 26 45% 27 48% 27 48%

Rate may be used to describe the national percentage of pupils that the individual child is as good as or better than on a standardised assessment

Reading and writing are extended skills that are socially valued and used throughout life. School is the vehicle that is supposed to help learners improve these skills (Edwards, 1993). The teacher’s handbook (DOE, 2007) states that each phase builds on the next phase of learning to read. From Grade 1 to Grade 3 learners learn to read and write, and from Grade 4 they read and write to learn. Learners should be kept positive about themselves and their ability when learning to read, considering that the more one reads the more reading and other skills such as vocabulary, grammar, and spelling improve. Because learners with CAPD avoid reading as it is difficult for them, it does not become easier. CAPD does not have a cure, and managing it means keeping the fear and avoidance of schoolwork at a level that does not hinder progress. Educators who focus on neatness instead of accuracy, and on fluency instead of comprehension, can worsen the situation. 5.6.1

Frik: Fostering success at school

Worldwide transformation in education has increased awareness that the learning taking place in the classroom has to be carried over to the household in order for teaching to be successful (Swart & Pettipher, 2005). Therefore, parents need to be an informed and involved as part of the educational team for any child, not only those with learning difficulties. 103

Children’s perspectives bring fresh light to the educational processes, to the way in which professionals and adults concerned may best help learners grow, and to learning support. The emphasis of this strategy is on listening to children’s views and working with them as active team members in the learning process and not as passive learners. Frik’s perspective revealed that this was not the case in his schooling career: Maybe I should have worked harder but school did not understand me and I did not understand what was so important about school. Most of school I felt was a waste of my time. I suppose I could have worked harder. (Appendix E)

Here, his lack of feeling understood as well as his lack of understanding of what was expected of him at school left him with guilt and regret. Communication and partnership between the school and his family may have helped avoid this situation during high school. Frik often mentioned that he did not know what was expected of him at school (Appendix E). For example, he was asked to write a short essay (see Figure 5.3) during class but was not allowed extra time.

Figure 5.3 Photographs of pages written by Frik

The untidiness reflected in the images in Figure 5.3 indicates that Frik was under pressure to write fast. His organisation and sequencing skills for the essay were poor, his writing was untidy, his spelling was weak, and he did not open pages in the usual book format but simply turned the double sheet over, skipping pages; in other words, he went from page 1, skipped pages 2 and 3, and went straight to the other side, page 4. The educator who marked the essay 104

had no idea that she had missed his concluding paragraph, which was at the back of the “doubled” sheet of paper. This incident may be considered a minor event by an outsider, but Frik felt embarrassed and, in his perception, had lost self-respect and trust in the system that had promised to provide him with help. When dealing with students who have failed to respond to a traditional learning environment, schools need to be flexible in their education programme. In terms of academic work, Frik felt that primary school was not as difficult as high school (Appendix E). The curriculum at the remedial school that Frik attended was specially formulated to help learners with learning disorders such as CAPD to achieve academic success, while this was not the case in the standard-level IEB high school curriculum. At the remedial school, Frik’s academic abilities and the school’s expectations or tasks were matched and Frik was able to cope. This balance of Frik’s ability and the school’s requirements shifted in high school and Frik’s positive perception of his academic skills decreased, even though socially he was enjoying high school. Change in either classroom or school placement is inevitable and occurs for many reasons, including family relocation, academic concerns, or incongruent school–family expectations. Change is frequently experienced as stressful, and especially for children it is necessary to ensure that their needs and capabilities are met by settling them in an appropriate environment. There are indeed dedicated parents who keep on “shopping” among schools until they find satisfactory answers and environments, since a child may feel that “one cannot run away from one’s own feet”, as Greg expressed it so aptly (Appendix E). Transformation in special education approaches since the Salamanca Statement (UNESCO, 1994) has led to greater recognition of the involvement both of learners and of parents in school education. Parents should be seen as their children’s first educators and especially if schools diagnose a learning disability in children, their families should not distance themselves from the learning process. This constitutes a systemic link to the concept of support from family, educators, and friends discussed above. In Frik’s case, it was evident that his parents’ arguments about the necessity of a remedial school and about school in general affected his understanding, perception, involvement, and development in school.

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5.6.2

Greg: Fostering success at school

In Greg’s experience, his teachers made an effort to understand him and showed that they cared (Appendix E). Greg recalls a significant incident when he changed primary school and had to be kept back a year: I remember that after I wrote my test the first week, the deputy head master took me for a day, [and I] sat for a day in the higher grade, and then in a helpful way showed me that I made the right choice to stay back for the year. Choices and no pressure were big. (Appendix E)

Children with learning disabilities often need support in assimilating both positive and negative characteristics in their self-image. While much time is spent helping them master academic skills, teachers should also be working on improving their self-esteem through recognition and appreciation of their areas of strength. An important strategy for parents, educators, and others who work with CAPD children is helping them feel special and appreciated. According to research by Campbell (2006), the presence of at least one adult who makes a child feel special and appreciated leads to greater resilience and hopefulness in the child. Adults can encourage children by noticing in a positive light what makes them different and by devoting quality time to them. A dedicated educator can exert a decisive positive influence on a learner’s life by making learning fun with stimulating, engaging lessons that are pivotal to a learner’s academic success, a need expressed by participants in this research. Some learners who are more prone to misbehaving, truancy, or disengagement are more dependent on an engaging teacher. Making the classroom an exciting environment for learning will hold learners’ fascination, and they learn best when they are both challenged and interested. Motivating learners may not be easy, but will benefit them immeasurably over time. Inspiring them is integral to ensuring their success and encouraging them to fulfil their potential (Catts, 1997). Motivation provided by the engaging educator usually stays with learners through later schooling or their careers, as could be corroborated by Greg’s experience of his teachers’ belief in him and the extra time that they spent with him. Their efforts influenced his marks to such an extent that he surprised himself at the academic success he obtained. Inspiration can assume many forms, from helping learners through the academic year with their short-term goals, to guiding them towards their future careers.

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5.6.3 Eliza: Fostering success at school Eliza’s grandmother managed Eliza’s organisational weaknesses by being part of the school network (Appendix E). Eliza and Greg both commented that in high school each teacher believed that their subject came first and that for weeks there were no tests or assignments, but all of a sudden teachers wanted something from you in the same week (Appendix E). If the system were more communicative, it would be less frustrating and overwhelming for the learner. A difference can be seen in smaller schools in which the educators from the different faculties communicate about their programmes. Greg noted that at the co-ed high school learners were given a full-year printout highlighting all important events or tests (Appendix E). Eliza found that her grandmother was able to cope with obtaining the information easier when Eliza was in primary school and only had one or two teachers for all her subjects. This became harder in high school when there was a different teacher for every subject and much of the communication had to be via electronics (Appendix E). 5.6.4

Paul: Fostering success at school

There has been a gradual move to mutual respect between educators and learners, and a shift from preaching information to a supportive learning environment that allows learners to become active and experiment (Evertson & Weinstein, 2006; Sapon-Shevin, 2008). The idea of mutual respect and listening to a learner’s perspective is discussed in almost all of the cases (Appendix E). Before Paul family emigrated, he felt misunderstood by his teachers: Mmm, well I guess I was lucky because I only did six months of Grade 4 in South Africa, then we left and the reports from the teachers were not nice. They said I was disorganised and I did not do my homework. I felt a bit lost and very scared for Australia. My English is still my weakest subject, but I read much more now and I’m good. I like to read now. It’s different. I’m good. (Appendix E)

Like Greg, Paul achieved more success at a different school and his perception of his schooling career improved when his relationship with his teachers improved. Paul mentioned that when his family emigrated, “the school was set up with computers and emails, and my mom new exactly what to do and organise; it was all clear and at her fingertips” (Appendix E). Two factors should be considered in Paul’s improvement: firstly, his repetition of half a year’s schooling in Australia might have allowed him to consolidate his skills (Appendix E). Secondly, the imaginative use of new technologies, as advocated by Campbell (2006), might 107

have made it easier for Paul’s teachers and family to share information and cooperate in teaching strategies to support him. It is also possible that both factors played a role to a varying extent in improving his experience and perceptions. He remarked: My mom says she does not think I would be doing law if I had carried on in South Africa. She was a teacher in South Africa and says between the Afrikaans and the way I was behaving about school in Grade 4, I would have been a very hard nut to crack when it came to doing school stuff. I was lucky because in Perth the teachers worked differently. They had a lot of technology already and all the homework was on the technology so my mom could check what I needed and make sure I did the homework and had all the books and stuff. (Appendix E)

Paul took medication that helped his concentration. He stated that while still in South Africa he would get very hungry if he forgot to take his medication and would try to notify his parents. Paul’s mother confirmed that some educators’ understanding of Paul’s need for Ritalin made a big difference on the days that medication was forgotten at home. Since eating in class before first break was normally prohibited, the allowance to eat and contact parents to bring medication helped Paul have a more normal day. There were occasions in South Africa, though, that other teachers would deny such permission, which did not occur in Australia as it was a school policy to contact parents if medication had been forgotten. 5.6.5

Sam: Fostering success at school

In spite of perceiving school as an unpleasant experience on the whole, Sam was able to comment positively on the assistance that some educators provided: Teachers made a difference because my standard was consistently low; I was almost expected to fail. I was a bad reader and writer, even though on a personal level I thought maybe I could do it. I wanted good marks, got better marks on computer than from writing tidy. (Appendix E)

He specifically remembered an educator in Grade 5 who stood out and about whom he responded positively: She was strict on homework and she would reward you. One day, if I didn’t do my homework she was in your face but kind. I got my best marks in her class because I knew she was always thinking about me. (Appendix E)

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Sam is currently enrolled for a business qualification at a college, but expressed regretful feelings, similar to Frik, about not taking his schoolwork more seriously. 5.6.6 Conclusion: Fostering success at school Establishing an effective family-school-therapist partnership is a process requiring honest and transparent intentions by all parties over time, since no isolated intervention by a single party can assure positive family-school relationships (Thompson, Thurlow, & Whetstone, 2001). On the whole, the participants in this study wanted to achieve, and the schools’ and teachers’ expectations and reflections made a difference to their motivation, attitude, and effort. All five participants showed that they were not averse to discipline when they could feel that it was motivated by genuine concern on their educators’ part. CAPD is a life-long struggle and the environment can help or hinder management initiatives and strategies. Actions do not always have to be on a grand scale to make a difference. Positive steps towards inclusion can be taken on a classroom-by-classroom and a school-byschool basis, and a single teacher can have a dramatic effect on the lives of learners who experience barriers to learning (Smith, Polloway, Patton, & Dowdy, 2006). Even Sam, who described himself as rebellious, responded positively to individual educators, and it is significant that their impression on his perceptions remained with him even after he completed his schooling. While inclusion is given shape and direction by policies and legislation, individual values, attitudes, and beliefs about society, schools and learners are powerful determinants of the extent to which inclusion is embraced. 5.7 COMMUNITY NETWORKING The local community and schools are important centres for the child, and they fulfil their function in terms of the exosystem envisaged by Bronfenbrenner (2009) (see Figure 5.4). Often community events and celebrations are shared with the family and school of a particular community. If a child is not part of the local school and has been sent to a special school, this socialisation has to be addressed and parents may need to attend the event not only at school, but perhaps also when celebrated at a religious place, for example Purim for the Jewish community at both school and synagogue. This was very evident in Frik’s case

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and the contrast was vivid in the other four cases where the participants felt part of the school community (Appendix E). Parents, family, and friends need to be aware of supportive initiatives that are available in communities, which can establish “cradle to career” conditions for learning that make it possible for every child to succeed. This strategy works by creating a collaborative leadership structure, embedding a culture of partnership, and aligning resources.

Figure 5.4 The exosystem – community networking (Adapted from Bronfenbrenner, 2009)

5.7.1

Frik: Community networking

Mismatches may occur when the home, culture, and values are at odds with the school or the views of a therapist. This was particularly evident in the case of Frik, who remarked: “I knew I had to be at a different school to my brother and friends; my holidays where not the same” (Appendix E). The contrast between Frik’s situation and the situations of the other four participants provides evidence that fitting in and a feeling of belonging to the community has a positive effect on the learner. Once the relationships within a school between the staff, learners, and families work positively, there is the array of partnerships, such as with other schools and the wider community, which can also be formed to assist learners with CAPD. This was beneficial for Frik (Appendix E). In Frik’s case, his involvement with joining the army provided him with the motivation to create goals for himself.

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5.7.2

Greg: Community networking

Greg noted that “all schools are different and the community of the all-boy’s school was different to that of the co-ed school” (Appendix E). It is important to feel comfortable and part of the community so that one’s energy can be focused on succeeding and flourishing in the environment. 5.7.3

Paul: Community networking

Paul observed that the ex-South African Jewish community in Perth was a close-knit and supportive one (Appendix E). This had a very positive effect on him as it provided him with a support system. The community’s strategy was aimed at encouraging each individual to be a responsible member who could make a difference. Paul developed socially, emotionally, and academically. He became motivated and engaged in learning. His family and school worked effectively together. The more his family reported that belonging to the community made one more “vibrant”, the safer he felt in the community. The structures and functions in a healthy community network are based on a foundation of collective trust that is vital to helping its members achieve self-sufficiency. When school and community partners share responsibility for the education of children and youth, a positive and long-lasting support structure and network emerge. 5.7.4

Eliza: Community networking

Eliza merged naturally with her local community and her family took part in the activities of the school synagogue. Her family’s assistance to other members of the community enabled Eliza to realise that every individual was unique and had own strengths and weaknesses (Appendix E). A community-oriented group like Eliza’s family develops a shared vision, builds a common policy framework, and aligns its resources. With strong parent and neighbourhood participation, and responsible planning, this family focused on the implementation of continual improvement. This example had a constructive effect on Eliza’s self-worth, motivation, choice of friends, extramural activities, and perception of her schooling career.

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5.7.5

Sam: Community networking

Sam relied heavily on the community network in that his mother was subsidised with fees and other support by the school and community. Some resentment was apparent from Sam’s mother who felt that she was constantly being called to the principal’s office to account for Sam’s poor marks or behaviour, whereas she wished for some positive words of reassurance instead of disapproval. However, if such support had not been available, Sam would not have been able to attend the private school. 5.7.6

Conclusion: Community networking

The importance of teamwork can be illustrated by a short parable entitled “A lesson from the Geese” by Milton Olson, in which he describes the power of teams in making a difference: “As each bird flaps its wings, it creates uplift for the bird following. By flying in a V formation, a flock adds 71% flying range in comparison with a single bird’s solitary flight” (York, 2008, p. 20). Similarly, people who share a common direction and sense of community can reach their goals more quickly and more easily because they are assisted by their mutual efforts (Jorgensen, 2006). This research recognises the importance of the community helping to support the success of every learner, but specialised initiatives must be considered for guiding and aiding learners with CAPD. The example of Greg may serve to underscore the special attention and sensitivity to their unique circumstances required by a learner and parent in the face of a complex learning disorder. For them, understanding required more than a quid pro quo of Greg’s attaining better marks to justify community assistance, but it was also found that the schools in this study had a strong community network that provided support for learners whose parents could not afford therapy and for the learners themselves when eventually exploring career options. Networking often requires new ways of the school and community working together. As interactive “partners” in an exosystem, they should recognise that effective assistance requires infrastructure and support coordination along the entire span of children’s education journey from their reception year to their completion of their final grade. The community network needs to provide services at nearly every step of the education continuum including early-childhood education, expanded learning opportunities such as after-school and holiday

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programmes, educational enrichments, youth mentoring services, tutoring services and job training. Ideally, community leaders, schools, therapists, and parents should make concerted efforts to identify the most important educational outcomes for children and commit to finding the best ways to achieve them. Contributions to system-building efforts may involve advocating policy changes, setting quality standards, and raising public and private funds for appropriate CAPD assistive programmes. 5.8 EFFECTS OF MACRO- AND CHRONOSYSTEMIC CHANGES As noted in sections 2.2.5 and 2.2.6, the macrosystem and chronosystem in Bronfenbrenner’s (2009) ecosystemic model involve respectively socio-cultural influences and “temporal” changes. These two encompassing systems frequently interact to such an extent that it is difficult to disentangle their operations and effects. This section will be devoted primarily to macrosystemic implications with reference to chronosystemic influences where appropriate. In South Africa, the most recent generation experienced one of the most significant sociopolitical chronosystemic changes in the country’s history. The national education system (as part of the macrosystem, see Figure 5.5) in particular underwent fundamental transformation that had a cascading effect on all its subsystems. Prior to 1994, the general education system in South Africa enforced separate education for different population groups, which led to discriminatory practices that excluded certain “races” from access to quality education. This resulted in the duplication of functions, responsibilities, and services, and vast disparities in per capita funding between the different education departments (Lomofsky & Lazarus, 2001). Each department of education had a dual system that separated learners with special educational needs from the so-called normal learners. Learners with special educational needs, such as CAPD, were placed in special schools, whereas the “normal” learners went to mainstream schools. However, not all of these departments of education made provision for learners with special educational needs (black communities in particular were severely marginalised), and thus many were “mainstreamed” by default (Lomofsky & Lazarus, 2001).

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Figure 5.5 The macrosystem (Adapted from Bronfenbrenner, 2009)

The 1994 democratic elections in South Africa marked an end to the apartheid education system and ushered in new changes. These changes included the creation of a single education system and the development of educational policies committed to human rights and social justice, which may be considered to relate in particular to the macrosystem with cascading effects into the exo-, meso-, and microsystems of education as a social reality. New initiatives and commitments were reflected in key policy documents such as the 

White Paper on Education and Training in a Democratic South Africa (DOE, 1995), which discusses the importance of addressing the needs of learners with special needs in both special and mainstream schools;



South African Schools Act (Republic of South Africa, 1996b), which compels public schools to admit learners and to serve their educational requirements without unfairly discriminating in any way;



White Paper on an Integrated National Disability Strategy (Republic of South Africa, 1997) that recommends specific action aimed at ensuring that people with disabilities are able to access the same rights as any other citizen in South Africa; and



National Commission on Special Educational Needs and Training and the National Committee on Education Support Services Report (Department of Education, 1997), which identified barriers leading to the inability of the education system to accommodate diversity.

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All of the above legal frameworks were based on international human rights agreements, such as the Salamanca Statement (UNESCO, 1994), which supported the development of an education system that recognised a wide range of diverse needs and ensured a wide range of appropriate responses. These frameworks articulated the goals of equity and the rights of all learners to equal access to educational opportunities. New policies in the macrosystem had a decisive transformational effect on the education of children with barriers to learning such as poor reading and writing skills. These children are now able to use assistance by readers and scribes, and may sit for examinations in separate venues. During class, they are able to use technology such as computer laptops or iPads for typing and spelling. Such seemingly minor practical changes at meso- and microsystemic level that resulted from policy transformations at chrono- and macrosystemic level can have a decisive effect on the educational perceptions of the individual learner with a learning disorder. Good examples from this study were Greg, who often had to rewrite his work in Grade 2 because it was not neatly written in the lines, and Frik, whose problems with writing and even writing materials caused him to lose marks (see section 5.8.1). The foregoing examples may also serve to illustrate the connection between the Bronfenbrenner model and IPA research in discovering the “meanings [that] particular experiences, events, states hold for participants” in their “lived experience” (Smith & Osborn, 2015, p. 53). Through qualitative research it was possible to explore “the ways through which a ‘self’ and its ‘world’ are constituted . . . in relation to experiences of ‘Reality’” as expressed in “the intricate web of purposes, motives, interests, needs, demands, feelings and so on” (Schostak, 2002, p. 18). Schostak (2002) also mentions the ways in which individuals orient their behaviour towards one another “in a world of material structures” (p. 18). These structures almost invariably work in a systemic relation, and the simple examples drawn from Greg’s and Frik’s narratives indicate how experience and perception can be better understood in the wider context of socio-ecological systems. Thus, in an interpretative analysis it is possible to discover that a minor fact can assume great or “rich” significance when viewed in the context of interrelated elements. One of the major aims of such insight is to work towards ways of ameliorating the anxiety that learners with CAPD experience and to pre-empt negative perceptions of learning. Similar examples of stressful schooling experiences, or some aspects of the schooling environment, which tended towards negative perceptions about learning, can be found among the other participants as well. The experiences and perceptions of Eliza, Paul, and Greg reflected their struggles with the academic aspects of their schooling 115

careers, but they had fond memories of the positive feelings that sporting activities provided them. 5.8.1

Frik: Macrosystemic influences

The South African Government’s commitment to “education for all” led to the development of a policy on inclusive education and training. At the time of the implementation of these policies, inclusive education strategies were at a very early stage of formulation (Donohue & Bornman, 2014). Regarding the potential value of technology, the use of iPads was not feasible, computers were not readily available for poor spellers, and the use of scribes and readers were costly. Since then, numerous assistive technologies and strategies have become available to learners with special needs, and parents and schools should increase their awareness of them. Frik, for example, remarked: “My writing, spelling, and reading have always been crappy! My ideas are good but it does not come out in paper like I picture it in my head” (Appendix E). Another example of the importance of scribes or technical aids for learners with SLDs comes from an essay that Frik wrote in high school. He made the error of not using consecutive pages, which resulted in his concluding paragraph not being seen and remaining unmarked. The use of appropriate technology or assistance such as by a scribe would have prevented a negative classroom experience. This will be discussed further below. In view of macrosystemic policies, there is theoretically no need for such difficulties to stand in the way of accessing content for learning, but practical issues such as a lack of adequate organisation and resources pose serious obstacles. 5.8.2 Eliza: Macrosystemic influences Eliza’s problems with Hebrew (Appendix E) points to the curriculum as a focal point of inclusion practices. With the move towards inclusion comes the need to look critically at the curriculum as a potential barrier to learning. The curriculum is often misunderstood as referring only to the syllabus or the content of what is taught, but it also includes the programme’s structure, the processes and methods of teaching/learning, methods of assessment and evaluation, and a range of factors characterising the particular shape of the whole programme (Donald et al., 2002). Inclusive school communities should therefore create overarching curriculum frameworks that can accommodate the needs of individual learners (Sands et al., 1995). Darling-Hammond and Falk (1997) maintain that because all learners learn differently and bring different life experiences to their learning, no single 116

highly prescriptive curriculum can be regarded as equally effective for all. The focus is thus no longer on the individual learner to fit in, but on the potential of the system to transform so that individual differences among learners can be accommodated (Ainscow, 1999; Vaughn et al., 2003). Eliza presented as a learner with specific learning difficulties but with areas of great strength. Therefore, her areas of slower reading, spelling, and mathematics may have precluded her from obtaining a university pass, but by using her strengths she could complete Grade 12 and could move forward with a career in physical training without feeling that she had failed in any manner. She did not experience the regrets that Frik did. The explicit curriculums that allowed for the allocation of marks in the field of sport could be regarded as a macrosystemic advantage for Eliza that she put to positive use. 5.8.3

Paul: Macrosystemic influences

Paul’s macrosystemic environment functioned in an unexpected way for him, since the Australian system freed him of the obligation of continuing with language subjects that gave him trouble. The environmental change, initially a geographical, physical one, carried with it new influences that reduced his academic pressure by allowing him to choose subjects at which he was stronger (Appendix E). Again, it is evident that curriculum and subject choices are important ecosystemic determiners for learners. Even different school policies in terms of Paul’s need of medication had an influence on changing his perceptions on schooling for the better. This type of policy should be an important consideration in the South African inclusive school environment. 5.8.4

Sam: Macrosystemic influences

Parents generally attempt to use all the resources available to enhance their children’s academic success and keep stimulating the child academically, but parents in affluent strata of society are better able to do so (Donohue & Bornman, 2014). In Sam’s case, with an absent father and an economically struggling single mother being unable to afford extra afterschool education classes, the Matthew effect (see sections 2.5.4 and 2.8.4) set in (Young, 2001). Sam’s mother took recourse to other community resources made available via the school. Although having access to such resources, some resentment was evident in both mother and son because of feeling judged when Sam not only failed to achieve but misbehaved. It cannot therefore be assumed forthwith that resource made available will be 117

used effectively. Policies in themselves cannot ensure successful outcomes, as Sam’s case indicated. Sam required maturity and a better relationship with his mentors, i.e. his mother, educators, and a responsible peer group to achieve more with schoolwork, but it did prove that positive ideas remained with him after leaving school. According to Education White Paper 6 (DOE, 2001), inclusion is about supporting all pupils, educators, and the education system as a whole, so that the wide range of learning needs can be met. Inclusion focuses on overcoming barriers in the system. The inclusion of learners with barriers to learning is a dynamic process that is constantly evolving and implies both societal and educational change (Donohue & Bornman, 2014). Successful inclusion requires a full array of school-based modifications and it increases the learning options for all learners. Schools need to align their focus with that of a democratic society and should provide an opportunity for children to be members of a society in which prejudicial labelling and separation from the whole are not a feature. Proper guidance about the application of resources will enhance their optimal utilisation as implied by Donohue and Bornman (2014). 5.8.5

Conclusions: Macrosystemic influences

The South African Schools Act of 1996 (Republic of South Africa, 1996b) recognises only two categories of schools: public and independent. Public schools are state controlled and independent schools are privately funded and governed. Independent schools’ right to exist is further confirmed in terms of Section 29 of the South African Constitution (Republic of South Africa, 1996a), provided they register with the state, do not discriminate based on race, and maintain standards not inferior to those of comparable public institutions. Independent schooling has a long history in South Africa, as some of the first education institutions in the country were missionary schools (Strydom, Hay, & Strydom, 2004). Since the advent of democracy in South Africa in 1994, many changes have occurred in the independent school sector. According to Lockhart (2006), independent schools are encouraged to be inclusive of learners who experience barriers to learning, but are not compelled to do so. Thus, even in independent schools, Sam’s mother would not have been able to rely only on the teaching supplied by the school, but would still have had to pay for the help of other educators and professionals to help with Sam’s CAPD. In another respect, the policy on languages in the curriculum made passing their final examinations harder for

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Eliza, Greg, Frik, and Sam than for Paul, who did not need a second language because of different requirements stipulated by Australian law. Policy-makers wish to base their decisions on scientific and valid research, but as noted previously, there is no complete “cure” for CAPD. Flexibility is needed when choosing a method and curriculum for children with SLDs (Goss 2006). Each child is unique and has specific needs in the inclusive environment. Educators are aware of this requirement for flexibility and employ various literacy methods to teach such learners to read, write, and learn (Goss 2006). These approaches are economically expensive and practically unfeasible for large numbers of learners. The schooling community in this study fostered inclusive practices for learners with CAPD, aiming at the ideal of promoting ownership and empowerment among all role players in supporting workable intervention efforts. The school worked with therapists as well as other specialised schools. Educators were sent on special courses such as continuing education programmes in which they were trained in other methods of teaching reading, for example using the Orton Gillingham Programme instead of the normal schools’ reading curriculum. Educators, heads of school, and therapists made applications to the IEB for approving extra time during examinations, assistance by scribes, and other forms of help (Appendix J). The attainment of such goals depends upon the ability of the community to build partnerships with all involved, which in turn requires sound communication between the community and policy-makers as interactive participants in the meso-, exo-, and macrosystems. Learners with SLD now form the largest group of disabled students in higher education, with the highest number found in the more affluent, first-established and prestigious universities, and the lowest number in institutions serving a lower social and economic catchment abroad (Peer & Reid, 2013). It may be concluded that parents from the former group appear more likely to recognise the learning difficulty and make rigorous and demanding use of the support that is available. In the analysis of Sam’s data about the Matthew effect (see sections 2.5.4 and 2.8.4) the irony was pointed out that even though extra resources were available to Sam’s economically struggling mother, Sam’s weak personal motivation and poor perception about schoolwork caused him not use such assistance effectively. In a society with easy access to information via technology, parents can be encouraged to gain information using technology that would be of benefit to the child. In Greg’s case, his mother was able to obtain study guides and examination papers for English that helped the 119

entire grade. Although some disadvantages of Internet searches may be found in a confusion of information overload for learners with reading difficulties, thoughtful and appropriate use by parents and family far exceeds deleterious effects. Even games may have a positive function. For example, Eliza’s mother thought that electronic games “hyped her up”, whereas her grandmother searched for articles on the value of such games in improving reaction time and helping children to focus and build skills such as problem solving. When one talks about children with language or auditory processing issues, the discussion may appear highly abstract, failing to fit “nicely” into a medical or social model. Consider for a moment an absurd scenario in which the wearing of spectacles was seen to confer an unfair advantage in examinations. All candidates were expected to be spectacle-free, unless an optician could certify that a candidate’s need could be met only by allowing the wearing of glasses in examinations. Suddenly, a completely new population of disabled learners was created, exactly as is done when a learner has weak spelling, slow reading, and poor handwriting. Consequently, an accurate but relatively slow reader with poor handwriting and spelling would be regarded as having a disability. Riddell, Tinklin, and Wilson (2005), in their study of higher education, recognises that disabled students are currently compelled to function within a system that understands disability in terms of mental or physical deficits – an understanding perpetuated by a range of bureaucratic and administrative arrangements that promote a medical concept of disability (see also section 2.4.6). In the daily process of teaching and learning, educators are not faced by an either/or choice, between a biomedically or socially construed response to learning difficulties. For most of the time, a wise response seems to lie somewhere in between the two (Goss, 2006). Learners’ characteristics need to be considered. Educators are often more sensitive to each child and will know what curriculum could work. This leads to the question whether South African policy-makers will allow educators to use their discretion or whether further turmoil will ensue because of a lack of clear guiding rules, a lack pointed out in particular by Donohue and Bornman (2014). Some impairments are arguably more self-evident than others are. The inability to fit the disability fairly and uncontroversially into any biomedical/school construction continuum causes these learners’ individual differences to be institutionally transformed into disabling factors such as severe dyslexia and, consequently, functional illiteracy. Spectacles are accepted because of the word of one optician, yet permission for assistance by scribes or extra-time concessions for a second-language examination requires a panel decision, a 120

medical history, and a battery of tests before it is even considered, and is still often not granted. In this study, Frik, for example, was granted permission for aid by a scribe for examinations, but not for small tests during school because such assistance was impractical. Such seeming inconsistencies do not make sense to learners and may cause them to lose faith in a system that is supposed to support them. The answer must be sought primarily among issues of institutional convenience and in an era were examination boards are commercial concerns, subject to market-place pressures, among issues of user-convenience and marketability. A mass education system has led to a mass assessment system. Examination boards compete for customers, and product marketability is likely to depend upon factors such ease of administration. The logistical imperatives are undeniable. Where several hundreds of candidates have to be processed through crowded examination halls to a remorselessly tight schedule, a single desk with a pen, question paper, and answer booklet comprising a formidably efficient process, makes no difference if 20% of the candidates are wearing prescription glasses. It would, however, make a considerable difference if large numbers chose to word-process their answers or use scribes, or if an invigilator could not call out, at the scheduled time, “Stop writing now”. Although educational practice has been moving in the right direction, the pace needs to be increased in the shift away from institutionally convenient assessment practice towards practices that are more genuinely inclusive. One of the negative strategies currently still at work is that boards of education are guided in their decision-making by policies aimed at easy implementation for the largest numbers of learners without due concern for the needs of the individual learner in an inclusive setting (Carpenter, 2010). The area of special needs education, including assistance for children with CAPD, has undergone significant change in the last 25 years worldwide, and specifically in South Africa in view of fundamental transformations in the education landscape after the advent of democracy (Rankapola, 2004). The movement towards inclusion equity – in addition to social equity – has been dynamic, resulting in a large growth in the diversity of children in the school system (Engelbrecht, 2001). Since the publication of the White Paper on Education and Training in a Democratic South Africa (DOE, 1995), the Education White Paper 6: Special Needs Education - Building an Inclusive Education and Training System (DOE, 2001a) and subsequent legislation, considerable changes have taken place in education to promote and aid a method of examination that is fairer to learners with learning disabilities. 121

Evidence of this is reflected in the liberty to apply to the IEB for an exemption in a subject, extra examination time, or assistance by a scribe, and by taking into consideration appropriate assessment adaptations, modifications, and concessions. The system of education should be structured in such a way that, irrespective of the learning context, opportunities should be provided for facilitating integration and inclusion of learners in all aspects of life (Engelbrecht 2006). The five cases considered in this study underscore the fact that each learning difficulty is unique, and that the unique situation of each learner is often impinged upon by inflexible policies within the school system. It would be ideal to have as much flexibility as possible so that appropriate solutions could be provided for each learner –it should be possible to gauge what works best in each case. 5.9 EXPERIENCES OF PARTICIPANTS AND INTERACTIONS OF SUBSYSTEMS The participants in all five cases had certain similar experiences and perceptions of their schooling careers that the researcher attempted to situate in an ecosystemic context as framed by Bronfenbrenner (2009). Through qualitative analysis, an endeavour was made to construct a narrative of each participant’s schooling career, starting with the diagnosis and treatment of CAPD in nursery school, and ending with their completion of Grade 12 and the National Senior Certificate. The experiences of these learners through their schooling career corroborated findings in the research literature that APD entails life-long debilitation associated with specific learning disorders and other labels such as dyslexia. CAPD as a disorder with a hereditary component is a struggle for families and individuals; because it cannot be “fixed” it needs to be managed. Many parents lack the skills to undertake a highly complex management process and therefore have to rely on the school or therapists to assist them. It is essential to bear in mind that a problem such as CAPD can be viewed in an ecosystemic model that explains interactions between the microsystem of the individual up to the macrosystem of national policy. It is at times possible that friction might arise in interaction between these systems because of misunderstandings, especially between microsystem (individual and family) and mesosystem (school), and that sound communication should be maintained to prevent interruption of effective management strategies. The research has indicated that a set of characteristics, attitudes, and behaviours can help lead persons with CAPD to positive perceptions about and outcomes for their schooling careers. 122

Unfortunately, it appears that undue emphasis is sometimes placed on inappropriate educational determinants in the macrosystem – for example theoretical policies and approaches that have not been proved as feasible in practice, as indicated by Donohue and Bornman (2014) – ironically often with disruptive cascading effects on other assistive attempts undertaken in the exo- and mesosystems. In other words, tactics and strategies for the development of positive perceptions among learners and their caregivers in the microsystem should be enhanced and not disrupted by school, community, and national initiatives originating in the meso-, exo-, and macrosystems. The narratives developed for this study provided indications that it is not necessarily only academic methodology that should be considered, but also new ways of employing other school activities such as sports to inculcate positive self-image values and perceptions. A sound sense of belonging to and acceptance by a team or community can in turn aid in strengthening a sense of structure and routine, which may serve to resolve organisational issues. Sound communication between all role players is essential, since at micro- and meso-levels families should support school efforts, and schools should support families through mutual understanding and consistent conduct. It is for schools, for example, vital to grant learners the extra time or support during examinations so that they do not feel overwhelmed. Parents and families, in turn, should make special effort to help learners to meet school demands through active participation in the learning and teaching process (Eliza’s grandmother serves as an excellent example here). Tolerance of difference and fostering of mutual respect play an important role. Learners need to feel worthwhile, understand the importance of school, as well as find a way to enjoy their learning experiences. 5.10

CHAPTER SUMMARY

The perceptions of participants about their “learning life” were considered in narrative themes that were brought into relation with various systems of Bronfenbrenner’s (2009) bioecological model. Further discussion was devoted to the participants’ awareness of the self and the effects of learning limitations on that self. Regarding the needs arising among participants because of these learning limitations, the micro- and mesosystemic support provided by family and educators was outlined. The school’s functioning in fostering success was viewed from the participants’ perspective, after which the importance of community networking for support initiatives was emphasised. The implications of the workings of 123

macro- and chronosystemic forces on other systems were noted in respect of potentially positive or negative influences on the lives of learners with SLD. In conclusion, special note was taken of the various impacts of systemic interactions in their mutual functioning, with the caution that concerns of the individual learner should be primary.

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CHAPTER 6 CONCLUSIONS AND RECOMMENDATIONS

6.1 CHAPTER PREVIEW This chapter serves to summarise the study in its entirety. The researcher also discusses her reflections, as well as the theoretical and practical implications of the study, the limitations that may apply to this investigation, and recommendations for future research. 6.2 SUMMARY OF THE STUDY This study explored the experiences and perceptions of five learners with CAPD from the angle of their individual perspectives on their schooling careers in an inclusive classroom. The researcher identified these learners in Grade R by means of a screening tool and was able to follow the development of most of them through the greater part of their schooling careers up to the end of Grade 12. As a speech–language and remedial therapist working in a high school setting, the researcher became aware of a potential link between auditory processing and later learning difficulties. She also noticed how family, educators, and schools struggled to meet each other’s needs in supporting struggling learners. These observations led to the rationale for a study aimed at a better understanding of the various systemic elements at work in advantaging or disadvantaging learners with SLD, and more specifically CAPD. To ground the study in IPA, it was decided to use purposive sampling to select appropriate participants whose experience and perceptions would lead to rich narrative data for the extraction of codes and themes. An interpretative qualitative approach was used to relate themes to the microsystem of Bronfenbrenner’s (2009) bio-ecological model in which the participants experienced their school-going “reality”. These experiences were contextualised as perceptions about having to cope with school as learners with CAPD in the mesosystem of school and community, after which consideration was given to the interactions between the various subsystems in Bronfenbrenner’s model. Thus, the rationale for the study was to deepen understanding of the “bigger picture”, as seen through the lens of Bronfenbrenner’s model, in which the participants were also functioning in interactive systemic patterns from their school reception year up to the completion of Grade 12. In undertaking an investigation of this nature, the researcher embarked on a research quest of a kind explained as follows by Schostak (2002):

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By interrogating the world appearing to consciousness, the “look” of the researcher meets the “look” of others. Like the sweep of a radar the positions of others, objects and their relationships are marked out. The nature of the questions posed guides the “coverage” of the world about and the way it is mapped in order to locate self in relation to others and objects. Hence it is important to search for guiding questions. However, these do not necessarily arise all at once at the beginning. The search for questions continues throughout the life of the project. Projects tend to be written up as if they are answers to key questions, gaps in knowledge, or issues that have not been noticed before. (p. 12)

This study was a long-term project and the search for questions and answers did indeed continue over the entire period. The key questions, gaps in knowledge, or issues requiring extra attention were about personal experiences and perceptions of learners diagnosed with a highly complex disorder, CAPD. The “look” of the researcher had to meet the “look” of others, for example in interviews, so that poorly understood learning problems could be reconsidered. The great value of IPA and qualitative analysis was underscored by the possibility of constructing narratives from data and finding themes which, in the words of Zhang and Wildemuth (2009), would uncover meaningful patterns underlying a social reality. The social reality experienced by the participants in this study could be regarded as a traumatic one of a life-long struggle with auditory processing difficulties that had had a hampering effect on their “world appearing to consciousness” (Schostak, 2002, p. 12). A supplement of this study was to provide learners and their parents or caregivers with the assurance that “It’s OK! What you experience is normal. This will help, but that won’t.” Although this investigation may make a contribution in providing such reassurance, a gap exists in the literature about determining the efficacy of intervention approaches and management strategies at various ages in the treatment of CAPD. More data are needed about the relationship between assessments, intervention or treatment programmes, and the outcomes or learners’ perceptions. In South Africa, considerable progress has been made in the introduction of policies on inclusive education and the availability of assessment in the private sector (the macrosystem), but the day-to-day management of the techniques and administration of resources, therapy, networks, and communication between learners, parents, schools, and therapists (the exo-, meso-, and microsystems) require not only further research, but also urgent attention to practical implementation.

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The theoretical framework of the study was formed from an in-depth literature review, which included consideration of the principles of inclusive education, as well as the clarification of the explanation, symptoms, and treatment of CAPD. Bronfenbrenner’s (2009) bio-ecological theory was also investigated to guide the framing of a research structure within which participants’ learning development and perceptions could be positioned from an ecosystemic perspective. Via tests, interviews, observations, documents, and other artefacts, data were gathered and analysed using qualitative, phenomenological analysis, after which Bronfenbrenner’s model was used as a platform for the themes that were articulated during data analysis. The final categories of themes that arose from the research were the self (each individual learner), the family and friends of the learner, the school and educators involved in the learner’s environment, the local community in which the learner lived, and the policymakers that affected the learning environment. Case narratives were composed from the interviews with the five participants in the study regarding their perspectives of their schooling careers, which enabled the researcher to explore the richness of qualitative data about the participants’ experiences and perceptions. The results from the data indicated that learners who were supported by parents, teachers, schools, policy-makers, and therapists, developed coping strategies and a more positive perception of their schooling career. Activities such as sports helped some participants in building self-esteem, friendships, and social skills, which encouraged them to assume more positive attitudes to all challenges in their lives. Each school that the participants had attended had embarked on inclusive education in a different manner. However, the participants and families who had a closer connection with the schooling environment and who were more involved with the school had better communication from the school. These participants had an improved understanding of the educators’ and the schools’ expectations, which enhanced their perception of their schooling life and their attitude to learning. In conclusion, although each participant experienced learning difficulties during their schooling careers and two of the participants felt regret at their lack of dedication to their schoolwork, they had positive perceptions about their schooling careers to varying degrees. All the participants had the perception that they were well accommodated educationally and emotionally by their schooling environments. If the Zulu proverb that “it takes a village to raise a child” is considered, this research highlights the need of the entire “village” – that is, learners, family, friends, schools, educators, communities, and policy-makers in the bio127

ecological system – to make a concerted effort to assist children with learning difficulties in experiencing a positive schooling career. 6.3 THEORETICAL AND PRACTICAL IMPLICATIONS Possible theoretical implications of this study are the development of new coping, management, and teaching strategies that could be used to help not only learners with CAPD, but also learners with various other auditory processing and learning disorders. Since practical implementation of these strategies should take place within inclusive education settings, collaborative partnerships need to be emphasised. The concept of partnership in this study is central to the participatory process. Partners are key players in the child or adolescent’s life, whose involvement is critical to the success of efforts that make these children into happy, healthy, independent adults. The entire social circle needs to aim at transforming all aspects of organisational life in a collaborative, integrated, and holistic way with a view to making them more functional, inclusive, and health promoting. The nature of a school as an open inclusive system necessitates that all aspects of school life such as leadership, school culture, parent involvement, discipline, curriculum, management, sports, and human resource development work together to address the barriers for learners with CAPD. All of these elements working together in a cohesive whole will promote the successful fulfilment of the needs of children with CAPD. Collaborative efforts should extend beyond conferring or collaborating with specialists from other fields (cross-disciplinary) regarding the diagnosis or treatment of individuals, but should include cooperation in the development of programmes where all involved in the schooling community are implicated. This will prove to be a challenge, especially in communities with socio-economic barriers, where more programme development and evaluation techniques need to be put in place so that they can participate as partners in the accommodation process and maintain intervention efforts. As people are naturally resistant to change, school leadership will have to work persistently to help change people’s orientation to paradigm shifts and changes in addressing the barriers that children face. Once educators and other school personnel can fathom those changes, even at levels such as a timetable adaptation, the change will be more effective. This participation should, however, be initiated by someone specific. This is where the educational psychologist, remedial therapist, social worker, occupational therapist, and speech and

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language pathologist can enter the domain. By playing an active role in the facilitation of change in our schools, they can initiate the support efforts of the whole schooling community. Learners with CAPD need support, coping strategies, open communication, and help to bolster their self-esteem. The family needs help to understand the conditions of CAPD and strategies how best to deal with their growing child in the school system. Teachers need to be educated on the treatment and symptoms of CAPD, how best to help the children cope, and keep the parents up to date with communications and vice versa. Teachers must not feel solely responsible for a child’s progress in a specific subject but must be able to use the resources of the therapist so that class work is not only explained by the teacher in school and consolidated by parents at home, but also extended and consolidated in therapy sessions, with all participants working collaboratively. Repetition of class work tasks is essential for children with specific learning difficulties and must be seen as a positive supportive front and not as simple repetition and lack of creativity. Assisting in homework tasks, the professional therapist would be able to divide the tasks into manageable sections and provide judicious support without spoon-feeding, which would detract from learners’ self-esteem and motivation to take responsibility for tasks. This useful technique could be transferred to facilitators and family members involved with homework. CAPD is a disorder that seems to remain present in its core form throughout life. The participants in this study, now young adults, through sharing their perceptions, have provided indications that it is possible to use own strengths in certain fields to compensate for weaknesses in others. Assistive efforts may increase their awareness of other avenues to explore in order to find niches or working environments that do not make undue demands on auditory perception skills. Thus, CAPD will still exist, but functionality will not be impaired. 6.4 LIMITATIONS OF THE STUDY This study was based on the experiences of five learners who all originally went to the same high-income, private, co-ed, single-religion, independent day school. This means that sufficient resources were more readily available to parents and educators in having recourse to professional assistance in identifying the children as having CAPD and supporting them where possible. Specialised intervention would be less likely in areas with schools catering for lower-income groups. Research undertaken as recently as 2011, for example, revealed that even in Gauteng, the most prosperous and best resourced among South Africa’s provinces, the majority of learners with disabilities seldom or never received specialised 129

support services (Donohue & Bornman, 2014). Further research into similar cases in underresourced communities is therefore indicated, since it was an aspect that fell beyond the scope of this study. Although the number of participants was small, which is a traditional objection to many qualitative research studies, it should be considered that the data obtained from the five cases were rich enough to provide valuable insights into the experiences and perceptions of learners with CAPD. Time limitations at the concluding period of the investigation made only interviews feasible as sources of data, but this deficiency was counterbalanced by the amount of data collected regarding early grades. Data collection can be time consuming and it is important to consider the possible difficulties that participants may experience in expressing themselves. They need to be interested and articulate. Problems that can cause difficulties in participants’ being able to express themselves include language differences, age, brain damage, and embarrassment (Creswell, 2013). In this five-case study, age, embarrassment, and the underlying subject of a processing disorder such as CAPD were definite limitations. The only way to ensure better results was by including parent discussions, some teachers’ knowledge, and other artefacts such as reports to obtain a better perspective on the participants’ views. My personal involvement with the participants in my capacity as a speech and hearing therapist may have led to a slight bias in the interpretation of the case studies from a speech and hearing perspective. However, I employed constant reflectiveness as a technique to guard against losing an objective perspective. 6.5 STRENGTHS OF THE STUDY The value of this study lies in the extended period of contact that the researcher was able to maintain with the participants: in four out of the five cases for the entire 13 years of their schooling careers. This enabled me to gain much incidental understanding, considering that long-term studies are rare. Because of thorough data collection about the participants’ early schooling and indications of CAPD, an excellent baseline assessment of their suitability for this study was possible. This made the findings from the interviews more credible.

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6.6 RECOMMENDATIONS FOR FURTHER STUDY This study focused on five learners with CAPD from a higher-income private school during their entire school careers. Three major indications for further research may be identified from this statement. Firstly, other investigations should consider a larger group of learners with CAPD. Secondly, a similar group should be considered, but then with inclusion of other communication disorders. Thirdly, attention needs to be given to learner groups from schools in lower socio-economic areas where therapy is not available in a private capacity. Such investigations could furthermore pursue the learning adjustment curve of participants into their working adult life to determine their progress and the impact of CAPD on their work careers. Family members could be included to determine how the disorder affected them and what types of support benefited them and the participants most. Where possible, special attention should be paid to ecosystemic factors. From such initiatives, it may be possible to promote the development of effective treatment programmes for learners with reading and spelling difficulties. Research into the efficacy of workshops for educators, particularly foundation phase educators, highlighting the role of the speech-language therapist in the treatment of learners with reading and spelling difficulties, is also a critical need. Such research would have great value for subsequent investigations into the efficacy of assistive efforts to support learners, particularly in the South African situation. There is currently a general lack of awareness about the role of the speech-language therapist in the educational context of the “inclusive” South Africa, and awareness of professional services that are available can serve as a departure point for ameliorating the difficulties experienced by learners with CAPD and SLD. 6.7 CONCLUDING REMARKS During my work as a therapist, I have met parents, teachers, therapists, heads of schools, and even policy-makers who had to deal with the issue of how children – each of them unique – need to conform with the schooling system like differently shaped pegs being whittled down for an “easy fit” into the proverbial square hole. Children should not be required to sacrifice aspects of their uniqueness in order to “fit”, or to be less than they are capable of being. Caring and sensitive educators and parents believe that children need the opportunity to grow and become successful, happy, secure young adults. Inspired by my personal contact with children with CAPD, I can only urge all parents, educators, and policy-makers to become as 131

knowledgeable about CAPD as they possibly can. Their attitude and skills in teaching and supporting these children in schools are critical. The observations of Bellis (2002b) in particular served as a guiding light for this conclusion about management techniques of CAPD. The appropriate treatment for CAPD should only be decided upon after a professional diagnosis of an auditory deficit. A clinician or therapist would assess the learner’s basic auditory skills or processes that underlie communication abilities, and, using normed tests, identify those auditory processes that are dysfunctional in a learner. Deficit-specific treatment for CAPD usually entails remediation of the underlying, disordered processes by facilitating improvement in associated higher-order, complex, functional ability areas. In other words, the process will involve effective screening, diagnostic tests, and the formulation of treatment or management strategies. Optimal remediation of the disorder is dependent on the efforts of not only professionals such as medical practitioners, psychologists, educationists, audiologists and speech-language therapists, but also family, parents and caregivers. Individuals with CAPD and their families must be motivated to learn and work for success since schools and healthcare professionals cannot solely be considered responsible for remediation. There are indications of increased professional research interest in the field of auditory processing difficulties, and it is to be hoped that more information and resources will become available for these families and health care professionals to manage CAPD difficulties in particular. This research confirms that learners with CAPD (like all other learners) are unique, that they require more individualised teaching approaches, and that management of CAPD needs to be tailor-made to fit each case. From the literature and the results of this study, it is evident that positive strategies are available for assisting learners with CAPD, especially to prevent them from becoming demotivated and giving up. It was also highly significant that some participants in this study may not have responded well to assistive efforts while in school, but that the “message” remained embedded in their minds and helped them to “resuscitate” positive principles for tackling new challenges. Personally, as a third-year student in speech and hearing therapy, I was diagnosed with dyslexia. My working memory was well above average, so I managed to get through school without much difficulty. I obtained academic colours and had grown up in Namibia where I spoke English, Afrikaans and German. I never struggled to the point of failure in the South African schooling system as my vocabulary and memory helped to compensate for any 132

difficulties. However, my difficulty with expressing myself on paper and allowing people to understand my vision is one of my greatest challenges. I recognise the difficulty in my clients, which rekindles my passion about making a difference in these children’s lives. In spite of great research and clinical advances in the field of CAPD, it is regrettable that much general doubt still exists about justification for recognising APD and CAPD as disorders. Especially parents, educators, and affected learners need reassurance not only that the problem is indeed real – however abstract to define and recognise – but also that it should not be considered an insurmountable obstacle. I would like to conclude with three quotations, the first by Haim Ginott, the eminent child and educational psychologist: I have come to a frightening conclusion. I am the decisive element in the classroom. It is my personal approach that creates the climate. It is my daily mood that makes the weather. As a teacher, I possess tremendous power to make a child’s life miserable or joyous. I can be a tool of torture or an instrument of inspiration. I can humiliate or humour, hurt or heal. In all situations it is my response that decides whether a crisis will be escalated or de-escalated, and a child humanized or dehumanized. Dr Haim Ginott

Ginott’s (n.d.) insight relates to the crucial role that educators play in the lives of learners, but learners, as well as their families and parents, will do well to bear the following in mind: [N]o boy or girl should ever be disheartened by lack or success in their youth but should

diligently and faithfully continue to persevere and make up for lost time. Winston Churchill (1946) The only place where success comes before work is in the dictionary. Donald Kendall (n.d.).

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Appendix A: Ethics clearance and permission forms

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Appendix B: Consent letters

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Date:January 1999

Elise M Kahan B.A. Speech and Hearing (WITS) Speech & Hearing Therapy LTCL Speech & Drama

Registered with South African Medical and Dental Council Registered with South African Speech Language and Hearing Assoc. TEL: 011 728-2715 / 082 771777 182 PR No/8212171

REG No/STA0015105

Dear Parents My name is Elise Kahan-Taurog and I am registered for a master’s degree in speech-language pathology at Wits University. Many children experience problems with reading and it is important that they are identified early so that they can receive the appropriate help. For this reason, I am currently trying to evaluate the effectiveness of the identification and prediction of language-based reading disabilities in Grade 0 children. It is hoped that the results will be of benefit to present and future pupils, parents, and educators. My research consists of a checklist (see Appendix A) that the teachers are required to fill out on each of their Grade 0 pupils. I would like 300 pupils to be involved. When the children are in Grade 1 the following year, they will be required to do a 20-word spelling test as well as a reading test. The hypothesis is that the children who were identified as at-risk on the checklist will be at risk for reading and spelling problems in Grade 1. The children will be free to attend any therapy the parents would like them to attend. Participation in the research project is entirely voluntary. Refusal to participate will involve no penalty or loss of benefit to which you are usually entitled. Furthermore, you may withdraw your child from the study at any time. All information about each child is confidential. Each child’s results are available to parents involved and any questions will be answered. No risks are involved in the research to yourself or to others. A summary of the results of the study will be made available to teachers and parents on request. Thank you for your time. If you require any further information, please contact me and I will do my best to answer your questions. Elise Kahan (011 728-2715 / 0827717182) Thanks again Elise Kahan

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Please fill in the form and give it in as you leave the hall, stating whether or not if you will allow your child to participate in the above study. The study focuses only on children from first language English speaking homes.

Child’s name _____________________________

Parents name _____________________________ Give consent I hereby

Contact No

____________

____________

Withhold consent /

For my child to participate in the study. (Please delete the part that is not applicable)

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Appendix C: Screening instrument

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Appendix D: Screening of participants

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Appendix E: Reading and spelling ESSI answer sheets, Grades 1 and 2

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Appendix F: NFER-Nelson reading comprehension test, Grades 1 and 2

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Appendix G: Field note examples about screening and rating scale

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Appendix H: Extracts from field notes by participants

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Appendix I: Extracts from field notes by researcher

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Appendix J: IEB application field notes

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