Speech-Language Acquisition and Scholastic Outcomes of Children with Hearing Impairment Following Early Intervention in South Africa: A Comparative Study

Abstract

Background: Children with congenital or early-onset sensorineural hearing impairment are at significant risk for delayed speech and language development, which can hinder their scholastic outcomes, particularly when early intervention (EI) is delayed or inadequate. Early Hearing Detection and Intervention (EHDI) has long been a critical focus within audiology; however, its effectiveness, particularly in Low-Middle Income Countries (LMICs) like South Africa, remains underexplored, with a lack of comparative research on Listening and Spoken Language–South Africa (LSL-SA) and Traditional Speech-Language Therapy (TSLT). Understanding the speech-language acquisition and academic trajectories of children receiving these interventions, and the role of parental involvement, is critical for optimising clinical and educational practices. Purpose: The primary purpose of this study was to investigate and compare the outcomes of therapeutic communication approaches, with a specific focus on the LSL-SA (adapted Auditory Verbal therapy) approach and TSLT, while considering the perspectives of parents in South Africa. The research further examined the challenges and barriers to implementing these interventions within resource-limited settings. The specific objectives at special schools for children who are deaf-and-or-hard of hearing (DHH) in South Africa included: to describe the therapeutic communication approaches to EI implemented; to describe the frequency and nature of the therapeutic communication intervention approaches; to determine the speech- language acquisition and scholastic outcomes of children who received LSL-SA; to determine the speech-language acquisition and scholastic outcomes of children who received traditional speech-language therapy; to compare the speech-language acquisition and scholastic outcomes of DHH who received TSLT versus those who received LSL-SA; to identify the barriers and strengths of the communication intervention approaches based on the needs and goals of families of DHH children. Methods: Generally, a quantitative, comparative, cross-sectional research design was adopted; however, each paper (presented as chapters in this thesis) outlines its specific research design and methodology. A non-probability, purposive sampling was used to select the records of DHH children enrolled in an EI programme, receiving either TSLT or LSL-SA at special schools in South Africa, as well as their parents. These records comprised audiology and therapy records, academic performance data, and parental questionnaires. Data were analysed using SAS version 9.4 for Windows. Generally, descriptive and inferential statistical analyses, including independent samples t-tests, chi-square tests, and logistic regression models, were conducted, as well as qualitative analysis using thematic analysis. For each paper (presented as chapters in this thesis), specific statistical analyses were employed and detailed in each chapter. Results: The findings revealed significant differences in communication outcomes between children who received LSL-SA and those who received TSLT. DHH children in the LSL-SA group demonstrated significantly higher gains in speech intelligibility, receptive and expressive language, and vocabulary development than those who underwent TSLT (p < 0.05). Specifically, 63% of children in the LSL-SA group achieved age-appropriate speech intelligibility, compared to 45% in the TSLT group (p = 0.046). Similarly, higher percentages of children in the LSL-SA group showed age-appropriate expressive vocabulary (58% vs. 39%, p = 0.048) and receptive language (60% vs. 39%, p = 0.043). Furthermore, 66% of children in the LSL-SA group were recommended for mainstream schooling, compared to 39% in the 19 TSLT group (p = 0.0023). LSL-SA also resulted in a higher proportion of children achieving age-appropriate language milestones within shorter intervention durations. These results highlight the effectiveness of LSL-SA in improving speech and language outcomes and supporting mainstream school placement. Children in the LSL-SA group not only achieved better language outcomes but also demonstrated superior scholastic outcomes. Learners from the LSL-SA group had better literacy and numeracy skills, with shorter durations of therapy before discharge and a higher likelihood of transitioning to mainstream schooling compared to the TSLT group (p < 0.05). Children in the TSLT group required longer intervention durations before progressing to grade-level academic competencies. This is particularly notable in the context of LMICs, where resource limitations often affect the duration and accessibility of interventions. Parental engagement was a critical determinant of intervention success. Higher parental participation in LSL-SA correlated with stronger communication and academic gains. While parents expressed a preference for the LSL-SA approach, they reported receiving limited counselling regarding communication intervention options. Despite this, parental commitment to the intervention was strong, driven by their aspirations for their child’s development. However, barriers to effective implementation of LSL-SA included linguistic mismatches, limited access to trained professionals, and resource constraints in public healthcare and education settings. Conclusion: This study provides empirical evidence supporting the efficacy of the LSL-SA approach over TSLT in enhancing both speech-language acquisition and scholastic outcomes for DHH children in South Africa. The findings provide compelling, context-specific evidence supporting policy reforms towards the integration of LSL-SA in EI programmes in South Africa; expansion of LSL-SA training programmes for clinicians and educators; improvement of multilingual therapy resources to bridge language accessibility gaps; strengthening of EHDI programme implementation to ensure timely intervention; and enhancement of parental support programmes to maximise intervention success. Ensuring effective collaboration between parents, professionals, and educators is essential for optimising the outcomes for children with hearing impairment. Furthermore, the findings highlight the pressing need to scale up EI services, making LSL-SA interventions more widely accessible and adaptable to the diverse cultural landscape of South Africa. By fostering stronger partnerships between families, educators, and early interventionists, these services can be significantly improved, ultimately enhancing the quality and reach of communication interventions for children with hearing impairment. Implications: These findings contribute to clinical practice, policy development, and future research in early intervention audiology. They emphasize the importance of adapting intervention models to the socio-cultural and linguistic diversity of South Africa. Further, longitudinal studies are recommended to track the long-term academic and social integration of DHH children across different intervention modalities.