Department of Communicative Disorders

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A Study of Argument in Selected Works in Argumentation and Debate
(University of Alabama Libraries, 1967) Smith, Mary John
Although Plato and Euclid, both pupils of Socrates, were probably the first two men to seriously contemplate logical problems, Aristotle's Organon represents the first systematic treatment of the subject in the history of philosophy. Likewise, Aristotle 1_s Rhetoric contains the first systematic adaptation of the principles of logic to the art of public address. Since that time, rhetoricians have continued to incorporate writings in logic into rhetorical theory. Formal logic, the philosophy of induction and scientific method, and more recently, the Toulmin structural model for argument, all have found a place in modern works in argumentation and debate. In addition, many writers in speech have gone beyond their philosophical heritage and introduced new types and uses of argument which are particularly suited to the needs of the public speaker. The resultant treatment given the definition and nature of argument by writers in speech provides the primary theoretical foundation which underlies the study of argumentation and, more broadly, the process of debate.
The relationship of developmental functioning to symptom presentation in young children with ASD
(University of Alabama Libraries, 2010) Pouncey, Melissa VanKirk; Barber, Angela B.; University of Alabama Tuscaloosa
The present study examined the differences between young children with Autism Spectrum Disorders (ASD) and typical development (TD) on developmental skills and core symptoms of ASD. Further, the relationship between core symptoms of ASD and developmental functioning level were assessed. Specific symptoms, joint attention, symbolic play, gestures, and RSB, as well as general symptom categories were assessed in children with ASD (n=10) and children with typical developmental (n=10) who were matched on mental age and gender. Method: Measures of social communication, speech, symbolic play, gestures, and joint attention were obtained through the Communication and Symbolic Behavior Scales (CSBS: Wetherby and Prizant, 2002). Developmental level was measured using the Mullen Scales of Early Learning (MSEL: Mullen, 1992). Results: Children with ASD demonstrated decreased abilities in symbolic play and understanding, social communication, joint attention, and gestures compared to children with TD. Children with ASD also demonstrated more RSB with body and objects. Strong correlations among social, symbolic, speech, and gestural were observed. Speech and symbolic skills, as well as social and gestural skills were the only relationships to remain highly correlated even when developmental level was controlled. Conclusions: These findings highlight the diagnostic significance of developmental level to core symptoms of ASD. Research aims and the impact of these findings on the development of specific therapy goals are also discussed.
Common practices of speech-language pathologists in bilingual assessment and intervention
(University of Alabama Libraries, 2013) Aguilar, Carla Janette; Saffo, Rachel W.; University of Alabama Tuscaloosa
Research in the literature shows that the percentage of individuals who are multicultural and multilingual is steadily increasing in the United States (Shin & Kominski, 2010). This rise has led to the increase of children who are bilingual on the caseloads of speech-language pathologists (SLPs) in the United States (Caesar & Kohler, 2007; Kritikos, 2003). Research is beginning to delineate evidence-based practice (EBP) in assessment and intervention for bilingual children. However, recent survey studies have shown that most SLPs in the United States are not providing this type of evidence-based service to children who are bilingual (Caesar & Kohler, 2007; Kritikos, 2003). The current survey study sought to identify variables that influence SLPs' use of evidence-based practice and their confidence in culture and assessment, as well as the influence of treatment methods on reported therapy gains. The researcher created an online survey and distributed it to SLPs across the United States (n=435). Regression analysis revealed that years of experience inversely predicted use of some methods of EBP, and language skill and number of bilingual SLPs in the facility positively predicted the use of other methods. Experiential demographics influenced confidence in culture and assessment more than didactic factors, and confidence in treatment and assessment positively predicted therapy gains.
Peer mediated intervention to improve social communication in young children with ASD
(University of Alabama Libraries, 2013) Craft, Lydia Dyer; Barber, Angela B.; University of Alabama Tuscaloosa
To date, no study has measured the effects of peer-mediated intervention (PMI) on autism symptoms in children under than four years of age. The current study examines the efficacy of the Stay, Play, Talk PMI (English, K., Shafer, K., Goldstein, H., & Kaczmerek, L., 1997) on the social communication skills of young children diagnosed with autism. The investigator paired three typically developing children (ages 3-5 years) each with a young child with autism (ages 3-4 years). These dyads played together during two to three, 20-minute weekly sessions for 6-8 weeks. A multiple baseline design across participants was implemented to measure the effectiveness of PMI on young children with autism's social initiations and responses characterized by non-coordinated gestures, gestures, and words. The investigator coded the frequency of each child's social initiations and responses to topics/conversations for each 20-minute play sessions. All three children with autism demonstrated increased social responses, though initiations remained variable. Typical peer buddies demonstrated increases in social initiations and responses. Results of this study support the usefulness of this intervention to improve social communication of young children with autism and contribute to limited knowledge of effective early social communication interventions for young children with autism.
Rationale for the tinnitus retraining therapy trial
(Wolters Kluwer, 2013) TRTT Study Grp; Formby, Craig; Scherer, Roberta; University of Alabama Tuscaloosa; Johns Hopkins University; Johns Hopkins Bloomberg School of Public Health
The Tinnitus Retraining Therapy Trial (TRTT) is a National Institutes of Health-sponsored, multi-centered, placebo-controlled, randomized trial evaluating the efficacy of tinnitus retraining therapy (TRT) and its component parts, directive counseling and sound therapy, as treatments for subjective debilitating tinnitus in the military. The TRTT will enroll 228 individuals at an allocation ratio of 1: 1: 1 to: (1) directive counseling and sound therapy using conventional sound generators; (2) directive counseling and placebo sound generators; or (3) standard of care as administered in the military. Study centers include a Study Chair's Office, a Data Coordinating Center, and six Military Clinical Centers with treatment and data collection standardized across all clinics. The primary outcome is change in Tinnitus Questionnaire (TQ) score assessed longitudinally at 3, 6, 12, and 18-month follow-up visits. Secondary outcomes include: Change in TQ sub-scales, Tinnitus Handicap Inventory, Tinnitus Functional Index, and TRT interview visual analog scale; audiometric and psychoacoustic measures; and change in quality of life. The TRTT will evaluate TRT efficacy by comparing TRT (directive counseling and conventional sound generators) with standard of care; directive counseling by comparing directive counseling plus placebo sound generators versus standard of care; and sound therapy by comparing conventional versus placebo sound generators. We hypothesize that full TRT will be more efficacious than standard of care, directive counseling and placebo sound generators more efficacious than standard of care, and conventional more efficacious than placebo sound generators in habituating the tinnitus awareness, annoyance, and impact on the study participant's life.
Real-time prosodic aspects of text generated speech
(University of Alabama Libraries, 2014) Kassas, Nure Biane; Buhr, Anthony P.; University of Alabama Tuscaloosa
The purpose of this study was to investigate the feasibility and effectiveness of a text to speech (TTS) device that allows the user to manipulate pitch and volume as speech is being generated. This device was intended to facilitate the communicative needs of individuals with complex communication needs (CCN) as a result of acquired neurological conditions such as dysarthria. An Android touchscreen tablet with a built-in speech engine was used as the hardware for the TTS device, and a post-audio signal processing approach was utilized to program the TTS device. Results were collected in two separate phases: auditory and use-based. During the auditory phase, participants listened to audio samples from the thesis TTS device, a typical TTS device, and human speech and then rated them based on perceived affect (positive vs. negative) or intent (question vs. statements) categories. During the use-based phase, participants provided feedback about the thesis TTS device after using it to communicate with the study investigator. Although auditory phase results indicated that the thesis device was currently not as effective as human speech when communicating emotion and intent, use-based findings were more promising. Use-based results revealed that the new features the thesis TTS provided (ability to manipulate pitch and volume) were considered beneficial.
Social influences on autonomic arousal in autism spectrum disorders
(University of Alabama Libraries, 2014) Turner, Carolyn Kate; Buhr, Anthony P.; University of Alabama Tuscaloosa
The purpose of this study was to gain new understanding of autonomic nervous system (ANS) dysfunction in familiar and unfamiliar social situations in children with autism spectrum disorder (ASD). Both Children with ASD and typically developing peers viewed three sets of stimuli on a computer screen: 1) a screensaver (initial and final baseline), 2) objects moving to music (attention), and 3) narratives produced by both a caregiver and a stranger (familiar and unfamiliar social situations). Physiological measures of heart rate and skin conductance were acquired to assess ANS functioning. It was expected that 1) ANS activity would differ between children with ASD and typically developing peers at baseline, 2) differences in ANS activity between the two groups would be greater in the attention vs. the baseline task, and 3) differences in ANS activity between the two groups would be greater in the unfamiliar vs. the familiar tasks. Results showed that sympathetic, but not parasympathetic, arousal was greater for children with ASD as compared to typically developing children, but these measures did not differ across tasks. Results are interpreted to suggest that children with ASD perceived the experimental conditions as more challenging as compared to children who are typically developing.
Pulmonary Function in Infants with Swallowing Dysfunction
(PLOS, 2015) Tutor, James D.; Srinivasan, Saumini; Gosa, Memorie M.; Spentzas, Thomas; Stokes, Dennis C.; University of Tennessee Health Science Center; St Jude Children's Research Hospital; University of Alabama Tuscaloosa
Background Swallowing dysfunction can lead to recurring aspiration and is frequently associated with chronic symptoms such as cough and wheezing in infants. Our objective was to describe the characteristics of infants with swallowing dysfunction, determine if pulmonary function abnormalities are detectable, and if they improve after therapy. Methods We studied 38 infants with a history of coughing and wheezing who had pulmonary function tests performed within two weeks of their diagnosis of swallowing dysfunction. The raised lung volume rapid thoracoabdominal compression technique was used. After 6 months of therapy, 17 of the infants repeated the tests. Results Initially, 25 had abnormal spirometry, 18 had abnormal plethysmography, and 15 demonstrated bronchodilator responsiveness. Six months later test were repeated for seventeen patients. Ten patients had continued abnormal spirometry, two patients remained normal, three patients' abnormal spirometry had normalized, and two patients' previously normal studies became abnormal. Eight of the 17 patients had continued abnormal plethysmography, six had continued normal plethysmography, and three patients' normal plethysmography became abnormal. After 6 months of treatment, eight patients demonstrated bronchodilator responsiveness, of which five continued to demonstrate bronchodilator responsiveness and three developed responsiveness. The remainder either continued to be non-bronchodilator responsive (two) or lost responsiveness (three.) The findings of the abnormal tests in most infants tested is complicated by frequent occurrence of other co-morbidities in this population, including gastroesophageal reflux in 23 and passive smoke exposure in 13 of the infants. Conclusions The interpretation of lung function changes is complicated by the frequent association of swallowing dysfunction with gastroesophageal reflux and passive smoke exposure in this population. Six months of medical therapy for swallowing dysfunction/gastroesophageal reflux did not significantly improve pulmonary function in these infants. Long-term studies will be necessary to determine which of these changes persists into adulthood.
The effects of focused stimulation, vertical structuring, and expansions on verbal language in young minimally-verbal children with Autism Spectrum Disorder
(University of Alabama Libraries, 2015) Chiarelli, Chelsea Renee; Barber, Angela B.; University of Alabama Tuscaloosa
Speech pathologists are often the first line of referral for young children at risk for an ASD. Often, SLPs, especially those who work in state-funded Early Intervention Programs (Part C-Early Intervention, IDEA, 2004), do not have access to training on autism-specific early intervention models (Stahmer, Collings, & Palinkas, 2005). In addition, children who are receiving Early Intervention in community settings often do not have available options for autism-specific interventions, which are offered in many university settings. As a result, the facilitation strategies of focused stimulation, vertical structuring, and expansions are often being implemented in therapy with these children. To our knowledge, no study has measured the effects of these commonly used language strategies on the verbal language in minimally verbal children with ASD. The purpose of this study was to measure the effects of focused stimulation, vertical structuring, and expansions on the acquisition of verbal language in minimally verbal children with ASD. Three toddlers diagnosed with autism were recruited for this study. Intervention took place twice a week for 20-minute sessions, followed by two-generalization probes 4 weeks post intervention. Two out of our three participants demonstrated gains in their verbal language inside of the intervention environment. Results of this study conclude that these intervention strategies are capable of being implemented in community-based intervention settings with successful outcomes.
Is dosage important?: parent and child outcomes with project impact therapy
(University of Alabama Libraries, 2015) Noble, Hylan; Barber, Angela B.; University of Alabama Tuscaloosa
The primary purpose of this study was to compare both pre- and post- language and social communication outcomes between two different groups, receiving various dosages of ImPACT (Improving Parents as Communicative Partners) therapy. A secondary objective was to investigate the feasibility of parent adherence to the ImPACT strategies and levels of self-perceived parent competency in implementing the treatment. Parent-mediated therapy has been shown to be a successful form of facilitating social skills and language in children with ASD (Ingersoll, 2012). Specifically, Project ImPACT implemented as an “off the shelf” model has resulted in increased social-engagement and communication as well as decreased parental stress (Ingersoll and Wainer, 2015). Results demonstrated clinically significant gains in social-communication across both groups, particularly in children receiving a higher dose of treatment. Parents also demonstrated increased parental satisfaction. Overall, the study highlights (1) the feasibility of implementing an “off the shelf” approach of the manualized Project ImPACT intervention in a clinic setting, without prior formal training, (2) emphasizes the importance of implementing parent-mediated interventions for the purposes of increasing overall functional communication in children with an ASD.
Addressing phonological memory in language therapy with clients who have Down syndrome: Perspectives of speech-language pathologists
(Wiley, 2016) Faught, Gayle G.; Conners, Frances A.; Barber, Angela B.; Price, Hannah R.; University of Alabama Tuscaloosa
BackgroundPhonological memory (PM) plays a significant role in language development but is impaired in individuals with Down syndrome (DS). Without formal recommendations on how to address PM limitations in clients with DS, it is possible speech-language pathologists (SLPs) find ways to do so in their practices. AimsThis study asked if and how SLPs address PM in language therapy with clients who have DS. It also asked about SLPs' opinions of the importance, practicality and difficulty of addressing PM in clients with DS. Methods & ProceduresSLPs participated in an online survey that asked if they address PM in clients with DS and, if so, how often and with which techniques. The survey also asked SLPs to rate their opinions of addressing PM in clients with DS with Likert scales. To contrast clients with DS, SLPs were asked about their practices and opinions with clients who have specific language impairment (SLI) and autism spectrum disorders (ASD). SLPs were recruited through e-mails sent from state organizations and researchers. To compare SLPs' practices and opinions across client types, frequency analyses and analyses of variance (ANOVAs) were run. Outcomes & ResultsIn all, 290 SLPs from 28 states completed the survey. Nearly all SLPs were currently practising at the time data were collected, and all worked with at least one of the three client types. Findings indicated SLPs less often addressed PM and used less variety when addressing PM with clients who have DS compared with clients who have SLI or ASD. Further, SLPs considered it less important, less practical and more difficult to address PM in clients who have DS when compared with clients who have SLI, whereas a similar pattern was found with clients who have ASD. Conclusions & ImplicationsSLPs' opinions could be one reason they under-address PM with clients who have DS. Other reasons include there are no evidence-based practice (EBP) guidelines on this topic, and there is not enough familiarity with the DS phenotype among SLPs. Future research on ways to address PM in clients with DS successfully are essential so that EBP guidelines can be established and language therapy can be made more effective.
Altered brain network dynamics in youths with autism spectrum disorder
(2016) Malaia, Evguenia; Bates, Erik; Seitzman, Benjamin; Coppess, Katherine; University of Alabama Tuscaloosa
Bama perks: the use of simulated context as treatment for adults with aphasia
(University of Alabama Libraries, 2017) Tucker, Marie Louise; Barber, Angela B.; University of Alabama Tuscaloosa
There is a growing interest in examining the efficacy of aphasia treatment programs that examine meaningful real-life outcomes rather than therapeutic outcomes within structured intervention settings (Chapey et al., 2008). This study measured language abilities, social networks, and quality of life for nine patients with aphasia over a ten-week span during a simulated coffee shop social communication intervention called Bama Perks. Using an evaluative approach, strengths and weaknesses were examined and results supported the feasibility of Bama Perks as a supplement to traditional therapy. Clinician and caregiver measures indicated client improvement in language skills and social communication skills, a growth in social networks, and a reduction in burden of diagnosis. Daily rating scales taken during each Bama Perks session revealed variability with marginal growth across measures of communication function, flexibility, and overall communication production. These findings contribute to growing evidence supporting socially simulated environments as therapeutic contexts for individuals with aphasia.
Administering articulation assessments on the iPad®
(University of Alabama Libraries, 2017) Jones, Cristen Kalea; Buhr, Anthony P.; University of Alabama Tuscaloosa
The purpose of this study is to investigate the significance of technology as a time- and a resource-saver. Children between the ages of 2 years, 5 months and 5 years, 11 months had their speech sound abilities assessed using the Goldman-Fristoe Test of Articulation (GFTA-3; Goldman & Fristoe, 2015). The administration of the assessment took two forms: (a) the iPad® method, and (b) the hard copy method. Raw scores were compared between the two methods to determine reliability. In addition, time to administer and time to score each assessment was compared between the two methods. Finally, the influence of a child’s experience with the iPad® was assessed with the frequency of redirections and imitations during the administration of the iPad®. Results showed that, when compared to the traditional hard copy version of assessment, the iPad® is a reliable instrument and will exhibit the same raw score. Results also showed that the time to administer each test did not differ, but the iPad® saves time because the scoring is fully automatic. Finally, results showed that a child’s familiarity with an iPad® at home as measured in days per week and minutes per sitting was not related to an increased time in testing, but was related to more redirections required for the iPad® assessment. Overall, the iPad® is a reliable and valid assessment tool that can save the clinician time in scoring the assessment while still establishing articulation abilities of the child.
The relationship between representational, beat, and cohesive gestures and speech disfluency in the 2012 presidential debate
(University of Alabama Libraries, 2017) Puzinauskas, Katerina Joanna; Buhr, Anthony P.; University of Alabama Tuscaloosa
Hand gestures are yoked to speech in a highly-correlated system, often referred to as co-speech (Hostetter, 2011). Both disfluency and gesture have been show to influence audience reaction during political debates (e.g., Pennebaker, Mehl, & Niederhoffer, 2003). This study examined the relation between speech disfluency and hand gesture in the First 2012 Presidential Debate between President Barack Obama and Governor Mitt Romney. Specifically, the frequency and type of speech disfluencies and gesticulations generated by candidates were identified, annotated, and compared. Speech and gesture variables were examined across multiple speech domains, including utterance and speaking turn. Results showed a correlation between the level of speech disfluency and the type of gesture within a set speaking turn for both speakers. Overall, findings suggest 1) associations between speech disfluencies and the five taxonomies of gestures (iconic, metaphoric, deictic, cohesive, and beat, and 2) relationships between variables and audience-reported outcomes for debate success.
An investigation into stuttering development: a longitudinal approach
(University of Alabama Libraries, 2017) Treleaven, Shanley Belle; Buhr, Anthony P.; University of Alabama Tuscaloosa
The purpose of this study is to examine the relation between daily emotions and stuttering. A longitudinal design was used to evaluate changes in the relation between emotions and stuttering over the fall and spring semesters of the 2015-2016 school year. The study participant consisted of child who was three years old when enrolled in the study. The child’s caregiver provided daily information regarding the four greatest emotional events and associated emotional arousal and speech disfluency. Conversational samples of speech were collected on weekly visits to the clinic, which were transcribed and coded for speech disfluencies. It was hypothesized that emotional arousal would be related to the child’s stuttering. It was also hypothesized that routine would impact longitudinal change in emotional arousal and associated stuttering. Results showed that intensity of emotional arousal was predictive of parent-observed stuttering when emotion was negative. However, stuttering did not significantly change over the duration of the study, and change in routine was not related to longitudinal change in emotion and stuttering.
The perception of emotion through static and dynamic facial expression in children with Autism Spectrum Disorder
(University of Alabama Libraries, 2017) Queen, Melanie Wilkie; Barber, Angela B.; University of Alabama Tuscaloosa
The current project examined the ability of children with Autism Spectrum Disorder (ASD) to perceive and judge emotional information conveyed in facial expression when compared to typically developing peers. The purpose of this study was to (a) compare how children with ASD and children with typical development (TD) differ in their ability to perceive and judge the emotional information conveyed by happy, sad, angry, and scared static facial expression; (b) compare how static decoding abilities relate to decoding abilities of integrated dynamic facial expressions, prosody, and verbal content; (c) measure the ability of children with ASD and children with TD to perceive and judge emotional information based on the perceptual features of the speaker (cartoon vs. human); and (d) examine the role of timing in the perception and judgment of emotional information in children with ASD and children with TD.
Differences in dietary intake, sensory processing, anthropometric measures, mealtime behaviors, and parental stress of children with ASD and other neurodevelopmental impairments
(University of Alabama Libraries, 2017) Henderson, Elizabeth Dianne; Gosa, Memorie M.; University of Alabama Tuscaloosa
Feeding difficulty is a frequently reported feature of neurodevelopmental delays and disorders that affect children, including Autism Spectrum Disorder (ASD). According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the diagnosis of ASD can include deficits in social interaction, restrictive and repetitive behaviors, rigid routines, fixated interests, and hypo- or hyperreactivity to sensory input. All of these factors can affect mealtime behaviors. Parents of children with a diagnosis of ASD frequently report problem behaviors at mealtime and decreased dietary variety. However, the extent to which specific characteristics of feeding difficulty are unique to children with ASD has not been determined. This study examined whether reported problem mealtime behaviors and decreased dietary variety are symptoms exclusive to children diagnosed with ASD or whether similar behaviors and patterns of dietary intake are present in other neurodevelopmentally delayed or impaired populations. The data for this project was collected through a variety of assessment measures that examined dietary patterns, problem mealtime behaviors, sensory processing, growth, and parental stress in children referred for evaluation by the University of Alabama’s ASD Clinic. The purpose of this study was to compare dietary intake, patterns of sensory processing, measures of growth, mealtime behaviors, and levels of parental stress among children with ASD to children with other neurodevelopmental diagnoses (speech-language delay, attention deficit disorder, or not otherwise specified). In this study, we found that children diagnosed with ASD did not exhibit significant differences in terms of dietary intake, patterns of sensory processing, measures of growth, mealtime behaviors, and levels of parental stress when compared to age-matched peers with other neurodevelopmental delays or disorders.
Efficacy of Auditory-Verbal Therapy (AVT) over Total Communication (TC) for language outcomes in children with cochlear implants: a systematic review
(University of Alabama Libraries, 2017) Shoffner, Amber; Hay-McCutcheon, Marcia; University of Alabama Tuscaloosa
Children with cochlear implants require intervention for both receptive and expressive language. Auditory-Verbal Therapy (AVT), which primarily focuses on the development of language through the auditory channel, and Total Communication (TC), which allows for the combination of sign, lipreading, and auditory stimuli for language development, are two intervention methods often used for children with CIs. This systematic review presents language outcomes in children using AVT and TC intervention approaches. We hypothesized that the use of AVT would result in better expressive language outcomes compared to the use of TC. We also hypothesized that both intervention approaches would result in equivalent receptive language outcomes. We found that children who received AVT had a higher percentage of favorable outcomes for both receptive and expressive language outcomes compared to children who used TC. Other additional factors were found to be significant for language outcomes such as age at implantation, communication mode, parent/family involvement, age at diagnosis, device differences, additional disabilities, socioeconomic status, and gender. Overall, we found a lack of research literature directly comparing AVT and TC. A large-scale systematic study of the interventions is still needed in order for professionals and families to make firm conclusions on the efficacy of these treatments for children with cochlear implants.
Impact of common morbidity on attainment of oral feeding skills in a modern cohort of infants born prematurely: a retrospective analysis
(University of Alabama Libraries, 2018) Schweers, Madeline G.; Gosa, Memorie M.; University of Alabama Tuscaloosa
Feeding during infancy is a complicated, multidimensional task involving dynamic coordination between sucking, swallowing, and breathing (Wolf & Glass, 1992). The synactive theory of infant development discusses the influence of the autonomic, motor, and state systems on the resulting stability and homeostasis of newborns (Als, 1982). The synactive theory proposes that the core of stability for all developing infants is the autonomic nervous system, especially the respiratory, circulatory, and digestive systems. The motor system supports the development of the state system – levels of arousal that range from deep sleep to a vigorous cry. The ability to attend and to actively process incoming stimuli is supported by the ability to maintain stability in the autonomic and motor systems and remain alert (Ross, 2012). By the synactive theory, feeding can be conceptualized as a developmental skill that emerges when the coordination for sucking/swallowing/breathing is present at approximately 35 weeks post gestational age along with maturation of the state system (Ross, 2012). Previous research has established that many common newborn morbidities, such as those that impact the cardiac and respiratory systems, can delay the post gestational age at which infants born prematurely achieve full oral feeding competency. The purpose of this project is to establish the impact of common newborn morbidities, as measured by the Morbidity Assessment Index for Newborns, on the resulting transition time and post conceptual age at which a modern cohort of preterm infants attain the skills and coordination necessary to support nutritional intake by exclusive oral means.

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