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 Acoustic Voice Quality Index (AVQI) in People with Parkinson's Disease Before and After Intensive Voice and Articulation Therapies: Secondary Outcome of a Randomized Controlled Trial
(2022) Moya-Galé, Gemma; Spielman, Jennifer; Ramig, Lorraine A.; Campanelli, Luca; Maryn, Youri
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.
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.
Age of acquisition effects differ across linguistic domains in sign language: EEG evidence
(Elsevier, 2020) Malaia, Evie A.; Krebs, Julia; Roehm, Dietmar; Wilbur, Ronnie B.; University of Alabama Tuscaloosa; Salzburg University; Purdue University West Lafayette Campus; Purdue University
One of the key questions in the study of human language acquisition is the extent to which the development of neural processing networks for different components of language are modulated by exposure to linguistic stimuli. Sign languages offer a unique perspective on this issue, because prelingually Deaf children who receive access to complex linguistic input later in life provide a window into brain maturation in the absence of language, and subsequent neuroplasticity of neurolinguistic networks during late language learning. While the duration of sensitive periods of acquisition of linguistic subsystems (sound, vocabulary, and syntactic structure) is well established on the basis of L2 acquisition in spoken language, for sign languages, the relative timelines for development of neural processing networks for linguistic sub-domains are unknown. We examined neural responses of a group of Deaf signers who received access to signed input at varying ages to three linguistic phenomena at the levels of classifier signs, syntactic structure, and information structure. The amplitude of the N400 response to the marked word order condition negatively correlated with the age of acquisition for syntax and information structure, indicating increased cognitive load in these conditions. Additionally, the combination of behavioral and neural data suggested that late learners preferentially relied on classifiers over word order for meaning extraction. This suggests that late acquisition of sign language significantly increases cognitive load during analysis of syntax and information structure, but not word-level meaning.
All purees are not created equal: thickness, adhesiveness, and cohesiveness of commercially available first foods
(University of Alabama Libraries, 2019) Summerford, Mickalyn Sue; Gosa, Memorie M.; University of Alabama Tuscaloosa
The purpose of this study was to investigate the thickness, cohesiveness, and adhesiveness of foods typically consumed as feeding skills develop in the first year of life. The subjective feeding difficulty levels 1-4, presented by Gerber and Beech-Nut, were examined with the International Dysphagia Diet Standardization Initiative (IDDSI) drip test, spoon tilt test, and fork pressure test to determine the thickness, cohesiveness, and adhesiveness of the foods offered at each of the four levels. The drip test, which measures overall thickness, was conducted by recording the amount of liquid that drips out of a 10-mL syringe after 10 seconds. The spoon tilt test, which evaluates cohesiveness and adhesiveness, was performed by tilting a sample of purée in a spoon and assessing the state of the sample as it slides off. Lastly, the fork pressure test utilized a standard metal fork to apply pressure to food samples to determine if particles are safe to swallow. The results of this study concluded that thickness, cohesiveness, and adhesiveness are not impacted by brand, marketed stage (levels 1-4), or packaging. However, this study did establish that food packaged in pouches are slightly less adhesive than food packaged in jars. This finding indicates that food in pouches require less oral motor skill to swallow. The results signify that the proposed levels of baby food are not based on a hierarchy of difficulty but are instead for marketing purposes. The results also concluded that the texture of food was not impacted by the use of “natural ingredients.” The difficulty level of each food was determined and mapped to the IDDSI framework to provide guidance on the developmental appropriateness of each “starter food” for use by clinicians treating pediatric patients with dysphagia.
Altered brain network dynamics in youths with autism spectrum disorder
(2016) Malaia, Evguenia; Bates, Erik; Seitzman, Benjamin; Coppess, Katherine; University of Alabama Tuscaloosa
Attitudes of stuttering within the social networks of people who stutter
(University of Alabama Libraries, 2019) Hawkins, Haley; Buhr, Anthony P.; University of Alabama Tuscaloosa
This study examined attitudes about stuttering in the social networks of people who stutter. This study included seven people who stutter (PWS) as well as 21 other participants across the social networks of the PWS. The PWS were asked to identify up to five individuals they consider to be close to, constituting the inner “circle” of their social network. These individuals were asked to identify two acquaintances and two strangers of the PWS to also participate in the study, constituting the outer circles of the social network. However, low participation rate made it possible to examine only the inner circle. A series of surveys were administered to the PWS and all recruited participants to assess how attitudes toward stuttering change as a function of the “distance” from the PWS, and to evaluate the prevalence of negative attitudes (i.e., stigma) about stuttering in the network. Results showed that perceived stigma was similar between PWS and those in their social networks. In addition, PWS rated their overall experiences of stuttering and the level of debilitation as less negative than their social networks. The perceived closeness of the individuals did not appear to have a major impact on the attitudes about stuttering. One limitation of the study is that stigma of stuttering proved to be an obstacle to studying the stigma itself. This suggests a need for more communication about stuttering within the networks of PWS.
Audiology, Medicine, and Pharmacy Interprofessional Preliminary Interviews and Discussions: Improving Hearing Health Care in Rural Alabama
(American Speech-Language-Hearing Association, 2022) Brothers, Emma B.; Hay-McCutcheon, Marcia J.; Hughes, Peter J.; Friend, M. Louanne; University of Alabama Tuscaloosa; Samford University
Purpose: Access and affordability of hearing health care varies depending on residency and individual financial means. Those living in rural areas have limited health care resources and experience higher levels of poverty compared to those living in urban regions. The purpose of this study was to determine the feasibility of interprofessional collaboration among physicians and audiologists and pharmacists and audiologists to improve access and affordability of hearing health care in rural communities. Method: Sixteen family physicians and medicine residents and 15 community pharmacists participated in the study. Physicians and residents completed an online survey to assess education regarding hearing health care and their understanding of hearing loss intervention. They also participated in small virtual focus group discussions. Pharmacists participated in virtual discussions based on guided questions. Results: The discussions with both physicians and pharmacists highlighted the need for more education, resources, and awareness of the negative impact of hearing loss on overall quality of life. Comments from these discussions were placed within the socio-ecological model of health behavior to increase understanding of hearing health behavior. Conclusions: Increased collaboration among medical professionals has the potential to improve access to hearing health care for those living in audiologically underserved regions of the country. Further research will identify how to increase effective and sustainable hearing health care resources in rural communities.
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.
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.
Contributions of Counseling and Sound Generator Use in Tinnitus Retraining Therapy: Treatment Response Dynamics Assessed in a Secondary Analysis of a Randomized Trial
(American Speech-Language-Hearing Association, 2022) Tinnitus Retraining Therapy Trial; Formby, Craig; Yang, Xin; Scherer, Roberta W.; University of Alabama Tuscaloosa; Johns Hopkins University; Johns Hopkins Bloomberg School of Public Health
Purpose: Tinnitus retraining therapy (TRT) has been widely used for 30 years, but its efficacy and the component contributions from counseling and sound therapy remain controversial. The purpose of this secondary analysis from the Tinnitus Retraining Therapy Trial (TRTT) was to compare treatment response dynamics for TRT (counseling and conventional sound generators) with partial TRT (pTRT; counseling and placebo sound generators) and standard of care (SOC; a patient-centered counseling control). Method: The TRTT randomized 151 participants with primary tinnitus (no signifi-cant hearing or sound tolerance problems) to TRT, pTRT, or SOC, each of which encouraged use of enriched environmental sound. The primary outcome, mean change in Tinnitus Questionnaire score assessed at baseline and follow-up across 18 months, was normalized for a common baseline and fitted with an exponential model. Time constants were estimated to quantify and compare the treatment response dynamics, which were evaluated for statistical significance using bootstrap analyses. Results: The change in response to TRT took less time to achieve than that for either pTRT or SOC, as demonstrated by time for normalized Tinnitus Question-naire scores to decline to 63% and 99% of baseline TRT values: 1.2 months (95% CI [0.2, 1.9]) and 5.7 months (95% CI [0.9, 9.0]), respectively. Correspond-ing SOC values were 2.7 months (95% CI [1.5, 4.1]) and 12.4 months (95% CI [6.9, 19.0]), while those for pTRT were 2.2 months (95% CI [1.2, 3.4]) and 10.1 months (95% CI [5.7, 15.9]). The differences were significant for TRT ver-sus SOC (p = .020), borderline significant for TRT versus pTRT (p = .057), but nonsignificant for pTRT versus SOC (p = .285). The magnitude of the asymp-totic treatment response did not differ significantly among groups. Conclusion: Sound generator use in TRT increases treatment efficiency (beyond any advantage from enriched environmental sound) without affecting treatment efficacy (determined by counseling).
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.
Discrepancy between defining and intervening with premature feeding and swallowing in the NICU: a survey
(University of Alabama Libraries, 2019) Barnes, Jennifer Elizabeth; Gosa, Memorie M.; University of Alabama Tuscaloosa
Feeding during infancy is a complex, multidimensional task that involves dynamic coordination between sucking, swallowing, and breathing (Wolf & Glass, 1992). Infants born prematurely, however, often display delayed swallow and/or immature/uncoordinated suck, swallow and respiration (Amaizu et. al, 2008). Neonatal Intensive Care Unit (NICU) guidelines for discharge typically include the following four physiological competencies: thermoregulation, control of breathing, respiratory stability, feeding skills and weight gain (Jefferies, A.L, 2003). A recent evidenced based systematic review that investigated the variables used to define successful feeding in the literature showed significant variability in the outcome measures used by medical and allied health professionals. This project sought to document the variables used by practicing speech language pathologists and nurses that care for premature infants in the NICU setting to define “successful feeding”, the potential influencers of those definitions, and to determine if a quantifiable difference exists in the variables used to label feeding as successful or unsuccessful between the two disciplines. The results showed that the variability documented in the literature, for identifying successful feeding, is also seen in current clinical practice. Further research to develop a standardized clinical guideline and to determine the efficacy of feeding/swallow interventions is warranted to guide clinicians through this intricate process of decision-making.
Early intervention effects on gesture use in young children with ASD: a national query of SLPs
(University of Alabama Libraries, 2020) Miller, Julia; Barber, Angela; University of Alabama Tuscaloosa
Gesture development, use, and repertoire differ in young children with ASD compared to those with typical development (Manwaring et al., 2018 and Watson et al., 2013). Gestures play a fundamental role in social interaction and therefore are often an important intervention outcome in early ASD interventions. However, which interventions are most often used and which of those are most effective remains unclear. Naturalistic Developmental Behavioral Interventions (Schreibman et al., 2015) most frequently incorporate gestures into their teaching targets and outcomes though gestures are often measured within a broader scope of social interaction. Therefore, even within the scope of NDBIs, techniques used to teach gestures, how gestures are measured, and how gestures are prioritized vary greatly and are often not reported distinctively. Further, SLPs are the primary interventionists for improving gestures and social communication though very little is understood regarding how SLPs address gestures in early interventions. Therefore, the purpose of this study was to survey practicing SLPs to determine which methods are most frequently used to teach gestures to young children with ASD and which of those methods are considered effective. Overall, SLPs reported a large range of experience in their training, methods used, and perspectives of efficacy as they relate to teaching deictic gestures.
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.
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.
Exploration of gender influences in restricted and repetitive behaviors in children with autism spectrum disorder
(University of Alabama Libraries, 2018) Evans, Madeleine G.; Barber, Angela B.; University of Alabama Tuscaloosa
More boys than girls have ASD at a ratio of 4:1 (Baio et al., 2018). In general, boys tend to demonstrate more ritualistic and repetitive behaviors (RRBs) than girls (Szatmari et al., 2012) though a gender bias may lead to under diagnosis of girls. Therefore, a female phenotype should be differentiated to improve diagnostic accuracy. This study seeks to describe and compare RRB profiles and frequencies in two age cohorts of girls and boys with ASD as measured by the Repetitive Behavior Scale-Revised (RBS-R) and the Childhood Routines Inventory (CRI). 214 children with ASD (42 girls; 172 boys) between 16 months and 10 years old (mean = 46.1 months) were included from an ASD clinical research database Two age cohorts were used (1-3 years; 4-10 years) to compare RRBs using parent reports. Girls younger than 3 had more repetitive (t = -1.66; p = .03), ritualistic (t = -.12; p = .004), and sameness behaviors (t = -1.9; p = .002). Older girls had more stereotyped behaviors than boys (t = -2.2; p = .001) and more ritualistic behaviors in general. Younger girls (n = 23) had more stereotyped (62.7%), restricted interests (58%), sameness (41%), compulsive (46%), ritualistic (36%), and self-injurious behavior (27%). Boys displayed RRBs and stereotypical behaviors. Girls demonstrate more repetitive behaviors than boys. RRB patterns and profiles will be discussed comparatively. These findings contribute the understanding of the female ASD phenotype.
Frontline Interventions: Considerations for Modifying Fluids and Foods for Management of Feeding and Swallowing Disorders Across the Life Span
(American Speech-Language-Hearing Association, 2020) Gosa, Memorie M.; Dodrill, Pamela; Robbins, JoAnne; University of Alabama Tuscaloosa; Harvard University; Brigham & Women's Hospital; University of Wisconsin Madison
Purpose: Individuals with dysphagia across the age continuum may require dietary modifications of fluids and foods for safe and adequate oral intake. Considerations of this frontline intervention are presented in this clinical forum dedicated to the discussion of dysphagia. Method: This clinical focus article reviews the technical challenges of providing modified fluids and foods across the life span as well as the literature specific to its origins, efficacy, challenges and solutions to standardization, and the methods for ensuring quality service delivery. Conclusion: Dietary modification is an often-used method of dysphagia management that presents unique challenges to the clinician for successful application. Speech-language pathologists in clinical practice across all settings must remain dedicated to evidence-based practice as they navigate service delivery of this strategy to individuals with dysphagia across the life span.
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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