Theses and Dissertations - Department of Communicative Disorders

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Lip EMG response to stuttering
(University of Alabama Libraries, 2020) Henley, Caroline; Buhr, Anthony; University of Alabama Tuscaloosa
The purpose of this study was to investigate whether viewing stuttering behaviors would elicit lip muscle activity. Thirty college-aged participants produced a series of 20 sentences and were presented with audio and audio-video versions of each sentence that included either stuttered or non-stuttered target words. Each target word included a syllable-initial stop sound that was either voiced or unvoiced and associated with tongue versus lip constriction location. Raw electromyographic (EMG) signals were acquired via surface electrodes from the upper lip, which were then digitized and high-pass filtered at 1 Hz and then rectified by an RMS filter. Overall area in volts was calculated for 1 second intervals associated with each target word. Results showed that EMG activity was greater for the speaking condition compared to audio and audio-video conditions, and that EMG activity was greater for the lip compared to tongue constriction location and for voiced versus unvoiced sounds in the speaking condition only. However, there was no appreciable EMG activity during the audio or audio-video conditions, contrary to expectations. Thus, although the study paradigm was successful in acquiring EMG signals, the stimuli failed to elicit lip activity.
The variability of stuttering and influential factors
(University of Alabama Libraries, 2020) Sherbert, Kayla Jane; Buhr, Anthony; University of Alabama Tuscaloosa
Stuttering is a disorder of speech fluency that is not well understood, in part due to its variable nature. Although a number of factors have been found to contribute to this variability, previous research has often been retrospective or experimental. In this study, forty-one college students completed a survey three times a day for at least two weeks. Each participant evaluated their experiences regarding their own speech fluency, affective state, and willingness to approach. It was expected that affective state would be associated with speech fluency as well as willingness to approach. The main finding of the study was that dimensions of affect (i.e., arousal and mood) were significantly associated with speech fluency, particularly in the morning compared to the afternoon or evening. Results are interpreted to suggest that the positive relation between speech fluency and affect could be outcomes of a common physiological state, a finding that could have important implications for fluency disorders such as stuttering.
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 perception of regional dialect in the state of Alabama
(University of Alabama Libraries, 2020) Sizemore, McKenzie D.; Buhr, Anthony; University of Alabama Tuscaloosa
The purpose of this study was to evaluate how accurate people are in perceiving the dialects in the state of Alabama. This study included 50 speakers, each of whom produced a portion of the “Arthur the Rat” passage, which was then rated by 60 listeners according to whether the speaker was from the state of Alabama or not and whether that person was from an urban or rural area. Overall results showed that people from both inside and outside of Alabama were significantly better than chance at determining if a person is from Alabama. However, when compared to participants from outside of Alabama, participants from Alabama are significantly better at determining if a person was from an urban or rural area. Results suggest that people from the state of Alabama are more attuned to the dialectal differences within the state of Alabama compared to those who are not born in the state of Alabama.
Vowel production variation in college students based on social integration
(University of Alabama Libraries, 2020) Chapman, Sarah Kristin; Reed, Paul E.; University of Alabama Tuscaloosa
Exemplar theory represents the encoding of individual experiences as a collection of episodic memories known as exemplars, which form “exemplar clouds” (Drager & Kirtley, 2016). Originally used to model phonetic classification in perception, the exemplar theory has been extended to speech production with evidence that the perception-production loop can cause shifts over time. While exemplars are considered robust and stable categories, Clopper (2014) suggested that shifts can occur when individuals move to an environment in which they are exposed to a high quantity of exemplars from different regional or social distributions. The present study investigated the following research question: Does involvement in highly structured social groups, such as Greek life, influence the variation of vowel productions in young adults? The overarching purpose of the study was to explore how immersion in new social groups leads to exemplar shifts in college students. The data from this study was collected from 30 in-state female students at The University of Alabama (15 Greek, 15 non-Greek) from a semi-structured interview, reading passages, and word list tasks. Results indicated a statistically significant difference in degree of monophthongization of /a͡ɪ/ based on Greek status. Specifically, participants in Greek organizations were significantly more diphthongal in reading passages and word list tasks, and the difference was trending towards significance for conversational tasks and all tasks combined. Thus, these results indicate that involvement in highly integrated groups such as Greek life may impact exemplar shifts in college students. Key words: sociophonetics, exemplars, production shift, social integration, monophthongization
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.
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.
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.
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.
Relationship of articulation and feeding skills in children: a pilot study
(University of Alabama Libraries, 2018) Dent, Lacey; Gosa, Memorie M.; University of Alabama Tuscaloosa
Feeding development begins during the embryologic and fetal periods with maturation of the head, face, and neck, the emergence of early oral motor reflexes, and continues well into early childhood. Children learn to eat in a predictable sequence. They transition from nutritional intake of a single consistency (liquid) to complex, multi-textured foods in just two short years. Children continue to refine their feeding skills through elementary age. Simultaneous to feeding development during childhood is speech and language development. One component of speech and language development is articulation. Articulation refers to the establishment of clear and distinct sounds in speech. Speech sounds are developing from birth and should be fully developed by age eight all the while, gaining clarity with repetition and feedback. Articulation and feeding both require intact orofacial structure and adequate oral motor function. Although the relationship between these two developmental processes is implied because of their shared developmental periods and anatomical structures, it has not been fully explored in the literature. This study investigated the relationship between feeding and articulation in children with known articulation deficits. A total of ten participants were recruited from the University of Alabama Speech and Hearing Center (UA SHC), but only three were included after exclusion. Participants demonstrated overlapping sound errors that corresponded to overlapping feeding skill error. For clinical purposes, the implication of an articulation and/or feeding screener would be beneficial in the evaluation process of either disorder to aid in the success of the child’s therapy.
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.
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.
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 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.
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.
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.
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.
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.
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.
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.

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