Tinnitus affects approximately 50 million people in the United States (U.S.) and can be a challenging problem to address. Many treatments for tinnitus have been proposed, including acupuncture and hypnosis. Efficacy studies regarding these two treatments for tinnitus have either failed to show a positive effect of treatment or have suffered from significant design flaws. This project aimed to determine the attitudes and practice patterns of acupuncturists and hypnotists regarding their treatments in tinnitus management as well as to determine the attitudes of audiologists and otologists about these treatments. Acupuncturists, hypnotists, audiologists, and otologists anonymously completed surveys via Research Electronic Data Capture (REDCap). The results of the surveys suggested that there is likely a wide range of opinions and practice patterns by professionals who offer acupuncture and/or hypnosis for the treatment of tinnitus and that a majority of audiologists and otologists who responded would recommend or might recommend these treatments for tinnitus.

The cervical vestibular myogenic potential (cVEMP) is a sound-evoked sonomotor response that can be recorded from the sternocleidomastoid (SCM) muscles in the neck. There is general agreement that the cVEMP provides information about the integrity of the saccule and/or inferior vestibular nerve. Since the amplitude of the cVEMP is correlated with the degree of tonic activation, the level of EMG can influence interaural asymmetries and lead to possible misdiagnoses of unilateral impairment. Thus, amplitude correction, or normalization, was created as a mathematical process to remove the influence of EMG on cVEMP amplitudes. Therefore, the purpose of this investigation was to determine whether the use of amplitude correction techniques would reduce significantly the P13-N23 interaural amplitude asymmetry data in otologically and neurologically intact adults when the level of EMG was varied. Participants included 20 adults, age 21-29. cVEMP testing was completed using EMG target levels ranging from 100 to 400 μV. Results indicated that statistically significant EMG level-dependent differences in cVEMP amplitude disappeared after amplitude normalization was applied. No significant differences in mean amplitude were observed between 300-400 μV EMG target levels though significant differences in EMG existed. The results of this study support the use of amplitude normalization to reduce the statistical upper limits of cVEMP interaural asymmetry measurement variables.

This study examined the predictive value of orthographic processing versus orthographic knowledge for spelling proficiency. Third-grade students with typical language and literacy skills completed measures of orthographic knowledge, orthographic processing, and spelling. Results showed that neither orthographic processing nor orthographic pattern knowledge predicted spelling proficiency. These results may help guide future research and inform spelling instruction.

HEARING AND SPEECH SCIENCES The Stability and Validity of Automated Vocal Analysis in Preschoolers with Autism Spectrum Disorder in the Early Stages of Language Development Tiffany Woynaroski Dissertation under the direction of C. Melanie Schuele, Ph.D. and Paul Yoder, Ph.D. Learning to use spoken words to communicate during the preschool years has been repeatedly linked with long-term outcomes in individuals with autism spectrum disorders (ASD). This replicated finding has motivated much research into the predictors of spoken language in young children with ASD. Previous studies have demonstrated that measures of child vocalization complexity and adult linguistic input as derived from conventional communication samples predict spoken language in samples of preschoolers with ASD who are heterogeneous in spoken language level. Measures of child vocalization complexity and adult linguistic input may be even more useful in predicting who will use words to communicate amongst the subset of children with ASD who are preverbal or just beginning to use words to communicate. Unfortunately, the time and cost inherent to conventional communication sampling make it difficult for clinicians to measure these important predictors in everyday clinical practice. This study drew on extant data from a recent longitudinal correlational study to explore whether automated vocal analysis, a less time-consuming and costly approach, may provide a valid and reliable alternative to conventional communication sampling for measurement of child vocalization complexity and adult linguistic input in preschoolers with ASD who are still in the early stages of language development. Our selected index of child vocalization complexity as derived via automated vocal analysis was stable with a single day-long audio-recording and non-significantly different from our index of child vocalization complexity as measured in conventional communication samples. In contrast, the stability and validity of our index of adult linguistic input as derived via the novel automated vocal analysis approach was not confirmed. Post hoc analyses demonstrated that both indices of child vocalization complexity had "added value" in predicting spoken vocabulary size in our sample even when controlling for adult linguistic input as measured in conventional communication samples. Results highlight the importance of child vocalization complexity as a predictor of useful speech in this population and support the use of time-efficient and cost-effective automated vocal analysis as a viable method of measuring this construct in everyday clinical practice. Keywords: useful speech, vocabulary, language development, automated vocal analysis, LENA, autism spectrum disorder

The purpose of this study was to investigate the relation among speech-language dissociations, one attentional processspecifically, distractibilityand childhood stuttering. Participants included 202 monolingual, English speaking preschool-age children (3;05;11 years of age) who do (82 CWS; 65 males) and do not stutter (120 CWNS; 59 males). Speech-language dissociations were identified using a correlation-based statistical procedure (Bates, E., Appelbaum, Salcedo, Saygin, & Pizzamiglio, 2003), which was applied to participants scores on five standardized speech-language (sub)tests. Distractibility was measured by the distractibility subscale of the Behavioral Style Questionnaire (BSQ; McDevitt & Carey, 1978). Between-group analyses were conducted to determine whether: (1) more CWS exhibited speech-language dissociations than CWNS; and (2) CWS exhibited poorer distractibility scores than CWNS. Within-group correlations assessed the relation between CWSs and CWNSs distractibility and speech-language dissociations. Generalized linear modeling (GLM) assessed whether interactions between distractibility and speech-language dissociations predict childrens frequency of stuttered, nonstuttered, and/or total disfluencies. Findings indicated that more preschool-age CWS exhibited speech-language dissociations than CWNS, and that more boys exhibited dissociations than girls. Additionally, CWS boys scored lower on the BSQs distractibility subscalesuggesting less distractibilitythan CWS and CWNS girls. Furthermore, CWSs, but not CWNSs, distractibility scores were associated with two out of four measures of speech-language dissociations. That is, for preschool-age CWS, greater attention (i.e., being less distractible) was associated with greater frequencies of dissociations. Lastly, findings showed that interactions between distractibility and frequency of speech-language dissociations were not predictive of childrens speech fluency breakdowns (i.e., stuttered, nonstuttered, and total disfluencies). In conclusion, more preschool-age CWSparticularly boysexhibit speech-language dissociations than their normally fluent peers, and, for CWS, there is a relation between greater attention (i.e., more non-distractibility) and speech-language dissociations. The latter finding appears to suggest that attentional processes are associated with speech-language dissociations exhibited by preschool-age CWS. However, precise understanding of this association must await future empirical study.

Purpose: The purpose of this study was to empirically assess whether preschool-age CWSs emotional diathesis (vulnerability), emotional stress, and their interaction are associated with these childrens stuttered disfluencies and whether those associations are mediated by sympathetic arousal (the latter indexed by tonic skin conductance level, SCL). Method: Participants were 49 preschool-age CWS (38 male). Each participant was exposed to relatively neutral (i.e., baseline), positive and negative emotion-inducing child-appropriate video clips and then performed age-appropriate narrative tasks. Measurement of participants emotional diatheses (e.g., emotional reactivity) was based on parents report (i.e., Childrens Behavior Questionnaires, CBQ), with their percentage of stuttered disfluencies and sympathetic arousal (i.e., SCL) measured during a narrative after viewing each baseline, positive and negative video clip. Results: Among the salient findings, the first finding indicated that preschool-age CWSs positive emotional reactivity was significantly positively associated with their percentage of stuttered disfluencies regardless of emotion stress condition. The second finding indicated that preschool-age CWSs negative emotional reactivity was more positively correlated with their percentage of stuttered disfluencies during narratives after positive, compared to baseline, emotion stress condition. The third finding indicated that preschool-age CWSs mean length of utterances (MLU) was positively associated with their positive emotional reactivity as well as percentage of stuttered disfluencies. Conclusions: Findings addressed whether, when and how the association of emotional processes and stuttering exists for preschool-age CWS. Regarding whether the relation exists, the first finding suggests that such an association exists, at least for positive emotional reactivity. Relative to when the relation exists, the second finding suggests that preschool-age CWSs negative emotional reactivity is more associated with their percentage of stuttered disfluencies under positive, compared to baseline, emotional stress. In terms of how emotional processes impacts childhood stuttering, the third finding was cautiously taken to suggest that positive emotional reactivity is associated with stuttering through MLU, rather than sympathetic arousal. Overall, present findings appear to support the notion that emotional processes play a role and that emotion warrants inclusion in any truly comprehensive account of childhood stuttering.

Purpose: The purpose of this study is to better understand problem behaviors in young children with hearing loss (HL) who use listening and spoken language. Method: Children with HL were compared to same-aged peers with language impairment (LI) and typical language (TL). Participants included 45 children and their parents (13 in the HL group and 16 in the LI and TL groups); the mean age was 43 months (SD 12.2). Results from the preschool version of the Child Behavior Checklist (CBCL/1.5-5) were compared across groups as well as language level. This study also compared the results of the parent-reported CBCL/1.5-5 to the teacher version, the Caregiver-Teacher Report Form (C-TRF) for children with HL to look for any inter-rater differences and differences across settings. Results: As a group, children with HL did not have significantly different internalizing or externalizing problem behavior composite scores on the CBCL/1.5-5 than children with LI or TL. Internalizing problem behavior scores were moderately associated with language level across all groups. Therefore, internalizing problem behaviors appear to be at least partially attributed to language across multiple populations of young children. It was also found that for children with HL, parent and teacher reported problem behavior scores were in concordance. Conclusion: In this sample of young children there were no significant group differences in internalizing or externalizing composite scores on the CBCL/1.5-5 between children with HL, LI, and TL. Internalizing problem behavior scores were moderately correlated with language level across all three groups, which is consistent with previous research. For children with HL, parent and teacher reported problem behavior scores were concordant.

Children with Specific Language Impairment (SLI) can present with deficits in receptive, expressive, or both modalities of vocabulary. Although typically developing children demonstrate vocabulary generalization from the receptive to expressive modality, the extent to which children with SLI can generalize between modalities has not yet been determined. Three male children with SLI (age 3;1 - 5;5) were taught separate sets of receptive and expressive vocabulary in a single subject multiple baseline multiple probe design. During each probe condition, vocabulary growth in both taught and untaught modalities was probed. Results demonstrated that all three children learned target vocabulary words in the taught modality. However, only the two oldest children (ages 5;4 and 5;5) demonstrated consistent cross-modal generalization from the expressive to receptive modality. Most generalization was maintained. The findings suggest that, in children with SLI, cross-modal generalization of vocabulary is most likely to occur from the expressive to the receptive modality.

The ability to adequately perceive and utilize the prosody of spoken language is important for successful communication. Children with hearing loss who use cochlear implants have demonstrated deficits in perception of stress and intonation in spoken language, but not rhythm in music, compared to children who use hearing aids or children who have normal hearing. These deficits have been attributed in part to limitations of cochlear implant technology. Wearing a hearing aid in addition to the cochlear implant can reduce some of these deficits. In this study, perception of stress, intonation, and speech rhythm was compared among 8-16 year old children with hearing loss who used cochlear implants, children with hearing loss who used bimodal technology - one cochlear implant and one hearing aid in the contralateral ear, and children with normal hearing. The results of this study indicated that most children were sensitive to stress, intonation, and rhythm of speech. Children with hearing loss were comparable to children with normal hearing in their sensitivity to stress and rhythm, and intonation present in unfiltered, connected speech, but were deficient in their perception of intonation present in low-pass filtered speech. Children with hearing loss were comparable to children with normal hearing when identifying the language of an utterance based on phonemic and prosodic cues, but were deficient when minimal phonemic cues were present. Children who used bilateral cochlear implants performed similarly to children who used bimodal technology, indicating that sensitivity to prosodic features was possible with either of the hearing technologies. Audiological factors such as early amplification, longer duration of auditory exposure, and adequate low-frequency access had a positive impact on perception of prosody in speech. The finding that children with hearing loss were comparable to children with normal hearing in their perception of stress and intonation is in contrast to previous findings, and might be attributed to differences in task design as well as in audiological and intervention characteristics of the children in this study compared to previous studies.