How Stuttering Develops: The Multifactorial Dynamic Pathways Theory Purpose We advanced a multifactorial, dynamic account of the complex, nonlinear interactions of motor, linguistic, and emotional factors contributing to the development of stuttering. Our purpose here is to update our account as the multifactorial dynamic pathways theory. Method We review evidence related to how stuttering develops, including ... Research Article
Research Article  |   September 18, 2017
How Stuttering Develops: The Multifactorial Dynamic Pathways Theory
 
Author Affiliations & Notes
  • Anne Smith
    Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana
  • Christine Weber
    Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana
  • Disclosure: The authors have declared that no competing interests existed at the time of publication.
    Disclosure: The authors have declared that no competing interests existed at the time of publication. ×
  • Correspondence to Anne Smith: asmith@purdue.edu
  • Editor: Julie Liss
    Editor: Julie Liss×
  • Associate Editor: Hans-Georg Bosshardt
    Associate Editor: Hans-Georg Bosshardt×
Article Information
Speech, Voice & Prosodic Disorders / Fluency Disorders / Speech, Voice & Prosody / Speech / Research Articles
Research Article   |   September 18, 2017
How Stuttering Develops: The Multifactorial Dynamic Pathways Theory
Journal of Speech, Language, and Hearing Research, September 2017, Vol. 60, 2483-2505. doi:10.1044/2017_JSLHR-S-16-0343
History: Received August 30, 2016 , Revised February 21, 2017 , Accepted April 19, 2017
 
Journal of Speech, Language, and Hearing Research, September 2017, Vol. 60, 2483-2505. doi:10.1044/2017_JSLHR-S-16-0343
History: Received August 30, 2016; Revised February 21, 2017; Accepted April 19, 2017

Purpose We advanced a multifactorial, dynamic account of the complex, nonlinear interactions of motor, linguistic, and emotional factors contributing to the development of stuttering. Our purpose here is to update our account as the multifactorial dynamic pathways theory.

Method We review evidence related to how stuttering develops, including genetic/epigenetic factors; motor, linguistic, and emotional features; and advances in neuroimaging studies. We update evidence for our earlier claim: Although stuttering ultimately reflects impairment in speech sensorimotor processes, its course over the life span is strongly conditioned by linguistic and emotional factors.

Results Our current account places primary emphasis on the dynamic developmental context in which stuttering emerges and follows its course during the preschool years. Rapid changes in many neurobehavioral systems are ongoing, and critical interactions among these systems likely play a major role in determining persistence of or recovery from stuttering.

Conclusion Stuttering, or childhood onset fluency disorder (Diagnostic and Statistical Manual of Mental Disorders, 5th edition; American Psychiatric Association [APA], 2013), is a neurodevelopmental disorder that begins when neural networks supporting speech, language, and emotional functions are rapidly developing. The multifactorial dynamic pathways theory motivates experimental and clinical work to determine the specific factors that contribute to each child's pathway to the diagnosis of stuttering and those most likely to promote recovery.

Acknowledgments
The work from the Purdue Stuttering Project summarized in this article was supported by the National Institute on Deafness and Other Communication Disorders Grant R01 DC00559 first funded in 1988. We express our gratitude to Gerald Zimmermann for his inspired approach to understanding the “causes” of stuttering. We thank David McFarland, Evan Usler, Bridget Walsh, and two anonymous reviewers for very helpful comments on earlier drafts of this article. Finally, our thanks to Soo-Eun Chang for providing the MRI image we used in Figure 1.
Order a Subscription
Pay Per View
Entire Journal of Speech, Language, and Hearing Research content & archive
24-hour access
This Article
24-hour access