Neural Markers of Persistence and Recovery from Childhood Stuttering: An fMRI Study of Continuous Speech Production

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Although symptoms of childhood stuttering fully manifest during overt, continuous speech production, little is known about the neural processes associated with speech production in children, and how these processes are disrupted, resulting in the overt manifestation of stuttering instances. Moreover, the majority of children who stutter recover naturally, but we do not know how children’s brains functionally adapt to cope with the disorder and achieve fluent speech. Absent such knowledge, the neurological deficits underlying stuttering and how the disorder resolves itself cannot be fully understood, a difficulty that limits our ability to develop advances in clinical assessment and intervention. Our long-term goal is to develop effective therapeutic interventions to treat and prevent persistent stuttering during childhood. The objective of the present application, which is the next step in pursuing that goal, is to determine brain activity patterns associated with continuous speech production in children with persistent (pCWS) and children who recovered from stuttering (rCWS). The central hypothesis of the application is that persistent stuttering is associated with anomalous brain activity in the neural circuits for speech-motor control, while recovery from stuttering is associated with greater involvement of right frontal areas. The rationale of this proposed research is that an empirically-based understanding of brain activity patterns associated with continuous speech production of pCWS and rCWS is foundational for the development of future therapeutic interventions attempting to modify anomalous activity. Using a novel fMRI technique, we will test our central hypothesis by pursuing the following specific aims: 1) Identify brain activity associated with continuous speech production that characterizes persistent stuttering, and 2) Identify brain activity associated with continuous speech production that characterizes recovery from stuttering. To achieve Aim #1, brain activity associated fluent speech production between pCWS and controls will be compared. Furthermore, brain activity associated with fluent and stuttered speech production in pCWS will be separated and compared. To achieve Aim #2, brain activity associated with fluent speech production between rCWS and controls will be compared. This application is innovative because it will be the first study to examine both cortical and subcortical activity associated with continuous speech production in children with high spatial resolution using a novel fMRI de-noising technique. Findings of this project will be significant because they are expected to fundamentally advance our understanding of the neural processes associated with fluent and disfluent continuous speech production in children who stutter and provide insights into neuroplasticity associated with recovery from childhood stuttering. Ultimately, this new knowledge may guide the future development of better treatment strategies for childhood stuttering.