Early childhood stuttering and risk for persistence: The impact of emotion on speech and cognitive control

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Developmental stuttering commonly emerges between 24-60 months of age with the majority of these children recovering from stuttering. For the remaining children, persistent stuttering into school-age years and adulthood confers significant risk for adverse impact on social-emotional, educational, and vocational outcomes. Although over the past years a variety of risk factors for stuttering persistence have been identified (e.g., stuttering severity, sex, age at onset, time since onset, articulation, language ability), there is still a critical need to optimize the accuracy with which stuttering persistence can be predicted. To date, predictive models have rarely considered the role of emotion; however, our preliminary data suggest that it plays a major role in stuttering persistence. Specifically, our cross-sectional work has demonstrated that cortical and autonomic markers of emotional reactivity and emotion-related cognitive control vulnerabilities in children who stutter (CWS) contribute to stuttering and are associated with persistence (pilot data). We recently extended this work and developed a novel methodology to test the effects of emotional reactivity on speech preparation and production in young children at risk for persistence. Based on our findings to date, the central hypothesis of the proposed project is that emotional reactivity plays a major role in stuttering persistence by interfering with both non-speech cognitive control (e.g. inhibition and execution) and speech preparation and production processes necessary for the early development of speech fluency and thereby confers heightened risk for stuttering persistence. To test this hypothesis, we will conduct a longitudinal study of young (3- to 4-year old) CWS. Annual lab visits will occur for 3 years from study enrollment and will involve a comprehensive stuttering assessment, a speech-language, cognitive, and temperament diagnostic battery as well as the systematic assessment of emotional reactivity, cognitive control, and speech preparation and production processes. The specific aims of the project are to: (1) determine if cortical and autonomic biomarkers of emotional reactivity predict outcome (persist versus recover) for CWS, (2) determine if emotion- related performance during a non-speech cognitive control task and a speaking task predicts outcome (persist versus recover) for CWS, and (3) determine whether markers of emotional contributions to stuttering provide additive predictive value when combined with other established variables associated with stuttering persistence. If successful, the proposed project addresses the continued clinical need to identify markers of risk for stuttering persistence and improve the accuracy of predictive models. These advances will allow clinicians to better pinpoint targets for assessment, set the stage for novel therapeutic approaches, and allow researchers to better evaluate the effects of early intervention due to an improved ability to distinguish persistent from transient cases. Thus, the proposed research supports the mission of NIDCD by discovering new knowledge that has the potential to improve outcomes of young children who stutter.