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

发育性口吃通常出现在24-60个月大的孩子， 从口吃中恢复过来对于剩下的孩子，持续口吃到学龄期， 成年后对社会情感、教育和职业产生不利影响的风险很大 结果。虽然在过去的几年里，已经确定了各种各样的口吃持续性的危险因素， (e.g.,口吃严重程度、性别、发病年龄、发病时间、发音、语言能力），仍有一个关键的 需要优化口吃持续性预测的准确性。到目前为止，预测模型 很少考虑情绪的作用;然而，我们的初步数据表明，它在 结结巴巴的坚持具体来说，我们的横断面研究表明，皮质和自主神经 口吃儿童情绪反应和情绪相关认知控制脆弱性的标志物 (CWS)有助于口吃，并与持久性（试点数据）。我们最近扩展了这项工作 并开发了一种新的方法来测试情绪反应对演讲准备的影响， 生产的幼儿在风险的持久性。根据我们迄今为止的发现， 提出的项目是，情绪反应起着重要作用，在口吃的持续性，通过干扰 具有非言语认知控制（例如抑制和执行）和言语准备， 生产过程所必需的早期发展的讲话流利，从而赋予 口吃持续性的风险增加。为了验证这一假设，我们将进行一项纵向研究， 年轻（3- 4岁）CWS。从研究入组起3年内每年进行一次实验室访视， 全面的口吃评估，一个语音语言，认知和气质诊断电池， 以及对情绪反应、认知控制和言语准备的系统评估， 生产过程。该项目的具体目标是：（1）确定是否皮质和自主神经 情绪反应性的生物标志物预测CWS的结果（持续与恢复），（2）确定情绪- 在非言语认知控制任务和言语任务期间的相关表现预测结果（持续 与恢复）为CWS，和（3）确定是否标记的情绪贡献口吃提供 当与其他与口吃相关的既定变量结合时， 坚持不懈如果成功，拟议的项目将解决持续的临床需求，以确定 口吃持续性的风险，并提高预测模型的准确性。这些进步将使 临床医生更好地确定评估目标，为新的治疗方法奠定基础，并允许 研究人员可以更好地评估早期干预的效果，因为他们能够更好地区分 从短暂的病例持续。因此，拟议的研究支持NIDCD的使命， 新的知识，有可能改善幼儿谁口吃的结果。

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.