Developmental Trajectories to Stuttering Persistence and Recovery

摘要 口吃或儿童期出现的流利性障碍，影响5-8%的学龄前儿童。虽然很多人 儿童口吃在发病后12-24个月内消失，7岁以上继续口吃的儿童 患慢性口吃的风险很大。对于坚持的孩子来说，说话往往成为一种终生的挣扎。这个 对学业/职业成就和心理社会发展的负面影响 这些孩子中的许多人都是体格健壮、经久不衰的。 先前对学龄前儿童口吃(CWS)的研究已经确定了人口统计学、行为和 通过比较不同组别的口吃表现，得出与口吃持续性相关的生理因素 学龄前儿童。然而，我们不知道儿童独特的发育途径是如何引导他们恢复或 坚持口吃。这限制了我们预测儿童患持续性(慢性)口吃风险的能力 并制定有效的预防和治疗战略。 这个项目第一次将实验重点转移到单个儿童身上，提供了一个动态的 说明神经、行为和经验因素如何随着时间的推移而展开，并对不同的 结结巴巴的结果。我们通过全面的纵向设计和结构方程来实现这一点 模型框架，其中我们绘制了与口吃有关的关键因素的发展轨迹。 在我们的方法中，我们使用了一种新的神经成像技术，功能近红外光谱(FNIRS)，它 允许我们在连续语音产生的同时记录大脑活动，这是这一点的一个明显优势 技术。我们将评估神经标记物是否源自我们研究中确定的fNIRS记录 年龄较大的CWS可以区分有坚持风险的学龄前儿童，从而帮助建立神经 口吃持久和恢复的基础。我们还将评估非典型耦合是否与 在横断面研究中检测到的交感神经系统活动和语言输出代表着一种风险 慢性口吃的因素。最后，口吃会给坚持的孩子留下持久的印记。充足的证据 显示年龄较大的儿童和成年人更有可能对他们的演讲和/或 产生沟通焦虑。然而，我们缺乏关于这些问题在年轻人中如何发展的连续图景。 儿童对口吃的意识正在形成。我们将研究行为、情感和 经验因素随着时间的推移而展开，并探索它们在口吃持续或恢复中的作用以及在口吃中的作用 发展消极的沟通态度。 这个项目将带来新的、全面的见解，了解为什么口吃在个别儿童中持续存在， 同时，帮助更好地确定治疗资源的优先顺序，确定预防和治疗的病因目标 干预，加快开发新的治疗方法。

Summary Stuttering or childhood onset fluency disorder, affects 5-8% of preschool-aged children. Although many children’s stuttering resolves within 12-24 months of onset, those who continue to stutter beyond age 7 are at significant risk for chronic stuttering. For children who persist, speaking often becomes a lifelong struggle. The negative consequences for academic/vocational achievement and psychosocial development suffered by many of these children are substantial and long lasting. Prior studies in preschool children who stutter (CWS) have identified demographic, behavioral, and physiological factors associated with stuttering persistence by comparing performance across groups of preschool children. Yet, we do not know how a child’s unique developmental pathway leads them to recover or persist in stuttering. This limits our ability to predict a child’s risk of developing persistent (chronic) stuttering reliably and to develop efficacious prevention and treatment strategies. This project shifts experimental focus, for the first time, to the individual child, providing a dynamic account of how neurological, behavioral, and experiential factors unfold over time and contribute to different stuttering outcomes. We achieve this through our comprehensive, longitudinal design and structural equation modeling framework, in which we map the developmental trajectories of critical factors implicated in stuttering. In our approach, we use a novel neuroimaging technique, functional near-infrared spectroscopy (fNIRS), that allows us to record brain activity concurrent with continuous speech production, a distinct advantage of this technique. We will assess whether neural markers derived from fNIRS recordings identified in our research with older CWS can distinguish preschool children at risk for persistence, thereby helping to establish a neural basis for stuttering persistence and recovery. We will also assess whether atypical coupling between sympathetic nervous system activity and speech output, detected in cross-sectional studies, represents a risk factor for chronic stuttering. Finally, stuttering leaves a lasting imprint on children who persist. Ample evidence shows that older children and adults are more likely to harbor negative emotions about their speech and/or develop communication anxiety. We lack a continuous picture, however, of how these issues develop in young children whose awareness of stuttering is emerging. We will examine how behavioral, emotional, and experiential factors unfold over time and explore their roles in stuttering persistence or recovery and in the development of negative communication attitudes. This project will bring new, comprehensive insights into why stuttering persists in individual children, and, in parallel, help better prioritize therapy resources, identify etiological targets for prevention and intervention, and accelerate the development of new treatments.