What’s New in Stuttering Research: From Theory to Practice

Many people have questions about the causes behind their own or their child’s stutter. While the causes of stuttering have been hotly debated, we are converging on a recently updated multifactorial dynamic pathways model.1

The Multifactorial Dynamic Pathways Model

This model identifies several areas that contribute to stuttering, including:

  • Genetics
  • Neurology
  • Motor aspects
  • Language aspects
  • Emotional aspects

The developers of this approach, Smith and Weber, define the multifactorial dynamic pathways model as follows:

“Stuttering, or childhood onset fluency disorder, is a neurodevelopmental disorder that begins during the preschool years when emerging neural networks critical for speech motor development produce unstable, aberrant control signals that give rise to stuttering-like disfluencies (SLDs). The occurrences of involuntary disruptions in speech, in turn, produce responses in the child’s internal and external milieu at both behavioral and physiological levels. These processes then may have epigenetic influences on the expression of genes involved in the development of speech motor systems.”

For those who aren’t speech-language professionals, this can sound complicated and intimidating. So how do you explain this to your clients and their families?

Here’s the explanation I like to use:

“The cause of stuttering is not well-defined. We believe that stuttering is a neurodevelopmental disorder, with both neurological and genetic components. Anatomy is not destiny, however. Environmental processes also influence the development and persistence of stuttering.”

Clinical Applications

Because stuttering develops and changes over time, it is important to begin therapy as soon as possible. A good chunk of treatment time, especially with young children who stutter, should consist of parent education. This includes counseling families on the causes and triggers of stuttering, making modifications to the child’s environment, and understanding the child’s emotional responses associated with stuttering.

Assessments should be comprehensive and cover areas such as speech motor, language, and overall life impact. Comprehensive language tests in addition to the SSI4 and the OASES,3 should be given to help uncover the linguistic and emotional aspects of stuttering.

Treatment should be holistic. Speech motor activities should help children bridge the gap between the therapy room and the real world.

As speech-language pathologists, our treatment can help create new pathways in the brain and strengthen existing ones through speech, language, and counseling activities.

  1. Smith, A., & Weber, C. (2017). How stuttering develops: the multifactorial dynamic pathways theory. Journal of Speech, Language, and Hearing Research, 60, 2483–2505.
  2. Riley G. (1994). Stuttering Severity Instruments for Children and Adults (SSI-3) (revised, third edition). Tigerd: CC Publications.
  3. Yaruss, J.S., & Quesal, R.W. (2008). OASES: Overall Assessment of the Speaker’s Experience of Stuttering. Bloomington, MN: Pearson Assessments.