Literature: How Stuttering Develops: The Multifactorial Dynamic Pathways Theory.(口吃如何發生？ 多動態路徑理論)

Smith, Anne; Weber, Christine. Journal of Speech, Language & Hearing Research.Sep2017, Vol. 60 Issue 9, p2483-2505. 23p.
DOI: 10.1044/2017_JSLHR-S-16-0343.


目的：學者們進而以多動態解釋ㄧ複雜且在動作、語言、情緒等非線性交互作用因素而造成口吃的原因，其目的是更新對多動態路徑理論之解釋。

方法：作者回顧關於導致口吃的文獻，包含基因、動作、語言和情緒因素，以及神經影像研究。並修正之前理論證據，雖然口吃的根源是言語感覺神經過程的受損，但口吃在生活過程中與語言和情緒等因素有強烈的相關。

結果：目前強調口吃初期在學齡前期的動態發展環境的解釋，在這個時期有許多神經行為系統持續地快速改變中，而此時與口吃兒童的互動似乎扮演一重要的關鍵角色，可能影響兒童之口吃是否能有自發性恢復或是持續有口吃之行為。

結論：依據 DSM V的定義，口吃或是兒童期語暢異常是一種神經發展障礙，語暢異常始於當支持言語、語言以及情感功能神經網絡正快速的發展之時，多動態路徑理論有益於實驗及臨床工作在決定是那些特定要素影響每一個兒童的路徑以進行診斷。

Purpose: We advanced a multifactorial, dynamic account of the complex, nonlinear interactions of motor, linguistic,and emotional factors contributing to the development of stuttering. Our purpose here is to update our account as the multifactorial dynamic pathways theory.

Method: We review evidence related to how stuttering develops, including genetic/epigenetic factors; motor,linguistic, and emotional features; and advances in neuroimaging studies. We update evidence for our earlier

claim: Although stuttering ultimately reflects impairment in speech sensorimotor processes, its course over the life span is strongly conditioned by linguistic and emotional factors.

Results: Our current account places primary emphasis on the dynamic developmental context in which stuttering emerges and follows its course during the preschool years. Rapid changes in many neurobehavioral systems are ongoing, and critical interactions among these systems likely play a major role in determining persistence of or recovery from stuttering.

Conclusion: Stuttering, or childhood onset fluency disorder (Diagnostic and Statistical Manual of Mental Disorders, 5th edition; American Psychiatric Association [APA], 2013), is a neurodevelopmental disorder that begins when neural networks supporting speech, language, and emotional functions are rapidly developing. The multifactorial dynamic pathways theory motivates experimental and clinical work to determine the specific factors that contribute to each child’s pathway to the diagnosis