The role of anxiety in stuttering: Evidence from functional connectivity

Persistent developmental stuttering is a neurologically based speech disorder associated with cognitive-linguistic, motor and emotional abnormalities. Previous studies investigating the relationship between anxiety and stuttering have yielded mixed results, but it has not yet been examined whether anxiety influences brain activity underlying stuttering. Here, using functional magnetic resonance imaging (fMRI), we investigated the functional connectivity associated with state anxiety in a syllable repetition task, and trait anxiety during rest in adults who stutter (N = 19) and fluent controls (N = 19). During the speech task, people who stutter (PWS) showed increased functional connectivity of the right amygdala with the prefrontal gyrus (the left ventromedial frontal gyrus and right middle frontal gyrus) and the left insula compared to controls. During rest, PWS showed stronger functional connectivity between the right hippocampus and the left orbital frontal gyrus, and between the left hippocampus and left motor areas than controls. Taken together, our results suggest aberrant bottom-up and/or top-down interactions for anxiety regulation, which might be responsible for the higher level of state anxiety during speech and for the anxiety-prone trait in PWS. To our knowledge, this is the first study to examine the neural underpinnings of anxiety in PWS, thus yielding new insight into the causes of stuttering which might aid strategies for the diagnosis and treatment of stuttering.