ABSTRACT
Stuttering is a neurodevelopmental disorder associated with profound psychosocial consequences. Individuals
who stutter commonly experience peer rejection, social isolation, and debilitating emotional responses to their
stuttering. These hidden features of stuttering vary widely across individuals and are challenging to treat, but
underlying causal mechanisms are not well-understood. The proposed project addresses this critical gap by
focusing on attentional processes that may drive psychological responses to stuttering. The project draws upon
the extensive literature on threat-related attention bias (AB), examining the extent to which such attentional
patterns are associated with stuttering. Threat-related AB refers to preferential allocation of attention toward
threatening stimuli and is a well-established finding in adults and children with clinical and subclinical anxiety.
Cognitive models attribute AB to imbalances in early processes that detect threat, or late processes that
modulate reactivity to threat, which manifest as faster detection of threat (vigilance), difficulty disengaging from
threat (maintenance), threat avoidance, or combinations of these tendencies. AB may feed anxiety by promoting
heightened sensitivity toward threat and hypervigilant scanning of environmental stimuli. Individuals who stutter
show analogous anticipatory behaviors related to speaking, suggesting that similar AB patterns may underlie
stuttering. The proposed project investigates threat-related AB in adults who do and do not stutter using a multi-
paradigm approach that combines behavioral and eye-tracking indices of AB. The primary aim is to establish
group differences in AB and identify the stage of processing at which differences emerge based on three widely-
used tasks associated with different stages of information processing and AB tendencies (Aim 1). Aim 2 is to
determine the extent to which threat-related AB in adults who stutter is general (consistent with anxiety) or
disorder-specific (reflecting personal lived experiences of stuttering) by comparing three categories of threat
stimuli representing increasing content specificity (general, stuttering-related, and personally-feared threat
words). Aim 3 applies mediation analyses to examine the role of AB as a critical mediating factor between
subject-level risk factors (related to temperament and attention control) and individual differences in stuttering
outcomes (impact and anticipation). The project is innovative in that it applies novel conceptual and experimental
approaches from AB research, uses eye-tracking methodologies that reveal dynamic attention patterns, and
includes mediation analyses to clarify contributions of AB and related factors to stuttering outcomes. Results will
increase our understanding of operative mechanisms shaping responses to stuttering and can provide a means
to identify individuals most vulnerable to adverse stuttering impacts. The long-term goal of the project is to
generate key data for future intervention studies designed to reverse AB through AB modification paradigms that
train attention away from threat. The proposed research thus supports the mission of NIDCD by advancing our
understanding of stuttering and providing a foundation for new approaches to its assessment and treatment.
