Conceptualizing and investigating the contextual variability of stuttering: The speech and monitoring interaction (SAMI) framework

Researchers, clinicians, and people who stutter find it difficult to adequately explain the variability across contexts in the frequency and severity of stuttering. The purpose of this paper is to present the speech and monitoring interaction framework of stuttering that incorporates potential deficits within the speech production system and a contextually modulated monitoring system to provide a biologically plausible explanation for the contextual variability of stuttering. SAMI incorporates trait and state factors within the speech production system and the monitoring system that can account for stuttering variability. The specificity of the neural substrates of the monitoring system and how the monitor interacts with the speech production system can be used to drive hypotheses based research and computational modeling of the contextual variable stuttering. The framework can also be used clinically to inform clients of the social and emotional factors contributing to their stuttering; while highlighting the importance of addressing these factors in therapy.