I wrote the following in response to the logical sequence of the linear P&A Model a few days ago: This is a citation from the article published by the authors: "The P&A model is shown in Fig. 1. This was first presented at the American Speech and Hearing Association Convention in Philadelphia, in November 2010 (Packman & Attanasio, 2010). The three factors are, (1) a deficit in the neural processing underpinning spoken language, which renders the speech production system unstable and prone to perturbation, (2) triggers, which are some inherent features of spoken language that increase the motoric task demands on that system, and (3) modulating factors, which determine the triggering threshold. The three factors are now explained in more detail." And this is my response: "The order is logically incoherent. Here's why: For deficits in neural processing to be (1), these deficits would have to have stable and consistent manifestation. However, the very mention of instability and perturbation makes it so that modulating factors that determine the triggering threshold must already have had a causal effect on neural processing and manifestation. As such, modulating factors would have to be (1). As for triggers as inherent features of spoken language that increase motoric demand, have studied been conducted that confirm that stuttering frequency increases as word and sentence complexity increase? (Yes, but enough to grant such importance to) Stutterers can say the most complex of words but struggle saying their name, which shouldn't be of much motor task demand. It is the most frequent word one will probably say throughout their lifetimes. And further, we may manage to successfully say a word, but if asked to repeat it because the other didn't hear us, that's when we stutter. As such, the triggers would better be defined as rooted in the anticipated urgency with which we believe (in the context of the specific social scenario) are supposed to say a word, i.e. you're supposed to say your name with no hesitation or struggle because it's your name. The sequence would then look like this: Existing modulatory tendency --> trigger --> combined modulatory tendency --> Overexcitation --> Instability and perturbations to neural processing --> Stutter. Some examples: Overly anxious \* demanding social scenario = Increased instability of neural processing and so more severe the stutter. Overly anxious \* undemanding social scenario or alone = relative stability of neural processing and balanced speech. Relaxed \* demanding social scenario = relative stability of neural processing and balanced speech. Relaxed \* undemanding social scenario or alone = Optimal neural processing and perfectly fluent speech. There are documented neural processing deficits in stutterers, of course, but I wouldn't deem the deficits as necessarily structural. I'd rather look at the deficits as established patterns of functional connectivity potentiated through synaptic connections over the course of countless iterative cycles (instances of stutter). And as a synaptic connection underwent the process of potentiation, same it can the process of depression, '**an activity-dependent reduction in the efficacy of neuronal synapses lasting hours or longer following a long patterned stimulus**.'" This is the what, but I don't know the how of initiating the reversion of this process. I don't believe it's cognitive though. Spontaneous recovery, which is the solution to have proven most permanent. Speech therapy is temporary and needs revamping now and again. And I do not think Cognitive Behavioral Therapy would derive much different results than those from speech therapy. Spontaneous recovery is interesting, giving the impression of a natural re-alignment of the physiological and of the senses that ultimately and unconsciously lead to the optimal mode of perception and cognition conducive to fluent speech.