*Comment #4:* *You stated: "reduced neuronal energy and potentially results from the synergy of decreased aerobic energy production, cellular hypoxia, decreased cerebral blood flow, decreased lysosomal and mitochondrial activity, increased glycolysis associated with the ARNT2 mutation, elevated dopamine levels, and decreased glucose metabolism. "* **I agree completely! Here is fantastic statement from a doctor that I think aligns very well with this***:* >*A big mistake I see made often on this sub is that a neurological explanation is used as something that happens before talking and that that would cause the stuttering. I believe it is the other way around; blood flow follows brain activation. So the apprehensive anxiety with someone else approaching us or us trying to speak, is what causes hypoactivation in certain areas and that IS the stuttering. It's the same as saying aggression is caused by increased activation of this lobe; it's not 'caused' by it, but it is the activation pattern we see caused by all the emotions leading up to it.* *The only way i cured my own stutter was by realising this and finding out that it was really just a masked form of social anxiety. It's why most of us can sing and talk to ourselves without much problems. Our brain is very, very excellent in hiding social pain from others, and much more ourselves sometimes.* *And in my experience it also does not bagatelise the impact of genetics for example, as for example if you have a mutation in a certain serotonin pump so that a certain nucleus stays hyperactivated longer, that could mean that people are impacted more after negative social cues. This does not mean the cause is neurological, but that our genetics and brain make up give us a more sensitive proclivity to stuttering.* *Once I have some time I will try to make a good write up to integrate my thoughts and the research into something more clear.* *I'm not contradicting the reduced blood flow that would maintain the stuttering due to dysfunction of the neurons obviously. But what do you think caused the disruption in the first place? In people with strokes or an oxygen deficiency at birth or severe mutations thst cause reduced blood flow it is very neurological. But this group is a relatively small group and many (especially the ones that can talk fluently alone or sing) have disrupted speech due to some negative social anxiety that is not being acknowledged and being worked around. If I would stop using my left arm for the coming 5 years from now on, you would measure reduced blood flow to certain parts in my right hemisphere. And this would for sure impact my arm usage when I would try to use it again. And if I have a very strong (subconscious) belief that the 'normal' usage of my arm would inflict some kind of social pain (just like we think the same with stuttering, even though we try to convince ourselves we don't), it would be very difficult to use it normally again.*