Great response! Have you already seen the [VRT hypothesis ](https://docs.google.com/document/d/107rhp9VpjBT7jjDdFwH9WE13GjYzZo_wMfIQHGj5NnU/edit?usp=sharing)summary I created? I’ve condensed over 1,000 pages of research studies into a single document. It’s a modern hypothesis on stuttering that dives deep into the role of dopamine neurotransmitters. It discusses how presynaptic tonic dopamine and postsynaptic striatal dopamine might contribute to developmental stuttering. I find their explanation about dopamine fascinating. >*Abnormalities in dopamine metabolism, resulting in:* >*- Poor quality of speech and/or poor control over focus of attention* >*- Relatively slow speech planning in general*  >*- A tendency to make somewhat more speech planning errors than non-stutterers. Speech motor control abilities somewhat below average, but not sufficiently so for them (or their listener) to be consciously aware that they are impaired* >*- Hypersensitivity to sensory feedback* >*- Abnormal dopamine metabolism and cerebellar impairment may both also play roles in impairing speech production and/or perception. They may cause speakers to become hypersensitive to cues that alert them to potential upcoming difficulty, and/or lead to misinterpretation of auditory feedback, thus distorting speakers’ perceptions of their performances.* >*These underlying weaknesses may undermine the speaker’s confidence in his ability to speak well enough and may thus predispose to stuttering but their contribution is much less important than that of the speaker’s understandings and beliefs: stuttering is primarily a cognitive disorder*  Dopamine explanation: Novel or unexpected stimuli (such as, stuttering anticipation) cause an initial phasic spike in synaptic dopamine levels – enabling us to orientate our attention towards those stimuli in order to identify and evaluate them. Negative emotional experience of stuttering could be described as an event that was less rewarding than predicted, thereby reducing dopamine release and weakening the motor program for the intended speech sequence that failed. Striatal dopamine receptor density and stuttering prevalence are closely correlated. Rewarding: it dampens our sensitivity so that the rises in synaptic dopamine are no longer so rewarding (pleasurable) and the falls are no longer so punishing. If a novel stimulus is then evaluated as rewarding, this spike in synaptic dopamine will be prolonged and increase – enabling further approach behaviour towards that stimulus. Any stimulus that leads to the anticipation of a primary reward will also cause a phasic spike in synaptic dopamine, facilitating approach behaviour towards that anticipated reward. Stuttering occurs as a direct result of phasic reductions in synaptic dopamine, brought on by the perception (or anticipation) of communication failure. If a novel stimulus is evaluated as punishing, the initial spike in synaptic dopamine will be reversed and a trough in synaptic dopamine levels will ensue – which inhibits approach behaviours toward that stimulus. Any stimulus that leads to the anticipation of a primary punishment will cause a phasic trough in synaptic dopamine, inhibiting approach behaviour towards that anticipated punishment. Dopamine plays a crucial role in operant conditioning, that occurs when a person’s speech performance is evaluated by the speaker as “punishing” or “rewarding"  **(aka incentive based learning)** **How can we naturally avoid any alteration in dopamine levels when experiencing a stutter trigger?** * Step 1: Identify & analyze your many reactions and responses especially in perceivably fluent speech. Perceivably fluent speech in a PWS does not equate to the absence of reactions and responses to stuttering  * Step 2: Accept (aka acknowledge) that such behaviors may represent anticipatory reactions and responses, impacting motor planning in the speech production phase * Step 3: Reflect your anticipatory reactions and responses to the internal realization of stuttering - which even when subtle, may represent a significant internal conflict