Attention, Executive Functions, and Speech Disfluencies in Stuttering and Nonstuttering Individuals: A Scoping Review

Attention and executive functions (EFs) have been hypothesized to play a regulatory role in speech planning and production, thereby influencing the occurrence of speech disfluencies. This scoping review examined evidence on the relationship between attention, EFs, and speech disfluencies in persons who stutter (PWS), persons who do not stutter (PWNS), and PWNS with other conditions (PWNS + C), where attention or EFs are impacted.

Following Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines, searches were conducted in Web of Science, Embase, MEDLINE, and Scopus using inclusive terms for attention, EFs, and speech disfluencies. Data extracted included study and participant characteristics, speech sample types, disfluency types, cognitive components assessed, instruments used, and findings on cognitive-disfluency associations. Out of 4,233 records screened, 51 studies were included.

Inhibitory control and working memory consistently emerged as key cognitive components linked to disfluency frequency, while cognitive flexibility and specific attention subdomains remain underexplored. In PWS, dual-task paradigms revealed paradoxical fluency improvements under increased cognitive load, suggesting dysregulated monitoring mechanisms. PWNS showed increased disfluencies primarily under high cognitive demands. PWNS + C exhibited broader regulatory deficits affecting fluency, highlighting reliance on domain-general cognitive control systems.

Findings from this review underscore the role of attention and EFs, particularly inhibitory control and working memory, in speech fluency across populations. Dual-task paradigms highlight that cognitive load does not consistently disrupt fluency but interacts with individual cognitive profiles and task demands. Future research could benefit from adopting multimodal, ecologically valid methods to explain how attention and EFs contribute to fluent speech.

https://doi.org/10.23641/asha.31079509.