Developmental stuttering affects 1% of the population and over 3 million individuals in the USA. However, there are other, lesser known fluency disorders that include neurogenic stuttering and cluttering. Today's blog will turn its focus to cluttering and take a brief look at the process of identification and treatment.
Complex Definition Alert!
Currently, the International Cluttering Association defines cluttering as "...a fluency disorder characterized by a rate that is perceived to be abnormally rapid, irregular or both for the speaker. These rate abnormalities further are manifest in one or more of the following symptoms: an excessive number of disfluencies, the majority of which are not typical of people who stutter; the frequent placement of pauses and use of prosodic patterns that do not conform to syntactic and semantic constraints; and inappropriate (usually excessive) degrees of coarticulation among sounds, especially in multisyllabic words. " (St. Louis, Myers, Bakker, & Raphael, 2007).
Translation Please!
So what does cluttering look/sound like?
1. Often people who clutter have what I (and many other SLPs) refer to as "machine-gun" speech. Their speech comes out in rapid bursts, which is described above as "irregular rate", and may include pauses where it doesn't feel appropriate.
2. A person who clutters may also demonstrate disfluencies that are unlike what we see in people who stutter. Some examples of disfluencies that are more typical of a person who clutters is excessive whole word repetitions, unfinished words, and interjections (i.e. um, well, etc.) I have also noticed more atypical disfluencies such as final part word repetitions (i.e. chair-air, bike-ike).
3. Finally, coarticulation refers to when a person collapses or omits a syllable of a word (i.e. "wuffel" for "wonderful").
Okay, Now It's Starting To Make More Sense...
Complex Definition Alert!
Currently, the International Cluttering Association defines cluttering as "...a fluency disorder characterized by a rate that is perceived to be abnormally rapid, irregular or both for the speaker. These rate abnormalities further are manifest in one or more of the following symptoms: an excessive number of disfluencies, the majority of which are not typical of people who stutter; the frequent placement of pauses and use of prosodic patterns that do not conform to syntactic and semantic constraints; and inappropriate (usually excessive) degrees of coarticulation among sounds, especially in multisyllabic words. " (St. Louis, Myers, Bakker, & Raphael, 2007).
Translation Please!
So what does cluttering look/sound like?
1. Often people who clutter have what I (and many other SLPs) refer to as "machine-gun" speech. Their speech comes out in rapid bursts, which is described above as "irregular rate", and may include pauses where it doesn't feel appropriate.
2. A person who clutters may also demonstrate disfluencies that are unlike what we see in people who stutter. Some examples of disfluencies that are more typical of a person who clutters is excessive whole word repetitions, unfinished words, and interjections (i.e. um, well, etc.) I have also noticed more atypical disfluencies such as final part word repetitions (i.e. chair-air, bike-ike).
3. Finally, coarticulation refers to when a person collapses or omits a syllable of a word (i.e. "wuffel" for "wonderful").
Okay, Now It's Starting To Make More Sense...
But wait! That's not all! There is quite a bit of symptom variability, as well as co-existing conditions, that make this an even more confusing diagnosis. Below is a list of characteristics and co-morbid conditions that have been seen in people who clutter:
Please Note: Some people who clutter may have several of the below symptoms/co-existing conditions, some may have only one, and some may have none at all!
If you feel this diagnosis is hard to grasp, you're not alone! Although we are gradually learning more and more about cluttering, there are still many speech-language pathologists who are not aware or are not familiar with this diagnosis! As a result, this condition goes largely misdiagnosed (as developmental stuttering) or undiagnosed ("I just speak too fast! I don't have a "real" speech problem!"). For a helpful chart that breaks down the similarities and differences between stuttering and cluttering, please take a look at this brochure created by Kathleen Scaler Scott for the National Stuttering Association.
I Think My Child Is Cluttering. Now What?
Since this a relatively lesser known diagnosis, your best bet would be to find a speech language pathologist who has experience in working with fluency disorders. As you have learned, cluttering is a highly variable disorder. We cannot prescribe a "one size fits all" plan of treatment. There must be careful and continuous observation in order to create a treatment plan that is specific to the symptoms your child is displaying. In the interest of educating you on what to expect, here are some common treatment objectives:
1. Self-Monitoring-
One common characteristic amongst people who clutter is limited awareness of their own speech. It is important to heighten the client's ability to monitor his or her disfluencies, rate, and/or mis-articulations. For a person who stutters, calling their attention to stuttering, although sometimes necessary, may initially cause an increase in disfluencies. However, for people who clutter, bringing their attention to their speech often helps them to improve their rate and overall clarity (at least for a short bit!).
2. Over-articulation-
Another common characteristic amongst people who clutter is the collapsing or omitting of syllables. By practicing the over-articulation of sounds, it calls a person's attention to all the syllables in a word, both stressed and unstressed. The speech of people who clutter may be monotone or "robotic." Practicing over-articulation can be worked on in conjunction with exaggerating stressed syllables and inflection.
3. Pausing and Phrasing-
Pausing and phrasing is a tool by which a person practices inserting more pauses into their speech, with attention to the proper placement of these pauses. For younger children, I will have them place pauses every 1-3 words, but as they get older, more attention will be paid to inserting pauses based on proper phrasing. I often will transcribe a client's language sample, to include both the words they say and the placement of their pauses. I will then have them mark up the paper with where the pauses should have gone. Having a visual representation of your speech is a helpful way to identify when there are way too many words being said between pauses (AKA machine gun speech). Pausing is also another tool in teaching a person to slow their rate, which I believe is much more effective and constructive when compared with saying "slow down."
4. Provide strategies for "typical" disfluencies-
As noted above, some people will demonstrate stutter-like disfluencies in addition to their cluttering characteristics. In this case, standard stuttering techniques should be addressed such as cancellations, pull-outs, etc.
Here is great video of a fellow SLP discussing the speech of a child who clutters. This particular language sample highlights what it sounds like when a child collapses and omits syllables.
Please Note: Some people who clutter may have several of the below symptoms/co-existing conditions, some may have only one, and some may have none at all!
- Limited or no awareness of their irregular speech pattern unless someone draws their attention to it (very different from what we see in PWS!)
- Sloppy handwriting
- Difficulty organizing thoughts, listeners easily get "lost"
- Learning disability
- Attention difficulties (i.e. ADHD)
- Auditory Processing Disorders
- Asperger's Syndrome/ Autism Spectrum Disorder
- Stuttering (Yes! A person can Clutter AND Stutter!)
If you feel this diagnosis is hard to grasp, you're not alone! Although we are gradually learning more and more about cluttering, there are still many speech-language pathologists who are not aware or are not familiar with this diagnosis! As a result, this condition goes largely misdiagnosed (as developmental stuttering) or undiagnosed ("I just speak too fast! I don't have a "real" speech problem!"). For a helpful chart that breaks down the similarities and differences between stuttering and cluttering, please take a look at this brochure created by Kathleen Scaler Scott for the National Stuttering Association.
I Think My Child Is Cluttering. Now What?
Since this a relatively lesser known diagnosis, your best bet would be to find a speech language pathologist who has experience in working with fluency disorders. As you have learned, cluttering is a highly variable disorder. We cannot prescribe a "one size fits all" plan of treatment. There must be careful and continuous observation in order to create a treatment plan that is specific to the symptoms your child is displaying. In the interest of educating you on what to expect, here are some common treatment objectives:
1. Self-Monitoring-
One common characteristic amongst people who clutter is limited awareness of their own speech. It is important to heighten the client's ability to monitor his or her disfluencies, rate, and/or mis-articulations. For a person who stutters, calling their attention to stuttering, although sometimes necessary, may initially cause an increase in disfluencies. However, for people who clutter, bringing their attention to their speech often helps them to improve their rate and overall clarity (at least for a short bit!).
2. Over-articulation-
Another common characteristic amongst people who clutter is the collapsing or omitting of syllables. By practicing the over-articulation of sounds, it calls a person's attention to all the syllables in a word, both stressed and unstressed. The speech of people who clutter may be monotone or "robotic." Practicing over-articulation can be worked on in conjunction with exaggerating stressed syllables and inflection.
3. Pausing and Phrasing-
Pausing and phrasing is a tool by which a person practices inserting more pauses into their speech, with attention to the proper placement of these pauses. For younger children, I will have them place pauses every 1-3 words, but as they get older, more attention will be paid to inserting pauses based on proper phrasing. I often will transcribe a client's language sample, to include both the words they say and the placement of their pauses. I will then have them mark up the paper with where the pauses should have gone. Having a visual representation of your speech is a helpful way to identify when there are way too many words being said between pauses (AKA machine gun speech). Pausing is also another tool in teaching a person to slow their rate, which I believe is much more effective and constructive when compared with saying "slow down."
4. Provide strategies for "typical" disfluencies-
As noted above, some people will demonstrate stutter-like disfluencies in addition to their cluttering characteristics. In this case, standard stuttering techniques should be addressed such as cancellations, pull-outs, etc.
Here is great video of a fellow SLP discussing the speech of a child who clutters. This particular language sample highlights what it sounds like when a child collapses and omits syllables.
Have any questions about cluttering or want to speak of your own experiences with cluttering? Share below!
*This entry is also featured on ASHA's (American Speech Language and Hearing Association) blog, ASHAsphere.
*This entry is also featured on ASHA's (American Speech Language and Hearing Association) blog, ASHAsphere.
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