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Focus On Cluttering

7/17/2013

19 Comments

 
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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 phrase repetitions and revisions, whole word repetitions, unfinished words, and interjections (i.e. um, well, etc.) 

3.  Coarticulation refers to when a person collapses or omits a syllable of a word (i.e. "wuffel" for "wonderful").  

4.  People who clutter may also omit words altogether (i.e. I went the park yesterday)

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!  

  • 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!)                                                       *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.  

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 ("You just speak too fast! You don't have a "real" speech problem!"). 

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 the client 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 (although this is not always true!).  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. 
19 Comments
Roberta Kornfield, M.S., CCC/SLP link
8/6/2013 02:23:58 am

Hi Brooke,

I am working on updating SpeechCare's website, and I was wondering if I could put a link to yours.

Roberta

Reply
Brooke Leiman MA, CCC-SLP link
8/6/2013 02:32:50 am

Roberta- Of course! I'll be sure to take a look at your website as well!

Reply
Mars
2/9/2014 12:39:27 pm

I appreciate seeing a clip of a child who, just like my son, is 11 yrs old with CAPD, been in S/L therapy since 4, and still has disfluencies, which I now believe is Cluttering. He did a successful summer program with Our Time, a theater program for "young people who stutter." But now I need to find someone who can assess him for Cluttering -- which I am pretty sure my mother and I both have as well. Thanks for posting this : ).

Reply
Brooke Leiman link
2/20/2014 04:09:55 pm

Mars-
Try this link to find a stuttering specialist...this is probably your best bet to find a therapist who knows something about cluttering (or at the very least might know someone else who does)

http://stutteringspecialists.org/index.php?option=com_comprofiler&task=usersList&listid=4&searchmode=1&Itemid=510

I'd love to hear more about Our Time. I've referred some clients to it due to their great reputation, but do not know much beyond what's on the website.

Reply
HJ
8/23/2014 06:10:03 pm

Hello
Thank you for several useful information you posted!
I am wondering whether a boy with ASD is cluttering or not.
If not, which disorder could you diagnose for him?

1) His speech comes out rapidly, like “machine gun”
Ex) “I am a boy.” => [ a! ɪ! ǽm! ə! bbɔ! ɪ! ] : each syllable with accent
2) Both [bi] and [pi] sound like [bbi]
3) Monotone
4) He usually opens his mouth

I appreciate If you answer my question. Thank you.

Reply
Brooke Leiman link
8/24/2014 04:13:24 am

HJ-

Unfortunately, I couldn't possibly provide a diagnosis for a child with the information you have given. I have seen cluttering or atypical disfluencies in several of my clients with ASD so it sounds like you should continue to explore this. The International Cluttering Association has some helpful information on how to assess for Cluttering which can be found at http://associations.missouristate.edu/ica/ (click on clinical issues on the bar on the left). I'm not sure what you mean by "he usually opens his mouth." Do you mean that before/during a disfluency he demonstrates a tense open mouth posture? This may be a secondary behavior related to stuttering, however we don't typically see that in a "pure" cluttering diagnosis.

Reply
LB
12/11/2014 06:44:49 am

Co-worker, emigrated from S. America. Learned English on his own 20 years ago. Speaks English well, but so, so FAST that he is nearly impossible to understand. I have known many immigrants who have learned English and speak it at "appropriate" speed(s). Could this be cluttering?

Reply
Brooke Leiman link
5/13/2015 09:24:52 am

A little late to respond, somehow this comment slipped by me. Unfortunately, the information you provided wouldn't be nearly enough to warrant a diagnosis. A clinician would also need to know how his rate is perceived in his native language. A clinician would also have to consider how the person's accent impacts intelligibility. If the person is truly concerned, it's worth having a consultation with a fluency specialist who would know what to look for!

Reply
Ryan Forsyth
7/4/2015 03:48:35 pm

Hi there, I'm from Australia nsw. have had cluttering my whole life since birth. But i was not clearly diagnosed until around 2007 there about. It has affected my development of learning in many ways, interacting with others and getting annoyed when not understood. I have a good grasp on cluttering information, but i was wanting to know if there was someone perhaps online or in person who could help me to get better speech in general? or even training videos, exercises i could have to practice. I find it difficult to doing exercises with speech on my own. If you like i can do recording of my voice to help with this inquiry.

Reply
Brooke Leiman link
7/14/2015 06:31:26 am

Hi Ryan!

I have reached out to a colleague in Australia and will email you directly with the best contact in your area.

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Sue Shepard link
11/18/2015 03:53:08 pm

At what age can treatment for cluttering begin?

Reply
Brooke Leiman link
3/11/2016 01:46:37 pm

At least in my experience, parents of children who clutter seem to come to me with concerns with their child's speech later than when their child stutters. I have never worked on cluttering before the age of 7, but not because you shouldn't just because I have not had a child come to me any earlier than that.

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Kenny
5/15/2016 03:45:58 pm

Hi! I'm Kenny from Indonesia, I just found out about cluttering now and I feel like I might have it, because I have most of the symptoms written above. I speak really fast and have poor grammatical skill in every language that I speak (I speak 3 languages). This has been bothering me for a long time but even worse now because I am working in a field that requires me to talk to public and I am afraid that they won't be able to catch what I am trying to say. I am planning to visit a pathologist to get diagnosed but now I live in Seoul and I'm wondering if it's okay because they won't understand my first but my 3rd language instead.
Thank you in advance.

Reply
Brooke Leiman link
10/5/2016 07:46:55 pm

Kenny-

It's always best to work with a clinician that is fluent in your dominant language. However, in this case, you just may not be able to find someone who is fluent in your native language. If you let me know your dominant language I can see if I know any stuttering specialists who may be willing to do teletherapy. If you can't find a clinician who speaks your dominant language, I would at least put a large emphasis on finding a clinician that has experience with working with adults with fluency disorders.

Reply
Chiharu Matsuura link
7/16/2016 09:55:36 am

Hello,

I knew this article through an article of ASHA.(I am international member of ASHA.)

Thank you for useful information.

May I translate this article into Japanese?
In addition, may I share it with the original?

Some parents and some therapists would like to know the contents, but they say that it is difficult as English.

Reply
Brooke Leiman link
10/5/2016 07:48:38 pm

Chiharu-

Why don't you go ahead and email me (Brooke@nationalspeech.com) and we can discuss this further!

Thanks!

Reply
Jennifer
10/5/2016 03:07:18 pm

I am teaching a class on speech disorders, and we are currently on stuttering. We were discussing neurogenic, psychogenic and developmental stuttering. I had a student ask me if cluttering could also be neurogenic, psychogenic or developmental. I can't find the answer in the literature I have been going through. Can you help me with this question?

Reply
Brooke Leiman link
10/5/2016 07:38:11 pm

Jennifer-

We do not separate cluttering into those 3 different categories as we do with stuttering. However, more research is necessary in order to fully understand the underlying cause/s of cluttering. I would suggest reviewing ASHA's Practice Portal for Childhood Fluency Disorders as it provides information on our current knowledge of cluttering that may be helpful in answering questions in your class. http://www.asha.org/Practice-Portal/Clinical-Topics/Childhood-Fluency-Disorders/

Reply
Stacey Henry
5/13/2018 08:05:17 pm

Thank you

Reply

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    Brooke Leiman MA, CCC-SLP, BCS-F Director of the Stuttering Clinic at National Therapy Center
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