Cluttering is a communication disorder resulting in decreased fluency and intelligibility that often coexists with stuttering.
An exact description of cluttering has not been accepted or agreed upon universally. In general, it is a communication disorder that results in decreased speech intelligibility and may involve one or a combination of the following areas: language, articulation, and fluency, as well as rate and self-monitoring skills.
The characteristics of cluttering vary among clients, but a consistent characteristic is an excessive speech rate. More than 60 other symptoms are listed in well-known chapters and books on cluttering. Some common characteristics include:
-Indistinct, “mumbling” speech involving sound distortions and omissions.
-Errors in connected speech that are not present or less pronounced in single-word production or connected speech that is produced slowly.
-Transpositions of sounds in words, phrases, or sentences (ex: “Many people think so” becomes “Many thinkle peep so”)
-Auditory processing difficulties
-Client may be unaware of his/her speech disorder and surprised when other people do not understand him/her
Stuttering vs. Cluttering
- Disfluencies on units smaller than the word level, such as sound prolongations and sound/syllable repetitions
- Effort/physiologic tension associated with disfluent moments
- Typically person has awareness of disfluencies and a sense of loss of control
- Difficulty making fluent transitions from one sound or syllable to the next.
- Disfluencies typically involve units larger than the sound or syllable level, such as word and phrase repetitions, incomplete phrases, and revisions.
- Little apparent physiologic tension
- Often demonstrate poor self-monitoring skills and decreased awareness of speech errors
- Difficulty making smooth transitions from one syntactic unit to another or one lexical choice to the next or sequencing his/her message cohesively and coherently
- Do not typically produce prolongations or tense pauses
- Fast and/or spurty speaking rate
- Linguistic encoding difficulties leading to poor cohesion and coherence of connected speech
- Reduced speech intelligibility due to articulation errors secondary to fast rate
Diagnosing this disorder:
Since cluttering affects articulation, language, voice, and fluency, its assessment includes each of these areas.
-Individuals may not clutter in all situations. Important to examine in several contexts: Reading lists of multisyllabic words, Reading passages, Spontaneous speech
-Rate language/speech samples for:
– Overall speech rate
– Regularity of rate
– Overall articulation accuracy
– Pragmatic language appropriateness
-Interview client regarding perception of speech difficulty and perception of social penalty of speech difficulty
-Writing sample analysis
– Short paragraph about vacation, etc.
- Looking for illegible writing
- Omissions of letters, syllables, words, as seen in speech
Two fluency-enhancing strategies can be useful in addressing cluttering: prolonged speech and reduced speech rate.
ASHA outlines that therapy should focus on:
Slowing rate (metronome, pacing boards, visuals, etc.)
- Use video or audio-taped conversations and have client identify places where he/she failed to monitor.
- Prepare samples of worst, mediocre and best speech, have them listen/rate daily to assist with ability to monitor on-line.
Using clear speech
- “over-articulate“ multisyllabic words/ discuss what they are feeling
- Imagine they are talking to a person with hearing loss
Using organized language
- Example: focusing on one topic at a time
Interacting with listeners
- taking turns in conversation at reasonable durations (such as 30 seconds)
- thinking about the listener as you speak
Reducing excessive disfluencies
- identifying mazes in his/her speech
Also important to work with parents on modeling clear speech and organized language.
Books for Clinicians:
The Source for Stuttering and Cluttering
by David Daly
- feelings and attitudes of adolescents
- Structured word, phrase & sentence tasks
- Addresses Clinician forms for tracking progress
- Self-evaluation forms for client
- Audiotape to model speech patterns
- Techniques for cluttering intervention
- A Cluttering Yahoo Group by Judith Kuster (Minnesota, USA) Questions/comments(online conference)
- Cluttering: A Facebook Social Network for Persons Who Clutter by Sr. Carol Mary Nolan (Massachusetts, USA) Questions/comments(online conference)
- NorCal Cluttering Group – A social gathering for PWC by Jonathan Wong (California, USA) Questions/comments (online conference)
- K-12 Academic Cluttering Community is a currently inactive yahoo group with only 5 members. K-12 Academics has a short explanation about cluttering.
Byrd, C. (2011). Fluency Disorders Fall 2011, Unit I: Slide Set 3 [PowerPoint slides].
Ramig, P.R. & Dodge, D.M. (2005 ). The child and adolescent stuttering treatment and activity resource guide. Clifton Park, NY: Delmar Learning.
Shipley, K.G. & McAfee, J.G. (2004). Assessment in Speech-Language Pathology: A resource manual (3rd ed.). Clifton Park, NY: Delmar Learning.
St. Louis, K.O. & Myers, F.L. (1994). Clinical management of cluttering. Language, Speech, and Hearing Services in Schools, 26, 187-195.
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