Cluttering is a syndrome characterized by a speech delivery rate which is either abnormally fast or irregular, or both.
Speech and language disorders may be classified into disorders of
- Language and
The fluency disorder most extensively described in the literature is, of course, stuttering, whereas the professional interest in other fluency disorders is relatively new, particularly in the United States.
However, the disorder of cluttering has been described in the European literature on phoniatrics (study and treatment of organs involved in speech production) and logopedics (study, and correction, of speech and language defects, disorders in communication and swallowing disorders) as early as in the 18th century.
Most speech-language pathologists are aware of the fluency disorder known as clustering, and most seasoned clinicians have managed a few clients with the disorder. Many remember these clients not by how well they responded to treatment but by how puzzling it was to know what to do with them and how challenging they were to treat.
“Cluttering is a syndrome characterized by a speech delivery rate which is either abnormally fast & irregular or both. In a cluttered speech, the person’s speech is affected by one or more of the following: Failure to maintain normally expected sound, syllable, phrase, and pausing patterns. Evidence of greater than expected incidents of disfluency, the majority of which are unlike those types of people who stutter.”
This definition expands the previous definition that focused only on two components:
an excessively rapid and/or irregular speaking rate, and disfluencies that are frequent but are not judged to be stuttering. Like all working definitions, this one must change as new data are gathered.
Admittedly, the definition is not wholly satisfactory, partly because it is based on the listener’s judgment. One especially frustrating problem is that people with the disorder frequently do not clutter, for example, when they speak in a short screening evaluation. In such cases, they are not diagnosed, or one must rely on subjective reports, by the clients or others, that cluttering does indeed exist.
- 1 Causes of Cluttering
- 2 Factors Affecting Cluttering
- 3 Symptoms of Cluttering
- 4 Assessment
- 5 Cluttering Treatment Approaches
- 6 Some Others Facts
Causes of Cluttering
With regard to cluttering, research is not far enough along to identify causes. There is very little genetic information on cluttering, except for anecdotal reports that the speech characteristics are present in more than one member of a family. There is no single cause of cluttering, and in fact, there may be medical causes of cluttering that are unique to the individual.
Conditions that affect concentration may be related to an individual’s cluttering, and there may be even some prescription medications that are used to treat independent illness or conditions that could bring about cluttering as a side effect. The use of alcohol or drug, such as marijuana/cannabis may also influence cluttering.
Factors Affecting Cluttering
Features of cluttering are sometimes observed in conjunction with other neurological disorders (e.g., ASD, Tourette’s and ADHD). Potential neurological underpinnings of cluttering include dysregulation of the anterior cingulate cortex and the supplementary motor area.
Systems that govern self-regulation may underlie cluttering qualitative interviews with those who clutter suggest that thoughts emerge before they are ready. The speaker is proposed to be talking a rate that is too fast for his or her system to handle, resulting in breakdowns in fluency and /or intelligibility.
Symptoms of Cluttering
- Rapid and/or irregular rate of speech
- Racing thoughts.
- Leaving off the ends of words.
- Omitting or distorting sounds or syllables.
- Words sound as if they are running into each other.
- Lots of starts and stops in speaking.
- Excessive use of disfluencies such as “um”, “uh”, repeating or revising phrases, or repeating words, unlike stuttering.
- Difficulty organizing thoughts and/or getting to the point.
- Limited awareness of how one’s speech sounds to others.
- Difficulties slowing down even when asked to do so.
- The tendency to interrupt the conversational partner.
- Words or ideas come out differently than intended.
- Difficulties with handwriting- legibility decreases with time.
- Difficulties sustaining attention for such activities like reading and/or small talk.
- Always “on the go.”
- Difficulties with typing words accurately, such as having to do excessive editing of email messages.
- Speech is often at its best in a structured situation in which the person is actively monitoring it, such as when being videotaped. Speech is usually at its worst when the person is more relaxed.
The speaker’s rate of speech is not always measured to be greater than average but is perceived by the listener as rapid. This is thought to be because speakers with cluttering speak at a rate that is too fast for their system to handle, resulting in the breakdown of clarity of speech.
Although some with cluttering lack awareness of their difficulties with communication, many are aware that others have difficulty understanding them. People with cluttering can experience the same effective and cognitive components and/or negative attitudes toward communication.
Individuals suspected of having a fluency disorder are referred to a speech-language pathologist for a comprehensive assessment. A thorough assessment focuses on components known to accompany fluency disorders. Assessments are individualized and based on the person’s communication environment.
Cluttering and stuttering don’t need to occur in all situations or even a majority of the time to be diagnosable disorders. Furthermore, some children may use secondary behaviours, such as substituting or omitting words or circumlocution, as a way to hide stuttering symptoms.
Another vexing issue is the extent to which language planning and pragmatic problems are implicated in the diagnosis of cluttering. We do not currently include language difficulties in the definition because there appear to be at least a few clutter for whom language problems are not evident.
A third confusing issue is that cluttering often- but not always-coexists with stuttering, although the two are now regarded as distinct fluency disorders by most authorities. Moreover, cluttering is often noticed before the stuttering takes over during the development of the disorder and after stuttering is treated successfully, but not while a person manifests significant stuttering.
Further adding to this confusion, even in relatively rare cases of “pure cluttering,” is that most clutterers or their families refer to their problems as “stuttering.”
Cluttering symptoms have been known to normalize during a formal evaluation of speech due to increased self-monitoring. Symptoms of cluttering often are observed more frequently in situations where the individual is more comfortable and therefore, less likely to monitor speech production.
Some of the concerns for assessment are as follows.
- There is a family history of stuttering or cluttering
- The child exhibits any negative reactions towards his or her disfluency
- The child exhibits physical tension or secondary behaviours (e.g., eye blinking, head nodding, etc.) associated with disfluency.
- Other speeches or language concerns are also present.
- The child is experiencing negative reactions from family members or peers.
- The child is having difficulty communicating his or her message in an efficient, effective manner.
- There is a parental concern.
- If a child has typical disfluency or a fluency disorder
- If the child is likely to recover without treatment
- If monitoring or treatment is required
Cluttering Treatment Approaches
Treatment for fluency disorders is highly individualized and based on a thorough assessment of speech fluency, language factors, emotional/attitudinal components, and life impact. In creating a treatment plan and setting goals for fluency. Ideally, a team approach is used in treatment planning, where child and family priorities and desired outcomes drive treatment goals and methods.
Clinicians engage in ongoing assessment to ensure that the treatment is appropriate for the changing experiences of the child and family as the child progresses through life and the treatment process.
Strategies For Reducing Impairment In Body Function
- Speech modification strategies
- Stuttering modification strategies
- Increasing speech efficiency
Strategies For Reducing Negative Reaction
- Cognitive restructuring
Strategies For Reducing Activity Limitation And Participation Reaction
- Generalization activities
- Accommodation at school and in the community
Counselling is an integral part of the assessment and treatment of children who stutter or clutter. Counselling skills should be used specifically to help speakers improve their quality of life by minimizing the burden of their communication disorder. The use of such skills in other areas of the speaker’s life.
Effective counselling involves the skills needed to help a client, family member, or caregiver move from s current scenario to a preferred scenario through an agreed-upon action plan. A focus on the therapeutic relationship is common across different counselling models, as recognized by the common factors theory in counselling.
Some Others Facts
Although the current criteria for cluttering include only symptoms of speech rate and fluency, other disorders may co-occur. For example, there is documentation of cluttered speech in children with learning disabilities. Tourette’s syndrome, autism, word-finding/language organization issue, and attention deficit hyperactivity disorders may occur in addition to a diagnosis of cluttering and cluttering has been documented with none of these additional features or diagnoses.
A disorder that can be seen as a consequence of cluttering is that of pragmatic disorder; individuals with cluttering may not attempt to repair breakdowns in communication, which may result in less than effective social interaction.
An interesting fact about cluttering is that unlike stuttering, many who clutter are unaware of their difficulties with communication. This one reason many are not diagnosed until adulthood. Another reason for the delay in diagnosis relates to the fact that cluttering is misunderstood among the public and professionals alike, and therefore, those who clutter may be misdiagnosed as stutterers or “anxious speakers”.
Adults who clutter have reported that in growing up, others have commented to them about “improving the communication,” but such comments tended to be vague, so the individual could never put his or her finger on what was causing this type of response. Cluttering can often co-exist with stuttering.
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