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Cluttering
What is cluttering?
Cluttering is a relatively rare (and controversial) disorder characterized by dysfluency similar to that seen in stuttering, but accompanied by other behaviors not typically seen in people who stutter. Among its additional symptoms are: Excessive and irregular speech rate (tachylalia). This
may be a real phenomenon or may reflect a rate of speech that appears fast because it is in excess of the patient’s motor and linguistic planning abilities. The resulting articulatory imprecision may have the perceptual effect of too-rapid rate.
A high number of interjections and prolonged interjections (drawling)
Symptoms (continued)
Impaired speech intelligibility, due to: Omissions of sounds, syllables, and occasionally,
whole words; Metathesis of speech segments Anticipatory and progressive assimilation of sound
segments Repetitions of initial segments Telescoping of multi-syllabic targets (usually via weak
syllable deletion) These symptoms appear ameliorated by slowed rate
of speech, pacing and monitoring.
Symptoms (continued)
Impaired (monotonic) prosody Impaired respiratory patterns for speech Co-morbid learning disability, usually in
reading/writing Relative lack of awareness of communicative
impairment, including dysfluencies and articulation errors.
Symptoms of Cluttering (Daly, 1994)Obligatory Symptoms Excessive repetitions Poorly organized thinking Short attention span and poor
concentration Lack of awareness of cluttering
problem
Facultative Symptoms Excessive speech rate Grammatical difficulties Delayed speech and language
development Auditory imperceptiveness Oral reading and reading
comprehension problems Writing problems
Other Facultative Symptoms Abnormal respiration Monotony Motor problems Family history of disfluency Academically weak in reading/language
arts Volume problems (explosive speech) Personality factors (aggressive, untidy,
impulsive) Articulation problems Lack of rhythm Small for age Academically strong in math Dysphonia Language/grammar difficulties (word
retrieval; word order; sentence simplification; verb conjugation; sequencing of prepositions; pronoun reference.
Symptoms of cluttering (Weiss, 1968)
Obligatory Symptoms Excessive repetitions (8-10) Short attention span and poor
concentration Lack of awareness of the
problem Perceptual weakness Poorly organized thinking
Facultative Symptoms Excessive speech rate Interjections Vowel stops Articulatory and motor disabilities Grammatical difficulties Vocal monotony Respiratory dysrhythmia Delayed speech development
Associated Symptoms Reading disorder Writing disorder Lack of rhythmical and
musical ability Restlessness and
hyperactivity EEG findings Lag in maturation Heredity
Etiology of cluttering
Currently unknown. Difficulty of isolating group; there is clear overlap between
cluttering and stuttering, and some individuals may have both conditions.
As with stuttering, there is a clear familial component. Almost certainly a neurological condition;
In early studies, over 90% of clutterers showed abnormal EEG function (Luchsinger & Landholt, 1951).
In other early studies, PWS and PWC showed inverse reactions to DAF, and drugs such as chlorpromazine (tranquilizer) and dexfenmatrazine (amphetamine).
May be frequently seen in Fragile X and certain other conditions See: http://www.fragilex.org/html/articulation.htm
Diagnostic considerations
Case history, including family history, academic history, etc.
Observation of speech and reactions to speech Spontaneous speech sample Oral reading of extended (3-5 minutes) passage 1
year below presumed reading level Rhythmic ability Writing sample Speech tasks used in stuttering assessments
Also observe when taping is discontinued Auditory memory via sentence repetition
Dx (continued)
Checklist for Possible Cluttering (Daly, 1991) 33 items rated on a 4 point scale; 99 possible points. 55+ strongly suggestive of cluttering 35-55 = stutterer-clutterer Items most sensitive to cluttering: 2,3,7,9,10,12,14,20,25,33.
Perceptions of Speech Communication (Daly, 1978) Adapted from Woolf (1967) Perceptions of Stuttering
Inventory. Low score indicates lack of awareness; the average PWS scores ~ 30.
Articulation and language assessments as appropriate. More guidelines for identifying cluttering at:
http://www.stuttersfa.org/br_clutt.htm
Therapy approaches
Recommendations from St. Louis & Myers: Reduce speaking rate (DAF sometimes helpful) Speaking softly to “calm down” speech system. Learning to pause at appropriate places
Via tape review, tapping Direct work on articulation
Beginning with short phrases and moving to lengthier units
Emphasis on unstressed syllables Increased self-monitoring skills and self-awareness Teach fluency enhancing skills as necessary to treat
stuttering symptoms
Treatment recommendations (continued)
Recommendations from Daly & Burnett: Modify speech rate and regularity via:
DAF Self-monitoring Window reading Breathing modification Oral motor syllable training program Over articulation of segments
Relaxation and mental imagery, including positive self-talk and affirmation
Increased self-awareness: Via video- and audio- tape Vibrotactile feedback Counseling and attitude change Interpersonal and listening skills
Improving attention span: Memory games Sequencing story events Problem-solving tasks
Other information about cluttering and its diagnosis and treatment at: http://www.mankato.msus.edu/dept/comdis/ku
ster/related.html If you have a client who you think clutters,
you may wish to refer him/her to the ongoing NIH study (PI: Christy Ludlow) on this topic: http://clinicalstudies.info.nih.gov/detail/A_1996
-N-0088.html