Welcome to Fluency Week! Today’s guest blog post is from Jessica Chase, M.A. CCC-SLP of Consonantly Speaking!
Cluttering Disorder Diagnosis, Treatment, and Freebies
Towards the middle of last school year, I gave a presentation on fluency disorders to the speech-language pathologists in my school district. They were very specific about what they wanted to learn about – cluttering. Luckily, I had worked with one adult and one elementary school student who cluttered as well as presented in my clinical about cluttering.
Some may ask, what is cluttering and how is it different from stuttering? According to the American Speech-Language Hearing Association (ASHA), cluttering is “a syndrome characterized by a speech delivery rate which is either abnormally fast, irregular, or both”. Cluttering is more closely related to rate, speech planning, and self-awareness while a person who stutters’ thoughts/sentences are more organized, but he or she has difficulty stating them without difficulties (such as speech with repetitions, prolongations, or blocks). However, cluttering and stuttering can co-occur. A person who clutters’ speech may display the following signs/symptoms:
· Disorganized speech planning
· Unsure of what to say or how to say something
· More interjections and revisions than that of a normal speaker
· Has no observable struggle when speaking
· Incorrect use of pauses (too long, too short, or incorrectly placed in a sentence)
· Perceived as having “jerky” speech
· Lack of self-awareness of fluency or rate
· Unable to maintain expected sound, syllable, phrase, and pausing patterns (St. Louis, Myers, & Baker, 2003)
· Abnormal respiration
· Hesitations
· May have poor handwriting or trouble organizing thoughts while writing
· Fast speech rate or talking fast in spurts
There are two YouTube videos that I recommend watching that showcase stuttering. One is an AIS client who discusses his cluttering(which co-occurs with his stuttering) and another of a reading sample of a child who clutters.
If you think that a client displays characteristics of cluttering, the next step is to assess that client. You can do so by obtaining case history information (ask about family history of fluency disorders, birth/developmental/medical history, onset, previous treatment, and learning difficulties), obtain an audio or video recording of a spontaneous speech sample as well as a reading sample to assess speech rate and disfluencies (listen closely during complex sentences and multi-syllabic words), and obtain a language sample (focus on syntactic structure, coherence, pragmatic skills, mazes, revisions, etc.). You can use the Predictive Cluttering Inventory (PCI) created by David Daly in 2006 to further assess the clients’ speech and language. This assessment can be found at http://associations.missouristate.edu/ICA/Translations/PCI/dalycluttering2006.pdf
Once you have diagnosed your client as a person who clutters, it is important to focus on the client’s ability to self-monitor his or her speech as well as reduce his or her speech rate. To help the client become more self-aware of his or her cluttering, play samples of his or her speech and discuss it, give examples of what cluttering sounds like, and give cues in conversational speech. Some ideas to help the client reduce his or her speech rate include using a delayed auditory feedback device, giving cues in conversational speech, having the client place stress on syllables or speak like a telegram (and then move to more natural speech), having the client speak as if he or she were singing with differences in stress/pitch, providing visual cues to help the client remember to pause, tapping out syllables, and use of a metronome to help keep a pace.
I have created a couple free resources that you can use with your clients. For a preview of each one and to download them, see below.
For more information about cluttering here are a few websites/books to check out:
· Cluttering Updated by: Kenneth St. Louis, Lawrence Raphael, Florence Myers & Klaas Bakker for The ASHA Leader – http://www.asha.org/Publications/leader/2003/031118/f031118a.htm
· Online Resources on Cluttering: The Other Fluency Disorder by: Judy Kuster – http://www.mnsu.edu/comdis/kuster/cluttering.html
· Stuttering Vs. Cluttering Brochure by: Kathleen S. Scott Ph.D. CCC-SLP for the National Stuttering Association – https://www.z2systems.com/neon/resource/nsa/File/Brochures/StuttervsClutter.pdf
· Cluttering by: Kevin Stuckey M. Ed. CCC-SLP for Super Duper Handy Handouts – http://www.handyhandouts.com/pdf/210_Cluttering.pdf
· The Source for Stuttering and Cluttering by: David A. Daly – can be purchased from Linguisystems at: http://www.linguisystems.com/products/display?itemid=10029
Jessica Chase is a certified speech-language pathologist who writes for the website Consonantly Speaking. You can follow her blog on Facebook, Twitter, and Pinterest as well!
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