Developmental stuttering affects 1 percent of the population and over 3 million people in the United States. However, there are other, lesser known fluency disorders that include neurogenic stuttering and cluttering. Telling the difference between stuttering and cluttering is often a point of confusion, so we take a closer look here at what, exactly, cluttering is—and the process of identifying and treating it.
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. ”
So what does cluttering look and sound like?
1. Often people who clutter have what I (and many other speech-language pathologists) 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 whole word repetitions, unfinished words and interjections (such as um and well). I have also noticed more atypical disfluencies, such as final part word repetitions (chair-air, bike-ike).
3. Coarticulation refers to when a person collapses or omits a syllable of a word (for example, “wuffel” for “wonderful”).
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. (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 stuttering).
- 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 (a person can clutter and stutter).
If you feel this diagnosis is hard to grasp, you’re not alone. As a result, this condition goes largely misdiagnosed (as developmental stuttering) or undiagnosed (“I just speak too fast! I don’t have a “real” speech problem!”). For a helpful chart that breaks down the similarities and differences between stuttering and cluttering, see this brochure created by Kathleen Scaler Scott for the National Stuttering Association.
So what do you do if you think your child is cluttering?
Since this a relatively lesser known diagnosis, your best bet would be to find a speech- language pathologist who has experience 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 your child is displaying. Here are some common treatment objectives:
- Self-Monitoring. One common characteristic among people who clutter is limited awareness of their own speech. 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, calling attention to their speech often helps them improve their rate and overall clarity (at least for a short bit).
- Over-articulation. Another common characteristic among 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. Here is a useful video of an 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:http://youtu.be/2AFygz-bxwQ
- Pausing and Phrasing. Using this technique, 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 one to three 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 speech is a helpful way to identify when there are way too many words being said between pauses (machine gun speech). Pausing is another too used in teaching a people to slow their rate, which is much more effective and constructive when compared with saying “slow down.
- 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. These include cancellations, pull-outs and the like. 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.
Brooke Leiman, MA, CCC-SLP, is the fluency clinic supervisor at the National Speech Language Therapy Center in Bethesda, Md. She is an affiliate of ASHA Special Interest Group 4, Fluency and Fluency Disorders. This blog post is adapted from a post on her blog, www.stutteringsource.com, which focuses on fluency disorders and their treatment.