A Quick Screen for Cluttering

Advanced Therapy Techniques Lonnie G. Harris, Ph.D., CCC-SLP

Clinical Signs: Language 1. Reading comprehension problems. 2. Language delay. 3. Word-finding difficulty. 4. Problems with syntax & grammar (e.g., sentence formulation).

Clinical Signs: Reading 1. Reversal of letters and words. 2. General reading delay. 3. When reading aloud, child may omit sounds, clusters, and syllables.

Clinical Signs: Speech 1. Excessively rapid rate. 2. Unusual prosody (tone and speech rhythm). 3. Repetitions of sounds, syllables, and words.

Clinical Signs: Articulation 1. Switching speech sounds (tutterbly for butterfly). 2. Sound omissions (helicopper for helicopter). 3. Assimilations. 4. Telescoping the ends of words together (e.g., missippi for Mississippi). Note, this is not the same as the phonological process of Coalescence. 5. Difficulty with /l/ and /r/.

Both stuttering and cluttering are fluency disorders, but they are not the same. Cluttering involves excessive breaks in the normal flow of speech that result from: • Disorganized speech planning • Talking too fast or in spurts • Being unsure of what one wants to say

By contrast, the person who stutters typically knows exactly what he or she wants to say but is temporarily unable to say it.

Most clutterers describe themselves as stutterers. To make matters worse, cluttering often occurs with stuttering. It is characterized by a rapid and/or irregular speaking rate, excessive disfluencies and, often, other symptoms, such as language or phonological errors and attention deficits.

To identify cluttering, you must listen to non-stuttered speech of the speaker. Evidence for a fluency disorder (one that is not stuttering) and excessive disfluencies would be present in a speaker who meets all of the following: • Does not sound “fluent” • Does not seem to be clear about what he or she wants to say • Has excessive levels of normal disfluencies. • Has little or no apparent physical struggle • Has few, if any, accessory (secondary) behaviors

A rapid and/or irregular speaking rate would be present in a speaker who has any or all of the following: • Talks “too fast” based on an overall impression or actual syllable per minute count • Sounds “jerky” • Has pauses that are too short, too long, or improperly placed

The clinical picture of a typical cluttering problem would be enhanced if the person has any of the following: • Confusing, disorganized language or conversational skills • Limited awareness of fluency or rate problems • Mispronunciation or slurring of speech sounds or deleting non-stressed syllables in longer words (“ferchly” for “fortunately”) • Confusing, disorganized language or conversational skills • Limited awareness of fluency or rate problems • Learning disability not related to reduced intelligence • Disability, hyperactivity, or limited attention span • Audition perceptual difficulties

Therapy for clutterers generally addresses the contributing problems first before focusing on fluency. Ordinarily, one of the first goals of therapy is to reduce the speaking rate, but very difficult to do. Some clutterers respond well to “timing” their speech to a DAF. Some do not.

Another technique is to use the analogy of the speedometer wherein rapid speech is above the “speed limit”. The SLP would give “speeding tickets” to the patient for exceeding the “limit.” Often the clutterer must be taught to pause deliberately. If the person is unaware of where to pause, it may be useful to write some unintelligible sentences from a tape recording that he or she actually said, first without spaces between words and then with normal spacing.

Articulation and language problems are often reduced if the clutterer can achieve a slower rate. One technique to try involves practice first using short, highly structured sentences, such as “Hi, my name is John. I live at 148 Third Street. I work at the drug store on Main Street.” Then progress to more normal language. It is also helpful to exaggerate stressed syllables in longer words while being sure to include all the unstressed syllables.

Also try planning both content of a message as well as the delivery. This is more difficult.