Cluttering Updated

Abstract

You have accessThe ASHA LeaderFeature1 Nov 2003Cluttering Updated Kenneth O. St. Louis, Lawrence J. Raphael, Florence L. Myers, and Klaas Bakker Kenneth O. St. Louis Google Scholar , Lawrence J. Raphael Google Scholar , Florence L. Myers Google Scholar and Klaas Bakker Google Scholar https://doi.org/10.1044/leader.FTR1.08212003.4 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In Most speech-language pathologists are aware of the fluency disorder known as cluttering, 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. Those who have reviewed the literature on cluttering are often struck by the paucity of research and the lack of a widely accepted definition. The list of cluttering symptoms (see sidebar on p. 21) and the commentaries from those with the disorder (see sidebar at the top right of p. 5) explain, in part, why defining cluttering is so difficult: It is hard to know which symptoms are essential to the disorder and which are incidental. Identification Our research has advanced the following working definition: "Cluttering is a syndrome characterized by a speech delivery rate which is either abnormally fast, irregular, or both. In cluttered speech, the person's speech is affected by one or more of the following: (1) failure to maintain normally expected sound, syllable, phrase, and pausing patterns; (2) evidence of greater than expected incidents of disfluency, the majority of which are unlike those typical of people who stutter." An example of cluttered speech can be seen in the sidebar at the center of p. 5. This definition expands previous definitions 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 listener 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 either are not diagnosed or one must rely on subjective reports, by the client or others, that cluttering does indeed exist. 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 clutterers 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 development of the disorders 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." Regardless, we are currently convinced that rate problems are somehow central to cluttering. There is the near universal impression that clutterers try to talk too fast, so fast that their speech intermittently breaks down. This explains the common clinical impression that most cluttering disfluencies result from placing excessive demands on the output capabilities of the speaker's linguistic and other systems. Clutterers also tend to slur or omit syllables of longer words, which compromise intelligibility during spurts of rapid speech. Many other symptoms have been reported in people who clutter. These optional symptoms include: lack of awareness of the problem; family history of fluency disorders;