1. Presented by: Renee Koskey & Kelly Vant
Cluttering
Presented by:
Renee Koskey
& Kelly Vant

2. History Documented in Europe since 1717
First textbook written in 1964 by Dr. Deso Weiss
Pure stutterers – 55%, Stutterer-Clutterers – 40%, Pure clutterers – 5% (Daly, 1996)
There is a great deal of discrepancy amongst professionals regarding the cause/s of cluttering, how to define cluttering, and therapy approaches to reduce cluttering

3. Cluttering Defined
“Fluency disorder characterized by a rate that is perceived to be abnormally rapid, irregular, or both for the speaker (although measured syllable rates may not exceed normal limits)” (St. Louis, et al., 2007)
“Cluttering is a disorder of speech and language processing resulting in rapid, dysrhythmic, sporadic, unorganized an frequently unintelligible speech. Accelerated speech is not always present, but an impairment in formulating language almost always is” (Daly, 1992)

4. Rate Abnormality 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
Inappropriate (usually excessive) degrees of coarticulation among sounds, especially in multisyllabic words
(St. Louis, et al., 2007)

5. Possible Models of Etiology
Central Nervous System Function Models
Cognitive Processing Capabilities Models
Genetic Models
Cluttering-Stuttering Models
Central Nervous System Function Models
Microscopic lesions in basal ganglia region
Studies using new brain imaging technologies suggest a link between cluttering and certain forms of learning disability and attention-related disturbances
Cognitive Processing Capabilities Models
1) linguistic processing, 2) attention, 3) central auditory processing, 4) motor-speech related functions, 5) multiple cognitive systems-related explanations
Suggests that cluttering is a linguistic syndrome
Genetic Models
Possible genetic predisposition for disfluent speech
Tends to be hereditary – occurring in males 4x more than females – suggests family history
Cluttering-Stuttering Models
Possible links
(St. Louis, et al., 2007)

6. What Is It? – The Characteristics
4 essential characteristics for a Dx
excessive number of whole word or phrase repetitions
poorly organized thinking (speaks before clarifying thoughts)
short attention span and poor concentration
lack of complete awareness of the problem
Repetitions – documented through observation
Organization – often lacking clarity of inner formulation of speech, word finding problems
Concentration/attention – inability to focus on details, poor auditory attention
Awareness – don’t understand why people have a hard time understanding them
(Daly, 1996)

7. (Daly, 1996)

8. Co-Existing Disorders
Generally Agreed Upon
Possible Theoretical Relevance
Fluency disorder
Language disorder
Central Auditory Processing Disorder
Rate deviations
ADD / ADHD
Basal Ganglia Syndrome
Stuttering
Specific learning disability
Apraxia of Speech
Articulation disorder
Subgroups of Cluttering
Rate – too rapid, too irregular (jerky)
Stuttering –
co-exits in 40%
PWS exhibit part-word repetitions, prolongations, blocks; PWC excessive but normal disfluencies, interjections, revisions, word repetitions, phrase repetitions, and unfinished words
Articulation – Deletion of sounds in multisyllabic words, deletion or neutralize syllables (explation for explanation), consistent substitutions or distortions
Language –
Pragmatic and narrative problems
Difficulty maintaining cohesive and coherent conversations
Attention – Exhibit many ADD/ADHD symptoms
SLD – Difficulties in expression, reading, and writing
CAPD – Exhibit similar speech characteristics such as rapid speech, omit weak syllables, excessive disfluencies, excessive verbal revisions
Basal Ganglia – difficulties with executive functioning
Apraxia – 9 of 12 symptoms overlap, differential diagnosis
Subgroups – comfortable diagnosing pure cluttering from co-existing with stuttering
(St. Louis, et al., 2007)

9. International Cluttering Association
First International Cluttering Conference held in May 2007 in Bulgaria
60 individuals representing 18 countries
Voted to form the ICA
Goal of ICA is to increase public and professional awareness about this communication disorder, so that ultimately more effective treatments can be established
Yahoo-based online support group
(International Cluttering Association, 2007)

10. Assessment Speech and Language Performance Tasks
Speech samples
Articulation tests
Language tests – comprehension and production
Computer-Based Cluttering Assessment Tool
Uses a speech naturalness scale of 1-9
Self-Awareness Measures
Self appraisal questionnaires
Other Potential Tasks and Measures
Oral exam, audiological evaluation, samples of motor skills
Speech samples - rote tasks, imitation, oral reading, monologue, conversation
Spontaneous language sample to get MLU
Some normalize when in front of a camera or microphone
Questionnaires – Self-Awareness of Speech Index (SASI),
Less aware of speech difficulties than PWS
(St. Louis, et al., 2007)

11. Supplementary Assessment Tools
Cluttering Symptoms Summary Checklist
4 mandatory symptoms
6 most common facultative symptoms
Other facultative symptoms
Checklist for Possible Cluttering
Total score
Cluttering Treatment Planning Profile
Speech and Motor Coordination
Language and Cognition
Behavioral – Pragmatic
Developmental
(Daly, 1996)

12. Therapy Increase awareness and self-monitoring skills
Improve rate (as well as articulation and speech intelligibility)
Improve linguistic and narrative skills
Improve fluency skills
Improve meta-cluttering skills
Improve phonatory and respiratory behaviors
Improve family, friend, and employer support
Improve collaboration with other team members
Foster transfer and maintenance
Increase awareness and self-monitoring skills:
Use audio and video-taped speech to monitor and self-correct.
Use feedback from listeners
Use computer-generated visual feedback of speech rate, such as Visi-Pitch
Heighten client’s sensory awareness of movements during nonspeech motor acts then during speech motor acts
Improve Rate
Use delayed auditory feedback
Use syllable-timed speech (i.e. metronome)
Pause for breath groups
Improve Linguistic and Narrative Skills
Teach elements of story grammar
Help clients sequence thoughts
Increase speed and accuracy of word retrieval
Improve Fluency Skills
Review audio- and videotapes for use of fillers, revisions, incomplete phrases, and other disfluencies
Improve Meta-Cluttering Skills
Point out specific attributes of client’s cluttering behaviors
Improve Phonatory and Respiratory Behaviors
Mark passages with pauses for breath intake
Improve Family, Friend, and Employer Support
Obtain feedback, during moments of clear speech and poor communication, from family and friends
Improve Collaboration with Other Team Members
Consult with or refer to psychologist, mental health specialist, pediatric or general neurologist
Need training in anticipating, perceiving, and responding to standard cues provided by listeners during conversations
Lack of research regarding effectiveness of therapy
(St. Louis, et al., 2007)

13. Therapy Modifying speech rate and regularity
Delayed Auditory Feedback (DAF)
Self-monitoring with DAF
Window reading
Breathing modifications
Drone-type speaking style
Oral motor syllable training program
Exaggerated mouth movements
Breathing Modifications
pause and take a new breath at each comma and period, between breath groups
Drone-Type
similar to continuous voicing
(Daly, 1996)

14. Therapy Promoting relaxation and mental imagery
Positive self-talk and affirmation
Increasing awareness of cluttering
Video / audio tape
The language of fluency
Vibro-tactile feedback
Counseling and attitude change
Group sessions
Interpersonal / listening skills
Improving attention span
(Daly, 1996)

15. References
Daly, D.A., (1996). The Source for Stuttering and Cluttering. East Moline, IL: LinguiSystems
St. Louis, K.O., Myers, F.L., Bakker, K., & Raphael, L.J. (2007). Understanding and treating cluttering. In E.G. Conture & R.F. Curlee (Eds.), Stuttering and related disorders of fluency (pp ). New York: Thieme Medical Publishers, Inc.
St. Louis, K.O., Raphael, L.J., Myers, F.L., & Bakker, K., (2003, Nov. 18). Cluttering updated. The ASHA Leader, p. 4-5, 20-22
International Cluttering Association (2007). Retrieved December 12, 2007, from