This material was written by Kenneth O. St. Louis, Ph.D., West Virginia University, and updated by Kathleen Scaler Scott, Ph.D., Misericordia University
How do you know if you or someone else has a cluttering problem?
Like stuttering, cluttering is a fluency disorder; but, the two disorders are not the same. Cluttering involves speech that sounds rapid, unclear and/or disorganized. The listener may hear excessive breaks in the normal flow of speech that sound like disorganized speech planning, talking too fast or in spurts, or simply 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. To make matters even more confusing, since cluttering is not well known, many who clutter are described by themselves or others as “stuttering.” Also, and equally confusing, cluttering may occur along with stuttering.
The most commonly agreed upon definition of cluttering represents basic criteria which all experts agree are found in all people who clutter to some degree. Under this definition, mandatory for a diagnosis of cluttering is that the speaker sounds fast to the listener at least some of the time. The concept is that even though the speaker may not be speaking faster than average, they are speaking at a rate that is too fast for their system to handle, resulting in communication breakdown. Under this definition, communication breakdown would appear in at least one of the following ways for a diagnosis of cluttering:
- Excessive moments of over-coarticulation, meaning that sounds and syllables are blended together “too much” so that it can sound like all sounds are syllables are not present (e.g., speaker says “ferchly” for “fortunately”).
- Excessive use of “normal disfluencies,” such as interjections (e.g. um, uh, er) and revisions (e.g., I would like to go—I was thinking about taking a drive).
- Pauses in places not expected grammatically, often making the speech sound “jerky” or “spurty”
These fluency and rate deviations are the essential symptoms of cluttering. However, there are a number of symptoms suggested in the latter part of the above definition that may or may not be present but add support to the impression that a person is cluttering. Accordingly, the clinical picture of a typical cluttering problem would be enhanced if the person in question had any of the following:
- Little or no apparent physical struggle in speaking.
- Confusing, disorganized language or conversational skills.
- Limited awareness of his or her fluency and rate problems.
- Temporary improvement when asked to “slow down” or “pay attention” to speech (or when being recorded).
- Several blood relatives who stutter or clutter.
- Social or vocational problems resulting from cluttering symptoms.
- Learning disability not related to reduced intelligence.
- Sloppy handwriting.
- Distractibility, hyperactivity, or a limited attention span.
- Auditory perceptual difficulties.
How is cluttering diagnosed?
Before getting treatment, it’s important that someone suspected of cluttering be diagnosed accurately. It is advisable to consult a speech-language pathologist to make the diagnosis. The assessment process involves determining if cluttering is present and differentiating it from other communication problems or other diagnoses that may cause difficulties with speech. These other problems/diagnoses, which are in addition to a speech diagnosis of cluttering, may also require contributions or reports from other professionals, such as classroom teachers, special educators, or psychologists. The evaluation should include consideration of the fluency problem, but also any co-existing speech, language, learning, and/or social problems. If the suspected clutterer is in school, it may be a good idea to get a comprehensive academic achievement test (e.g., mathematics, writing, and reading) and even an intelligence test. The diagnosis should specify whether or not cluttering is present and also what other problems are present, such as stuttering, a language disorder, or a learning disability. It is important to note that if a person who stutters also clutters, sometimes the cluttering will not be noticed until the stuttering diminishes, either on its own or from speech therapy.
How is cluttering treated?
Therapy for people who clutter generally addresses what impacts communication breakdowns the most. Ordinarily, one of the first goals of therapy is to reduce the speaking rate, although this may not be easy for the clutterer to achieve. It is common for those with cluttering to use pausing less frequently than speakers without cluttering. Therefore, one way to achieve a slower rate that is in line with what their system can handle is to insert pauses in natural places. 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 recording) that he or she has actually said, first without spaces between words and then with normal spacing. Seeing the difference can often assist in learning to find appropriate pause locations. Another technique that has been found helpful with young clutterers is to use the analogy of a speedometer wherein rapid speech is above the “speed limit” and “speeding tickets” are given for exceeding the “limit.”
For some, slowing rate of speech by adding pauses is enough to increase speech clarity. For others, unclear speech still exists between the pauses. When this happens, it may also be helpful for clutterers to learn to exaggerate stressed syllables in longer words while being sure to include all the un-stressed syllables (e.g., “par·tic´·u·lar,” “con·di´·tion·al,” or “gen·er·o´·si·ty”). Some clutterers benefit from planning both the content (the “what”) of a message as well as the delivery (the “how”). For example, the “what” can be taught as formulating the main message in key words (e.g., “Computer isn’t responding. I reboot. Works again.”). The “how” then focuses on filling in the appropriate details (e.g., “My computer often doesn’t respond when I am trying to work on it. I restart the computer before trying again. Often, restarting helps the computer to respond properly again.”)
Many cluttering symptoms are often reduced if the clutterer can achieve a slower rate that is more in line with what their system can handle. Sometimes, however, additional articulation (pronunciation) and/or language problems need to be addressed directly. One technique involves planning out what one is going to say using a specific structure (e.g., when relating a story to someone, tell about the people, place, any events and the ending). After practice, they learn to present information in such a structure more automatically when conveying information to others.
As noted, many people who clutter also stutter. And often the cluttering is covered up or masked by the stuttering. In some of these individuals, the cluttering emerges as the individual gets control of the stuttering or begins to stutter less. Yet, whether or not the clutterer also stutters (or previously stuttered), any therapy techniques that focus attention on fluency targets such as easy onset of the voice or more prolonged syllables can also help the person to manage many of the cluttering symptoms. The important thing is that the clutterer learn to pay attention to—or monitor—his or her speech and do anything that makes it easier to remember to do so. Practicing pausing and/or emphasizing all sounds and/or syllables in words even when not needed helps the person who clutters to better monitor their speech and realize sooner when a real communication breakdown has occurred.
What is the likelihood that therapy will help?
Many people who clutter are initially skeptical that therapy can help. Regardless of age, over time they come to see that learning strategies to tune in and monitor their speech can be helpful. Since most cluttering symptoms resolve through simple adjustments such as rate, prognosis for improvement is good. Motivation is a key element. Successful candidates have good reason for working hard to change, such as the likelihood of a job promotion for adults, or the likelihood that they will have to repeat themselves less for children. Therapy does take a lot of practice and monitoring, but much can be done to help those who clutter manage their cluttering.
How can I get help for cluttering?
Since cluttering is neither common nor well understood, speech-language pathologists (SLPs) may express doubt about whether or not they can effectively evaluate and treat cluttering. If so, they can be referred to a number of sources of information about the disorder. (See the references on back panel.) With such information, many of these SLPs may well be willing to provide therapy for cluttering. Fortunately, most SLPs who are specialists in stuttering are also willing to evaluate and treat cluttering as well. The Stuttering Foundation can supply you with the names of individuals in your geographic area that are recognized as specialists in fluency disorders. Call toll-free 800-992-9392 or visit www.StutteringHelp.org.
Where Can I Learn More About Cluttering?
Myers, F. L. & St. Louis, K. O. (1992). Cluttering: A clinical perspective. Kibworth, Great Britain: Far Communications. (Reissued in 1996 by Singular Press, San Diego, California.) (An edited book by several other well-known authorities on the nature, diagnosis, and treatment of cluttering. Available for free download at website of International Cluttering Association: http://associations.missouristate.edu/ICA)
Scaler Scott, K. (2016). Cluttering: Another Look. Boston: Stuttering Foundation of America (a DVD with the latest updates on definition, assessment, and treatment of stuttering)
Scaler Scott, K. (2018). Fluency Plus: Managing Fluency Disorders in Individuals with Multiple Diagnoses. Thorofare, NJ: SLACK, Inc. (workbook for clinicians and SLP students)
Scaler Scott, K., & Ward, D. (2013). Managing Cluttering: A Comprehensive Guidebook of Activities. Austin, TX: Pro-Ed, Inc. (workbook for clinicians)
Scaler Scott, K. & St. Louis, K. O. (2009, July). A perspective on improving evidence and practice in cluttering. Perspectives on Fluency and Fluency Disorders, 19(2), 46-51 (article explaining the changes in the field of cluttering)
Ward, D., & Scaler Scott, K. (Eds.) (2011). Cluttering: A Handbook of Research, Intervention, and Education. London: Psychology Press. (An edited book by several other well-known authorities on the nature, diagnosis, and treatment of cluttering. Updated with the most current information on cluttering).
Scaler Scott, K. (2015). Treatment techniques for children, teens, and adults with cluttering. Abstract published in Procedia—Social and Behavioral Sciences. Proceedings of the 10th Oxford Dysfluency Conference, Oxford, United Kingdom.Elsevier: ScienceDirect. p. 327.
Scaler Scott, K. (2019). Cluttering symptoms in school-age children by communicative context: A preliminary investigation. International Journal of Speech-Language Pathology. DOI:10.1080/17549507.2019.1637020
St. Louis, K.O., Raphael, L.J., Myers, F.L., & Bakker, K. (2003). Cluttering updated. The ASHA Leader. Retrieved from http://leader.pubs.asha.org/article.aspx?articleid=2292318
Weiss, D. (1964). Cluttering. Englewood Cliffs NJ: Prentice-Hall. (A well-known source on cluttering with extensive coverage of early European contributions.)