By Lacey Heid
I was diagnosed with a mild cluttering disorder when I was 24 years old. Cluttering is a type of fluency disorder, and it often gets misdiagnosed or undiagnosed altogether. I want to discuss what has helped me improve my speech. Hopefully, this will help others who clutter find some strategies that may help improve their speech, as well as shed some light for SLPs on ways to help their clients with fluency disorders.
Ever since I can remember, I always knew my speech was “different.” I can remember my parents always telling me to “slow down,” to think about what I had to say before I said it. The sad fact was that even when I thought about what I had to say, and when I thought I was speaking slowly, people still had a hard time understanding me. I was so used to hearing 20 years of my own speech, I couldn’t hear the difference between my speech and that of others. The only thing I could hear was the irregular, yet constant disfluencies when I tripped over a word, or a part of a word. For years, I heard people refer to my speech as “stuttered” and, therefore, labeled myself as a stutterer.
I went to speech therapy as a child, not for speech rate, but for poor /s/ articulation. My mom was concerned about my speech rate, but the SLP and teachers said that it was common for my age (and what 5-year-old isn’t overexcited about everything?) and that I would more than likely grow out of it.
As I got older though, my peers started reacting to my speech rate. Although I had a lot of friends, there would be that occasional person that playfully mocked my “stuttering” or mentioned that I always talked too fast.
In the working world, it became worse. As a teenager, I always worked in fast-paced minimum-wage environments. Co-workers and customers had a hard time understanding me, and it became more obvious to me as their comments became more numerous. I had difficulties speaking to authority figures, as well as talking on the phone. I was constantly told to speak more quietly, and “what’s” and “huh’s” became a more frequent response from my listeners. At age 24, I realized how much I was letting my speech hold me back from better jobs and opportunities. I wanted to be an overall better communicator. I decided to start speech therapy.
And that’s when I learned the truth. I was not a stutterer at all. In fact, I was a clutterer. A person who clutters is often misdiagnosed as a stutterer because cluttering does have some characteristics of stuttering. There are important reasons to separate them. While stuttering is noted by repetitions, prolongations, blocking, and secondary “escape” behaviors, cluttering is noted by excessive normal disfluencies, rapid bursts of speech (“excited speech”), and slurred/omitted syllables. While a stutterer can usually hear and feel their speech disfluencies, a clutterer is usually unaware of them, and therefore, has a hard time self-monitoring. Cluttering is often misdiagnosed, or in my case, undiagnosed, even though onset can occur as early as the preschool years. Until the person’s speech rate starts to interfere with school or work performance, a person may not realize they have a cluttering disorder.
After my initial speech and language evaluation, my SLP (who at the time was a student clinician) and I began to work on numerous strategies focusing on slowing my speech rate, and becoming more intelligible. We had started with some reading activities involving different strategies such as elongating multi-syllabic words, exaggerated speech, pausing, breathing, etc.
Although I understood the point to the exercises, I didn’t appreciate their meaning until the day I walked into the room and my SLP told me we were going to record parts of the session, and then play the recordings back so that I could hear myself talk. Not many people like hearing the sound of their own voice, my being one of them, so I was highly reluctant, but I turned to my positive attitude. It was for my own good. She had taped our casual conversations at the start of the session, and then she taped my reading samples using the strategies that we were focusing on. When she replayed our conversations, I heard it. I heard how fast I spoke. I heard the missing parts of the words, the rapid speech, and I heard how strained my voice sounded at the end of my sentences (because I would speak on residual air). Then, we listened to the recordings of the reading samples.
This was the turning point in my speech therapy, because I heard the difference. I heard the pausing. I heard every sound in every word. I understood everything I had said. That is the point when I realized that I could talk more slowly and I could be understood. All I had to do was take these strategies and apply them to everyday conversation.
These are the various strategies that helped me speak more clearly … to read more, go to www.stutteringhelp.org.
Self-Monitoring - This is by far the most important strategy in my improvement. I needed to be able to hear my own speech rate as I was speaking and adjust my speech accordingly. If I couldn’t hear myself omitting syllables, or hear myself “cramming” words together, I wouldn’t be successful in stopping or preventing myself from cluttering. If I couldn’t feel my breath becoming short, I couldn’t tell myself to stop talking and take a breath. If I couldn’t discriminate between my “fast” speech and my “normal” speech, I wouldn’t be successful in carrying over my speech therapy into my functional world. Self-monitoring began when I heard the difference between my fast conversational speech and my normal reading speech. This is where the uncomfortable recordings of my voice helped so much, because I was able to feel myself performing the action of speaking slower, and then I was able to play back and hear myself speak at a normal rate. There was a huge positive reinforcement when the correlation was discovered. We also did exercises where I listened to other random speakers on various sound clips, and I was able to be the “clinician” and determine which speakers were speaking at a normal rate, and which ones were speaking at a faster rate. It is all about awareness and discrimination, and once I was aware of my own speech rate, and able to discriminate the differences between “fast” and “normal” I was then able to monitor my rate by hearing myself and comparing my rate to that of my conversational partners.
Breathing and Pausing - Before therapy, I often tried to get all of my thoughts and words into one breath. If I was mid-sentence, I would keep talking on that single breath, even if it meant squeezing my lungs until I absolutely had to breathe. This is called speaking on “residual air.” One of the first exercises done in my therapy was based on pausing. As I read passages, I was told to take notice of how many times I paused, and how many times I took a breath. As I became more aware of my pausing and breathing, I noticed that those times gave me opportunities to slow my speech rate. With every new pause, and every new breath, I was able to start again with a “fresh slate,” so that even if my last phrase was rapid, that breath or pause was a constant reminder to “slow down.” Just learning the skill of pausing and breathing appropriately while speaking has made my speech so much more intelligible, especially because I use it as an opportunity to clear my head of all the excess thoughts, and think about what I need to say. If this means taking an extra long pause, it is a small price to pay to prevent cluttered, unintelligible speech.
Confidential Voice - Because my speech was so hard to understand, my natural response was to speak louder. If I spoke louder, I could be heard easier, right? Unfortunately, that was incorrect. I just spoke fast and loud. I felt I had to push those words out. In therapy, I learned how to speak using my “confidential voice.” Imagine being in a room of people and having a conversation with someone, but only wanting yourself and that person to hear what you are saying. To me, it felt like an octave above whispering, and it was a challenge to get to. When I used this strategy though, it took so much strain off of my vocal cords, and it made intonation, articulating, pausing, and a slow speech rate so much easier to carry out.
Intonation and Word Separation - Intonation was my best friend throughout speech, it was the only thing I could do naturally, and it helped with my intelligibility. While clutterers are known for their strings of monotone phrases, my speech actually had some stress to it, except for when I spoke on residual air (the lack of air to exhale restricted the vibration of my vocal cords, so in order to get the words out fast enough, I had no air to use for word stress or pitch changes). Intonation really helped separate my words from each other. It is natural in “normal” speech to string small words together like “it is, to the, to do,” etc. As a clutterer, this normalcy just makes it harder for listeners to understand my speech. Trying to separate them using a glottal stop or pausing sounded unnatural, but by using intonation, I was able to highlight some of those small words and separate them that way. An exercise that proved helpful was taking a sentence and reading through it, but each time, emphasizing a different word. Practice makes perfect, and the more places I saw opportunity for intonation, the easier it was to separate my words from each other.
Elongating multi-syllabic words - In my own cluttering experience, I attempted to make every word the same duration. In other words, I would pronounce a one syllable word like “art” in the same amount of time I would say a two syllable word such as “artist,” and likewise for three syllable words like “artistic.” Because I was saying longer words in a shorter amount of time, different sounds (and sometimes whole syllables) were getting lost, making my speech difficult to understand. By stretching these words out, I was able to get a perspective on just how long it should take to say longer words. My clinician provided a computer program that recorded our speech sessions not only auditorally, but visually as well. I was able to see my speech in sound wavelengths. My “slow” speech would show nicely patterned, rhythmic bumps that separated nicely with every pause and waved smoothly through each syllable in longer words. My “fast” speech was irregular, and spurts of bumps would be scattered through with no obvious pattern or consistency. This type of program was helpful, because it allowed me to hear and see the difference.
Exaggerated Speech - Although this exercise felt incredibly ridiculous at first, and when paired with confidential speech was highly challenging, as a clutterer, it has helped my articulation improve dramatically. My speech rate was so fast, and I was so eager to get to the next word in my sentence that I would delete sounds and whole syllables in words. Exaggerated speech allowed me to literally exaggerate every sound in a word. By opening my mouth wider, it forced my articulators to take longer to reach and execute, thus lengthening my time spent on a single word. Again, practice makes this easier. After spending time trying to pronounce every sound in a word appropriately, it will feel more natural to speak with the same concept, while actually missing a sound will feel unnatural.
Continuous Voicing - This has helped me sound more natural while speaking slowly. When I first started speech therapy, I had to go from my normalcy of speaking at a fast rate with no pausing to the opposite side of the spectrum - slow speech, articulation, pausing, breathing, etc. Separating my words was one of the hardest skills to learn, but it was so important for intelligibility purposes. I tried to pause unnaturally between words, and treat each word individually, but my speech did not flow nicely using that strategy; although I was understandable, it felt very uncomfortable. My clinician then suggested continuous voicing, and that has been my best strategy and ally in conversation. The goal is to keep all of these other practiced strategies in mind, all while continuously voicing throughout the entire sentence. This allows me to sound more natural, all the while keeping a nice rhythm to my speech, allowing my words to be separate from one another without the “choppy” feeling I had before.
Stressing unstressed syllables - This was the most challenging for me, but I used it to my benefit. Many words and parts of words have a natural stress when vocalized. For example in the word “natural” the syllable “na” has the most emphasis, while the following syllables “tur” and “al” tend to lag behind it in an unstressed fashion. In these exercises, I had to take those unstressed syllables and read them with the same emphasis as the other naturally stressed syllables. This was difficult because it goes against the normal pattern of speech, but it again helps not to omit words or parts of words just because they are unstressed.
Rate - Knowing my rate helped me define what “normal” versus “fast” really meant. My clinician worked hard to calculate my rate in given exercises for immediate feedback, and these numerous references helped me clarify how my speech rate compared with a normal speech rate. Does my speech rate sound like it’s at a fast 240 syllables per minute, or is it closer to a more normal range around 200? Having these constant references helps me refer back to examples both good and bad, and I can get the literal “feeling” of a normal rate.
Now, of course, I do not use all of these strategies all the time. Some work better than others, and sometimes I take the few most appropriate for the conversational situation I am in. The key is that a person has all of these tools to their disposal, and they hear the differences when these strategies are applied, versus just trying to “slow down.”
I don’t know if I’ll ever gain 100% perfect fluency, and it would be unreasonable to think I should. Even normal speakers are not perfectly fluent all the time. But since I started speech therapy, my intelligibility is much higher, and it shows in my listener’s reactions. There are fewer “what’s” and “huh’s,” and I don’t have to repeat myself nearly as often. No one has made a remark on how fast I talk. I haven’t felt out of breath from speaking on residual air in months. The hope and intention is that if these strategies are used enough, they will eventually become habits, and speaking will just keep getting easier as time goes on.