Special thanks to our colleague, Dr. Kathleen Scaler-Scott for agreeing to provide this important information to help SLPs differentially diagnose and effectively treat those who clutter. The resources listed at the end of this blog will help with further learning and understanding of this communication difference.
Cluttering is a real communication disorder that has been confusing for many due to broad and sometimes conflicting definitions. Experts have been working to decrease this confusion by narrowing the definition to the symptoms of cluttering that all experts agree upon. This is known as the Lowest Common Denominator (LCD) definition of cluttering. This definition can be used as a straightforward tool for identifying, diagnosing and treating cluttering.
Let’s break down the LCD definition from St. Louis & Schulte, 2011:
Cluttering is a fluency disorder wherein segments of conversation
- in the speaker’s native language,
- typically are perceived as too fast overall,
- too irregular, or both.
The segments of rapid and/or irregular speech rate must further be accompanied by one or more of the following:
(a) excessive “normal” disfluencies
b) excessive collapsing or deletion of syllables; and/or
(c) abnormal pauses, syllable stress, or speech rhythm
And clarifying even further:
1. Cluttering must occur in naturalistic conversation, but it need not occur even a majority of the time. Clear but isolated examples [of clutter-like speech] that exceed those observed in normal speakers are sufficient for a diagnosis.
2. This may also apply to the speaker’s mastered and habitual non-native language, especially in multilingual living environments.
3. This may be true even though syllable rates may not exceed those of normal speakers.
4. Synonyms for irregular rate include “jerky,” or “spurty.”
5. These [excessive “normal”] disfluencies are often observed in smaller numbers in normal speakers and are typically not observed in stuttering.
6. Collapsing includes, but is not limited to, excessive shortening, “telescoping,” or “over-coarticulating” various syllables, especially in multisyllabic words.
What are the symptoms that might make me want to consider a diagnosis of cluttering?
As noted above, the mandatory criterion of cluttering is that the speech in the speaker’s native language that sounds too fast overall, too irregular or both.
If your client sounds fast at least some of the time to listeners, this would be a first sign that they might meet the criteria for cluttering. Their rate doesn’t have to be measured as faster than average, just sound fast to the person listening. If anyone ever reports, “They speak really fast”, consider the potential for a diagnosis of cluttering.
So they sound fast, now what?
Under the Lowest Common Denominator definition, if the client sounds fast at least some of the time, they meet the first (and only) mandatory criterion for cluttering. That doesn’t mean they are a person who clutters yet. The theory is that those who clutter speak faster than their system can handle; therefore, when they do, there is some type of breakdown in intelligibility and/or clarity of message.
As a next step, the client must meet at least one of criteria a, b, or c in the LCD definition for a diagnosis. To help clarify these criteria, this is the way I rule in/out each one:
A. Excessive “normal” disfluencies. Ask yourself: Does my client use revisions, and/or filler words to an excess at least some of the time? “To an excess” is determined by your clinical judgment. If my client takes significantly longer than your average speaker to get a message across, listeners say they can’t follow them or figure out their message, and/or is described as an inefficient speaker, then they meet this criteria for cluttering.
Note, however, that you need to find the root cause of the excessive normal disfluencies. If they are due to a language disorder or due to them talking around things to avoid stuttering, those areas must be treated first. Using excessive fillers because of limited proficiency in the language they are speaking must also be considered.
If a client has normal disfluencies to excess, sounds rapid, and when you have them slow their rate, these disfluencies decrease, then likely this is cluttering. But remember they could stutter and/or have a language disorder and have cluttering as well. You just need to deal with the reason for the excessive normal disfluencies in treatment. For example, if a language disorder and cluttering, decreasing rate will help, but the language disorder needs to be addressed.
B. Excessive collapsing and/or deletion of syllables. Ask yourself: Do others say they can’t understand the speaker? Do listeners say they are always mumbling? That their speech is unclear? If so, they may meet this criterion for cluttering.
If you have them slow their rate and clarity normalizes, it is likely cluttering. If you notice that they reduce syllables, like “commcation” for “communication” but this occurs inconsistently, then it is likely cluttering.
Articulation and phonological disorders need to be ruled out; but these tend to occur in patterns on specific sounds. Over-coarticulation occurs when the speaker speaks at a rate faster than their system can handle.
Therefore, if the speaker slows rate to a level their system can handle, over-coarticulation tends to significantly decrease and/or disappear completely.
Note, Dysarthria also needs to be ruled out; however, when people with dysarthria slow rate, their speech will sound clearer, but not like a typical speaker. When someone who clutters slows rate, their speech will sound like a typical speaker.
C. Abnormal pauses, syllable stress or speech rhythm. Ask yourself: Does the client’s speech sound jerky or spurty? When I look at where the speaker places their pauses, are they in places that are different than what would be expected grammatically? For example, does the client say, “I want to go to the//concert next week” vs. “I want to go to the concert//next week”. This is one example, and it will occur multiple times for those who clutter.
What we think happens is the person does not pause as much as a typical speaker. When they are finally forced to pause to take a breath, the pause ends up in unexpected places. If someone suspected of cluttering slows their speech by putting pauses in natural places in their speech, this symptom will often disappear.
What if I don’t hear the symptoms all the time?
This does not mean you can completely rule out a diagnosis of cluttering. Just like in stuttering, cluttering does not have to occur all of the time or even a majority of the time for a diagnosis. It can be situation specific, but still have a functional impact on the speaker getting their message across effectively in important situations, such as classroom participation or discussions, and/or social conversations with friends.
Why should I care about this as an SLP?
Many people I’ve worked with and that I’ve encountered in the cluttering community have stories of being misdiagnosed or having their real communication struggles dismissed.
We are learning more and more about how to more effectively diagnose and treat cluttering, and more and more about the negative impact the communication disorder can have upon a person’s quality of life. It’s important to use the new information that is available to help ensure that the diagnosis and treatments are accurate.
Although it is improving, there is not enough time spent on this important communication disorder in speech-language pathology training programs. We appreciate you reading this on behalf of people who clutter and those who have a passion to help them.
For more clinical help with cluttering, please refer to these sources:
Scaler Scott, K. (2018). Fluency Plus: Managing Fluency Disorders in Individuals with Multiple Diagnoses.Thorofare, NJ: SLACK, Inc.
Scaler Scott, K., & Ward, D. (2013). Managing Cluttering: A Comprehensive Guidebook of Activities. Austin, TX: Pro-Ed, Inc.
For more research information on cluttering, please refer to this source:
Ward, D., & Scaler Scott, K. (Eds.) (2011). Cluttering: A Handbook of Research, Intervention, andEducation. London: Psychology Press.
