Cluttering: A Lesser Known Communication Disorder
Do you or someone you know have difficulty communicating clearly? Perhaps people seem to often have difficulty understanding you, or ask you to repeat yourself a lot. Maybe your boss has given you feedback that you need to improve your communication skills during your performance feedback. There may be a reason for your symptoms, a condition known as cluttering. Read on to learn more!
Note: The information presented in this blog is for educational purposes only and is not a substitute for any kind of professional advice. Always consult a professional for your particular needs and circumstances. For the full disclaimer, see https://www.infinitehorizonspeech.com/disclaimers
I am a speech-language pathologist (SLP) and I focus on treating stuttering and cluttering in my new practice, Infinite Horizon Speech and Language Services. This year I took a deep dive into learning about cluttering. Fortunately, I came across very helpful lectures and resources on this topic. During one lecture, the book Too Fast for Words by Rutger Wilhelm was recommended. I quickly ordered it and read it. I was excited to learn so much about cluttering from Rutger’s first-hand experiences. It greatly improved my understanding of the experience of cluttering!
I also learned that there is a support group for cluttering called Cluttering Speech on Facebook. I joined the group and have been grateful to participate and learn from everyone’s experiences. Rutger Wilhelm is also a member of the group, and he invited me to be interviewed for his YouTube channel, Too Fast for Words. I was excited for the opportunity and completed the interview yesterday! You can find the video here. In addition, here are my responses to the interview questions.
1. How did you find out about the existence of cluttering?
I first learned about cluttering in graduate school when learning how to diagnose speech and language disorders. We had a book called Assessment in Speech-Language Pathology, and there were descriptions of stuttering and cluttering, as well as a chart to help differentiate the symptoms between the two. I still use that chart often!
I also had the opportunity to participate in a diagnostic team focused on assessing people who stutter. A diagnostic team refers to you, another student, and a clinic supervisor who work together on the evaluation and report. My diagnostic team partner had previously treated a person who cluttered in the university clinic, and she also shared her experiences with me.
2. How would you describe the phenomenon of cluttering in your own words?
Cluttering is difficulty being understood due to some combination of excessively fast rate, irregular rhythm, articulation errors, and disorganized language. However, the formal definition is much better! More research is needed on cluttering, but the current working definition is that “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.” (St. Louis and Schulte, 2011, as cited in Scaler Scott and Ward, 2013).
3. How is cluttering different from stuttering according to you?
Cluttering is characterized by irregular rate, rhythm, and/or articulation errors, whereas stuttering is characterized by atypical dysfluencies such as blocks, repetitions, and prolongations. People who stutter may also exhibit struggle behaviors during a moment of stuttering such as eye blinks, hand or foot tapping, or facial grimacing. These behaviors are known as physical concomitants. Additionally, people who clutter may also exhibit disoganized language. This is not a characteristic of stuttering; however, a person who stutters may also have a language delay or disorder.
4. What is your approach to treating cluttering?
My approach to treating cluttering is to first help the client understand that there is a reason for the speech difficulties that they are experiencing. Unlike stuttering, which most lay people recognize, cluttering symptoms are not as distinct. As a result, people who clutter may feel frustrated that they find it difficult to improve their speech, and they may feel feelings of guilt or shame over this. It can be a tremendous relief to know that there is an underlying reason for their symptoms, and that they can improve with appropriate treatment techniques.
After that, I would assess the client’s particular cluttering symptoms and the level of severity. Some cluttering symptoms are manifested more in physical speech characteristics, whereas others are more in language organization. When I refer to physical speech characteristics, I mean how clearly the person pronounces words, their rate of speech, volume, and whether or not there are dysfluencies. When I refer to language, I am referring to how the person formulates and expresses their ideas. For example, do they provide enough background information when telling a story? Do they explain things in an organized fashion? Regarding severity, are the person’s symptoms present most of the time? Or do they only emerge in certain situations?
After a thorough evaluation, I educate the client about cluttering. Then, I teach the client how to identify moments of cluttering and self-monitor. I teach the client how to differentiate speech-related cluttering symptoms from language-related cluttering symptoms. Then, we learn techniques to improve each type of symptom.
5. What is the most difficult part in treating cluttering for you as a SLP? And what is the easiest part?
The most difficult part of treating cluttering is identifying it. The symptoms can be general and similar to other speech and language disorders, and they may only emerge in certain contexts. Furthermore, people who clutter tend to have improved speech when they focus on it more – such as when their speech is being evaluated by an SLP! In addition, cluttering can also co-occur with stuttering. Therefore, both symptoms of cluttering and stuttering may be present.
That is why a thorough understanding of cluttering and a good clinical ear are so important. The SLP must also be very observant to pick up observed symptoms and those reported in the case history and client interview. Sometimes it may take some time in treatment before a definitive diagnosis can be made. In addition, speech samples or video recordings from outside the evaluation session can also be helpful.
The easiest part is educating clients about what cluttering is. I am a huge speech and language nerd, and I get so excited to learn about speech and language for myself! So, when I get to talk about it with clients, it’s a lot of fun! Also, it is rewarding to see the understanding and relief clients experience when they become informed about cluttering.
6. Which techniques do you use in therapy?
I would like to start by saying that I have learned so much by reading Managing Cluttering by Kathleen Scaler Scott and David Ward and Cluttering: Current Views on Its Nature, Diagnosis, and Treatment by Yvonne van Zaalen and Isabella Reichel. I appreciate how the authors have described cluttering and treatment techniques in their books!
First, the client must be able to identify moments of cluttering. Awareness of cluttering moments is often reduced to the person who clutters as compared to their listener. The person who clutters (PWC) may be surprised that their listener did not understand them.
Improving self-awareness can be targeted by listening to recordings of the PWC speaking. PWC often find that they notice the cluttering more easily when listening to a recording than when they are speaking “live.”
Next, the client may be taught about speech rates and how to adjust their speech rate. A program called Praat can be very helpful for accomplishing this. Yvonne van Zaalen and Isabella Reichel discuss a procedure for measuring speech rate and pauses using Praat in their book, Cluttering: Current Views on Its Nature, Diagnosis, and Treatment.
You can record the client’s speech with Praat, and then it is converted into a spectrogram. A spectrogram is a way to visually represent sound. You can replay different parts of the speech sample and see when the client is speaking versus not speaking. You can use a fluency calculator to obtain the speaking rate and use the spectrogram to measure the length of the pauses. This gives the clients objective, measurable data from which to analyze their performance on a task and their progress over time.
Clients can also learn traditional “stuttering modification” techniques, such as cancellations and pull-outs, to manage moments of cluttering. Cancellation refers to when a person notices a moment of cluttering, stops, and repeats the cluttered portion of speech more clearly. An example might be “Guess what? Yesterday there was a hecoter ’bove my house and all of the sudden...a helicopter above my house and all of the sudden...” A pull-out is similar, but it refers to the person noticing the cluttered speech in the moment and repairing it immediately. For example, “Guess what? Yesterday there was a hecoter ’bove... a helicopter above my house and all of the sudden...” These techniques can promote self-monitoring, because the client acknowledges a moment of cluttering and “resets” their speech.
Identifying speech and language aspects of cluttering is also important, so the client knows whether they need to adjust aspects of their speech or language. For example, fully articulating multisyllabic words versus learning how to tell a story with adequate background information and with a clear order of events.
If the client does not express their ideas clearly (by this I am referring to their language skills), they may need to work on ordering their ideas and expressing them clearly. Sometimes, PWC share a lot of information all at once. It can be helpful to learn how to “chunk” information and organize it so that the listener can follow their train of thought.
Clients also need to learn how to self-monitor for listener understanding and identify and repair conversation breakdowns. For example, the client should learn how to recognize facial expressions indicating confusion or when someone is “smiling and nodding” because they do not understand. They can learn to pause in these instances and start to speak more slowly, and/or ask the listener if they need clarification.
Finally, the client must learn how to monitor their speech and language independently and problem-solve independently.
7. What other strategies are there to let PWC better cope with cluttering?
Learn how to be kind to yourself and cultivate resiliency. None of us are perfect and everyone has challenges. Learning how to be kind to yourself can also help you be more empathetic towards others. Resiliency can help you cope with your challenges. It helps you handle difficult moments and recover from them in a timely fashion. I liked Brene Brown’s book, Rising Strong, about resiliency. I am intrigued by how resiliency can be cultivated and strengthened. It is something that you can learn and improve!
Also, learn about the neurodiversity movement. Now more than ever, differences are being embraced and celebrated. According to Understood.org, “neurodiversity is a viewpoint that brain differences are normal, rather than deficits” and that “neurodiverse people experience, interact with, and interpret the world in unique ways.” Furthermore, “this concept can help reduce stigma around learning and thinking differences.”
“That’s the basic idea of neurodiversity — that differences don’t have to only be looked at as weaknesses. They’re not problems that need to be “fixed” or “cured.” They’re simply variations of the human brain. The neurodiversity view is also personal. Being neurodivergent can help shape identity and how people see themselves and their value in the world. Neurodiverse people experience, interact with, and interpret the world in unique ways. That can sometimes create challenges. But it can also lead to creative problem-solving and new ideas — things that benefit everyone.”
Learn to embrace your strengths and look for hidden advantages as a person who clutters.
Finally, if you are dealing with anxiety or depression, don’t wait to reach out and get help. Counseling can also help you develop a positive self-image and address anxiety or depression that may have resulted from your speech difficulties. For example, Rutger shared in the book how he experienced a lot of anxiety about losing his job or being able to get a job due to others having difficulty understanding him. Job anxiety is a good example of when counseling could help to process these feelings and fears, in addition to speech therapy to address difficulty communicating.
8. What general advice do you have for people who clutter?
You can be a great communicator! Don’t let cluttering hold you back. Educate yourself, learn the techniques to help you communicate clearly, and soar!
9. What questions do you have for people who clutter?
-How can SLPs reach people who clutter? Since symptoms are so generalized, how do we educate people about what cluttering is and help more people recognize what is going on and that there is help available?
-What has helped you cope with cluttering over the long-term? Does it still feel tiring sometimes?
10. What general advice do you have for other SLPs?
Learn about various types of fluency disorders and how to recognize each one. Educate yourself about the difference between stuttering and cluttering. While you may rarely encounter a person who clutters in your clinical practice, your knowledge and appropriate diagnosis may mean the world to one person or a handful of people. You can truly change the course of their life.
Some good resources include both of the cluttering videos from The Stuttering Foundation, especially the “Cluttering: Another Look.” I would also recommend Cluttering: Current Views on Its Nature, Diagnosis, and Treatment by Yvonne van Zaalen and Isabella Reichel, Managing Cluttering by Kathleen Scaler Scott and David Ward, and, of course, Too Fast for Words!
Share what you know with other SLPs – the more clinicians who recognize cluttering, the better it will be for PWC!
11. Did the book Too Fast For Words help you or your clients?
Absolutely! It was a game-changer for me! I have never heard such a detailed account of how cluttering affected someone’s life. It also helped reading a detailed account of the cluttering symptoms. Thank you for writing this book, Rutger. It will help SLPs better understand and treat cluttering, and will also help PWC learn that they are not alone and that there is help and hope!
References:
Brown, B. (2017). Rising strong. Random House US.
Cluttering. Stuttering Foundation: A Nonprofit Organization Helping Those Who Stutter. (2020, November 1). Retrieved January 22, 2022, from https://www.stutteringhelp.org/training/cluttering
Cluttering: Another look. Stuttering Foundation: A Nonprofit Organization Helping Those Who Stutter. (2020, August 7). Retrieved January 22, 2022, from https://www.stutteringhelp.org/training/cluttering-another-look
Morin, A. (2021, October 15). What is neurodiversity? Understood. Retrieved January 22, 2022, from https://www.understood.org/articles/en/neurodiversity-what-you-need-to-know
Scott, K. S., & Ward, D. (2013). Managing cluttering: A comprehensive guidebook of activities. Pro-ed.
Shipley, K. G., & Mcafee, J. G. (2009). Assessment in speech-language pathology. Delmar.
van Zaalen, Y., & Reichel, I. K. (2015). Cluttering: Current views on its nature, diagnosis, and treatment. iUniverse.
Wilhelm, R. (2020). Too fast for words: How discovering that I don't stutter but clutter changed my life. Big Time Publishers.
Keywords: Keywords: speech therapy, stuttering, cluttering, learning disabilities, dyslexia, childhood apraxia of speech, voice, teletherapy, telepractice, Texas, Houston, Cypress, Tomball, Klein, Spring, Woodlands