(4/5) Chapter 6 - Cluttering & Other Types of Fluency Disorders

Fluency and its Disorders

cluttering

A disorder of fluency that often coexists with stuttering

It is characterized by a reduced speech intelligibility, rapid and irregular speech rate, imprecise articulation, dysfluencies, disorganized language, poor prosody, and inefficient management of discourse

Speakers do not manifest obvious concern about their speaking patterns

Some may report poor thought organization

Little experimentally controlled research exists on treatment, although it has been found that decreasing the rate of speech and increasing the client's awareness of the problem are often effective

prevalence of cluttering

In the United States is unknown, but in Germany it is reported to be 1.8% of 7- to 8-year-old children

More common in males than females

characteristics of cluttering

Rapid but disordered articulation and resulting indistinct (unintelligible) speech; rate variations

Impaired prosodic features with frequent pauses

Impaired fluency with excessive amounts of dysfluencies, especially word and phase repetitions, interjections, and revisions; possible rapid repetition of syllables, along with other forms as well

Clearer articulation and improved intelligibility at slower rate of speech

Omission and compression of sounds and syllables

Jerky or stumbling rhythm

Monotonous tone

Spoonerisms (unintentional interchanges of sounds in a sentence; e.g., "Many thinkle peep so" instead of "Many people think so")

Disorganized language production

Reportedly, a lack of concern about or reduced awareness of one's speech problem

Lack of anxiety about or negative reactions to one's speech difficulty

Disorganized thought processes (a controversial feature)

causes of cluttering

Unknown

Genetic transmission and subtle brain damage have been among suggested factors

Some experts think that it is a central language disorder (a disassociation between thought and language) but there is little empirical support for this idea

cluttering assessment

Assessed much like stuttering of early childhood onset with an emphasis on its special features (e.g., excessive rate and rate variations, articulatory breakdowns and speech intelligibility, prosodic variations, dysfluencies, lack of concern)

A detailed case history and an extended speech sample will help analyze the symptom complex

There is little or no controlled treatment research

Clinicians may administer the Cluttering Severity Instrument, a computer software program developed to assess and rate the overall intelligibility, speech rate regularity, speech rate, articulatory precision, typical disfluency, language organization, discourse management, and prosody

cluttering treatment

Reducing the rate of speech usually improves clarity as well as fluency

If thought problems or language formulation problems are dominant, teaching the client to plan sentences and other forms of expression before actually producing them might be helpful

Increasing a client's awareness of his or her speech problems through the use of audio or video recordings can be helpful

Some people who clutter are surprised when confronted with recordings of their own speech

Unfortunately, video samples do not always convince people who clutter of their problem, especially the increased speech rate

Maintenance of fluent speech with typical articulation is the major problem in treating persons who clutter

Systematic treatment research is needed to develop unique and more effective treatment procedures for cluttering

malingered stuttering

This is faked stuttering exhibited to gain an advantage from the problem; symptoms are well planned (researched by the individual)

The individual knows he or she is faking

Gains may be negative reinforcement that occurs when a child, faking stuttering, avoids a difficult oral presentation to the class

Diagnostic features include lack of adaptation, absence of reduction in stuttering under delayed auditory feedback, masking noise, and reduced speech rate

psychogenic stuttering

Stuttering falling under this controversial term is of adult onset

It is not malingering because it is not consciously fabricated to gain an advantage

The individual may be unaware of the origin of the problem

Dysfluencies are similar to those found in stuttering of childhood onset

May be associated with depression, anxiety, post-traumatic stress, and such other psychiatric disorders

Triggering factors include stressful life situation including divorce, illness, death of a loved one, loss of a job, and so forth

May be associated with neurodegenerative diseases, compulsive disorders, stroke, traumatic brain injury, and so forth in some individuals, complicating a psychogenic diagnosis

Dysfluencies may not be affected by adaptation, masking noise, and delayed auditory feedback