Cluttering Lecture Notes
Cluttering
Definition
Cluttering is a fluency disorder characterized by:
Sudden bursts of rapid speech, which can make it difficult for listeners to follow the speaker.
Speech that is difficult to understand due to distorted sounds or omitted syllables.
Speech that is somewhat disfluent, including an excessive number of normal disfluencies.
Perceived as too fast (accelerated speech rate), too irregular (variable rate with bursts), or both.
Failure to maintain normally expected sound, syllable, phrase, and pausing patterns (St. Louis et al., 2003). This irregular rhythm disrupts speech clarity.
It is a speech-motor disorder affecting the planning and execution of speech movements.
Often unintelligible due to rapid rate, misarticulations, and excessive disfluencies.
Developmental stuttering may co-occur, compounding the challenges in diagnosis and treatment.
Often accompanied by disorganized language (mazing), characterized by tangential and incoherent sentences, as well as learning and neuropsychological problems such as attention deficits and impaired executive functioning.
Characteristics
Must occur in naturalistic conversation and is random, distinguishing it from more controlled speech patterns.
Syllables are omitted, sounds slurred, or syllables are collapsed, particularly in multisyllabic words.
Syllable rate can be rapid with misarticulations and disfluencies, impacting overall speech intelligibility. The rate may vary significantly within the same utterance.
Speech may appear jerky due to abrupt changes in rate and rhythm.
Collapsing includes excessive shortening or “over-coarticulating” various syllables, especially multisyllabic words, making speech sound compressed.
Normal disfluencies are most prevalent, often frequent, and include:
Repetitions: multisyllabic words and phrases are repeated, sometimes excessively.
Revisions: frequent changes in the content or structure of an utterance.
Interjections/fillers: use of “um,” “uh,” and other filler words that disrupt the flow of speech.
Rate problems are central to the disorder, impacting both fluency and clarity.
Example Transcripts (St. Louis et al., 2012)
"Oh, I think I my speech is garbled. I speak too fast…Other people always say ‘What did you say to me? Speak slower please’….I hear I hear myself. Uh my my words get garbled to myself I garble my words…"- Illustrates difficulties in articulation, speech intelligibility, and rate. The speaker is somewhat aware of their speech issues.
"It’s mostly like explanation of something. Like I want to say something is I I mean to say ‘it’s extemporaneous,’ but I can’t think of the word ‘extemporaneous’ - I think of uh - it’s something you say as it comes out of the - you can’t remember - that sort of thing, y’know?"- Illustrates difficulties in language, specifically word-finding and formulation.
Neurological Underpinnings (Ward et al., 2015)
Neurological basis for cluttering, suggesting differences in brain structure and function compared to typical speakers.
Sentence Reading Condition:
Speech +: 9 sec (Time taken to read sentences with speech)
Rest: 11 sec (Time taken at rest)
Picture Description (Time taken to describe a picture)
Speech +: 18 sec
Sentence Reading (Varying times for sentence reading)
Speech +: 20, 27, 29, 36, 38, 40 sec
Ward et al. (2015) - Adults Who Clutter
AWC > Controls- Z statistic: 2.3, 3.1 (Areas where adults who clutter show greater activity than controls. Z-statistic indicates the significance of the difference.)
Controls > AWC- Z statistic: 3.1, 5.0 (Areas where controls show greater activity than adults who clutter. Z-statistic indicates the significance of the difference.)
54, 28, 46, -34, -10, -38, 54 (Specific brain regions or measurements where differences were observed; positive values indicate greater activity in controls, negative values indicate greater activity in AWC)
Differential Diagnosis
Covert stuttering:- Avoiding, escaping words that may be stuttered. Individuals attempt to hide their stuttering, leading to unusual speech patterns.
Cluttering versus…
Language – based “normal” disfluencies: Differentiating typical disfluencies from those associated with cluttering.
Word finding problems: Difficulty retrieving and using appropriate vocabulary.
Lack of background information: Speech may seem disorganized due to lack of understanding of the topic.
Difficulty sequencing events: Problems narrating or explaining events in a logical order.
Comparison of Developmental Stuttering to Cluttering (Table 18.4)
Developmental Stuttering
Etiology:
Probably neurophysiological (anomalies in left hemisphere) exacerbated by temperament and environment. Genetic factors, brain structure, and individual temperament can all play a role.
Typical Onset:
Usually ages 2-5, with some onsets in school years. Early childhood is the most common period for stuttering to begin.
Speech Characteristics:
Single-syllable whole-word repetitions, part-word repetitions, prolongations, and blocks. These are core stuttering behaviors.
Frequency is usually more than 3% syllables stuttered. A common benchmark for diagnosis.
Secondary behaviors (escape and avoidance) common. These include eye blinks, head nods, and word substitutions to avoid stuttering.
Pattern varies somewhat. Stuttering can be inconsistent, varying in severity and type of disfluency.
Client's Level of Concern:
Client typically shows frustration and embarrassment about stuttering, as well as fear of speaking. Emotional reactions are often significant.
Other Diagnostic Information:
Frequency and severity are often variable from day to day and situation to situation. Contextual factors can influence stuttering.
Treatment:
School-age children and adults benefit from integration of behavioral, affective, and cognitive focus of stuttering therapy. Therapy addresses both speech behaviors and emotional responses.
Cluttering
Etiology:
Neurological anomalies appear to consist of overactivity in premotor cortex pre-SMA (supplementary motor area) and basal ganglia. Differences in brain activity are believed to contribute to the rapid and irregular speech patterns.
These suggest a problem in planning and execution of speech-motor control. Difficulties in motor planning impact speech fluency.
Typical Onset:
May be present in preschool years, but often not diagnosed until problem interferes with school performance. Cluttering may not be evident until academic demands increase.
Speech Characteristics:
Excess of normal disfluencies, lack of intelligibility, especially during rapid bursts of speech. These disfluencies, combined with rate issues, reduce clarity.
May slur syllables and leave out others entirely. Known as collapsing or telescoping syllables.
Client's Level of Concern:
Frequently unaware of problem, except when listeners tell him they can't understand what he's said. Lack of awareness is a key feature of cluttering.
Other Diagnostic Information:
Often accompanied by stuttering, as well as language, attention, auditory processing, writing, and reading problems, and other learning disabilities. Co-occurring disorders are common.
Treatment:
Increase awareness of cluttering, particularly fast speech rate. Helping the client recognize and monitor their speech patterns.
Help client self-regulate speech rate and fluency. Strategies to control rate and improve fluency.
Improve awareness of listener cues and language skills such as narrative organization and pragmatics. Enhancing communication effectiveness.
Differential Diagnosis: Cluttering Versus…
Atypical disfluencies
Word final disfluencies
Repetitions with or without a pause in between
Turn out the light-t-t so I can go to sleep
Turn out the light-ight so I can go to sleep
Prolongations- I am going to play-hay outside now
Commonly found in client with other diagnoses, such as autism or attention deficit hyperactivity disorder, though can be found in those with no other diagnosis. These disfluencies can be present in various conditions.
Clients may present with both cluttering and atypical disfluencies BUT these symptoms are not cluttering. It's important to distinguish between cluttering and other types of disfluencies.
Differential Diagnosis Example
“This weekend I went, I went to find a pair- well, I needed some jeans. I went to several, well, there were several stores I was interested in. I wanted something that was not too, well, something reasonable in price. It was hard, it was difficult, well, the most difficult thing about shopping for the well the jeans was finding a pair that was well my correct size.”
Are the revisions, interjections due to…
Avoidance of moments of stuttering? Does the speaker anticipate and avoid stuttering?
Trying to organize and formulate thoughts? Is the speaker struggling to express their ideas clearly?
Rapid speech? Is the disorganized speech a result of speaking too quickly?
Teasing It Out… Possible Source
Covert stuttering
Language organization
Articulation/phonological disorder
Atypical disfluencies/other nonrelated disorder
Things to Observe
Tension observed before the switch? Look for physical tension that may indicate stuttering.
Reports of avoidance? Does the speaker admit to avoiding certain words or situations?
How do they do on standardized tests of word findings/language organization? Assess language skills with formal tests.
Consistent errors across words. Note any consistent articulation errors.
Other language and/or pragmatic problems. Assess overall communication skills.
Sample of AWC (Fluency Bank)
What are the speech and/or language characteristics you notice in this speaker? Analyze the speech sample for specific features.
What is interfering with his speech intelligibility? Determine the factors impacting clarity.
TalkBank Browser
More on Pauses…
Stuttering may be accompanied by pauses as the speaker stops before a moment of tension (blocking). These pauses are oftenfilled with tension or struggle.
Word finding/language problems may be accompanied by pauses as the speaker attempts to recover the word and/or phrase. These pauses are more related to language formulation.
A person who is cluttering will benefit from pausing in controlled situations. Controlled pauses can improve speech clarity.
Pausing in inappropriate places may be observed. This could be an indicator of underlying language or thought disorganization.
Activity: Pausing
2 minute monologue
Insert 2 second pauses at clause boundaries when speaking in monologue to your partner.
Debrief with partner:
What did the pauses do to your speech? How did pausing impact your fluency and clarity?
How would you teach pausing with a person who clutters? What strategies would you use?
What kind of support would you give? How would you encourage and assist them?
If You Observe…
Syllable collapsing, unintelligible speech- How do you tease out an articulation/phonological disorder? Assess articulation skills separately to determine if errors are due to motor issues.
Word finding and/or language processing problems- How do you tease out a language disorder? Use language tests to evaluate vocabulary, grammar, and language organization.
Stuttering –like disfluencies- How do you tease out a developmental stutter? Look for core stuttering behaviors such as part-word repetitions and prolongations, as well as secondary behaviors.
Atypical disfluencies- How do you tease out pragmatic or other language disorder? Assess social communication skills and look for other language-related issues.
Activity: Evaluation Planning
When planning an evaluation for a high school student, describe the steps you would take for differentiating cluttering from a stuttering, language, pragmatic and/or speech sound disorder. Consider assessments covering all areas of communication.
Assessment of Cluttering
Formal Measures
Daly’s Predictive Cluttering Inventory (DPCI): A standardized tool specifically designed to assess cluttering.
Articulation and language assessments: Comprehensive evaluations of speech sounds and language abilities.
Oral motor assessment (e.g. assessment of diadochokinesis): Examines the speed and coordination of oral movements.
Cluttering Severity Instrument (free) : Link
Non-Formal Measures
Analysis of speaking samples for disfluencies:
% disfluencies broken down into normal disfluencies and SLD (stuttering-like disfluencies): Quantify and categorize disfluencies in a speech sample.
Location, length and number of pausing: Analyze pauses for patterns and appropriateness.
Lack of awareness of disfluencies and overall intelligibility: Assess the speaker's self-awareness and how well they are understood.
Speaking rate: Measure speech rate in syllables per minute or words per minute.
Intelligibilty: Subjective and objective measures of how well the speaker is understood.
Collapsed words and/or sounds and slurred words: Note instances of reduced clarity due to articulation issues.
Descriptive Statement
PRAGMATICS
Lack of effective self-monitoring skills: Difficulty recognizing and correcting errors in their own speech.
Lack of awareness of own communication errors or problems: Unaware of the problems they exhibit.
Compulsive talker; verbose; tangential; word-finding problems: Tendency to talk excessively and stray from the topic.
Poor planning skills; mis-judges effective use of time: Difficulty organizing thoughts and managing time effectively.
Poor social communication skills; inappropriate turn-taking; interruptions: Problems in social interactions due to poor communication skills.
Does not recognize or respond to listener's visual or verbal feedback: Fails to notice or react to listener cues.
Does not repair or correct communication breakdowns: Does not attempt to clarify or correct misunderstandings.
Little or no excessive effort observed during disfluencies: Lack of physical tension or struggle during disfluencies.
Little or no anxiety regarding speaking; unconcerned: Appears unconcerned about their speech difficulties.
Speech better under pressure (improves short-term with concentration): Speech may improve temporarily when focused or under pressure.
SPEECH-MOTOR
Articulation errors: Inaccurate production of speech sounds.
Irregular speech rate; speaks in spurts or bursts: Variable speech rate with sudden accelerations.
Telescopes or condenses words: Syllables or sounds are omitted, making words compressed.
Rapid rate (tachylalia): Abnormally fast speech rate.
Speech rate progressively increases (festinating): Speech rate accelerates throughout an utterance.
Variable prosody; irregular melody or stress pattern: Unusual intonation or emphasis in speech.
Lack of pauses between words and phrases: Few or no pauses, leading to a rushed speech pattern.
Initial loud voice trailing off to unintelligible murmur: Speech starts loudly then fades into an inaudible murmur.
Repetition of multi-syllabic words and phrases: Repeating entire words or phrases, not just individual sounds or syllables.
Co-existence of excessive disfluencies and stuttering: Presence of both cluttering and stuttering behaviors.
LANGUAGE-COGNITION
Language is disorganized; confused wording; word-finding problems: Difficulty expressing thoughts in a coherent manner.
Poor language formulation; poor story-telling; sequencing problems: Problems constructing narratives and organizing information logically.
Disorganized language increases as topic becomes more complex: Language issues become more pronounced with complex topics.
Many revisions; interjections; filler words: Frequent changes in wording and use of filler words.
Seems to verbalize before adequate thought formulation: Begins speaking before fully forming their thoughts.
Inappropriate topic introduction, maintenance, or termination: Difficulty starting, maintaining, or ending conversations appropriately.
Improper linguistic structure; poor grammar; syntax errors: Errors in grammar and sentence structure.
Distractible; poor concentration; attention span problems: Difficulties focusing and maintaining attention.
MOTOR COORDINATION-WRITING PROBLEMS
Poor motor control for writing (messy): Difficulties with handwriting and fine motor skills.
Writing includes omission or transposition of letters, syllables, or words: Errors in writing similar to speech errors.
Oral diadochokinetic coordination below expected normed levels: Reduced speed and coordination of oral movements.
Respiratory dysrhythmia; jerky breathing pattern: Irregular breathing patterns during speech.
Clumsy and uncoordinated; motor activities accelerated or impulsive: General difficulties with coordination and motor control.
Analyzing Speech Sample
“This weekend I went, I went to find a pair- well, I needed some jeans. I went to several, well, there were several stores I was interested in. I wanted something that was not too, well, something reasonable in price. It was hard, it was difficult, well, the most difficult thing about shopping for the well the jeans was finding a pair that was well my correct size.”
15/23 (Number of Stuttered Syllables/Total Number of Syllables)
14/22 (Number of Disfluent Words/Total Number of Words)
5/22 (Number of Interjections/Total Number of Words)
4/4 (Number of Revisions/Total Number of Utterances)
49% extraneous syllables
Treatment for Cluttering (Bennett, Lanouette (2011); Myers (2002); Myers and St Louis (2007))
Increase client’s knowledge and awareness of cluttering-
Educate the client about the characteristics and impact of cluttering.
Encourage client to transcribe their own speech: This helps them to become more aware of their speech patterns.
Help client to become aware of his thought process while speaking in rapid bursts: Understanding what triggers the rapid speech.
3 point awareness scale- 1 = mild; 2= moderate; 3 = severe
Rate speech on the scale to gauge severity.
Modify speech to match numerical scale: Adjust speech to align with different severity levels.
What does it feel like to go to fast? This helps the client understand the physical sensations of rapid speech.
Modifications to speech-
Increased rate = increase natural pauses: Adding pauses to slow down the speech.
Sounds or syllables deleted and/or collapsed = emphasize all sounds and syllables: Focus on producing each sound clearly.
Atypical pauses = learn places for natural pauses (if needed): Inserting pauses at appropriate junctures.
Poor intelligibility = increase natural pauses, emphasize ending sounds: Improving clarity by slowing down and emphasizing word endings.
Cluttering strategies can be incorporated before an anticipated moment of cluttering and after: Using strategies proactively and reactively.
Treatment for Cluttering (Guitar, 2025)
Increase client’s awareness of rate: Improving self-monitoring skills.
Tune in to sensory feedback to learn feeling of different speaking rates: Helping the client recognize the physical sensations of different rates.
Teach client to attend to nonverbal listener cues: Recognizing listener reactions to adjust speech.
Pausing and phrasing: Practicing appropriate pausing and phrasing techniques.
Teach “strong speech”: Emphasizing clear articulation.
Improve linguistic skills-
Explicity work on language organization and social communication skills: Addressing underlying language issues.
GILCU (Gradual Increase in Length and Complexity of Utterance)
Facility fluency
Use DAF (Delayed Auditory Feedback) and fluency shaping as appropriate
Increase client’s knowledge and awareness of cluttering
Treatment for Atypical Disfluencies
Identify and extinguish (Sisskin & Wasilus, 2014)-
Word final syllable stutter is suppressed- not helpful for developmental stuttering but because the awareness and negative feelings are not there, suppression or elimination has been shown to work
DAF= delayed auditory feedback to help in rate control (van Borsel et al, 2005)
Fluency shaping techniques-
Stretched syllables at the beginning of a phrase
may not be a good time to address disfluencies; Is it effecting communication? Is it more important to address intelligibility?
Self-advocacy
Child-Friendly Activities
Child-friendly language- “tail-sounds”, “strong speech”, “stop signs”: Using age-appropriate terminology to teach concepts.
Give clinician speeding tickets to clinician, then child, for fast rate: A fun way to address rapid speech.
Teach concept of speedometer and ask them to speak at 90 mph then 30 mph: Visual aids to regulate speech rate.
Address language and pragmatic skills (see Guitar text): Working on underlying communication issues.
Figure 18.2: Child walking and talking rapidly and then walking slowly and timing speech to slow walking movements as an activity for children in treatment for cluttering. Fast and slow music are used to help timing of walking and talking.
Cluttering Resources
International Cluttering Association: Free resources, assessment guidance and free assessment materials, general information for people who clutter, families, and SLPs
The Cluttering Experience by Rutger Wilheim
Joseph Dewey Youtube Channel
Anything by Kathleen Scaler Scott, PhD
Debunking Myths About Cluttering (ASHA article)
Speech Sample
A-a-and [tension] then I get p-p-packed up. I eat breakfast and then I get dressed. Then then then I make my bed. Then I put my my my shoes on. Then I go to the bus sop and then I wait for the bus for a long, long, long time. It’s sometimes It’s sometimes late mostly it’s late and um most of the time its sometimes early and half- half the time its late, half the time its early, ha-a-a-lf [tension] the time its eight o’clock.
Case Study
A 9 year old boy was referred for a fluency evaluation. He had a history of speech and language problems and was seen for therapy for over 3 years. He had begun to stutter at age 4 when he was putting longer sentences together. Formal tests of language revealed average receptive vocabulary and language skills but expressive language skills placed him in the 15th percentile. Stuttering severity was mild, with 3% of syllables characterized by syllable and word repetitions. He