Imagine an incredibly messy house. The dirty dishes overflow so much, it’s difficult to distinguish the sink from the counter. The strewn about clothing creates somewhat of a wardrobe sea that flows from one room to the next. Neighbors complain and can’t understand this poor level of cleanliness. But the craziest thing about it all is that the owner looks at this debris-bedecked house and sees not a speck of dust, a dirty dish or a mislaid piece of clothing. 

Life is a lot like that for K.P., a fifth grade student at McCormick Elementary School in suburban Cincinnati. But instead of a cluttered house, K.P. has cluttered speech. Due to his disorganized language and conversational skills, it’s difficult to distinguish one thought from the next. His increased rate and poor articulation creates somewhat of a slurred syllable sea that flows from one partially enunciated word to the next. This makes his speech difficult for teachers and peers to understand. But K.P., after eight years of speech therapy, still can’t recognize or agree with others' observations.

Cluttering is a communicative disorder that involves short attention span, inability to listen and difficulties with syntax. Cluttering is similar to, and is often confused with, the speech disorder stuttering. Clutterers display disorganized speech planning, talking too fast or in spurts or simply being unsure of what to say. By contrast, a person who stutters typically knows exactly what he or she wants to say, but is temporarily unable to say it.

Thanks to Candace Fening, K.P.’s school-based speech-language pathologist, he wasn’t misdiagnosed with stuttering. About a year and a half ago, she was working with him on a separate issue, his central auditory processing disorder, and she realized he suffered from a speech problem as well. But the million-dollar question was: Which speech problem?

“I knew he had a fluency disorder, and I could tell it wasn’t exactly stuttering. After doing some research, I found a description of cluttering and he fit almost every single characteristic of the disorder,” she recalls. “I pulled the evaluation that Cincinnati Children’s Hospital had done on him. It was a very in-depth and intense test that did a thorough auditory and speech examination. It mentioned misarticulating, but it didn’t diagnose cluttering. So, that’s when I went on the Internet for more information.”

And on the Web, she discovered a Mecca of information about cluttering. Fening, and thousands of therapists nationwide, are using Internet-based resources such as www.asha.org, www.kidshealth.org and www.stutteringhelp.org and it’s increasing the professional awareness that’s vital to correctly pinpointing this vexing communication problem.

The definition of cluttering adopted by the fluency disorders division of the American Speech-Language-Hearing Association says cluttering is a fluency disorder characterized by a rapid and/or irregular speaking rate, excessive disfluencies and often other symptoms such as language or phonological errors and attention deficits. Evidence for a fluency disorder – one that is not stuttering – and excessive disfluencies, would be present in a speaker who meets the all of the following:

• Does not sound "fluent," that is, does not seem to be clear about what he or she wants to say or how to say it
• Has excessive levels of "normal disfluencies," such as interjections and revisions
• Has little or no apparent physical struggle in speaking
• Has few if any accessory (secondary) behaviors

A rapid and/or irregular speaking rate would be present in a speaker who has any or all of the following:

• Talks "too fast" based on an overall impression or actual syllable per minute counts
• Sounds "jerky”
• Has pauses that are too short, too long or improperly placed

These fluency and rate deviations are the essential symptoms of cluttering. In addition, however, there are a number of symptoms suggested in the latter part of the above definition that may or may not be present, but add support to the impression that a person is cluttering. Accordingly, the clinical picture of a typical cluttering problem would be enhanced if the person in question had any of the following:

• Confusing, disorganized language or conversational skills
• Limited awareness of his or her fluency and rate problems
• Temporary improvement when asked to "slow down" or "pay attention" to speech
• Mispronunciation or slurrring of speech sounds or deleting non-stressed syllables in longer words (e.g., "ferchly" for "fortunately")
• Speech that is difficult to understand
• Several blood relatives who stutter or clutter
• Social or vocational problems resulting from cluttering symptoms
• Learning disability not related to reduced intelligence
• Sloppy handwriting
• Distractibility, hyperactivity or a limited attention span
• Auditory perceptual difficulties

Another resource Fening finds useful is the Source for Stuttering and Cluttering by David A. Daly (LinguiSystems, Inc., 1996). “This particular text really confirmed for me that he wasn’t a true stutterer, he’s a clutterer,” she explains. “Since we started doing exercises in the Source for Stuttering and Cluttering book, I’ve seen improvements at the word level. He’s starting to use some of the prolongation strategies and he says his words a little slower and more concise. We hope to start seeing improvements in his spontaneous conversation.”

As is common with many clutterers, K.P. has a family history of communication problems. He has one deaf brother and another brother that stutters. Consequently, along with the brothers’ homework, Fening sends home a copy of the pages K.P. worked on that day in his workbook, a supplement of the Source for Stuttering and Cluttering book.

In addition, his parents pre-teach classroom information to K.P. Therefore, classroom teachings aren’t novel and he can follow along, despite his communication disorders. K.P. is also strongly encouraged to participate in extracurricular activities where he can work on his public speaking. For example, he’s in a Lego™ League that builds intricately designed items and competes against kids of all ages. He is the team leader and he has to express himself clearly as he demonstrates and explains the item his team built to a panel of judges without any adult support.

Although K.P. is a gifted student, Fening often uses K.P.’s speech therapy sessions to record him as he reads from books such as Edwina the Emu (HarperTrophy, 1997), a second grade level book. “Even a second grader would have better enunciation than [K.P.], but the idea is to start with the basics and let him evaluate his speech when we play back the recording,” says Fening.

Within the next few weeks, Fening plans to videotape K.P. reading to enhance the curriculum and assist him in visualizing his speech deficiencies. “Clutterers have very poor insight into their own disorder, and that’s what makes it really challenging,” Fening adds. “If you’re not aware that you have a problem, it’s difficult to fix it”

Because of K.P.’s dual communication disorders, his school offers additional accommodations such as preferential seating in the classroom and an F.M. system in his classroom to amplify the teacher’s voice directly into his headphones.

An informational report published on www.asha.org entitled Cluttering Updated by Kenneth O. St. Louis, Lawrence J. Raphael, Florence L. Myers and Klaas Bakker says a number of therapeutic strategies have been recommended over the years, many of which we have found to be effective with specific clutterers. These include speech, language and other skills that may affect the clutterer’s ability to communicate effectively. The authors selected common goals or principles for cluttering treatment and prioritized them as follows: slowing rate; heightening monitoring; using clear articulation; using acceptable, organized language; interacting with listeners; speaking naturally; and reducing excessive disfluencies.

While Fening characterizes K.P. as a nine – on a scale with one being the best and 10 being the worst – in terms of his communication disorder severity, she is determined to leverage these suggested methods to drastically improve K.P.’s speech. 

“[K.P.’s] expectations are that he will someday go to an Ivy League college and that he will succeed in life academically,” says Fening. “He is truly fascinating. We do everything short of standing on our head to figure out how to make it click. But I’m confident that sooner or later, it will.”


Amy Storer is the editor of TherapyTimes.com. Questions or comments can be directed to editorial@TherapyTimes.com.


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