Cluttering

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Cluttering
ICD-10 F98.6
ICD-9 307.0

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Background

Cluttering (also called tachyphemia) is a speech disorder and a communication disorder characterized by speech that is difficult for listeners to understand due to rapid speaking rate, erratic rhythm, poor syntax or grammar, and words or groups of words unrelated to the sentence. Cluttering has in the past been viewed as a fluency disorder[1].

Presentation

The person with cluttering may experience a short attention span, poor concentration, poorly organized thinking, inability to listen, and a lack of awareness that one's speech is unintelligible.

Cluttering is sometimes confused with stuttering. Both communication disorders break the normal flow of speech. However, while stuttering is most often analyzed as a speech disorder, cluttering is a language disorder. In other words, a stutterer has a coherent pattern of thoughts, but can't say it; in contrast, a clutterer has no problem putting thoughts into words, but those thoughts become disorganized during speaking. Cluttering not only effects speech, but affects thought patterns, writing, typing, and conversation[2].

Stutterers are usually dysfluent on initial sounds, when beginning to speak, and become more fluent towards the ends of utterances. In contrast, clutterers are most clear at the start of utterances, but their speaking rate increases and intelligibility decreases towards the end of utterances.

Stuttering is characterized by struggle behavior, such as overtense speech production muscles. Cluttering, in contrast, is effortless.

To compare, a stutterer trying to say "I want to go to the store," might sound like "I wa-wa-want to g-g-go to the sssssssssstore." In contrast, a clutterer might say, "I want to go to the st...uh...place where you buy...market st-st-store."

Cluttering is also characterized by slurred speech, especially dropped or distorted /r/ and /l/ sounds; and monotone speech that starts loud and trails off into a murmur.

Clutterers often also have reading and writing disorders, especially sprawling, disorderly handwriting, which poorly integrate ideas and space.[3] A clutterer described the feeling associated with a clutter as:

It feels like 1) about twenty thoughts explode on my mind all at once, and I need to express them all, 2) that when I'm trying to make a point, that I just remembered something that I was supposed to say, so the person can understand, and I need to interrupt myself to say something that I should have said before, and 3) that I need to constantly revise the sentences that I'm working on, to get it out right. [4]

Another clutterer wrote on an Internet support group:

I just seem to rush through the words, and often slur words together and/or mumble—and as a result I often have to slow down, concentrate, and repeat myself.

Related Disorders

Cluttering can often be confused with language delay, language disorder, learning disabilities, and attention deficit disorder[5].

Cluttering versus Stuttering

Cluttering and stuttering sound very similar to the lay ear, especially when they are at their worst. However, they are markedly different disorders and clutterers and stutterers are very different.

Stutterers:

  • Are very aware of their disorder
  • Perform worse when speaking under stress
  • Have a hard time fluently giving short answers
  • Often have inhibited, neat handwriting
  • Therapy focuses on relaxation techniques, calling attention away from speech
  • Are typically withdrawn, shy, or introverted
  • Typically were fluent, but then started stuttering
  • Know exactly what they want to say but cannot say it
  • Have organized speech
  • Have good listening skills

Clutterers:

  • Are very unaware of their disorder
  • Perform better when speaking under stress
  • Have a hard time fluently giving long answers
  • Have hasty, repetitious, uninhibited, messy handwriting
  • Have little to no fear of their speech and are careless in speech
  • Therapy focuses on calling attention to speech details
  • Are typically outgoing or extroverted
  • Typically were never very fluent
  • Do not know exactly what they want to say, but say it anyway
  • Have disorganized, tangential, grammatically incorrect speech with word substitutions
  • Are impatient listeners, frequently interrupt, and have poor turn-taking skills in conversation

Treatment

Because clutterers have poor awareness of their disorder, they may be indifferent or even hostile to speech-language pathologists. Treatment for cluttering usually takes longer than stuttering treatment. Delayed auditory feedback (DAF) is usually used to produce a more deliberate, exaggerated oral-motor response pattern. Other treatment components include improving narrative structure with story-telling picture books, turn-taking practice, pausing practice, and language therapy.

History

Battaros was a legendary Libyan king who spoke quickly and in a disorderly fashion. Others who spoke as he did were said to suffer from battarismus.[6] This is the earliest record of the speech disorder of cluttering.

In the 1960's, cluttering was called tachyphemia, a word derived from the Greek for "fast speech." This word is currently not used to describe cluttering because fast speech is not a required element of cluttering.

Deso Weiss described cluttering as the outward manifestation of a "central language imbalance." In Weiss's book on cluttering, he used Central Language Imbalance or CLI as synonymous with what cluttering is described as today.[7]

Over the past twenty years, Kenneth O. St. Louis, Lawrence J. Raphael, Florence L. Myers, and Klaas Bakker have been working to standardize a definition of cluttering. Judith Kuster maintains a robust section of cluttering resources and articles in her Stuttering Homepage.[8]

The first conference held specifically on cluttering was held in May of 2007[9] in Razlog, Bulgaria. It was called, "The First World Conference on Cluttering," and had over 60 participants from across North America, Europe, the Middle East and Asia.[10] It was held in Bulgaria partly because of cluttering research efforts by Professors Dobrinka Georgieva and Katya Dionissieva of Neofit Rilski.[11] Part of the conference was awarding the first Deso Weiss Award for Excellence in Cluttering, which went to Kenneth St. Louis for his contributions for understanding and knowledge about cluttering.[12]

Cluttering Confusion

Spoonerisms, malapropisms, Colemanballs, and Freudian slips are examples of cluttering. Stuttering as a common term often refers the speech disorder of cluttering, rather than to the speech disorder of stuttering. Cluttered speech is exhibited by normal speakers, and is often referred to as stuttering--this is especially true when the speaker is nervous, where nervous speech more closely resembles cluttering than stuttering.

People with ADD or ADHD may have many of the same symptoms as clutterers, including being inattentive, restless, short tempered, and impatient.

Famous Clutterers

Weiss claimed that Battaros, Demosthenes, Pericles, Justinian, Bismarck, and Winston Churchill were clutterers. He says about these people, "Each of these contributors to world history viewed his world holistically, and was not deflected by exaggerated attention to small details. Perhaps then, they excelled because of, rather than in spite of, their [cluttering]." [13]

See also

Definitions

Cluttering has been in the process of being defined for the last forty years. A current definition of cluttering is:

Cluttering is a fluency disorder characterized by a rate that is perceived to be abnormally rapid, irregular, or both for the speaker (although measured syllable rates may not exceed normal limits). These rate abnormalities further are manifest in one or more of the following symptoms: (a) an excessive number of disfluencies, the majority of which are not typical of people who stutter; (b) the frequent placement of pauses and use of prosodic patterns that do not conform to syntactic and semantic constraints; and (c) inappropriate (usually excessive) degrees of coarticulation among sounds, especially in multisyllabic words[14].

Cluttering researchers

Cluttering research is still in its infancy. Cluttering research peaked and faded away in the 1960's, but interest in cluttering research has drastically increased and there are numerous books on cluttering that are currently being written. Because of this renewed interest in cluttering, the current cluttering researchers are pioneers in this speech disorder. Most of the cluttering researchers were stuttering researchers who studied cluttering as a secondary behavior, however there are a few dedicated cluttering researchers. The most notable of the cluttering researchers are:

References

  1. Daly, David A. (1999). Curlee, Richard F., ed. Stuttering and Related Disorders of Fluency. New York: Thieme. p. 222. ISBN 0-86577-764-0. Unknown parameter |coauthors= ignored (help)
  2. http://www.stammering.org/cluttered.html
  3. http://www.content.onlypunjab.com/Article/Fluency-Disorders--Stuttering-vs-Cluttering/4200320092003249120
  4. Reyes-Alami, C. "Interview with a Person who Clutters". Retrieved 2006-01-01. Unknown parameter |creationdate= ignored (help)
  5. Daly, David A. (1999). Curlee, Richard F., ed. Stuttering and Related Disorders of Fluency. New York: Thieme. p. 233. ISBN 0-86577-764-0. Unknown parameter |coauthors= ignored (help)
  6. Weiss, Deso (1964). Cluttering. Foundations of Speech Pathology. New Jersey: Prentice Hall, Inc. p. 1. LC 64-25326. Unknown parameter |middle= ignored (help)
  7. Weiss, Deso (1964). Cluttering. Foundations of Speech Pathology. New Jersey: Prentice Hall, Inc. p. 20. LC 64-25326. Unknown parameter |middle= ignored (help)
  8. Judith Kuster. "Other related fluency disorders". Retrieved 2007-03-28.
  9. "First World Conference on Cluttering". Retrieved 2007-03-28.
  10. http://wvutoday.wvu.edu/news/page/5871/
  11. http://www.mnsu.edu/comdis/isad10/papers/myers10.html
  12. http://www.mnsu.edu/comdis/isad10/papers/profin10/profin10.html
  13. Weiss, Deso (1964). Cluttering. Foundations of Speech Pathology. New Jersey: Prentice Hall, Inc. p. 58. LC 64-25326. Unknown parameter |middle= ignored (help)
  14. St. Louis, K. O., Myers, F. L., Bakker, K., & Raphael, L. J. (2007). Understanding and treating cluttering. In E. G. Conture & R. F. Curlee (Eds.) Stuttering and related disorders of fluency, 3rd ed. (pp. 297-325). NY: Thieme.

Sources

  • St. Louis, K. O., Raphael, L. J., Myers, F. L., & Bakker, K. (2003, Nov. 18). Cluttering updated. The ASHA Leader, pp. 4-5, 20-22.
  • Studies in Tachyphemia, An Investigation of Cluttering and General Language Disability. Speech Rehabilitation Institute. New York, 1963.
  • Daly, D. A. (1996). The source for stuttering and cluttering. East Moline, IL: LinguiSystems.
  • Myers, F. and K. St. Louis, (1992) Cluttering: A Clinical Perspective, Leicester, England: Far Communications



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