Neurogenic cluttering

A case of acquired symptomatic cluttering in a 61-year-old patient with documented cortical, subcortical, cerebellar, and medulla lesions is presented. The subject's communication-related behaviors are described, and a comparison is made between this case, idiopathic cluttering, and the few cases of acquired symptomatic cluttering that have been reported     

Cluttering after brain damage

On the basis of published cases and of observations made in two patients, a syndrome of acquired cluttering after brain damage in adults is delineated, and a hypothesis is presented regarding the patho-physiology of the disorder.     

Disfluencies in cluttered speech

The purpose of this study was to examine the nature and frequency of occurrence of disfluencies, as they occur in singletons and in clusters, in the conversational speech of individuals who clutter compared to typical speakers. Except for two disfluency types (revisions in clusters, and word repetitions in clusters) nearly all disfluency types were virtually indistinguishable in frequency of occurrence between the two groups. These findings shed light on cluttering in several respects, foremost of which is that it provides documentation on the nature of disfluencies in cluttering. Findings also have implications for our understanding of the relationship between cluttering and typical speech, cluttering and stuttering, the Cluttering Spectrum Hypothesis, as well as the Lowest Common Denominator definition of cluttering. EDUCATIONAL OBJECTIVES: At the end of this activity the reader will be able to: (a) identify types of disfluency associated with cluttered speech; (b) contrast disfluencies in cluttered speech with those associated with stuttering; (c) compare the disfluencies of typical speakers with those of cluttering; (d) explain the perceptual nature of cluttering.     

Public attitudes toward—and identification of—cluttering and stuttering in Norway and Puerto Rico

PurposeThe study sought to compare public attitudes toward cluttering versus stuttering in Norway and Puerto Rico and to compare respondents’ identification of persons known with these fluency disorders.MethodAfter reading lay definitions of cluttering and stuttering, three samples of adults from Norway and three from Puerto Rico rated their attitudes toward cluttering and/or stuttering on modified versions of the POSHA-Cl (for cluttering) and POSHA-S (for stuttering). They also identified children and adults whom they knew who either or both manifested cluttering or stuttering.ResultsAttitudes toward cluttering were essentially unaffected by rating either cluttering only or combined cluttering and stuttering on the same questionnaire in both countries. The same was also true of stuttering. Attitudes were very similar toward both disorders although slightly less positive for cluttering. Norwegian attitudes toward both disorders were generally more positive than Puerto Rican attitudes. The average respondent identified slightly more than one fluency disorder, a higher percentage for stuttering than cluttering and higher for adults than children. Cluttering–stuttering was rarely identified.ConclusionGiven a lay definition, this study confirmed that adults from diverse cultures hold attitudes toward cluttering that are similar to—but somewhat less positive than—their attitudes toward stuttering. It also confirmed that adults can identify cluttering among people they know, although less commonly than stuttering. Design controls in this study assured that consideration of stuttering did not affect either the attitudes or identification results for cluttering.Educational objectives: The reader will be able to: (a) describe the effects—or lack thereof—of considerations of stuttering on attitudes toward cluttering; (b) describe differences in public identification of children and adults who either clutter or stutter; (c) describe differences between attitudes toward cluttering and stuttering in Norway and Puerto Rico.     

Lexical access,story re-telling and sequencing skills in adults who clutter and those who do not

Cluttering is a rate-based disorder of fluency, the scope of whose diagnostic criteria currently remains unclear. This paper reports preliminary findings from a larger study which aims to determine whether cluttering can be associated with language disturbances as well as motor and rate based ones. Subtests from the Mt Wilga High Level Language Test (MWHLLT) were used to determine whether people who clutter (PWC) have word finding difficulties, and use significantly more maze behaviours compared to controls, during story re-telling and simple sequencing tasks. Independent t tests showed that PWC were significantly slower than control participants in lexical access and sentence completion tasks, but returned mixed findings when PWCs were required to name items within a semantic category. PWC produced significantly more maze behaviour than controls in a task where participants were required to explain how to undertake commonly performed actions, but no difference in use of maze behaviour was found between the two groups when retelling a story from memory. The implications of these findings are discussed.Educational objectives: (a) To identify issues surrounding the difficulties in diagnosing cluttering, (b) to identify and describe previous accounts of a language component in cluttering, (c) to describe how difficulties with lexical access and maze behaviour might be associated with cluttering, (d) to describe how data from the current research inform our present understanding of theories on cluttering.     

Changing Polish university students’ attitudes toward cluttering

PurposeThis quasi-experimental design study in Poland explored the extent to which attitudes toward cluttering of university students could be changed or improved after a series of activities dedicated to attaining deeper recognition of problems associated with fluency disorders.MethodUniversity students were assigned to either an Experimental or a Control group, with 39 in each (total = 78). They all completed the Polish version of the Public Opinion Survey of Human Attributes–Cluttering (POSHA–Cl) on two occasions up to eight weeks apart.Participants in the Experimental group attended the following intervention activities: watching and discussing an educational video on cluttering, participating in a workshop on the nature of cluttering, and watching and discussing a documentary on the life experiences of people struggling with fluency disorders. The Experimental group also filled out an open-ended questionnaire at the end of the study.ResultsPre-intervention comparisons indicated that participants assigned to either of the Experimental or Control groups differed significantly on 2 of the 15 summary ratings (13 %) of their pre-POSHA–Cl attitudes toward cluttering. For the Experimental group, the intervention resulted in significant positive changes in cluttering attitudes on 8 of the 15 summary ratings (53 %). In contrast, pre- and post- POSHA–Cl scores for the Control group were essentially unchanged (0 of 15 ratings).ConclusionsThis quasi-experimental study demonstrated that it is possible to positively modify the cluttering attitudes of university students. This has implications for the length, content, and experiential components of interventions designed to improve public attitudes toward fluency disorders.     

Differential diagnosis of cluttering and stuttering in Bulgaria

Fifteen stutterers, primarily children, who visited the Medical Pedagogical Department at the University of Blagoevgrad were evaluated for a variety of criteria used in Bulgaria to differentiate cluttering, stuttering, and mixed cluttering and stuttering. The same battery of tests was administered to all subjects. Based on these criteria, five subjects were diagnosed as clutterers, six as stutterers, and four as mixed. Daly's (1992–1993) Checklist for Possible Cluttering, Experimental Edition was also utilized to classify the subjects. Differences between the differential diagnostic criteria used by Bulgarian logopedists and other authors are discussed.     

Studies of cluttering: Perceptions of cluttering by speech-language pathologists and educators

Speech-language pathologists (SLPs) and educators were surveyed by mail regarding their views on the problem of cluttering. The average respondent was aware of a few clutterers, and these individuals were most likely to be placed, educationally, either in a regular classroom or learning disabilities setting. “Clutterer” was the preferred label for these individuals by the majority of respondents. most respondents did not feel adequately trained to manage clutterers. SLPs' knowledge of cluttering symptoms and etiology were surprisingly consistent with the literature. Reports of therapy with clutterers were inconsistent and typically pessimistic.     

Cluttering and stuttering exhibited in a young professional

S 18, a young adult professional, was self-referred for stuttering. Assessment indicated deficits consistent with both stuttering and cluttering, including prolongations, syllable repetitions, secondary escape behaviors, rapid speech rate, and poor expressive language. The client had no awareness of cluttering characteristics. Therapy goals included improved breath control, slowed rate, easier onset of articulation, and increased awareness of speech. Progress toward therapeutic goals was consistent. However, his motivation decreased as therapy progressed. He was discharged from direct treatment after 13 months, at which time he could employ therapeutic techniques to improve his fluency and intelligibility when speech was disordered.     

Is cluttering a motor disorder?

A 15-year-old-boy was referred on account of a fluency disorder that was not thought to be stuttering. The problems of the lack of an adequate definition of cluttering are discussed along with the inherent problems of providing a wide-based assessment of this client group. Assessments were conducted on the motoric, linguistic, and intellectual abilities of this client, and the findings are discussed.     

Annotations of research and clinical perspectives on cluttering since 1964

In 1964, Deso Weiss published his landmark text Cluttering, after much persuasion by Charles Van Riper to put his thoughts in writing regarding this enigmatic speech and language disorder (Van Riper, personal communication, 1992). To our knowledge, Weiss's book was the only book in English devoted entirely to cluttering. Nearly 30 years later, a second text entitled Cluttering: A Clinical Perspective was published (Myers & St. Louis, 1992). The following annotations summarize nearly all that has been written on cluttering since Weiss's classic publication in 1964.     

Pause time and phonation time in stuttering and cluttering

This study examined the potential usefulness of automated analysis of on-off speech patterns in the differentiation of stuttering from cluttering. Two groups of fifteen persons who had been previously classified as stutterers and clutterers served as subjects for this investigation. The data indicate that stutterers tend to have greater mean pause times and lower mean phonation times than clutterers. This result corresponds to the clinically observable characteristics of these groups. It is concluded that automated analysis of on-off speech patterns provides some basis for the differential diagnosis of stuttering from cluttering.Supported, in part, by a general research support grant from NIMH to the Research Foundation for Mental Hygiene, Inc.     

Cluttering: Assessment, treatment planning, and case study illustration

Successful treatment of clients who present with a multitude of interrelated impairments is frequently dependent upon thorough and accurate diagnosis of the problems. Individuals who clutter often demonstrate a variety of speech and language deficits that make diagnosis difficult. Two clinical tools believed to be useful for obtaining and organizing diagnostic data and for planning treatment with clients who show symptoms of cluttering are discussed. The case study report illustrates the utility of these tools for collecting and organizing all pertinent data.     

A tabular summary of cluttering subjects in the special edition

Tables summarizing results of questionnaires, completed by authors, for each cluttering subject are presented. The first table summarizes symptoms and abnomalities manifested by the 29 clutterers. The second table summarizes the targets, procedures, and results of therapy for 15 of the clutterers for whom knowledge of therapy was available.     

Efficacy of delayed auditory feedback for treating cluttering: Two case studies

Two clutterers were treated with similar preplanned delayed auditory feedback (DAF) procedures, using probe samples in which the DAF was not present to measure treatment efficacy. Whereas both clients met established fluency criteria during treatment, both clutterers had difficulty transferring gains to probe sessions—one more than the other. Differences in results of DAF treatment are discussed from the perspectives of differences in cluttering severity, coexisting disorders, and supplementary clinical techniques.     

Cluttering: Data in search of understanding

Much of what is known about cluttering is the product of anecdotal clinical observations rather than findings from systematic empirical research. As a result, the credibility of much of this information is substantially compromised as is its diagnostic value. Current research efforts, unfortunately, continue to reflect many of these same weaknesses.