This text-based course is a transcript of the live seminar, “Cluttering: Functional Treatment Techniques,” presented by Kathleen Scaler Scott, Ph.D., CCC-SLP, BRS-FD.
>> Kathleen Scaler Scott: Some of you may have listened to my prior presentation on SpeechPathology.com which related to some issues in cluttering, how to define cluttering, how to determine if your client actually is cluttering, and we will review some of the information necessary for us all to be on the same page for this presentation. Today’s presentation is focused more on actual treatment techniques that you can use with your clients of all ages. I am a researcher, but I am also a practicing clinician and have been for many years. Currently on my caseload, I have several cluttering clients and I have treated clients with cluttering who also have other speech and language issues, other diagnoses such as autism spectrum, ADHD, and also stuttering. I have treated a wide range of ages and want to share with you some of the strategies, techniques, and activities that I have found to be helpful with my clients.
Definition of Cluttering
When I am speaking of cluttering, I wanted to be clear of the definition that I am using for this. There has been a lot of confusion in the past about cluttering, its definition, and the thought behind whether cluttering is or is not a language disorder or whether it is a larger syndrome. Over the past several years, Dr. Ken St. Louis and some others in the field have been working on scaling down the definition of cluttering to something that they call their lowest common denominator definition. As researchers in the field have talked with adults with cluttering, we have found that although there may be things like language issues or ADHD type symptoms in many with cluttering, this is not true across the board. There are people who just present with the speech related cluttering symptoms that I will discuss today. This tells us that if we are seeing someone and want to talk about just the cluttering type symptoms, we need to focus just on the speech. For right now, because we are seeing that there are people out there who just have these cluttering type symptoms, we really do not have enough research to say cluttering also involves language or attention type symptoms. Right now, based upon the research that we have and the knowledge we have from speaking with individuals with cluttering, we need to focus only upon the symptoms of the cluttered speech. Then we would all be on the same page, and it would not get too confusing as to what might also be an autism spectrum disorder or learning disability.
Going by this lowest common denominator definition, I find it has been really straight forward in terms of determining whether or not my client is exhibiting cluttering symptoms, and how to manage those symptoms. In this definition, there are several things that must happen in order for your client to receive a diagnosis of cluttering. First, the client must have a perceived fast rate, rapid or irregular rate and that “perceived” is important. In the past, we had thought that a client needed to have a faster rate of speech than the typical speaker. In fact, when we have measured some clients with cluttering and their rate of speech, we found that it is not always faster than a typical speaker. Usually when you are listening to a client with cluttering you are hearing that they sound really rapid. It seems as if they are going quickly, and you may not understand what they are saying. Your perception may be that they are speaking faster than normal because they are not putting as many pauses in their speech or they are putting pauses in atypical places. They tend to get really fast, speaking very quickly, not putting in any pauses, and their intelligibility breaks down. Then they may change to something that is a little more typical and understandable, but then they get going quickly again. If you average out the normal rates of speech and the higher rates of speech, you may get someone who comes out as having a typical rate of speech. The good news for you in determining whether or not your client has cluttering is that you do not necessarily have to measure their rate of speech. You certainly can do this to give some objective data, but your diagnosis does not hinge upon that data. Your diagnosis hinges upon you and/or others (teachers, significant others, parents) saying that their rate of speech is really fast or it seems like sometimes they are really fast and sometimes they are not. They may have atypical rate of speech and this is about the perception. If your client fits these criteria of the perceived rapid and/or irregular rate of speech, then you can say the person has the potential for cluttering.