Dr David Ward of the University of Reading, co-editor of a new book on cluttering, argues for due attention to be given to this less well-known condition which can occur alongside stammering.
Consider the term "disorder of fluency" and for the majority of us that will mean we are pretty much exclusively thinking about, stammering. However, in the shadows lies a second more "obscure" disorder. Cluttering is an often misunderstood, and certainly under researched disorder, yet this condition should be of interest to those who stammer and those interested in the study of stammering because the two disorders commonly co-occur, and share certain characteristics. Knowledge of one disorder can help inform our understanding of the other.
Why is cluttering misunderstood? Firstly, while there has been much anecdotal evidence and speculation, there has been little in the way of well controlled research on the subject. This has led to problems; not least with definition. While there is considerable common ground as to key features of cluttering, there are currently differences of opinion amongst experts as to which further characteristics are core to its diagnosis, and which may be associated with the disorder, but more peripheral. The current working definition (St Louis & Shulte, 2011) is too lengthy to include here, but to summarise: cluttering can be recognised primarily as a speech output which sounds either overly rapid, too irregular or both. In addition, speech must be either be poorly articulated or contain an excessive number of "normal like" disfluencies such as ums, ers, restarts etc. There may also be unusually placed pauses. A commonly observed feature (though currently existing outside the working definition) is high level problems with language processing and language organisation. The general impression of cluttered speech is that of a fast, perhaps jerky, confused, muddled and disorganised speech output. Regardless of which features are present, speech intelligibility is inevitably compromised.
Cluttering and stammering
A complicating feature of cluttering is that it rarely occurs alone; appearing alongside attention deficit hyperactivity disorder, dyspraxia, dyslexia, autistic spectrum disorder and of particular relevance here, stammering. There are estimates that between 18%-50% of people who stammer also clutter (Daly 1986, 1993; Freund, 1952; Myers and St Louis, 1992; Preus, 1992). It is hard to verify the accuracy of these figures, but in my fluency clinic I commonly see children and adults referred for a stammer, but who on assessment are found to have more significant problems with a clutter, whose existence they were completely unaware of.
Here then lies an apparent paradox, and within it the second reason for cluttering's comparative obscurity. With notable exceptions, particularly amongst those who suffer more profoundly from the disorder, cluttering rarely has the same negative impact on a person's sense of self that a stammer so often can. Those who both stammer and clutter will recognise their stammering repetitions, prolongations and blocks as significant impediments to fluency but in the vast majority of cases the cluttering features are unlikely to be seen as pathological, or representing any sense of loss of control (though loss of control it is).
Whilst the person who clutters does not usually feel negatively impacted by his/her speech output, their life story often can be. From the listener's perspective, there is usually no sense that there is anything "wrong" as such, but conversational partners are usually impacted by cluttering more than the "sufferer" themselves. Very commonly, parents of children who clutter become frustrated at repeatedly failing to understand their son's or daughter's speech - trying, usually in vain, to get them to slow down. Adults who clutter are frequently referred not because they themselves are concerned, but via line managers because their perfectly competent staff are failing to secure jobs in middle and higher management due to their poor intelligibility. In addition to the core problems with being understood, those who clutter frequently present as being disorganised, rushed, and nervous - not welcome traits in either social or work place environments.
So what do we know about cluttering? Well as I have already suggested, not a great deal, although the formation of the International Cluttering Association in 2007 has given a substantial boost to public interest and proper scientific investigation, and this has lead to the beginnings of investigations involving such areas as genetics and brain studies. With the latter, there is some tentative evidence that (like stammering) subcortical regions may be implicated in the condition. Again like stammering, cluttering is predominantly a developmental disorder. The onset period is not well understood, nor is the way cluttering develops, but its recognisable onset is usually later than is the case with stammering which arises largely (though not exclusively) at the preschool stage. What is very likely, though, is that some young children who clutter may go undiagnosed; it may either be misdiagnosed as a language disorder, a speech disorder, or more likely not diagnosed at all. Fortunately, and as mentioned earlier, because of the common overlap between stammering and cluttering, many cluttering children are identified when receiving help for a stammer. Adults, too, appear in clinics having had treatment in their youth for stammering, but apparently not for cluttering, of which there is usually no mention in any previous notes.
Recovery from cluttering in pre-adolescent children is not fully understood, but like stammering, there seems to be no "cure" once it has persisted into adulthood. There is growing evidence that intervention can be effective with both children and adults, although severe cluttering can be resistant to therapy. While therapy will need to be flexible in order to address the specific concerns to each individual, common places to start, both with children and adults, involve helping the client develop awareness of the problem and motivating change in communication skills.
I would be pleased to hear from anyone who has any concerns or questions about cluttering or cluttering therapy: firstname.lastname@example.org.
For further information about cluttering visit the International Cluttering Association's website: www.associations.missouristate.edu/ICA/
Extended version of article from Spring 2011 Speaking Out, page 16
Daly, D.A. (1986) 'The clutterer', in K.O. St Louis (ed.) The atypical stutterer: principles and practices of rehabilitation, New York: Academic Press.
Freund, H. (1952) 'Studies in the interrelationship between stuttering and cluttering', Folia Phoniatrica, 4: 146-68.
Myers, F.L. and St. Louis, K.O. (1992) 'Cluttering: Issues and controversies', in F.L Myers and K.O. St. Louis (eds) Cluttering: A clinical perspective, Kibworth, Great Britain: Far Communications.
Preus, A. (1992) 'Cluttering or stuttering: Related, different or antagonistic disorders', in F.L Myers and K.O. St Louis (eds) Cluttering: A clinical perspective, Kibworth, Great Britain: Far Communications.
St Louis, K. and Schulte, K. (2011) 'Defining cluttering: The lowest common denominator', in Ward, D. and Scaler Scott, K. A hand book of cluttering: Research, Intervention and Education (pp233-253). Hove: Psychology Press