About the presenter: Emily Garnett, M.S., CF-SLP, received her master's degree in Speech Pathology from West Virginia University in August of 2009, where she completed her master's thesis on cluttering. Emily is currently completing her clinical fellowship in Charleston, WV, where she is employed by Genesis Rehabilitation Services in two assisted living facilities. After finishing her clinical fellowship, Emily plans to pursue a doctorate degree in communication disorders. Her clinical and research interests are in fluency, voice, and adult neurogenic communication disorders.
About the presenter: Kenneth St. Louis, Ph.D, professor at West Virginia University, is a mostly recovered stutterer. He has focused his entire career on fluency disorders with the primary goal of helping people who stutter. His work setting has been in higher education, where he has supervised graduate students doing therapy with stuttering and cluttering, taught courses in fluency disorders, and carried out research in stuttering and cluttering. St. Louis is a Board Recognized Specialist and Mentor in Fluency Disorders and author of Living With Stuttering: Stories, Resources, Basics, and Hope. He was awarded the first Deso Weiss Award for Excellence in Cluttering, which recognizes the international contribution of an individual to understanding about cluttering.


Differences in Hesitations between Clutterers and Non-Clutterers

by Emily Garnett and Kenneth O. St. Louis
from West Virginia, USA

Disfluencies exhibited by non-stutterers (and possibly clutterers), according to the Systematic Dysfluency Analysis (SDA) (Campbell & Hill, 1994), include hesitations, interjections, revisions, unfinished words, and phrase repetitions (St. Louis et al., 2003). These disfluencies are sometimes called normal disfluencies, in that they are also evident in the speech of persons without fluency disorders, but may still detract from the overall flow of speech. One general symptom of cluttering according to St. Louis and colleagues (St. Louis, Myers, Bakker, & Raphael, 2007; St. Louis & Schulte, in press) is abnormal pauses, which contributes to what they refer to as an "irregular" rate. Irregular rate is variable and choppy, filled with abnormally placed pauses that are possibly due to attempting to plan a coherent utterance.

Many previous authors (e.g., Bakker, Myers, Raphael, & St. Louis, in press; Myers & St. Louis, 1996; Van Zaalen, Wijnen, & DeJonckere, 2009; Ward, 2006) have been interested in the different types of disfluencies exhibited by clutterers and how they differ from non-clutterers. Using the SDA, some of these authors have found differences in clutterers, especially for interjections and revisions, but not hesitations (Myers & St. Louis, 1996; Bakker et al., in press). In a companion article in this conference regarding time estimation (Garnett & St. Louis, 2010), I (first author), took several steps to assure that individuals in the cluttering group were in fact clutterers, and many tests to differentiate them from normal speakers were performed. For example, the subjects were required to provide a conversation sample consisting of answering open-ended questions such as "Tell me about your family." I conducted separate disfluency analyses on the first 420 syllables of the conversation samples and included eight disfluency categories: interjections, revisions, unfinished words, prolongations, phrase repetitions, word repetitions, syllable repetitions, and hesitations. I found that clutterers had significantly more hesitations (81 total) than controls (12 total). The 81 hesitations accounted for nearly one-third of the total number of disfluencies (279) exhibited by clutterers as shown in Figure 1.

Figure 1. Frequency of disfluencies of six clutterers and six matched normal speakers according to type of disfluency.

These data are somewhat at odds with previous and other reports (Myers & St. Louis, 1996; Bakker et al, in press; Myers, St. Louis, Bakker, Raphael & Frangis, 2004) wherein, using SDA procedures, clutterers were observed to be very similar to controls and to non-cluttering but excessively rapid speakers. Moreover, all three groups had much higher levels of interjections and revisions than for any of the other disfluency categories; i.e., unfinished words, phrase repetitions, word repetitions, syllable repetitions, sound repetitions, or prolongations. Interestingly, hesitations were virtually absent from all three groups, perhaps related to criteria listed in the SDA guidelines as a pause of one second or greater.

The SDA definition requires the hesitation to last for at least one second. I did not use this strict requirement. Instead, since I wanted to capture the essence of irregularity of speech, in this study, I regarded a hesitation as any interruption in their speech that I did not consider to be a pause of any type. Sometimes hesitations occurred for what I thought might have been word finding difficulties. Importantly, hesitations were not simply empty pauses. Context indicated subjectively that the person was attempting to think of or searching for a word. Sometimes the hesitations occurred immediately before a short revision (as when revising the initial sound of a word from incorrect to correct). In short, hesitations were any interruptions (not necessarily silent) that were not pauses.

This difference in definition is likely what explained the statistical differences in hesitations in my study. So what could this difference mean if found by other researchers as well? Hesitations, depending on their length, could significantly detract from the perception that the speaker providing a "clear message." Moreover, hesitations also detract from to the overall flow of speech. Often clutterers put these hesitations in odd places. If you consider your own speech, you might hesitate if you were trying to remember someone's name. That would be a more appropriate place for a hesitation. Clutterers, however, may hesitate just before saying a "routine" word such as "his" by initially beginning to say "my" and then slightly pausing, and changing it to "his" (for example in the sentence "Muh... (hesitation) — His lunch looks delicious.").

Others have attempted to replicate these results, but without consistent definitions, have concluded that reliability of hesitation frequencies might be suspect. Future research may be carried out to address this issue directly (Klaas Bakker, Florence Myers, and Lawrence Raphael, personal communication, October 26, 2009). In the meantime, we offer the hypothesis that hesitations, defined in a way similar to that used in this study, offers a promising window within which to better understand the irregularity of rate in the speech of clutterers.



Bakker, K., Raphael, L. J., Myers, F. L., & St. Louis, K. O. (in press). A preliminary comparison of speech rate, self evaluation, and disfluency of people who speak exceptionally fast, clutter, or speak normally. In D. Ward & K. S. Scott (Eds.) Cluttering: Research, intervention, education. East Sussex, UK: Psychology Press.

Campbell, J. G., & Hill, D. G. (1994). Systematic Dysfluency Analysis. Evanston, IL: Northwestern University.

Garnett, E. O., & St. Louis, K. O., (2010). Hesitations in cluttered speech. Paper presented at the 1st Online Conference on Cluttering. (April, 2010), (http://www.mnsu.edu/comdis/ica1/papers/garnett2c.html)

Myers, F. L., & St. Louis, K. O. (1996). Two youths who clutter, but is that the only similarity? Research and opinion on cluttering: State of the Art and Science. Journal of Fluency Disorders, 21, 297-304.

Myers, F. L., St. Louis, K. O., Bakker, K., Raphael, L. J., & Frangis, G. (2004). Disfluencies of cluttered and excessively rapid speech. Poster presented at the Annual Convention of the American Speech-Language-Hearing Association. Philadelphia, PA.

St. Louis, K. O., Myers, F. M., 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.

St. Louis, K. O., Raphael, L. J., Myers, F. L., & Bakker, K. (2003, November). Cluttering updated. The Asha Leader, 8(21), 4-5, 20-23.

St. Louis, K. O., & Schulte, K. (in press). Defining cluttering: The lowest common denominator. In D. Ward & K. S. Scott (Eds.) Cluttering: Research, intervention, education. East Sussex, UK: Psychology Press.

Van Zaalen-Op't Hof , Y, Wijnen, F., & DeJonckere, P. H. (2009). Differential diagnostic characteristics between cluttering and stuttering, Part one. Journal of Fluency Disorders, 34, 137-154.

Ward, D. (2006). Stuttering and cluttering: Frameworks for understanding and treatment. East Sussex, UK: Psychology Press.


SUBMITTED: March 15, 2010

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