About the presenter: Christina Wilkerson is a second year graduate student in Communication Sciences & Disorders at Missouri State University with an interest in how cultural differences in Latin American countries affect awareness and/or knowledge of the fluency disorder cluttering and what if any social bias exists toward individuals who clutter.
About the presenter: Klaas Bakker, associated with Missouri State University since 1990; specializes in fluency disorders; research focus on fluency disorders (assessment and diagnostic evaluation of cluttering and stuttering); develops new technologies for the assessment and measurement of clinical aspects of speech (dys)fluency; Associate Editor for the Journal of Fluency Disorders; Chair of the Taskforce on Technology of Special Interest Division 4 (Fluency and Fluency Disorders).


Effects of Cultural Influences Upon Awareness of Cluttering: Latin American Countries

by Chris Wilkerson and Klaas Bakker
from Missouri, USA

The purpose of this paper is to speculate, based on available literature, how cultural variation may interact with the awareness of cluttering when considering North and South (or Latin) American countries. There is no generally accepted word for cluttering in Spanish, and perhaps this also means that literature on cluttering written in Spanish is limited because of the lack of a term for it. A lack of literature in turn predicts that awareness of this unique enigmatic speech fluency disorder may be affected as well. This paper provides a theoretical foundation to researching these possibilities. At the end of this paper discussion points are formulated that hopefully may engage individuals from both North and Central-South American countries to teach us more about the differential awareness of cluttering in their regions.

Online conferences generally create unique new opportunities for sharing information and engaging interested individuals. As a matter of speaking they create virtual meeting places, at low or no cost, while they have the potential to reach out to much larger and international audiences than would be possible with traditional conferences that are held in physical rather than virtual locations. This online conference creates the opportunity for interested individuals and specialists worldwide to engage in exchanges and sharing ideas about cluttering. As the topic of this paper is about international cultural variations, these interactions are particularly valuable.

We have only begun to understand how cultural variations may affect the incidence, severity, or specific perceived or factual characteristics of cluttering. One group researched cultural variations in public attitudes (St. Louis, Coskun, Ozdemir, Topbas, Goranova and Filatova, in press, a) and public awareness (St. Louis, Goranova, Georgieva, Coskun, Filatova, & McCaffrey, in press, b; St Louis & McCaffrey, 2005) with respect to cluttering and stuttering in four different countries: Bulgaria, Turkey, Russia and the USA. Overall the findings in these studies revealed remarkable similarity in attitudes and awareness of both cluttering and stuttering. The similarity in responses to the "Experimental version of Public Opinion Survey of Human Attributes" (POSHA) questionnaire was remarkable given the obvious cultural differences among the individuals from the participating countries. However, these countries did have in common that cluttering as a fluency disorder different than stuttering is acknowledged, that there is a word for it, as well as a presence of literature on the subject.

One might wonder if awareness and attitudes relative to the typical clinical signs of persons who clutter would also be the same in countries where there is no clear acknowledgment of the problem. In recent work on translations of information about cluttering to other languages on the website of the International Cluttering Association it became clear that there are languages that do not have a word for cluttering. And as a result one might wonder if the lack of this type of recognition, and probably a lack of literature about it, could affect cluttering, or persons who clutter themselves.

One language that does not have a word for cluttering is Spanish. Spanish is spoken in almost all of Central and South America (except for Brazil). This then provides a unique opportunity to research the effect on public attitudes and awareness of cluttering in the absence of a term for it.

International Cluttering Survey

To determine the degree of awareness at a professional level, the ICA surveyed committee members of the Committee of International Representatives informally about cluttering in their respective countries to gain a global picture of cluttering (Reichel & Bakker, 2009, p. 63). To accomplish this, Isabella Reichel, Chair of the Committee of International Representatives, distributed the International Cluttering Survey (ICS) to fellow committee members. There were nine questions of which the following three pertained to awareness. The first was designed to ascertain the level of awareness of cluttering in a general sense by speech therapists; the second was to determine if any training was provided to speech therapists for the identification, assessment and treatment of cluttering; and the third was whether each country's respective professional organizations have a definition for cluttering (Reichel & Bakker, 2009, pp 63-65). The authors summarized their findings as:

ICS results specific to Argentina, the only Hispanic country associated with the ICA at this time, indicated there was no definition for cluttering; and, although a representative of Argentina reported that some type of training was available for speech-therapists to learn how to treat cluttering, they also reported that speech therapists in their country were generally unaware of cluttering (Reichel & Bakker, 2009, pp. 63-64).

Responses by the Argentina representative on other ICS survey questions included the need for international collaborative research and better diagnosis and treatment procedures for cluttering as goals for international members of the International Cluttering Association. On the question about specific goals for their country, the Argentina representative did not provide suggestions specific to Argentina (Reichel & Bakker, 2009, p. 63).

Aside from Argentina, no other countries are represented in the ICA with Spanish as the primary language. This suggested that perhaps the awareness, knowledge and attitudes about cluttering could differ in these countries compared to other countries that acknowledge the presence of cluttering, at least to some degree. In other words, this presents a unique way to establish if there are interactions between cultural variations and aspects of cluttering or characteristics of persons who clutter.

Potential Effect of Cultural Influences

There is very little available literature on the subject of the effect of international cultural differences on communication disorders such as cluttering. According to Marshall (2000), there is ever increasing attention toward the effects of culture on the facets of daily life (p. 355). Therefore, in this author's opinion, determining culturally based goals would be an invaluable service to advance how best to educate and increase awareness of cluttering. Related to this, Battle (2002) stated, "...culture is the lens through which one perceives and interprets the world," and communication is the pivotal point upon which these attributes teeter and work to become balanced (p. 3). Communication defines a culture and is defined by the culture. A culture's nucleus is composed of and exposed through its explicit (e.g., observable features such as language and dress) and implicit (e.g., gender roles, values and perceptions) behaviors (p. 5).

"Definitions of health and illness differ among cultures. How a disability is viewed varies in such areas as perception of severity, impact on life, beliefs regarding etiology and preferences for treatment," and despite the incorporation of advances in science, medicine and technology, cultures throughout the world have continued to preserve traditional customs (as cited in Salas-Provance, Erickson, & Reed, 2002, p. 151).

To be aware of a communication disorder such as cluttering, one's culture must define within the bounds of its beliefs and values atypical communication in whatever modality communication occurs. Therefore, communication disorders must be considered in the context of the cultural aspects that constitute its makeup. Battle (2002) stated the presence or absence of proficiency in communication must be determined as an aspect of an individual's performance within the group. Atypical communication, once identified, is then subject to those same cultural beliefs and values as to what is accepted practice for treatment and the benefits of the treatment. Additionally, identification of and accepted practice for treatment of atypical communication disorders can be compounded by the level of cultural diversity actively present within a society and its ethnic influences (p. 4).

Battle (2002) contends a society that is multicultural in nature is "... characterized by a diversity of cultures with varieties of religions, language, customs, traditions, and values" (p. 5), and "ethnicity refers to a shared culture that forms the basis for a sense of peoplehood based on the consciousness of a common past" (p. 4). Thus, the complex nature inherent in the amalgamating of cultures and the extant of ethnicity can convolute the demarcation of atypical communication within one's culture.

Hispanic cultural variations

As in many cultures, awareness of cluttering and other communication disorders can potentially be hindered by cultural beliefs. Customarily, Hispanics consider their family to be their most esteemed asset. The family's welfare supersedes the welfare of the individual with the disability being considered as belonging to the family (as cited in Salas-Provance, Erickson, & Reed, 2002, p. 152). According to Langdon (2009), in Hispanic cultures, disabilities that do not present with visible physical characteristics are more difficult to accept and understand. In many instances, uncontrollable outside factors are believed to cause disabilities, which result in treatment being sought by curanderos (natural healers), rather than professionals. In some cases treatment is not sought due to acceptance of the disorder or the belief that the cause of the disorder was spiritual in nature (pp. 91-92).

Marshall (2000) stated, for children with speech and language difficulties, availability of treatment by speech therapists in non-western countries is restricted or provided by other individuals from a variety of professions or the individual's community (p. 355). Furquim (1998) reported that in Brazil provision of services for communication disorders did not occur in their elementary school system, but was provided for in universities, private practice or through the public healthcare system for those identified. In regards to stuttering, Furquim (1998) said, "We do not have any entity, governmental or private, that will give directions or will help the individual with fluency disorders" (p. 1). Not only is there no treatment provided, but in Brazil's culture, there is an intolerance of stuttering. Individuals have difficulty with employability and acceptance into colleges (p. 1). Yet, in Malaysia and Indonesia, stuttering and voice disorders, if not perceived as severe are accepted and services for treatment are not sought (Marshall, 2000, p. 363). Thus, it is intrinsically important to consider the influence culture plays on delineating a communication disorder for the identification and treatment both medically and socially of the disorder, especially one as shrouded as cluttering is in many cultures.

Peters-Johnson and Taylor (1986) said, "Societies may differ in their definition of what they consider abnormal communicative behaviour and how it should be treated. For this reason, it is unreasonable to impose the communicative standards of one society to determine 'normalacy' in another" (p. 158). Therefore, it is reasonable to suggest that the level of awareness of cluttering is strongly affected and influenced by a culture, its diversity and ethnicity.

Discussion Points

The aforementioned may make clear that there are good reasons why awareness, attitudes and acknowledgment of cluttering in Latin American countries may be affected by aspects unique to Hispanic culture. This is, of course, in need of empirical verification as cross cultural differences in awareness and attitudes were not observed by St Louis et al (in press, a & b) in countries where cluttering was at least to some degree established as a diagnostic entity, and that have a word for cluttering in the primary language.

Discussion point 1: Is it fair to conclude that cluttering, and associated awareness and attitudes, are determined by the presence or absence of a term for it in the primary language?

Discussion point 2: Is it possible that awareness of, and attitudes about, symptoms typical for cluttering differ in Hispanic cultures because of cultural differences alone?


Battle, D. E. (2002). Communication disorders in multicultural populations (Third ed.). Woburn, MA: Butterworth-Heinemann.

Furquim, C. R. (1998, September 8). Fluency and fluency disorders lab. Retrieved May 14, 2009, from http://www.mnsu.sdu/comdis/isad/papers/claudia.html

Langdon, H. W. (2009). Providing optimal special education services to Hispanic children and their families. Communication Disorders Quarterly, 30(2), 83-96. doi:10.1177/1525740108325430

Marshall, J. (2000). Critical reflections on the cultural influences in identification and habilitation of children with speech and language difficulties. International Journal of Disability, Development and Education, 47(4), 355-369. doi:10.1080/10349120020012672

Peters-Johnson, c. & Taylor, O. (1986). Speech, language and hearing disorders in black populations. In O. Taylor (Ed.), The nature of communication disorders in culturally and linguistically diverse populations (pp. 159-179). San Diego, CA: College Hill.

Reichel, I. K., & Bakker, K. (2009). Global landscape of cluttering. Perspectives on Fluency and Fluency Disorders, 19(2), 62-66.

Salas-Provance, M. B., Erickson, J. G., & Reed, J. (2002). Disabilities as viewed by four generations of one Hispanic family. American Journal of Speech-Language Pathology, 11, 151-162. doi:10.1044/1058-0360(2002/015)

St. Louis, Coskun, M., Ozdemir, Topbas, S., Goranova, E., and Filatova, Y., (in press, b). Public awareness of cluttering: USA, Bulgaria, Turkey, and Russia. In K. Bakker, L. J. Raphael & F. L. Myers (Eds.). Proceedings of the First World Conference on Cluttering (2007), Bansko, Bulgaria.

St. Louis, K. O., Goranova, E., Georgieva, D., Coskun, M., Filatova, Y., & McCaffrey, E. (in press, a). Public awareness of cluttering: USA, Bulgaria, Turkey, and Russia. In K. Bakker, L. J. Raphael & F. L. Myers (Eds.). Proceedings of the First World Conference on Cluttering (2007), Bansko, Bulgaria.

St. Louis, K. O., & McCaffrey, E. (2005). Public awareness of cluttering and stuttering: Preliminary results. Poster presented at the Annual Convention of the American Speech-Language-Hearing Association. San Diego, CA, November, 2005.


SUBMITTED: March 12, 2010

Return to the opening page of the conference