|About the presenter: John A. Tetnowski, Ph.D., CCC-SLP, holds the Ben Blanco/BoRSF Endowed Professorship in Communicative Disorders at the University of Louisiana at Lafayette. He is a Board Recognized Fluency Specialist and Mentor and was the NSA's Speech-Language Pathologist of the Year in 2006. He has authored nearly 50 publications relating to stuttering, assessment procedures, and research methodologies and has worked clinically with people with fluency disorders for over 20 years.|
To use a biblical reference, I was the ultimate "doubting Thomas" when it came to cluttering. I cannot count the number of times that someone referred a "clutterer" to me and I simply thought of them as just another "stutterer" who happened to have both a rapid rate and some type of concomitant language or learning disorder. After all, that is what the literature says. Surveys from 25 years ago (e.g. Blood and Seider, 1981 and St. Louis and Hinzman, 1988) say that a large percentage of people who stutter (PWS) will have some other speech, language or learning disorder. These studies actually indicate that almost 2/3 of people who stutter have some other concomitant speech, language, and/or learning disorder. More recent surveys seem to show a slightly lower but still high incidence of stuttering and concomitant disorders (Arndt and Healey, 2001). Quite honestly, when I used to receive a referral of a "possible clutterer", I used to think to myself "Here's another referral from someone who doesn't know how to treat stuttering and is just passing it off as something else".
With my early limited knowledge of cluttering, I felt justified in my thoughts. Many individuals that stutter do have rapid speaking rates along with concomitant language, speech, or learning disorders. But I could just not justify why they needed their own diagnostic category......that is until I finally saw the light.
Beginnings of change
From my background I knew all the major definitions if cluttering. It always did amaze me though of how vague these definitions were. From the definition of Weiss (1968) that described cluttering as "the verbal manifestation of central language imbalance" to the definition of Luchsinger and Arnold (1965) that described cluttering as "a disability to formulate language that results in confused, hurried (tachyphemia) and slurred speech that results from a congenital and inheritable syndrome". I really didn't know what cluttering was.... I could never seem to get a firm grasp on exactly what cluttering meant and what a person who clutters (PWC) really sounded like. I always thought that in spite of the diagnosis, we still need to treat the symptoms. If a person has a diagnosis of "cluttering" or "stuttering"; "What was the difference, as long as they received some gain from the intervention".
The momentum for change
The momentum for change came at my current job. One of my co-workers told me about all the clutterers that we had on the University caseload. I looked at them and started to see that they really weren't stuttering. They were nonfluent, but they weren't really stuttering. It was something else. One of my doctoral students, Kathy Scaler Scott asked if we could do a doctoral seminar on cluttering and this really opened the door to my understanding cluttering. We read almost all there was to read on cluttering (to see a copy of the syllabus, see Tetnowski and Douglass, in press), but we also began to investigate cluttering for ourselves. For example, in one of our studies, we found that the pauses and speech rate of cluttering were different from stuttering (Scaler Scott & Tetnowski, 2006). In a later study we found that many of the nonfluencies exhibited in cluttering were different from those found in stuttering (Scaler Scott, Grossman, & Tetnowski, 2006). The bottom line is that cluttering was its own entity.
The moment of realization
The true moment of realization came to me during the First World Congress on Cluttering, held in Katarino, Bulgaria. At that meeting, I met, talked to, and interviewed two people who were widely recognized as true clutterers. One of these individuals has made a sample of his speech available on this online conference and through the International Cluttering Association's Homepage (International Cluttering Association, 2010). I strongly suggest listening to his speech sample for a better understanding of cluttering. Please do note that his speech is somewhat rapid and irregular and that his nonfluencies are not typical stuttering-like disfluencies. This is the single most influential speaker that has allowed me to see what cluttering really sounds like. As a result of my conversations and study, I have finally come to terms with a valid definition of cluttering.
In my mind, we needed to find the most common factors that exist in all people who clutter. Some have language, learning, or literacy issues, however, that is not the common factor that ties all of these individuals together. The common factors are: 1) a significant amount of nonfluencies, many of which are not stuttering in nature, and 2) rapid and/or irregular speech. This rapid and or irregular speech does not always lie outside of speaking rate normative data.
The belief comes to fruition
After the many years of discovery, I realize that my belief is not alone. The definition provided by St. Louis, Myers, Bakker, and Raphael (2007) and defines cluttering as,
"...a fluency disorder characterized by a rate that is perceived to be abnormally rapid, irregular, or both for the speaker (although measured syllable rates may not exceed normal limits). These rate abnormalities further are manifest in one or more of the following symptoms: (a) an excessive number of disfluencies, the majority of which are not typical of people who stutter; (b) the frequent placement of pauses of prosodic patterns that do not conform to syntactic and semantic constraints; and (c) inappropriate (usually excessive) degrees of coarticulation among sounds, especially in multisyllabic words." (pp.299-300).
This definition is the basic terminology that defines cluttering. However, cluttering is so often misunderstood because its symptoms are often confused with concomitant disorders. Tetnowski (2007) has shown that many people who exhibit cluttered speech do indeed have many other concomitant disorders. However the definition of St. Louis et al. (2007) narrows cluttering down to its basic common features and can be the basis for understanding and defining cluttering. It is the basis of my belief that also limits confusion with other disorders.
In summary, I now believe that cluttering really does exist, however, I believe it must be defined by its most basic characteristics. In addition, cluttering may exist in isolation, but it is far more likely to exist with concomitant disorders. The following statements are the basis of my current beliefs about cluttering:
What I believe cluttering is:
What I believe cluttering is not:
I sincerely hope that my journey has helped you to understand this greatly misunderstood disorder!
Arndt, J. & Healey, E.C. (2001). Concomitant disorders in school-age children who stutter. Language, Speech and Hearing Services in Schools,, 32, 68-78.
Blood, G. & Seider, R. (1981). The concomitant problems of young stutterers. Journal of Speech and Hearing Research,, 46, 31-33.
International Cluttering Association Homepage (2010). http://associations.missouristate.edu/ICA/. Downloaded, April 1, 2010.
Luchsinger, R., & Arnold, G.E. (1965). Cluttering: Tachyphemia. In Voice-Speech-Language (Clinical communicology: Its physiology and pathology),. Belmont, CA: Wadsworth Publishing Company. >[? Scaler Scott, K., Grossman, H. G. & Tetnowski, J. A.(2007). Diagnosis of a single case of cluttering according to four different criteria. A poster presentation at the First World Congress on Cluttering, Katarino, Bulgaria.
Scaler Scott, K. & Tetnowski, J.A. (2006). Analysis of physical correlates of speech in Cluttering: A case study. Paper presented at the Annual Conference of the American Speech-Language-Hearing Association, Miami, Florida.
St. Louis, K.O., Myers, F.L., Bakker, K., & Raphael, L.J. (2007). Understanding and treating cluttering. In E.G. Conture and R.F. Curlee (Eds.), Stuttering and related disorders of fluency, (3rd ed.). New York: Thieme.
St. Louis, K.O., & Hinzman, A.R. (1988). A descriptive study of speech, language, and hearing characteristics in school-aged stutterers. Journal of Fluency Disorders,, 13, 331-355.
Tetnowski, J.A. (2007). Cluttering and concomitant disorders. Paper presented at the First World Conference on Cluttering, Katarino, Bulgaria.
Tetnowski, J.A. & Douglass, J.E. (in press). Cluttering in higher education. In D. Ward and K. Scaler Scott (Eds.), Cluttering: Research, Intervention, Education,. London: Psychology Press.
Weiss, D.A. (1968). Cluttering: Central language imbalance. Pediatric Clinics of North America, 15, 705-720.
SUBMITTED: April 5, 2010
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