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About the presenter: David A. Daly, Ed.D. (Penn State University) is an ASHA FELLOW and holds Specialty Certification in Fluency Disorders. David has worked as an SLP in the Michigan public schools, University of Alabama in Birmingham Medical School, and for 25 years as professor at the University of Michigan where he directed the Speech Clinic and Shady Trails Camp for stutterers. He has written three books on treating stutterers. In 2003, David received the Frank Kleffner Lifetime Clinical Service Award for his research and clinical contributions. Currently David operates a private practice specializing in stuttering and cluttering. |
Cluttering: Characteristics Identified as Diagnostically Significant by 60 Fluency Experts
by David Daly
CLUTTERING is very difficult to diagnose. Most clutterers speak very fast, are usually unaware of their disfluencies and misarticulations, show confused language, as well as motor coordination problems. Furthermore, many cluttering clients are difficult to treat, often resisting our best therapeutic efforts.
At the 2006 International Fluency Association Conference in Ireland the findings of an international study to determine which factors fluency experts from around the world use to identify cluttering problems in children and adults. were presented.
Sixty (60) fluency experts from around the world completed my 50-item questionnaire. First, they RATED the factors they felt most important for identifying cluttering (Almost Always, Frequently, Sometimes, Infrequently, or Almost Never). Second, they RANK ORDERED the top ten statements which they felt most accurately described cluttering. And third, the listed other features they thought the inventory omitted. The attached form shows the 33 items that the experts considered the most critical diagnostic signs.
Item 8. Telescopes or condenses words (omits/transposes sounds/syllables) was ranked the number 1 characteristic of cluttering by 93% of the experts. Item 27. Lack of effective, sufficient self-monitoring skills was rated number 2 (by 90%). Six additional items were rated important by 80% or more of the respondents.
The study revealed that good agreement on the importance of specific items for identifying and diagnosing cluttering was indeed possible. This was true despite the experts being educated and trained in different academic programs around the world. A new diagnostic tool of 33 items for identifying cluttering on a 7-point scale is proposed.
Our data suggest that the higher the score on this inventory, the higher the probability that the person is a clutterer. However, "Clutterers," that is, those clients with scores of 120 or more are quite rare. Typically, clients we have seen present with scores between 80 and 120. These scores we believe are indicative of a classification or diagnosis we call "Clutterer-Stutterer." One-third of stuttering clients typically show some signs of cluttering.
Cluttering clients often require additional treatment strategies. We have found that simply trying to get them to slow down was non-productive. However, activities to improve their speech coordination, speech intelligibility, and awareness were most helpful, along with activities to improve their related language difficulties and memory problems.
This new inventory will be published in the revision of my Source for Stuttering and Cluttering book, but until it is available I thought you might like to try it with your "atypical stutterers." Try treating some of the associated symptoms rather than their rapid rate alone. Please call or email me if you have questions: (248) 474-2244 or dadaly@umich.edu
July 10, 2007