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This article presents a variety of treatment approaches based on an understanding of four components of communication, and describes cluttering intervention focusing on problem identification, speech rate reduction, appropriate pausing, appropriate monitoring, and addressing story narrating skills. Therapeutic considerations, taking into account the specific characteristics of cluttering, will also be presented. Finally, building clients' confidence, emotional skills, and sense of accomplishment will turn the therapeutic process into awareness of realistic expectations and motivation to pursue challenging goals.
Cluttering Treatment: Theoretical Considerations and
Intervention Planning
Yvonne van Zaalen
Institute of Applied Sciences, Fontys University
Eindhoven, the Netherlands
Isabella K. Reichel
Program in Speech and Language Pathology, Touro College
New York City, NY
Financial Disclosure: Yvonne van Zaaeln is an Associate Professor at Fontys University.
Isabella K. Reichel is an Associate Professor at Touro College.
Nonfinancial Disclosure: Yvonne van Zaalen has no nonfinancial interests related to the content of
this article. Isabella K. Reichel has no nonfinancial interests related to the content of this article.
This article presents a variety of treatment approaches based on an understanding of four
components of communication, and describes cluttering intervention focusing on problem
identification, speech rate reduction, appropriate pausing, appropriate monitoring, and
addressing story narrating skills. Therapeutic considerations, taking into account the
specific characteristics of cluttering, will also be presented. Finally, building clients
confidence, emotional skills, and sense of accomplishment will turn the therapeutic process
into awareness of realistic expectations and motivation to pursue challenging goals.
Cluttering is a disorder of speech fluency in which people are not capable of adequately
adjusting their speech rate to the syntactical or phonological demands of the moment (van Zaalen,
2009). When language production is relatively easy, people with cluttering (PWC) are capable of
producing fluent and intelligible speech. When language production demands are more complex,
the speech rate should be adjusted to the language complexity. PWC tend to have difficulties doing
so. This reduced ability of PWC to control their speech rate results in either a higher than normal
frequency of disfluencies or multiple speech errors. This article presents various intervention
approaches based on an understanding of four components of communication: cognitive, emotional,
verbal-motor, and communicative. The article focuses on problem identification, speech rate
reduction, appropriate pausing, and addressing monitoring and story narrating skills. Therapeutic
considerations, taking into account the specific characteristics of cluttering, will also be presented.
Speech Rate
The speech rate is influenced by two components: speech execution and pauses. Syllable
duration normally is rather consistent, while pause duration varies to a great extent between
speakers. Daly (1992) observed significant improvements in clients with cluttering when a
synergistic and multi-dimensional perspective in treatment was implemented. Myers and Bradley
(1992) introduced a widely followed synergistic perspective in treating clients with cluttering. This
perspective integrates different approaches in treating PWC who manifest various symptoms. It
may be noted that these symptoms interact, and affect each other in a variety of ways. Addressing
multifaceted interactions of these symptoms can be very challenging.
Subtyping of Cluttering
Differences in symptoms of cluttering led researchers to identify various subtypes of
cluttering, such as dysarthric, dysrhythmic, dysphasic, motor, and linguistic (Damsté, 1990;
Ward, 2006). van Zaalen (2009) described two types of cluttering: syntactic and phonological.
Similarly Reichels Brief Cluttering and Stuttering Questionnaire (BCSQ) sought to identify the
same types of cluttering based on clientsresponses to a question: What interferes more with
your communication? Planning and formulating thoughts or fast and unclear speech?(Exum,
Absalon, Smith, & Reichel, 2010). Difficulties in planning and formulating thoughts would indicate
phonological cluttering, while fast and unclear speech would indicate syntactic cluttering. We will
now describe how these two types of cluttering can be differentiated.
Syntactic Cluttering. Syntactic cluttering refers to problems in grammatical encoding
and word retrieval at a fast speech rate. Such symptoms occur more frequently in linguistically
complex situations. The problems are manifested by normal disfluencies, such as word and
phrase repetitions, interjections, hesitations, and revisions (van Zaalen, 2009).
Phonological Cluttering. Phonological cluttering, according to van Zaalen (2009), refers to
problems in phonological encoding and is characterized by word structure errors (e.g., coarticulation,
telescoping, or syllable sequencing errors) at a fast speech rate, especially in multisyllabic words.
Similarly to syntactic cluttering, symptoms of phonological cluttering occur more frequently in
linguistically complex speaking situations. For a discussion as to how such subtyping can assist
in the treatment of cluttering, see van Zaalen and Reichel, in press).
Four Components of Communication
The four component model of Stourneras (in Bezemer, Bouwen, & Winkelman, 2006)
explores the interaction of different communication components in cluttering: cognitive, emotional,
verbal-motor, and communicative. Clinicians who work with PWC may use this model to improve
the performance of their clients in all four components of communication (van Zaalen & Winkelman,
2014; van Zaalen & Reichel, in press).
Cognitive Component in Cluttering Therapy
PWC often feel misunderstood and incompetent. Negative thoughts and feelings of PWC
are not as deep as such thoughts and feelings in people with stuttering, but they contribute to
doubts about the future, uncertainty about treatment, low self-esteem, and motivation (Daly,
1993, 1986; Reichel, 2010). While practicing a different manner of speech, most PWC will not feel
comfortable, in the beginning. Their speech does not feel naturalto them. A clinician should
be aware of such clientscognitions and negative self-appraisal. The clinician should play back
segments of the clients speech, using audio and video recordings in order to demonstrate to the
client that the new speech pattern is much more intelligible.
Emotional Component in Cluttering Therapy
PWC may respond to their failure to speak clearly and to be understood by experiencing
anxiety and frustration (Dalton & Hardcastle, 1993), nervousness, sadness, and low self-esteem
(Reichel, 2010). Daly (1993, 1986) proposed a combination of cognitive training, counselling,
attitude changes, relaxation, affirmation training, and positive self-talk in working with PWC.
Reichel (2010) adapted Bar-Ons (2000) emotional intelligence (EI) competencies for the use of
clinicians who work with clients with a predominance of cluttering-like symptoms. The five EI
competencies are: (1) Emotional self-awareness, (2) Impulse control, (3) Reality testing, (4) Empathy,
and (5) Interpersonal relationships. The focus on such emotional competencies can help in
improving awareness of emotions and communication behaviors, facilitating the ability to
manage emotions for self-control, cognitively processing emotions, assessing events realistically,
considering the emotions of listeners, and increasing the ability of PWC to improve responsibility
for meeting expectations of others (Reichel & Draguns, 2011).
Verbal-Motor Component in Cluttering Therapy
In most cases, it is possible to address the fast articulatory rate by slowing down the
speech rate with syllable tapping. Such work on speech rate reduction needs to be performed in a
carefully structured manner, with both auditory and visual feedback. In addition to moderating
or tempering the speech rate, the clinician should consider the degree of motoric and linguistic
complexity involved in the speaking task, in order to facilitate better cohesiveness or synergy of
speech and language output (Myers, 2011). PWC are able to make all verbal-motor movements
adequately, but not when the speech rate is fast. They have a problem in the planning and not just
in the execution of oral-motor movements (e.g., jaw movements). It is important to address the
verbal-motor skills at the word level. Priority is given to working on correct sequencing of syllables,
especially in multisyllabic words at a fast speech rate. The next step is to practice such skills at
the sentence level and later in spontaneous speech.
Communicative Component in Cluttering Therapy
The literature on cluttering describes many of the stigmatizing characteristics of PWC, such
as not being interested in communication, not being a good listener, and exhibiting behavior that
is aggressive, expansive, explosive, extroverted, impulsive, uncontrolled, and/or hasty (Freund,
1966; Weiss, 1964). The abnormal communication skills of PWC such as poor listening, abnormal
turn-taking and verbosity and impulsivity, need to be addressed by clinicians who work with PWC.
A period of frequent and direct feedback from the environment (e.g., family members, colleagues)
can contribute to an increase in speech awareness. Partner-focused communication (adjusting the
message to the listener) is a skill which needs to be facilitated in PWC as one of the most important
goals of the clinical process (van Zaalen & Reichel, in press).
Treatment Planning
Phase I: Identification
Cluttering therapy always starts with identification, making the PWC aware of symptoms
at the time they occur. During the identification phase, social exchanges are encouraged by asking
clients to modify their communication patterns during the diagnostic and therapeutic exercises.
Listening to clientsown recordings is a very effective home assignment.
Phase II: Speech Rate Reduction: Syllable Tapping and Audio-visual Feedback Training
After clients become aware of their speech symptoms, articulatory rate reduction can be
initiated to improve fluency and intelligibility. Two particularly effective ways of slowing down the
articulatory rate are syllable tapping and audio-visual feedback training (AVF-training; van Zaalen,
2014, van Zaalen & Reichel, in press). With both approaches, the clients syllable and rate awareness
are facilitated. Once syllable awareness is achieved at different levels of linguistic complexity, the
clinician may use AVF-training to work on rate, rhythm, pauses, and prosody. PWC are trained
to spell out every syllable, and to make adequate pauses or focus on prosody. Reducing the
articulatory rate has a positive effect on all communication related parameters.
Speech Rate Reduction: A Conscious Decision.PWC are not able to adjust their
speech rate appropriately in order to accommodate language complexity. Although clients can be
taught how to slow down their speech rate, it takes a significant amount of attention capacity to
achieve this objective. Therefore, most clients are not able to automatize speech rate reduction.
An attempt to do so requires a conscious decision and resolve, almost like deciding to learn
a second language. A distraction of any kind can interfere with clientsattempts to use their
technique, to the point where another conscious commitment must be made in order to start
working on the speech rate again. Clinicians should aim for the highest articulatory rate
(+/0.5 syllables per second) at which the client is still fluent and intelligible.
Appropriate Pausing. Pauses in speech are of tremendous importance, both in the
production and understanding of speech. In order to be capable of monitoring speech at the
sentence level, a speaker needs sufficient pause time between sentences. Pauses between sentences
allow for normal breathing patterns. Appropriate pausing provides adequate time to plan the
structure of a new speech plan. Pauses are also needed for listenersunderstanding of speech. If
the pause is too long, listeners can get the impression that the speaker stopped talking; when
pauses are too short, listeners may not have enough time to process what was just told to them.
Pause duration is correlated to speech rate; the faster the speech rate, the shorter the pause
duration. Normal pausing between sentences is usually an indication of a normal speech rate. A
normal pause has a duration of 0.51.0 second in most languages. Pause duration between sentences
is usually equal to pause duration between speakers (turn-taking behavior).
Phase III: Monitoring
Development of an internal feedback loop during conversation is essential for PWC in
order to detect moments of fast and/or variable articulatory rate, disfluency, or poor intelligibility.
The internal feedback loop consists of the elements of self-observation, self- judgment, and
self-correction. Regular recordings of conversations in daily life are made, listened to, and analyzed
in order to develop this internal feedback loop.
Phase IV: Narrative Skills
Speech output control in a secure environment is relatively easy. Adequate narrative skills
are necessary in order to communicate at different levels of language complexity within the fast
rate of human communication. Telling PWC to take time to formulate your thoughts before you
talkin running speech does not work. Exercises in formulation of thoughts can help to improve
the skills so that correct wording is ready in less time. Focusing on speech planning is helpful
rather than focusing on language planning alone.
Therapeutic Considerations
The therapeutic considerations for treatment of cluttering include the following:
It is important for the client to practice daily, beginning on the first day of therapy. It
is also crucial that the amount of exercise each day should be tailored to the symptoms,
skill level, and needs of each individual client.
Treatment plans for cluttering should each start with identification exercises. After the
identification exercises, the clinician should discuss exercises that improve the clients
speech, memory, and attention skills.
As soon as the client is aware of the speech difficulties, it is essential to praise and
reinforce the client every time a goal is achieved. The sense of success and of mutual
journey will bring hope, pride, and courage to attempt to overcome the remaining
symptoms of cluttering (Reichel, 2010).
A Speech Situation Checklist (Brutten & Shoemaker, 1974) adjusted for PWC can be
used to plan a hierarchy for practicing in various conversational situations. Exercises
will be implemented first in the situations that are known to pose little difficulty
(van Zaalen & Reichel, in press).
In order for cluttering intervention to be successful, planning an intensive program of
therapy is recommended. Self-monitoring skills take time to develop and are acquired
with intensive practice (Bennett Lanouette, 2011).
The short-term results of cluttering treatment are influenced by two main components:
a positive impact on speech behavior and a positive impact on cognitions and
emotions. Speaking clearly is particularly beneficial for PWC, even if it is only in a few
conversational settings (Miyamoto, 2011).
When cluttering is accompanied by stuttering in adults, the specific symptoms of
cluttering need to be prioritized unless people have anxiety or fear of speech secondary
to stuttering. St. Louis, Raphael, and Myers (2003) and van Zaalen and Winkelman
(2009) suggest using fluency enhancing techniques for working with clients who have
both cluttering and stuttering.
In children with a combination of cluttering and stuttering, it is better to start therapy
with stuttering modification approach because this is consistent with what children
expect to address in therapy and thereby helps to establish the needed client-clinician
rapport. After a couple of sessions, the clinician can let the child know that, at this
point, cluttering symptoms should be addressed as well.
This article has set forth a program of cluttering therapy, taking into consideration
cluttering subtyping and four components of communication. The present treatment planning
includes problem identification, speech rate reduction, appropriate pausing, monitoring and
focusing on story narrating skills. Therapeutic considerations take into account the specific
characteristics of cluttering, and explain the reasons for frequent and short home exercises.
Training PWC in self-awareness is of the highest priority. The acquired pattern of speech should
become the clients habitual way of talking, which should become automatic and effortless.
Finally, building clientsconfidence, emotional skills, and sense of accomplishment will turn the
therapeutic process into awareness of realistic expectations, motivation to pursue challenging
goals and, very importantly for every human beingthe joy of successful communication.
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... The main characteristics of cluttering are increased speech rate and excessive disfluencies (2,6,7,8,9,10) . Fast speech was reported both by studies that assessed speech rate (8,9) and compared it with normative standard (11) , as well as by reports of the own adults who clutter (1) . ...
... One of the most important goals in the cluttering treatment is to reduce the speech rate (10,12,13) and to reduce the excess of common disfluencies (12,13) . It is worth mentioning that the goal of reducing speech rate is also indicated to improve the broad spectrum of cluttering clinical manifestations (13) . ...
... A central aspect of cluttering therapy is speech monitoring (4,10,12) , which provides control of speech rate. In order to obtain this domain of oral production, the speaker uses auditory feedback (14) , which also assists in the maintenance of speech fluency (15) . ...
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Introduction Auditory feedback changes, in general, provide the increase of the speech fluency of people who stutter, but few studies have investigated the effects on speech of people who clutter. Purpose: To compare the speech rate and frequency of speech disruption in spontaneous speech and reading of adults with and without cluttering, with two different auditory feedbacks. Methods Participants were 16 adults, divided into two groups: Research Group (G1) composed by eight cluttering adults; Control Group (G2), composed by 8 fluent adults, paired by age and gender to participants of G1. The participants of G1 should present at least 10% of common disfluencies, and speech rate higher than the standards expected for age and gender. The procedures used were audiology assessment and fluency evaluation (spontaneous speech and reading) in two listening conditions, with Non-Altered Auditory Feedback (NAF) and after with Delayed Auditory Feedback (DAF). Results DAF caused reduction of flow of syllables per minute and frequency of common disfluencies in G1 during spontaneous speech task. In reading, there was a decrease in speech disruption and flow of syllables per minute, in G2, influenced by the effect of DAF. Conclusion The delayed auditory feedback effect in adults who clutter was positive in spontaneous speech due the reduction of speech rate and common disfluencies that are the main manifestations of this disorder.
... HBK sıklıkla kekemelik ile birlikte görülüyor olsa da salt HBK ve kekemeliğin eşlik ettiği HBK terapi şekilleri açısında da farklı uygulamaları gerektirmektedir (Langevin & Boberg, 1996). İki akıcılık probleminin birlikte görüldüğü durumlarda birincil hedef kekemelik semptomlarıdır (van Zaalen & Reichel, 2014). Langevin ve Boberg (1996)'nın kekemelik ve HBK semptomlarını bir arada sergileyen katılımcılar ile Boberg ve Kully (1985) tarafından geliştirilen 'Comprehensive Stuttering Programı' nın etkililiğine yönelik çalışmalarında; kekemelik terapisinin farklı bağlamlarda konuşma hızı üzerindeki kontrolü artırdığı bildirilmiştir (Langevin & Boberg, 1996). ...
... Genelleme yaparken HBK'si olan kişilerin sohbet aşamasında zorlanacakları unutulmamalıdır. Çünkü karmaşık ifadelerde sesletim hızlarını nasıl yavaşlatacaklarını bilseler bile bunu sohbete aktarmak oldukça dikkat isteyen bir durumdur (van Zaalen & Reichel, 2014). ...
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Amaç: Bu çalışmada dil ve konuşma bozuklukları alanında yer alan ve akıcılık bozuklukları şemsiyesi altında bulunan HBK’nin tanımı, kapsamı, özellikleri, değerlendirilmesi ve terapisindeki güncel bilgilerin sentezlenmesi amaçlanmıştır. Böylece klinik ve araştırma alanında HBK’ye dikkat çekilmesi sağlanacaktır. Yöntem: Bu çalışmada geleneksel derleme yöntemi kullanılmıştır. İnceleme kapsamında; HBK’de görülen konuşma akıcısızlıkları, dilsel-motor özellikler, etiyoloji, eşlik eden bozukluklar, HBK’nin değerlendirilmesi ve terapisine ilişkin alanyazın incelemesi gerçekleştirilmiştir. Bulgular: Yapılan incelemeler sonucunda, HBK’de konuşma hızının ötesinde akıcısızlık özellikleri, dil ve iletişim gibi diğer becerilerin de etkilendiği görülmüştür. Bunun yanı sıra HBK’nin diğer dil ve konuşma bozukluklarına ek olarak da görülebildiği, nadiren izole olarak görüldüğüne dair bulgular olduğu; HBK’nin etiyolojsi ile ilgili birçok farklı görüş ileri sürülmüş olup bunlarla birlikte bozukluğun nörolojik ve genetik temellerinin bulunduğuna dair pek çok kanıt temeli olduğu da görülmüştür. HBK’si olan bireylerde çeşitli becerilerde meydana gelen etkilenmelerin, bu bozukluğun çalışılması zor alanlardan biri olmasına neden olabildiği belirlenmiştir. Bu nedenle ayrıcı tanı içeren bir değerlendirmenin yapılması, terapi hedeflerini belirlemeye de yardımcıdır. Sonuç: HBK değerlendirmelerinde; konuşma hızının yanı sıra konuşmadaki akıcısızlık özellikleri, dil ve sesletim becerileri, dinleme ve anlatım becerileri, sözel olmayan iletişim becerileri, motor koordinasyon, işitsel ve görsel algı, bilişsel ve entelektüel beceriler, farkındalık ve kendini izleme gibi çok çeşitli becerilerin incelenmesi önerilmektedir. Birçok alanı etkilemesi nedeni ile çalışılması zor bir bozukluk olan HBK’de terapi genel olarak tanımlama, farkındalık, hız sesletim-dil becerilerinin çalışılması ve izleme-takip aşamalarından oluşmaktadır. Bunlarla birlikte, HBK ‘kimsesiz çocuk’ benzetmesi ile anılmaktadır. Çünkü hem dil ve konuşma terapisi alanında hem de bozukluğu yaşayan bireyler arasında HBK’ye ilişkin farkındalığın oldukça düşük olduğu belirtilmektedir. Anahtar Sözcükler: akıcılık bozuklukları, akıcısız konuşma, akıcısızlık tipleri, hızlı bozuk konuşma, konuşma anlaşılırlığı
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Purpose This case study is presented to inform the reader of potential speech, language, cognitive, and emotional characteristics in preadolescent cluttering. Method This case study describes a 10-year-old boy who started to clutter during preadolescence. The case illustrates that, in some adolescents, cluttering can co-occur with temporary stuttering-like behavior. In this case, signs of disturbances in speech-language production associated with behavioral impulsiveness as a young child were noted. Speech, language, cognitive, and emotional results of the case are reported in detail. Results The changes in fluency development are reported and discussed within the context of changes in the adolescent brain as well as adolescent cognitive and emotional development. While being unaware of their speech condition before adolescence, during preadolescence, the changes in brain organization lead to an increase in rate and a decrease in speech control. Given that the client had limited understanding of what was occurring, they were at risk of developing negative communication attitudes. Speech-language therapists are strongly advised to monitor children with cluttering signals in the early years of their adolescence. Supplemental Material
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BACKGROUND: This integrative review is of two literatures on cluttering treatments. It integrates into those two reviews a third literature to show an alternative way for cluttering to be treated in the future. OBJECTIVE: The aim is to encourage professionals involved in treating those who clutter to reflect on how conceptual frameworks can affect their treatment choices. METHODS: Works from three literatures on interventions are examined. Literatures covering two historic periods of cluttering treatments are compared to one another and to a third literature that offers an alternative framework for working with those who clutter. RESULTS: Treatment approaches to cluttering have almost universally focused on remediating impairments associated with the disorder. This impairment focus flows from a medical model –a model that views cluttering as a disease, located in the person, in need of remediation. An alternative framework, called the social model, one that focuses on the social conditions surrounding cluttering, is reviewed for its applicability to cluttering therapy. CONCLUSIONS: The medical model, used by authors since cluttering first appeared in the literature, carries within it assumptions about the selection and sequencing of clinical goals aimed at reducing cluttering symptoms. The social model alternative would likely shift the focus to working on ways for promoting the life participation of those who clutter. The applicability of social model practices to the treatment of cluttering is explored and encouraged.
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Purpose Among the best strategies to address inadequate speech monitoring skills and other parameters of communication in people with cluttering (PWC) is the relatively new but very promising auditory–visual feedback (AVF) training (van Zaalen & Reichel, 2015). This study examines the effects of AVF training on articulatory accuracy, pause duration, frequency, and type of disfluencies of PWC, as well as on the emotional and cognitive aspects that may be present in clients with this communication disorder (Reichel, 2010; van Zaalen & Reichel, 2015). Methods In this study, 12 male adolescents and adults—6 with phonological and 6 with syntactic cluttering—were provided with weekly AVF training for 12 weeks, with a 3-month follow-up. Data was gathered on baseline (T0), Week 6 (T1), Week 12 (T2), and after follow-up (T3). Spontaneous speech was recorded and analyzed by using digital audio-recording and speech analysis software known as Praat (Boersma & Weenink, 2017). Results The results of this study indicated that PWC demonstrated significant improvements in articulatory rate measurements and in pause duration following the AVF training. In addition, the PWC in the study reported positive effects on their ability to retell a story and to speak in more complete sentences. PWC felt better about formulating their ideas and were more satisfied with their interactions with people around them. Conclusions The AVF training was found to be an effective approach for improving monitoring skills of PWC with both quantitative and qualitative benefits in the behavioral, cognitive, emotional, and social domains of communication.
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Introduction It is expected that the quality of the working alliance between SLPs and persons who clutter matters. The term ‘working alliance’ is an important concept in cluttering and stuttering treatment and can be described as the degree to which the therapy dyad is engaged in collaborative, purposive work. The concept includes, among other factors, a shared understanding of therapy goals, and the relevance of the therapy approach to achieving those goals. There has been an increasing interest regarding research that supports the therapeutic relationship as an evidence-based component of interventions in speech-language pathology, and recent research (Sønsterud et al., 2019) support that a critical element for successful stuttering therapy lies, among other factors, in the concept of the working alliance. Purpose Although there is consensus that SLPs should openly and honestly discuss the individual’s goals and expectations for therapy, personal motivation and the impact of the working alliance for people who clutter has not been investigated. This paper highlights the importance of open and honest discussion around not only the individual’s goals for treatment, but also the tasks or activities to be incorporated in that treatment. Relevant and specific quantitative and qualitative assessments for measuring the working alliance are required to investigate the concept of the working-alliance in more detail. The Working Alliance Inventory - Short Revised version (WAI-SR) is regarded to be one useful tool to evaluate this client-clinician relationship. WAI-SR is quick and easy to use and explores the working alliance across the three processes of bond, goal and task. Conclusion This paper contains no research results. Anyhow, some considerations on this concept, both from a person who clutters and SLP perspectives, are included in this paper. Research is required to investigate whether shared understanding of treatments goals, agreement on tasks, and a respectful and trustful bond may become important predictors for successful therapy outcome also for people who clutter.
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Purpose This article presents a collaborative initiative of members of the Committee of the International Representatives of the International Cluttering Association (ICA) upon celebrating the 10th anniversary of the ICA. Such collaborative efforts are designed to improve communication skills, enlighten lives of people with cluttering, and serve as models for speech therapists and other health care professionals in countries around the globe. Method This initiative began with a seminar at the Inaugural Joint World Congress in Japan in 2018 and continues with an article for this special issue on cluttering based on the contents of the papers presented at the Congress. Sixteen researchers and speech therapists from 15 countries in Africa, Asia, Europe (East and West), America (North and South), and the Middle East have explored the following themes related to cluttering: cluttering awareness, research, professional preparation, intervention, and self-help groups. Results This article adds to the body of international literature on cluttering and illustrates that, for the past 10 years, hypothesis-testing research in cluttering continues to be conducted across language barriers and national boundaries, and interventions that are implemented in some locales are being tested and taught in other parts of the world; furthermore, new cluttering treatments are being disseminated for professional preparation and clinical practices. Conclusions This article demonstrates how global engagement of the ICA's international representatives has led to the exchange of ideas about awareness of cluttering and professional preparation and the best strategies for the treatment of this communication disorder in countries around the world.
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The global emphasis of the International Cluttering Association (ICA) is manifested in multiple dimensions. This article focuses on two of them, namely, resources available through the ICA Web site and the results of an International Cluttering Survey (ICS), which had been presented to 25 members of the Committee of the International Representatives of the ICA. The answers of the representatives to questions regarding awareness of cluttering, definitions, professional preparation, goals for education about cluttering and approaches for achieving goals, are compared and analyzed.
The fourth edition of this acclaimed book honors the philosophy that discoveries of the past are the bedrock of the present and the inspiration for future explorations. It discusses the nature, diagnosis and treatment of stuttering and related disorders. It does so in an up-to-date, reader-friendly manner suitable for students with no or limited background or experience in the nature and treatment of stuttering and related fluency disorders. The text provides comprehensive content covering all relevant aspects of stuttering including etiology, development, diagnosis, and treatment The chapter authors represent a diverse group of global scholars and practitioners Ebook available Online at MediOne ISBN 978 1 68420 253 9
Stuttering and Cluttering provides a comprehensive overview of both theoretical and treatment aspects of disorders of fluency: stuttering (also known as stammering) and the lesser-known cluttering. The book demonstrates how treatment strategies relate to the various theories as to why stuttering and cluttering arise, and how they develop. Uniquely, it outlines the major approaches to treatment alongside alternative methods, including drug treatment and recent auditory feedback procedures. Part one looks at different perspectives on causation and development, emphasizing that in many cases these apparently different approaches are inextricably intertwined. Part two covers the assessment, diagnosis, treatment, and evaluation of stuttering and cluttering. In addition to chapters on established approaches, there are sections on alternative therapies, including drug therapy, and auditory feedback, together with a chapter on counselling. Reference is made to a number of established treatment programs, but the focus is on the more detailed description of specific landmark approaches. These provide a framework from which the reader may not only understand others' treatment procedures, but also a perspective from which they can develop their own. Offering a clear, accessible and comprehensive account of both the theoretical underpinning of stammering therapy and its practical implications, the book will be of interest to speech language therapy students, as well as qualified therapists, psychologists, and to those who stutter and clutter.
Examined the Emotional Quotient Inventory (EQ-i), a comprehensive model and measure of emotional and social intelligence. The findings presented in this chapter suggest that emotional and social intelligence is multifactorial array of interrelated emotional, personal, and social abilities that influence one's overall ability to actively and effectively cope with daily demands. The author presents data on the development and psychometric properties of the EQ-i, including internal consistency, stability reliability, factor structure, and validity. The factor structure of the construct is composed of the following 10 components: self-regard, emotional self-awareness, assertiveness, empathy, interpersonal relationship, stress tolerance, impulse control, reality testing, flexibility, and problem solving. In addition to these key components, 5 facilitators of emotionally and socially intelligent behavior are described: optimism, self-actualization, happiness, independence, and social responsibility. (PsycINFO Database Record (c) 2012 APA, all rights reserved)