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Defining cluttering: The lowest common denominator

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... Cluttering is commonly considered a fluency disorder characterized by various symptoms such as poor speech intelligibility, a speaking rate perceived to be too fast or irregular, inappropriate prosody, as well as the presence of disfluencies (St. Louis, Myers, Bakker, & Raphael, 2007). Aside from its historical roots alongside stuttering (St. Louis & Schulte, 2011;van Riper, 1982;Weiss, 1964), one of the symptoms almost universally attributed to cluttering is excessive disfluency. ...
... A frequently cited working definition of cluttering (St. Louis et al., 2007;St. Louis & Schulte, 2011) posits that cluttering is "a fluency disorder wherein segments of conversation in the speaker's native language typically are perceived as too fast overall, too irregular, or both. The segments of rapid and/or irregular speech rate must further be accompanied by one or more of the following: (a) excessive 'normal' disfluencies; (b) exce ...
... re varying perceptions, consultation between the judges ensued to arrive at consensus. Three main characteristics were used to determine the presence of cluttering, based on the working definition of cluttering by St. Louis, Raphael, Myers, and Bakker (2003), which is essentially the same as the definitions reviewed earlier (St. Louis et al., 2007;St. Louis & Schulte, 2011). Namely, participants classified as PWC manifested segments of perceived rapid and/or irregular speaking rate and also at least one of the following: (a) perceived excessive disfluency, the majority of which are unlike those of people who stutter, (b) evidence of pauses in linguistically inappropriate positions, and/or (c) evidence of o ...
Article
Unlabelled: The purpose of this study was to examine the nature and frequency of occurrence of disfluencies, as they occur in singletons and in clusters, in the conversational speech of individuals who clutter compared to typical speakers. Except for two disfluency types (revisions in clusters, and word repetitions in clusters) nearly all disfluency types were virtually indistinguishable in frequency of occurrence between the two groups. These findings shed light on cluttering in several respects, foremost of which is that it provides documentation on the nature of disfluencies in cluttering. Findings also have implications for our understanding of the relationship between cluttering and typical speech, cluttering and stuttering, the Cluttering Spectrum Hypothesis, as well as the Lowest Common Denominator definition of cluttering. Educational objectives: At the end of this activity the reader will be able to: (a) identify types of disfluency associated with cluttered speech; (b) contrast disfluencies in cluttered speech with those associated with stuttering; (c) compare the disfluencies of typical speakers with those of cluttering; (d) explain the perceptual nature of cluttering.
... Instead it is suggested that those who display characteristics of cluttering, but where a diagnosis of cluttering is not certain, either because the symptoms are not present in sufficient number or not obviously enough expressed, may be more appropriately described as being placed on a cluttering " spectrum " . St Louis and Schulte (2011) argue this could lead to too broad a definition, incorporating too many people and characteristics. Note that CSB and the LCD perspectives are not mutually exclusive (Ward, 2010): those who do not fit the LCD model but show cluttering-like qualities in their communication could fit on the cluttering spectrum. ...
... Aside to the problem with agreeing on diagnostic criteria, the diagnosis of cluttering is further complicated by the fact that the disorder rarely occurs in isolation. Cluttering commonly co-occurs with stuttering, but attention deficit hyperactivity disorder (ADHD), dyslexia, autism spectrum disorder (ASD) and learning disorders may also co-occur, amongst others (Bakker, 1996; St Louis & Schulte, 2011; Ward, 2010). This results in difficulty with attributing findings from research studies to cluttering alone. ...
... Given that cluttering commonly normalises under assessment conditions (Scaler Scott & Ward, in press) we might expect that the PWC group might not express cluttering symptoms at their most obvious under data collection conditions as exist in the present research. Further research is needed to evaluate the scope of the LCD definition (St Louis & Schulte, 2011) which currently does not include a linguistic component. The present research lends some support to the idea that PWC have a linguistic deficit at the lexical level. ...
Article
Unlabelled: Cluttering is a rate-based disorder of fluency, the scope of whose diagnostic criteria currently remains unclear. This paper reports preliminary findings from a larger study which aims to determine whether cluttering can be associated with language disturbances as well as motor and rate based ones. Subtests from the Mt Wilga High Level Language Test (MWHLLT) were used to determine whether people who clutter (PWC) have word finding difficulties, and use significantly more maze behaviours compared to controls, during story re-telling and simple sequencing tasks. Independent t tests showed that PWC were significantly slower than control participants in lexical access and sentence completion tasks, but returned mixed findings when PWCs were required to name items within a semantic category. PWC produced significantly more maze behaviour than controls in a task where participants were required to explain how to undertake commonly performed actions, but no difference in use of maze behaviour was found between the two groups when retelling a story from memory. The implications of these findings are discussed. Educational objectives: (a) To identify issues surrounding the difficulties in diagnosing cluttering, (b) to identify and describe previous accounts of a language component in cluttering, (c) to describe how difficulties with lexical access and maze behaviour might be associated with cluttering, (d) to describe how data from the current research inform our present understanding of theories on cluttering.
... Defining cluttering has been-and continues to be-a difficult and somewhat controversial issue (cf. St. Louis & Schulte, 2011;Ward, 2011). Nevertheless, most researchers agree that abnormalities in speech rate are crucial to a diagnosis of cluttering, and that cluttering is not just a subtype of stuttering, although these disorders may and often do coexist (Howell & Davis, 2011). For example, people who stutter (PWS) typically exhibit syllable repetitions, whol ...
... ve some disruption in their ability to estimate time. This disruption may be caused by an internal time clock that is disrupted in some manner, or may be due to an increase in the time required to formulate an utterance. are worse when the person speaks rapidly. PWC also may omit or run syllables together (St. Louis, Myers, Bakker, & Raphael, 2007;St. Louis & Schulte, 2011). PWC may have difficulty planning or knowing what they want to say and/or may talk too fast or in bursts, whereas PWS typically have no problems planning their utterances but have involuntary interruptions in their speech output, both of which are perceived by the listener as disfluent (St. Louis, 1998). In lay definitions of cluttering ...
... Louis & Hinzman, 1986;St. Louis & Rustin, 1992). Recently, St. Louis and Schulte (2011) advanced the following definition of cluttering: ...
Article
https://www.asha.org/uploadedFiles/ASHA/Publications/cicsd/2014F-Verbal-Time-Estimation-in-Cluttering.pdf
... disorder, both, or perhaps more to do with executive functioning than either (Daly, 1986;Preus, 1996;St. Louis, Myers, Bakker, & Raphael, 2007;Van Zaalen, Wijnen, & De Jonckere, 2009a;Ward, 2010;Weiss, 1964). These differences have led researchers to apply different criteria when defining their experimental groups. It has been helpful, then, that St. Louis and Schulte (2011) recently refined their working definition of cluttering, in what they call the 'lowest common denominator' (LCD) definition. As the name implies, this is conservative perspective, including only a limited number of core cluttering characteristics. They acknowledge that this definition may subsequently need to be revised and updated as m ...
... as too fast overall, too irregular, or both. The segments of rapid and/or irregular speech rate must further be accompanied by one or more of the following: (a) excessive 'normal' disfluencies; (b) excessive collapsing or deletion of syllables; and/or (c) abnormal pauses, syllable stress, or speech rhythm (St. Louis & Schulte, 2011, pp. 241-242). St. Louis and Schulte (2011) qualify this definition further as follows: for example, that cluttering need not occur frequently but sufficiently often to exceed that seen in normal speakers; that the irregular speech rate may be described as "jerky" or "spurty"; and, that collapsing of syllables can include excessive shortening, "telescoping," or "over-coarticulati ...
... ere scanned using functional MRI (see Table 1). Participants were recruited through the clinical contacts of the first author (DW), and through advertisement on the British Stammering Association website. All adults who clutter had been diagnosed as cluttering by a qualified speech and language therapist (DW) using the LCD definition of cluttering (St. Louis & Schulte, 2011). Recall that this definition implicates a speech rate that appears to be overly rapid or jerky in delivery. At least one of three additional features must also be present: excessive number of nonstuttering like dysfluencies, abnormal pausing or speech rhythm, excessive coarticulation (see Section 1.1 for the complete definition). ...
Article
Background: Cluttering is a fluency disorder characterised by overly rapid or jerky speech patterns that compromise intelligibility. The neural correlates of cluttering are unknown but theoretical accounts implicate the basal ganglia and medial prefrontal cortex. Dysfunction in these brain areas would be consistent with difficulties in selection and control of speech motor programs that are characteristic of speech disfluencies in cluttering. There is a surprising lack of investigation into this disorder using modern imaging techniques. Here, we used functional MRI to investigate the neural correlates of cluttering. Method: We scanned 17 adults who clutter and 17 normally fluent control speakers matched for age and sex. Brain activity was recorded using sparse-sampling functional MRI while participants viewed scenes and either (i) produced overt speech describing the scene or (ii) read out loud a sentence provided that described the scene. Speech was recorded and analysed off line. Differences in brain activity for each condition compared to a silent resting baseline and between conditions were analysed for each group separately (cluster-forming threshold Z>3.1, extent p<0.05, corrected) and then these differences were further compared between the two groups (voxel threshold p<0.01, extent>30 voxels, uncorrected). Results: In both conditions, the patterns of activation in adults who clutter and control speakers were strikingly similar, particularly at the cortical level. Direct group comparisons revealed greater activity in adults who clutter compared to control speakers in the lateral premotor cortex bilaterally and, as predicted, on the medial surface (pre-supplementary motor area). Subcortically, adults who clutter showed greater activity than control speakers in the basal ganglia. Specifically, the caudate nucleus and putamen were overactive in adults who clutter for the comparison of picture description with sentence reading. In addition, adults who clutter had reduced activity relative to control speakers in the lateral anterior cerebellum bilaterally. Eleven of the 17 adults who clutter also stuttered. This comorbid diagnosis of stuttering was found to contribute to the abnormal overactivity seen in the group of adults who clutter in the right ventral premotor cortex and right anterior cingulate cortex. In the remaining areas of abnormal activity seen in adults who clutter compared to controls, the subgroup who clutter and stutter did not differ from the subgroup who clutter but do not stutter. Conclusions: Our findings were in good agreement with theoretical predictions regarding the neural correlates of cluttering. We found evidence for abnormal function in the basal ganglia and their cortical output target, the medial prefrontal cortex. The findings are discussed in relation to models of cluttering that point to problems with motor control of speech. Educational objectives: This paper reports findings on the neural correlates seen in adults who clutter, and offers hypotheses as to how these might map onto the behaviours seen amongst those who clutter. Readers will be able to (a) identify the structures that are implicated in the disorder of cluttering, (b) understand arguments relating these structures to the behavioural expression of the disorder, (c) understand some of the complexities in interpreting data pertaining to recovery from cluttering, (d) understand where future efforts in research into the neurological correlates of cluttering should be focussed.
... native language typically are perceived as too fast overall, too irregular, or both." They also stated that their rapid/irregular speech rate must further be accompanied by "(a) excessive 'normal' disfluencies, (b) excessive collapsing or deletion of syllables, and/or (c) abnormal pauses, syllable stress, or speech rhythm" (St. Louis et al., 2007;St. Louis & Schulte, 2011). Considering these definitions, one of the characteristics of cluttering disfluencies is higher frequency of normal disfluencies (NDF), which are often observed in smaller numbers in normal speakers (St. Louis et al., 2007;St. Louis & Schulte, 2011). For the classification of NDF and assessment of cluttering, van Zaalen and Reichel (201 ...
... f syllables, and/or (c) abnormal pauses, syllable stress, or speech rhythm" (St. Louis et al., 2007;St. Louis & Schulte, 2011). Considering these definitions, one of the characteristics of cluttering disfluencies is higher frequency of normal disfluencies (NDF), which are often observed in smaller numbers in normal speakers (St. Louis et al., 2007;St. Louis & Schulte, 2011). For the classification of NDF and assessment of cluttering, van Zaalen and Reichel (2015) elaborate the classification of NDF as "word repetition (WR)," "partword repetition (PWR)," "interjection (Int)," "revision (Rev)," and "phrase repetition (PR)." Contrarily in stuttering, which is also a common fluency disorder, frequently observe ...
Article
Purpose In this study, we investigated the classification of cluttering by assessing speech based on the ratio of disfluencies (RDF) and attempted to identify cluttering and cluttering–stuttering by classifying disfluencies according to previous studies and the Japanese Standardized Test for Stuttering. We further investigated the factors that contribute to the occurrence of disfluency by comparing the disfluencies of three tasks (spontaneous speech, oral reading, and retelling a memorized story) and examining the relationship between RDF and speech rate. Method The participants comprised 20 Japanese adults who stutter. Participants were required to perform an oral reading task, retelling a memorized story task, and a spontaneous speech task. We subsequently classified their disfluencies and calculated the RDF (normal disfluencies that are often observed in cluttering/stuttering-like disfluencies). Results About half of the participants met the cluttering criteria, that is, an RDF of above 3. Analyzing speech disfluencies revealed that a high RDF is associated with fewer stuttering-like disfluencies that increase the denominator of the RDF formula or many “interjections” that make its numerator smaller. Conclusions These tendencies of speech disfluencies could influence cluttering identification. We should further utilize the RDF considering the findings of this study.
... cognitive deficits. Both subjects had normal language production in the sense that they did not show word finding difficulties or grammatical and syntactic anomalies. Nevertheless, subject 2 had some disruption in the flow of verbal messages (fast rate of speaking, excessive collapsing, or deletion of syllables; see above) indicative of cluttering (St. Louis and Schulte, 2011). On subtests of PALPA, both subjects obtained normal scores in subtests tapping phonology, lexical and semantic processing, although subject 2 had a slightly decreased performance on auditory lexical decision of non-words. Their performance on semantic and phonological fluency were normal. Executive functions were normal, but subject 2 ...
... As for subject 2, our results indicated that his speech was also rhythmically atypical, with a tendency to accelerate excessively, resulting in an increased percentage of consonant errors particularly omissions, and even unintelligible production. Such speech disorder is suggestive of a mild form of cluttering (St. Louis and Schulte, 2011). The current working definition of cluttering (St. Louis et al., 2007) is a fluency disorder characterized by a speech rate that is perceived to be abnormally rapid, irregular or both. These rate abnormalities further may be result in one or more of the following features: (1) excessive disfluencies; (2) abnormal pauses, syllable stress ...
Article
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Foreign accent syndrome (FAS) is a speech disorder that is defined by the emergence of a peculiar manner of articulation and intonation which is perceived as foreign. In most cases of acquired FAS (AFAS) the new accent is secondary to small focal lesions involving components of the bilaterally distributed neural network for speech production. In the past few years FAS has also been described in different psychiatric conditions (conversion disorder, bipolar disorder, and schizophrenia) as well as in developmental disorders (specific language impairment, apraxia of speech). In the present study, two adult males, one with atypical phonetic production and the other one with cluttering, reported having developmental FAS (DFAS) since their adolescence. Perceptual analysis by naïve judges could not confirm the presence of foreign accent, possibly due to the mildness of the speech disorder. However, detailed linguistic analysis provided evidence of prosodic and segmental errors previously reported in AFAS cases. Cognitive testing showed reduced communication in activities of daily living and mild deficits related to psychiatric disorders. Psychiatric evaluation revealed long-lasting internalizing disorders (neuroticism, anxiety, obsessive-compulsive disorder, social phobia, depression, alexithymia, hopelessness, and apathy) in both subjects. Diffusion tensor imaging (DTI) data from each subject with DFAS were compared with data from a group of 21 age- and gender-matched healthy control subjects. Diffusion parameters (MD, AD, and RD) in predefined regions of interest showed changes of white matter microstructure in regions previously related with AFAS and psychiatric disorders. In conclusion, the present findings militate against the possibility that these two subjects have FAS of psychogenic origin. Rather, our findings provide evidence that mild DFAS occurring in the context of subtle, yet persistent, developmental speech disorders may be associated with structural brain anomalies. We suggest that the simultaneous involvement of speech and emotion regulation networks might result from disrupted neural organization during development, or compensatory or maladaptive plasticity. Future studies are required to examine whether the interplay between biological trait-like diathesis (shyness, neuroticism) and the stressful experience of living with mild DFAS lead to the development of internalizing psychiatric disorders.
... guage of the speaker are perceived typically as too fast overall, too irregular, or both. e segments of a rapid and/ or irregular speech rate must be accompanied further by one or more of the following: (a) excessive normal dis uencies; (b) excessive collapsing or deletion of syllables; and/or (c) abnormal pauses, syllable stress, or speech rhythm (St. Louis & Schulte, 2011). Most dis uencies of people with cluttering (PWC) are normal dis uencies (Myers & Bradley, 1992;St. Louis, 1996). First, normal dis uencies, such as interjection, revision, and word and phrase repetitions, are produced with mild tension and a normal speech rhythm, and they o en appear in uent speakers. Normal dis uencies are also distin ...
... asual inspection of LD and AD/HD symptoms clearly indicates that individuals with these disorders frequently have many of the same symptoms associated with PWC. ey further hypothesized that important di erences can be inferred between cluttering and LD or AD/HD in the areas of dis uency and speech rate. When the de nition of cluttering is narrowed (St. Louis & Schulte, 2011), differences, and similarities between cluttering and LD become clear. To this end, van Zaalen, Wijnen, and Dejonckere (2011) set objective norms to differentiate the speech and language characteristics of cluttering from those of LD. ey summarized that although cluttering and LD have been hypothesized to be genetically-based disorders, ...
Article
This study aimed to investigate the rate and type of co-occurring disorders in children receiving special support for stuttering in speech and language classrooms (resource rooms and special classes for children with speech and language disorders) and compare the results of the Japanese Checklist for Possible Cluttering (JCPC) ver. 2 between the high-score and not-high-score groups. Results indicated that 27 (11.4%) of 237 children who had fluency disorder and were trained as children who stutter (CWS) were either medically diagnosed or suspected by their teachers as having co-occurring disorders. The co-occurrence of disorders was observed significantly more frequently in the high-score than not-high-score groups. The most frequent co-occurring disorders in the high-score group were “AD/HD (N=4),” followed by “Asperger syndrome (N=3),” “intellectual disability (N=3),” and “LD (N=3),” which were consist with previous studies aside from “intellectual disability.”
... Cluttering, and the much better-known stuttering, are somewhat similar but independent fluency disorders. Numerous authors (e.g., St. Louis & Schulte, 2011) have surmised that listeners, when they hear and see stuttering, even in its mild to moderate forms, soon recognize that the speaker is struggling to finish specific words or to begin to say something. With cluttering, especially in the more ...
... 299-300). Further refined by St. Louis and Schulte (2011), these lowest common denominator definitions of cluttering identify the common factor of rapid and/or irregular speech rate and various perceptual symptoms that result from those rate disturbances, for example, prosodic anomalies or excessive "normal" disfluencies. ...
Article
Purpose This quasi-experimental design study in Poland explored the extent to which attitudes toward cluttering of university students could be changed or improved after a series of activities dedicated to attaining deeper recognition of problems associated with fluency disorders. Method University students were assigned to either an Experimental or a Control group, with 39 in each (total = 78). They all completed the Polish version of the Public Opinion Survey of Human Attributes–Cluttering (POSHA–Cl) on two occasions up to eight weeks apart. Participants in the Experimental group attended the following intervention activities: watching and discussing an educational video on cluttering, participating in a workshop on the nature of cluttering, and watching and discussing a documentary on the life experiences of people struggling with fluency disorders. The Experimental group also filled out an open-ended questionnaire at the end of the study. Results Pre-intervention comparisons indicated that participants assigned to either of the Experimental or Control groups differed significantly on 2 of the 15 summary ratings (13%) of their pre-POSHA–Cl attitudes toward cluttering. For the Experimental group, the intervention resulted in significant positive changes in cluttering attitudes on 8 of the 15 summary ratings (53%). In contrast, pre- and post- POSHA–Cl scores for the Control group were essentially unchanged (0 of 15 ratings). Conclusions This quasi-experimental study demonstrated that it is possible to positively modify the cluttering attitudes of university students. This has implications for the length, content, and experiential components of interventions designed to improve public attitudes toward fluency disorders.
... However, a suitably constrained definition is prerequisite to ensure researchers and clinicians alike are working from a consistent viewpoint with the same disorder. With this in mind, St Louis and Schulte (2011) proposed the lowest common denominator definition (LCD) which states that cluttering is: " …a disorder wherein segments of conversation in the speaker's native language typically are perceived as too fast, too irregular, or both. The segments of rapid and/or irregular speech rate must further be accompanied by one or more of the following: (a) excessive 'normal' disfluencies; (b) excessive collapsing or deletion of syllables; and/or abnormal pauses, syllable stress, or speech rhythm. ...
... Speech/Language data files were collected from 14 adults who clutter (AWC: 11 males, 3 females; aged 20–55 years) 9 adults who stutter (AWS: 7 males, 2 females; aged 20-52) and 18 controls (CTL): 14 males, 4 females; aged 19–53 years). All AWC and AWS had been diagnosed as having cluttering and/or stuttering by a qualified speech and language therapist using the LCD definition of cluttering (St Louis & Schulte, 2011). Nine of the AWC group had comorbid stuttering (AWCS) ranging in severity from mild to very mild as assessed by a speech therapist using the Stuttering Severity Instrument-3 (Riley, 1994). ...
Article
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The breadth of behaviours that may be considered as cluttering continues to be contentious. The current lowest common denominator (LCD) definition of cluttering excludes the possibility of high level language deficits. However, recent studies suggest that those who clutter may have linguistic deficits alongside motor control difficulties. This paper reports behavioural findings from a larger data set collected during functional MRI scans with adults who clutter (AWC), adults who stutter (AWS) and controls (CTLs). Participants were asked to read short passages aloud and describe pictures. Speech data were analysed and coded for stuttering like dysfluencies (e.g. blocks) and normal dysfluencies (e.g. revisions and fillers) by two speech and language therapists. One-way ANOVAs showed that AWC use significantly more revisions than AWS and CTLs both when reading aloud and when describing pictures. AWC showed a trend toward increased co-articulation when describing a picture compared to AWS and CTL although this failed to meet significance level, AWC speaking rates was evaluated as similar to the two other groups. Results suggest that both spontaneous speech and oral reading outputs of AWC can be differentiated from AWS and CTL by the number of revisions used. We speculate that excessive co-articulation might differentiate AWC from AWS and CTLs in spontaneous speech but this does not appear to hold true for oral reading.
... Cluttering can be defined as ''a disorder of both speech and language processing that frequently results in rapid, dysrhythmic, sporadic, unorganised, often unintelligible speech'' (see St. Louis & Schulte, 2011;Daly, 1993, p. 7). In addition, speech may be poorly articulated and contain an excessive number of normal (or non-stammered) dysfluencies (such as ums, ers and restarts) and unusually placed pauses (St. Louis & Schulte, 2011). ...
... language processing that frequently results in rapid, dysrhythmic, sporadic, unorganised, often unintelligible speech'' (see St. Louis & Schulte, 2011;Daly, 1993, p. 7). In addition, speech may be poorly articulated and contain an excessive number of normal (or non-stammered) dysfluencies (such as ums, ers and restarts) and unusually placed pauses (St. Louis & Schulte, 2011). Cluttering is characterised by three main features: (1) a rapid and/or irregular articulatory rate (Daly, 1993;St. Louis, 1992;Louis, Raphael, Myers, & Bakker, 2003); (2) a higher than average dysfluency rate that is dissimilar to that seen in stuttering, and (3) reduced speech intelligibility due to bursts of fast speech and indistinc ...
Article
In individuals with an intellectual disability, speech dysfluencies are more common than in the general population. In clinical practice, these fluency disorders are generally diagnosed and treated as stuttering rather than cluttering. To characterise the type of dysfluencies in adults with intellectual disabilities and reported speech difficulties with an emphasis on manifestations of stuttering and cluttering, which distinction is to help optimise treatment aimed at improving fluency and intelligibility. The dysfluencies in the spontaneous speech of 28 adults (18-40 years; 16 men) with mild and moderate intellectual disabilities (IQs 40-70), who were characterised as poorly intelligible by their caregivers, were analysed using the speech norms for typically developing adults and children. The speakers were subsequently assigned to different diagnostic categories by relating their resulting dysfluency profiles to mean articulatory rate and articulatory rate variability. Twenty-two (75%) of the participants showed clinically significant dysfluencies, of which 21% were classified as cluttering, 29% as cluttering-stuttering and 25% as clear cluttering at normal articulatory rate. The characteristic pattern of stuttering did not occur. The dysfluencies in the speech of adults with intellectual disabilities and poor intelligibility show patterns that are specific for this population. Together, the results suggest that in this specific group of dysfluent speakers interventions should be aimed at cluttering rather than stuttering. Learning outcomes: The reader will be able to (1) describe patterns of dysfluencies in the speech of adults with intellectual disabilities that are specific for this group of people, (2) explain that a high rate of dysfluencies in speech is potentially a major determiner of poor intelligibility in adults with ID and (3) describe suggestions for intervention focusing on cluttering rather than stuttering in dysfluent speakers with ID.
... ty of which are non-stuttering-like disfluencies (i.e., phrase repetitions, revisions, interjections, multisyllabic whole word repetitions, and single-syllable whole word repetitions without tension); atypical placement of pausing in speech; and, excessive over-coarticulation of sounds (i.e., collapsing syllables such as "communy" for "community") (St. Louis & Schulte, 2011). Three million people, or 1% of the U.S. population stutter (Bloodstein & Bernstein Ratner, 2007). Of this three million, experts in fluency disorders estimate that between 33% and 67% also clutter (Ward, 2006). ...
Article
Full-text available
Cluttering is a type of fluency disorder characterized by perceived rapid and/or irregular speech rate and at least one of the following symptoms: excessive disfluencies, the majority of which are non-stuttering-like disfluencies; atypical placement of pausing in speech; and/or excessive over-coarticulation of sounds (St. Louis & Schulte, 2011). Various treatments have been implemented to decrease the rate and increase the clarity of speech in persons who clutter (PWC). This study compared the efficacy of two types of cluttering treatments, pausing and overemphasis, to determine which would reduce the occurrence of over-coarticulation in conversational speech of a teenage male. A decrease in over-coarticulation was exhibited with use of both strategies; however, pausing was determined to reduce the percentage of over-coarticulated words in conversational speech more than overemphasis. This strategy was also the strategy most likely to be implemented in carryover by the participant.
... The variability within the group of children with AS ranges from 'no stuttering' to 'moderate', while the variability within the group of CWS ranges from 'very mild' to 'very severe'. Three of the group of children with AS met the diagnostic criteria for cluttering, according to the St. Louis and Schulte (2011) definition. Specifically, these children first met the primary criteria mandatory for diagnosis of cluttering, i.e. perceived rapid and/or irregular rate of speech. ...
Article
In recent years, there has been increased identification of disfluencies in individuals with autism, but limited examination of disfluencies in the school-age range of this population. We currently lack information about whether the disfluencies of children with autism represent concomitant stuttering, normal disfluency, excessive normal disfluency, or some form of disfluency unique to the school-age population of children with autism. This paper explores the nature of disfluencies in school-aged children with autism in comparison with matched children who stutter and controls. It explores stuttering-like disfluencies, non-stuttering-like disfluencies and word-final disfluencies. This study compared disfluency patterns in 11 school-aged children with Asperger's syndrome (AS), 11 matched children who stutter (CWS), and 11 matched children with no diagnosis (ND). Analyses were based on speech samples collected during an expository discourse task. Results reveal statistically significant differences between children with AS and CWS and between children with AS and those with ND for the percentage of words containing stuttering-like disfluencies. In the AS group, four out of 11 (36%) met the common diagnostic criteria for a fluency disorder. Disfluencies in the AS group differed qualitatively and quantitatively from the CWS, and included a larger distribution of word-final disfluencies. This study provides initial data regarding patterns of disfluency in school-aged children with AS that, with careful consideration and the cautious application of all findings, can assist therapists in making more evidence-based diagnostic decisions. Findings offer evidence that when working with children with AS, disfluencies both similar and dissimilar to those of CWS may be identified in at least a subset of those with AS. Therefore, children with AS should be screened for fluency disorders during their initial evaluation and treated if it is determined that the fluency disorder negatively impacts the effectiveness of communication.
... worthwhile addition to maximize this content with greater detail, particularly in the discussion of cluttering. For example, the author could consider expanding the content on cluttering to include discussion on the 'least common denominator' definition of cluttering and the cluttering spectrum hypothesis (Myers, Bakker, St. Louis, & Raphael, 2012;St. Louis & Schulte, 2011;Ward, 2011). This would bring more attention to the notion of the difficulty in settling on one definition of cluttering and focusing on the characteristics of the disorder. I anticipate another area of this chapter growing -Stuttering as a Result of Stress and Injuries While in the Military. Speech and language services to this populati ...
... s (NSLDs) such as interjections and revisions. Several researchers have noted excessive NSLDs in autism (Lake et al., 2011;Scaler Scott et al., 2014;Stirling, Barrington, & Douglas, 2007).Whether deficits in working memory play a role in the presentation of excessive NSLDs has yet to be investigated.Excessive NSLDs are also a feature of cluttering (St. Louis and Schulte, 2011), which has been noted in autism (Scaler Scott et al., 2014). ...
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This paper will present the latest information regarding what is known and unknown about the presence, possible causes, and potential effective treatments of fluency disorders in Autism Spectrum Disorders (ASDs). Advanced review of cognitive features of ASDs which may play a role in contributing to dysfluencies in this population will be discussed. Examples of practical application of existing information to evaluation and treatment will be presented.
... The above definition by St. Louis and Schulte (2011) mentions 'excessive normal disfluencies' (which also include silent pauses) and abnormal pausing patterns. Also Myers (2011) refers to a disrupted flow or timing of a message in cluttering as a result of insertions of "pauses or fillers" (p.154). ...
Article
Purpose: Speech and language development in individuals with Down syndrome is often delayed and/or disordered and speech disfluencies appear to be more common. These disfluencies have been labeled over time as stuttering, cluttering or both. Findings: were usually generated from studies with adults or a mixed age group, quite often using different methodologies, making it difficult to compare findings. Therefore, the purpose of this study was to analyze and describe the speech disfluencies of a group, only consisting of children with Down Syndrome between 3 and 13 years of age. Method: Participants consisted of 26 Dutch-speaking children with DS. Spontaneous speech samples were collected and 50 utterances were analyzed for each child. Types of disfluencies were identified and classified into stuttering-like (SLD) and other disfluencies (OD). The criterion of three or more SLD per 100 syllables (cf. Ambrose & Yairi, 1999) was used to identify stuttering. Additional parameters such as mean articulation rate (MAR), ratio of disfluencies, and telescoping (cf. Coppens-Hofman et al., 2013) were used to identify cluttering and to differentiate between stuttering and cluttering. Results & conclusion: Approximately 30 percent of children with DS between 3 and 13 years of age in this study stutter, which is much higher than the prevalence in normally developing children. Moreover, this study showed that the speech of children with DS has a different distribution of types of disfluencies than the speech of normally developing children. Although different cluttering-like characteristics were found in the speech of young children with DS, none of them could be identified as cluttering or cluttering-stuttering.
... The rater was given instructions to mark utterances as either fluent (0) or dysfluent (1: "if speech is dysfluent at all"). These instructions were followed by guidelines summarising the symptoms of two fluency disorders: stuttering (American Psychiatric Association, 2013) and cluttering (Louis & Schulte, 2011). A sentence was considered dysfluent if it contained at least one interruption to speech flow. ...
Article
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Stuttering is a disorder in which the smooth flow of speech is interrupted. People who stutter show structural and functional abnormalities in the speech and motor system. It is unclear whether functional differences reflect general traits of the disorder or are specifically related to the dysfluent speech state. We used a hierarchical approach to separate state and trait effects within stuttering. We collected sparse‐sampled functional MRI during two overt speech tasks (sentence reading and picture description) in 17 people who stutter and 16 fluent controls. Separate analyses identified indicators of: (1) general traits of people who stutter; (2) frequency of dysfluent speech states in subgroups of people who stutter; and (3) the differences between fluent and dysfluent states in people who stutter. We found that reduced activation of left auditory cortex, inferior frontal cortex bilaterally, and medial cerebellum were general traits that distinguished fluent speech in people who stutter from that of controls. The stuttering subgroup with higher frequency of dysfluent states during scanning (n = 9) had reduced activation in the right subcortical grey matter, left temporo‐occipital cortex, the cingulate cortex, and medial parieto‐occipital cortex relative to the subgroup who were more fluent (n = 8). Finally, during dysfluent states relative to fluent ones, there was greater activation of inferior frontal and premotor cortex extending into the frontal operculum, bilaterally. The above differences were seen across both tasks. Subcortical state effects differed according to the task. Overall, our data emphasise the independence of trait and state effects in stuttering.
... PWC were recruited by two speech therapists after listening two times the recordings. The diagnostic decisions were based on their subjective impressions, the speech-language pathology anamnesis and the working definition of cluttering (St Louis & Schulte, 2011). All participants were native Hungarian speakers with normal hearing, coming from a similar social and cultural background. ...
... godine (Weiss, 1964;prema Sardelić i Rendulić, 2012), ali do danas ne postoji općeprihvaćena definicija ovog poremećaja. U radnoj definiciji najmanjeg zajedničkog nazivnika St. Louis i Schulte (2011;str. 241-242) opisuju brzopletost kao "poremećaj tečnosti čiji su segmenti konverzacije u govorniko- vom materinskom jeziku zamijećeni kao jako brzi, neregularni ili oboje. ...
Article
Diferencijalna logopedska dijagnostika pretpostavlja prepoznavanje nekog poremećaja i njegovo razlučivanje od drugih poremećaja koji imaju neke zajedničke simptome. U području poremećaja tečnosti govora, netečnosti predstavljaju zajednički simptom koji se može pojaviti kao dio kliničke slike različitih razvojnih i stečenih poremećaja kao što su razvojno mucanje, neurogeno mucanje, psihogeno mucanje, sindrom brzopletosti, afazija, dizartrija, apraksija, palilalija, Parkinsonova bolest te različiti genetski sindromi poput Downovog sindroma, Fragilnog X sindroma, Prader-Willijevog sindroma, Touretteovog sindroma, Neurofi bromatoze tip I i Turnerovog sindroma. Na temelju pregleda novije literature, u ovom radu prikazan je opis navedenih poremećaja tečnosti govora, njihova opća i specifična simptomatologija te su naglašeni diferencijalno dijagnostički kriteriji. Budući da diferencijalna dijagnostika poremećaja tečnosti još uvijek predstavlja veliki izazov u području logopedije, ovaj rad može poslužiti kliničarima kao orijentir u dijagnostičkom postupku. Različiti poremećaji zahtijevaju različite terapijske postupke stoga je postavljanje točne dijagnoze temelj planiranja i provođenja uspješne intervencije. Istraživanja poremećaja tečnosti govora većinom su metodološki neujednačena i veliki broj njih čine studije slučajeva. Buduća istraživanja u ovom području trebaju obuhvatiti veći broj ispitanika, detaljno analizirati govorne i negovorne karakeristike kroz različite govorne zadatke kako bi rezultati istraživanja mogli imati teorijsku i kliničku primjenu.
... PWC were recruited by two speech therapists after listening two times the recordings. The diagnostic decisions were based on their subjective impressions, the speech-language pathology anamnesis and the working definition of cluttering (St Louis & Schulte, 2011). All participants were native Hungarian speakers with normal hearing, coming from a similar social and cultural background. ...
... ch rate, and their speech was characterized at least by one of the following: (1) excessive disfluencies (the majority were non-stuttering-like), (2) inappropriate use of prosodic patterns, and/or (3) specific articulation characteristics (e.g. inappropriate degrees of coarticulated sounds or omissions of sounds and syllables) (Bakker et al., 2011;St. Louis & Schulte, 2011). The latter means that PWC may articulate much less accurately than control speakers because of their fast articulation rate. Subjective judgements of the evaluating experts were confirmed by objective measurements during the analysis: the mean articulation rate of PWC was 6.9 (SD: 2.8) syllables/s, the mean articulation rate of control ...
Article
The aim of the study is the analysis of the error-repairs of people with cluttering (PWC), whether they repair their speech errors similarly to control speakers or not. Error-repairs were analysed in spontaneous speech samples of 13 PWC and 13 age- and sex-matched control speakers. Error-to-cutoff time, duration of the editing phase, and error-to-repair time were measured. Strategies of repairs (point of interruption, proportion of delays, and types of editing terms and phases) were also examined. Results of the two groups were compared. Results show that there are no differences between the two groups in the total duration of error-repairs. However, there might be differences between the two groups in the self-repair strategies. Results suggest that control speakers might try to plan the error-repairs in parallel with the speech production and they interrupt the speech when the repair is available. In contrast, PWC interrupt speaking earlier perhaps to focus on planning self-repairs.
... as well as by an abnormal speech rhythm (St. Louis & Schulte, 2011: 241-242). Speech rate and articulation rate (i.e. average speech tempo including and excluding pauses, respectively) are of central importance for understanding cluttering. Previous research (Bakker, Myers, Raphael, & St. Louis, 2011;Oliveira, Broglio, Bernardes, & Capellini, 2013;St. Louis & Schulte, 2011;St. Louis, Myers, Bakker, & Raphael, 2007;Van Zaalen-op't Hof, Wijnen, & De Jonckere, 2009) has confirmed that speech rate and articulation rate are significantly faster in cluttering than in control speech. However, there are no differences between cluttering, exceptionally rapid speech and control speech if speakers have to speak as fa ...
Article
Abstract Purpose Cluttering is a type of fluency disorder characterized by a speech rate which is perceived to be fast and/or irregular as well as by an abnormal speech rhythm. As far as we know, no research has been conducted as yet using objective measurements and acoustic phonetic description on the rhythm of cluttered speech. The aim of this study is to show by objective measurements whether there are any differences between the rhythm of cluttered and control speech, and which parameters point to such differences. Methods For the analysis, recordings of spontaneous speech samples were taken from people who clutter (PWC) as well as from control speakers. Typical speech rhythm values and articulation rate were calculated in each speech sample. Results Results have confirmed that the rhythm of cluttering is slightly different from that of control speech in terms of various values, but the effect size is only small. It must be noted, however, that the difference between the two groups was not apparent in all analyzed values. Conclusion The timing differences between cluttered and control speech are manifested primarily in the articulation rate while peculiarities in speech rhythm are almost negligible.
... When assessing the symptoms of stuttering associated with autism, we should consider the possibility that the symptoms are related to cluttering. According to St. Louis and Schulte (2011), "Cluttering is a fluency disorder wherein segments of conversation in the speaker's native language typically are perceived as too fast overall, too irregular, or both. The segments of rapid and/or irregular speech rate must further be accompanied by one or more of the following: (a) excessive 'normal disfluencies,' (b) excessive collapsing or deletion of syllables, and/or (c) abnormal pauses, syllable stress, or speech rhythm." ...
Chapter
The number of case reports of children with autism spectrum disorder (ASD) who stutter is increasing. The duration of intervention for stuttering in children with attention-deficit hyperactivity disorder (ADHD) is often greater than for children who only stutter. Whether there is a similar pattern in children with ASD who stutter should also be examined. In this study, the factors influencing the prognoses of two children with stuttering and ASD were investigated. One child's stuttering had improved and had almost been eliminated, and the other's stuttering continued. The results of the investigation showed that a significant increase in language ability and the absence of physiological problems assisted in eliminating stuttering. The child who continued to stutter originally showed a higher than average language level and high anxiety. Preventing and eliminating anxiety that accompanies ASD, in addition to intervention for stuttering, may be indispensable to reduce stuttering and improve fluency.
... A beszéd temporális jellemzői egyrészt megmutatják az artikulációs mozgások gyorsaságát, másrészt árulkodnak a beszédtervezési és önellenőrzési folyamatokról is (Gósy 2004). Több beszéd-és nyelvi zavar elsődlegesen a tempó zavarával áll öszszefüggésben, így például a dadogás, a hadarás, avagy a dizartria is (ryan 1992;st. louis-schulte 2011;Tumanova et al. 2011;chon et al. 2012). A szupraszegmentális szint temporális jellemzői közé tartoznak az artikulációs tempó, a beszédtempó és a szünettartás sajátosságai. Az artikulációs tempó elsősorban a beszédszervek működésének gyorsaságától függ. értékét nem, illetve csak kis mértékben befolyásolják a magasabb szintű nyelvi folyama ...
Article
Purpose The study aimed to investigate how cluttering specialists rated degree of, prominence or saliency of various communication dimensions as contributing to the overall cluttering, severity. Method Using a 9-point Likert type scoring system, 31 cluttering specialists (with an average of 19, years of experience with cluttering) rated the relative importance of eight speech and language, dimensions often associated with cluttering, from ‘1’ (‘not important’) at the low end to a ‘9’ (‘very, important’) at the high saliency end. Results Though the salience ratings differed, the values in most cases were toward the high end of the, rating scale. Additionally, correlational analyses revealed several patterns of inter-correlation among, the dimensions indicating that contribution of each communication dimension to overall cluttering, severity may not be the same for all. Rather, it suggested that these dimensions may speak to cluttering, severity through differential perceptual pathways that characterized the thinking of the experts who, participated. Conclusion Greater understanding of the various communication behaviors contributing to cluttering, severity is needed for theoretical, research and clinical purposes. To the extent that the dimensions, studied are thought to be relevant for cluttering, the results strengthen the notion that these, dimensions (and perhaps others) should be included if we are to capture a comprehensive picture of, cluttering severity.
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Due to the lack of research regarding the efficacy of treatment approaches to cluttering, speech language the rapists (SLTs) are lacking in information regarding how to approach cluttering clients. The purpose of this presentation is to present a new view of examining evidence-based techniques for treating cluttering in children and adults. Through interactive discussion, methods for managing children, teens, and adults with cluttering will be presented. Assessment and treatment principles will be covered. Specific activities for increasing effective communication in a variety of clients and the evidence base to these activities will be presented. After attending this seminar, SLTs should be able to: 1) state three principles of cluttering assessment; 2) state three principles of cluttering treatment; 3) state three sources of literature establishing evidence base of treatment methods; 4) state three activities to address cluttering in children, teens, and adults with cluttering. Data gathered during actual treatment sessions will be presented in case study format. Overcoming obstacles in managing clients with cluttering using evidenced-based approaches a will be discussed.
Article
Cluttering is discussed openly in the fluency literature, but few educational opportunities for learning more about cluttering exist in higher education. The purpose of this manuscript is to explain how a seminar in cluttering was developed for a group of communication disorders doctoral students. The major theoretical issues, educational questions, and conclusions are discussed. Although I have worked for some 15 years in the field of higher education, a request from one of my students took me by surprise. The request was for an elective seminar on the topic of cluttering. Since I have had both a clinical and theoretical interest in the topic, I agreed and started thinking about the issues that would need to be addressed. Within a few weeks, I realized what a predicament I had gotten myself into. Not only was I sailing on uncharted waters, but, to my knowledge, I was teaching one of the first seminars on cluttering in North America. I determined that the seminar should address at least three major areas. Each of these areas centered on the philosophical principles/issues that guided the course building process. In turn, as my students and I resolved each of these issues together, we identified important questions for clinicians and researchers interested in cluttering. This article will outline these key these issues and questions. Implications and future directions for dealing with the topic of cluttering in higher education, clinical work, and research will be presented.
Book
Many children and adults experience impairment of their communication skills. These communication disorders impact adversely on all aspects of these individuals' lives. In thirty dedicated chapters, The Cambridge Handbook of Communication Disorders examines the full range of developmental and acquired communication disorders and provides the most up-to-date and comprehensive guide to the epidemiology, aetiology and clinical features of these disorders. The volume also examines how these disorders are assessed and treated by speech and language therapists and addresses recent theoretical developments in the field. The handbook goes beyond well-known communication disorders to include populations such as children with emotional disturbance, adults with non-Alzheimer dementias and people with personality disorders. Each chapter describes in accessible terms the most recent thinking and research in communication disorders. The volume is an ideal guide for academic researchers, graduate students and professionals in speech and language therapy.
Article
Purpose Cluttering is a fluency disorder that has been noted clinically in individuals with fragile X syndrome (FXS). Yet, cluttering has not been systematically characterized in this population, hindering identification and intervention efforts. This study examined the rates of cluttering in male young adults with FXS using expert clinical opinion, the alignment between expert clinical opinion and objectively quantified features of cluttering from language transcripts, and the association between cluttering and aspects of the FXS phenotype. Method Thirty-six men with FXS (aged 18–26 years; M = 22, SD = 2.35) contributed language samples and completed measures of nonverbal cognition, autism symptoms, anxiety, and symptoms of attention-deficit/hyperactivity disorder (ADHD). The presence of cluttering was determined by the consensus of two clinical experts in fluency disorders based on characteristics exhibited in the language sample. Cluttering features (speech rate, disfluencies, etc.) were also objectively quantified from the language transcripts. Results Clinical experts determined that 50% of participants met the criteria for a cluttering diagnosis. Phrase repetitions were the most salient feature that distinguished individuals who cluttered. Although the presence of cluttering was not associated with autism symptoms or mean length of utterance, cluttering was more likely to occur when nonverbal cognitive ability was higher, ADHD symptoms were elevated, and anxiety symptoms were low. Conclusions Half of the male young adults with FXS exhibited cluttering, which supports FXS as a genetic diagnosis that is highly enriched for risk of cluttering. Cluttering was associated with increased ADHD symptoms and cognitive ability and reduced anxiety symptoms. This study contributes a new description of the clinical presentation of cluttering in men with FXS and may lead to improved understanding of the potential underlying mechanisms of cluttering and eventual refinements to treatment and diagnosis.
Article
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Purpose. Using an adaptation of the Experimental Edition of the Public Opinion Survey of Human Attributes (POSHA-E), investigators sought to compare public attitudes toward cluttering with those toward stuttering in four country samples, each in a different language. The POSHA-E was developed to measure public attitudes of stuttering but was modified to provide written definitions of cluttering and stuttering. Method. Convenience samples of 60 to 90 adult respondents from Turkey, Bulgaria, Russia, and the USA (302 total) rated POSHA-E items on 1-9 scales for cluttering and stuttering after reading the definitions. Results. Public attitudes toward cluttering and stuttering were similar for all respondents combined, but significant differences occurred. Attitude differences from country-to-country were greater than differences for cluttering versus stuttering. Conclusions. Positive and negative attitudes toward cluttering appear to be similar to those toward stuttering, and a cluttering stereotype appears likely.
Article
One of the main symptoms of cluttering is atypical pausing. However, there is little information about what this atypical pausing means, because typical speakers also have pauses not only at syntactic boundaries, but also within syntactic structures, and even within words. The aim of this study is to analyse how pausing strategies of persons who clutter differ from pausing strategies of normal speakers and speakers with exceptionally rapid speech (ERSs). Results show that there is a difference between the groups in the frequency and/or duration of pauses and the place of their occurrences. ERSs have less and longer pauses than persons who clutter (PWCs) and control speakers. There is difference between PWCs and control speakers only in the duration of pauses. The results contribute to the assessment, diagnosis, and therapy of cluttering.
Chapter
Fluency disorders have the potential to cause difficulty with social interaction. This may be due to the fact that disorders of fluency, including stuttering, cluttering, and atypical disfluency, may co-occur with other disorders whose features include pragmatic symptoms. Co-occurring disorders include autism, attention deficit hyperactivity disorder, genetic syndromes, and language-based learning disabilities. In these cases, pragmatic difficulty may be related primarily to difficulties with knowledge of social rules or executive function features such as impulse control. The potential negative impact of the fluency disorder itself on social interaction is often underestimated. Affective and cognitive components of fluency disorders may lead to avoidance behaviors, such as decreased eye contact or limiting verbal output. Although these behaviors are rooted in fear, they can be misinterpreted as true pragmatic difficulties. Regardless of the cause, fluency disorders may result in difficulties with social interaction. This chapter provides information and strategies to help the practicing clinician effectively identify, evaluate, and treat disorders of social communication in clients with fluency disorders.
Article
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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
Article
In this article, disfluent word-repetitions are analysed in cluttered and control speech. The main questions are the following: (1) Do different functions of word-repetitions occur in different ratio in cluttered and control speech? (2) Are there any differences between PWC and control speakers in durational parameters of disfluent word-repetitions? Results show that there are differences between the two groups of speakers in the types of word-repetitions, and in their durational parameters. In cluttered speech, the most frequent type of repetitions were covert self-repairs while in control speech canonical repetitions are dominated. There were significant differences in the durational parameters of word-repetitions of both groups except in the function of covert self-monitoring. According to the results, it can be concluded that as in earlier studies, analysis of the frequency of types of disfluencies in themselves is not enough as this analysis does not always show the differences between the two groups. It is important to learn more about the durational and functional characteristics of the specific types of disfluencies comparing them in cluttered and control speech.
Article
Cluttering is a fluency disorder which can be characterised by excessive disfluencies. However, the low number of studies dealing with the analysis of disfluencies in cluttering show contradictory results. The aim of this article is to analyse disfluency clusters in cluttered, fast and typical speech. Frequency of all disfluency clusters and those complex disfluencies which contain more than two constituents were analysed. The number and types of the constituents of complex disfluencies and the reason of their occurrence were analysed in detail. Results show that complex disfluencies occurred the most frequently in cluttered speech, and the least frequently in exceptionally rapid speech (ERS). Persons who clutter (PWC) had more and much longer complex disfluencies than typical speakers. Complex disfluencies which suggest difficulties in linguistic formulation occurred in cluttering significantly more times than in typical speech. The results bring us closer to understanding why there are perceptually more disfluencies in cluttered speech than in typical one. In addition, they also seem to strengthen the notion that cluttering is a language disorder.
Article
Cluttering is a syndrome characterised by a wide range of symptoms. It always contains one or more key elements such as abnormally fast speech rate, greater than expected number of disfluencies, reduced intelligibility due to over-coarticulation and indistinct articulation, inappropriate brakes in speech pattern, monotone speech, disturbance in language planning, etc. Drama activities and storytelling share a number of features that allow spontaneous use during therapy process and detachment from real-time, concrete place or true identity, and therefore allow unprecedented freedom in choosing and creating speech-language expressions. The use of drama elements and techniques in cluttering therapy enables better focusing of the child during therapeutic process and better integration of acquired speech/language skills and knowledge. During therapy, we should be aware to correct the patient both in speech production and in the perception of his/her own speech. From the aspect of speech pathology, it is important how auditory and visual information during patient’s production influence on his/her overall perception of his/her own speech. For all those reasons, it is especially important to choose the appropriate story or event and to present it in a way that ensures good interaction during therapy. The presentation of dramatisation is the ideal tool for stimulation and development of different speech activities, with focus on fluency, correct articulation and other elements that make up values of spoken language. Drama techniques can be implemented trough drama activities or storytelling. When working with children, storytelling and drama techniques can be integrated and combined in multiple ways in order to provide robust and flexible transition toward a structured language.
Article
Purpose: The objective of this study was to compare the symptoms of cluttering among school-age children who do and do not clutter in the contexts of monologue, conversation and expository discourse. Method: A matched pairs design was used to compare cluttering symptoms according to the Lowest Common Denominator (LCD) definition of cluttering, a definition representing the core speech and fluency characteristics of cluttering agreed upon among experts. Cluttering symptoms (over-coarticulated words, normal disfluencies, abnormal pauses) in eight school-aged males with cluttering were compared to eight controls matched by sex and grade level in school. Symptoms were compared in the speech contexts of conversation, monologue and expository discourse. Result: Regardless of the speaking context, significantly more over-coarticulated words were found in children with cluttering (CWC) as compared to controls. Significantly more normal disfluencies were produced by CWC during monologue only. Conclusion: Study findings confirm increased over-coarticulation and normal disfluencies in specific speaking contexts in CWC when compared to controls. These findings provide the premise for clinical implications for cluttering assessment and diagnosis. Findings also provide the basis for further investigation of the validity of the LCD’s symptom of abnormal pausing for accurate diagnosis of people who clutter.
Article
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Tumultus sermonis (TS), cluttering, is a highly specific phenomenon in the field of speech fluency disorders. The development of knowledge in this area is characterised by long-standing difficulties in determining the adequate terminology, diagnostic and therapeutic procedures. The knowledge of TS is also extremely inspirational in the acquisition of a deeper understanding of the process of speech communication and its disorders. The paper presents the current state of knowledge of this communication disorder from the perspective of Clinical Speech Therapy and the perspective of clinical assessment and therapy for people with TS.
Article
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BACKGROUND: Cluttering has been described in the literature on speech disorders for over 300 years. Despite this, it remains a poorly understood condition whose history has not been analyzed as a whole to identify common themes and underlying frameworks. OBJECTIVE: The purpose of this review is to identify thematic questions and frameworks contained within the literature on cluttering since the earliest found reference in 1717. METHODS: Information from influential historical and contemporary documents were analyzed. Particular attention was paid to the types of questions, both implicit and explicit, that were posed in these materials. This information was ultimately organized into five thematic strands, presented here in the form of key questions. RESULTS: Five questions were derived from our historical analysis: (1) What should the problem be called? (2) What kind of problem is it? (3) What are its defining features? (4) What are its causes? and (5) How should it be treated? The first four questions are discussed in this review. The fifth question will be addressed in a forthcoming paper. CONCLUSIONS: Consensus has been achieved on what to call the disorder (cluttering) and in what domain it should be placed (fluency). Less agreement exists regarding its defining features, causes, and treatment. We propose that alternative conceptual frameworks may be useful in breaking new ground in our understanding and management of this complex condition.
Article
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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.
Article
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The investigators sought to explore and compare the identification of cluttering vs stuttering in four different country samples. After reading lay definitions of the two fluency disorders in their own language, convenience samples of 60-90 adult respondents from Turkey, Bulgaria, Russia, and the US identified 51-119 children or adults who either cluttered, stuttered, or both. They also indicated whether or not they, themselves, cluttered or stuttered. The majority of respondents in all four samples identified at least one person who cluttered, stuttered, or cluttered and stuttered. The average respondent identified one person with a fluency disorder, most likely a stutterer, less likely a clutterer, and least likely a clutterer-stutterer. Both similarities and differences characterized those identified in the three groups, e.g., the sex ratios were not the same. As with stuttering, the public apparently is aware of cluttering individuals and can identify such persons.
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