You may have heard about stuttering disorders, but cluttering disorders are much less known. In fact, people who clutter often go misdiagnosed or undiagnosed because it's not a widely recognized disorder. Both stuttering and cluttering impact speech clarity and conversational skills and fall under the category of fluency disorders; however, they differ in various ways. A differential diagnosis between cluttering and stuttering is important to determine which treatment will best help you improve your communication.
Stuttering occurs when someone knows precisely what they want to say and how to say it but struggles with the actual production of speech. Cluttering, on the other hand, presents a different challenge. It involves an imbalance between speech rate and language formulation. Essentially, people who clutter speak faster than their ability to organize their thoughts into coherent speech, resulting in a jumbled and disorganized message that's difficult for others to understand.
In this blog post, we will dive deeply into the nature of fluency disorders, their common symptoms, the differences between stuttering and cluttering, how speech-language pathologists evaluate individuals, and how speech therapy can help. More specifically, we will discuss:
What is a Fluency Disorder?
A fluency disorder is a speech disorder characterized by disruptions in the smoothness of fluent speech. It may be marked by an unusual rate, rhythm, and fluency. These disfluencies can include repetitions of sounds, syllables, words, and phrases, as well as sound prolongations and blocks. Such interruptions can also be accompanied by excessive tension, avoidance of speaking, struggle behaviors, and secondary behaviors or no behaviors at all.
Fluency disorders can vary in severity and may affect an individual’s ability to communicate effectively in social, academic, and occupational settings.. Speech-language pathologists assess and treat fluency disorders, often using a combination of strategies to help individuals improve their speech fluency and communication skills.
There are two types of fluency disorders: stuttering and cluttering. Stuttering is the more common of the two, while cluttering is less common.
What is Stuttering?
Stuttering is a type of fluency disorder characterized by physical interruptions in speech, often accompanied by secondary behaviors.
Stuttering Disfluencies (the physical interruptions in speech)
Repetitions: Repeating sounds, syllables, words (e.g., "why why why"), and phrases.
Blocks: Attempting to say something but being unable to get the sound out (e.g., "why-----are you here?").
Prolongations: Prolonging sounds (e.g., "llllike this").
Filler words: Using words like "uh," "um," etc., or interjections and revisions (this is a common occurrence in the speech of both people who stutter and people who do not stutter).
Secondary Behaviors
Secondary behaviors, also referred to as secondary symptoms, describe the entire range of reactions, strategies, and escape behaviors that people who stutter typically employ when they become aware of their stutter. This can include anything from switching a word they think they may stutter on to tapping a pen on a table.
Types of Stuttering
Developmental Stuttering (Childhood-Onset Fluency Disorder): This is the most prevalent type of stuttering, usually appearing in early childhood.
Neurogenic Stuttering: This type of stuttering occurs due to brain damage or injury.
Psychogenic Stuttering: This rare form of stuttering is caused by extreme emotional trauma or stress.
Additional Factors about Stuttering
Stuttering severity can vary from day to day and hour to hour.
Stuttering is not related to a person's intelligence.
Language problems can accompany developmental stuttering.
Males are at a higher risk of developing stuttering and are twice as likely as females to exhibit stuttering initially and continue stuttering over time.
There is often physical tension associated with the stuttering moment.
Causes of Stuttering
While the exact causes of stuttering are not fully understood, several factors contribute, including neurological, genetic, and environmental influences:
Brain Function: Speaking involves the left cortex and subcortical structures like the basal ganglia and thalamus. These form a loop called the cortico-basal ganglia-thalamo-cortical loop, crucial for fluent speech. People who stutter may have trouble with this loop, affecting timing cues during speech. (Source)
Genetics: Studies show that identical twins, who share the same genes, often both stutter. This suggests a strong genetic component, though environmental factors also play a role.
Key Gene (GNPTG): This gene affects the brain's waste disposal system. If it doesn’t work well, cellular waste can build up, impacting neural signals. Poor connectivity in the speech loop can lead to stuttering.
How Common is Stuttering?
Stuttering impacts about 1% of the population. Here's a breakdown of its occurrence:
Children: Stuttering is more common in children; however, many children outgrow stuttering.
Adults: Approximately 1% of adults continue to stutter.
Gender: Males are at a higher risk of developing stuttering and are twice as likely as females to exhibit stuttering initially and continue stuttering over time.
Co-Occurring Disorders of Stuttering
Stuttering often co-occurs with other disorders. Here are some common ones:
Language Disorders: Children who stutter may also have expressive and receptive language disorders, which can impact their overall communication abilities.
Speech Sound Disorders:
Articulation Disorders: Challenges with pronouncing sounds correctly can accompany stuttering.
Phonological Disorders: Difficulty in organizing sound patterns can affect speech clarity.
Attention-Deficit/Hyperactivity Disorder (ADHD): Characterized by inattention, hyperactivity, and impulsivity, ADHD can impact attention and focus during speech therapy.
Autism Spectrum Disorder (ASD): Children with Autism Spectrum Disorder may exhibit stuttering alongside difficulties with social communication and other behaviors.
How Stuttering Can Impact Daily Life
Stuttering can significantly impact various aspects of daily life, influencing not just communication but overall well-being and social interactions. Here are some key areas where stuttering may have an effect:
Avoidance of social interactions: Avoiding public speaking or situations where communication is required.
Workplace communication difficulties: Challenges in communicating with colleagues and clients, which may impact career growth.
Academic challenges: Academic challenges: Difficulties in class or during oral presentations, affecting academic performance.
Personal struggles: Misunderstandings and frustration in everyday conversations.
Advocacy and support: Struggling to advocate for needs or seek support.
Routine tasks: Challenges with tasks such as speaking on the phone, ordering food, or asking for directions.
These challenges can lead to emotional difficulties, including stress, frustration, and feelings of inadequacy.
Challenges Reported by People with a Stuttering Diagnosis
Difficulty getting words out.
Being interrupted by others.
Feeling isolated from peers who do not stutter.
Reluctance to speak in school, at work, and in social situations.
The Speech-Language Pathologist's Assessment of Stuttering
Childhood fluency disorders, such as stuttering, are typically diagnosed by a speech-language pathologist (SLP) through a comprehensive evaluation process. Here’s an overview of how the diagnosis may be made:
Gathering Information
Case History: The SLP collects a detailed record of the disorder, including its onset, development over time, and current status. This helps in understanding the progression and patterns of the fluency disorder.
Family History: A family history of stuttering or other speech disorders can provide insights and help assess the likelihood of persistence. Knowing about relatives with similar issues can aid in understanding genetic or hereditary factors.
Medical History: Exploring medical or neurological conditions is crucial to rule out other contributing factors and ensure the fluency disorder is not a symptom of another underlying condition.
Assessing Your Speech
Speech Sample Collection: The SLP gathers speech samples to analyze fluency issues. These might include spontaneous speech, oral reading, or phone calls. The goal is to capture a variety of speaking contexts for a comprehensive view of speech patterns and fluency.
Formal Assessment: Using standardized tools and tasks, the SLP evaluates speech fluency. This includes tasks like reading aloud, conversational speech, and spontaneous speech samples. Standardized assessments provide a baseline for measuring the severity and frequency of stuttering.
Speech Analysis: The SLP analyzes speech patterns to determine the frequency, duration, and severity of stuttering events. They also assess secondary behaviors, such as facial grimaces or head movements, and emotional reactions to stuttering.
Assessing Beyond Speech
Attitude Rating Scale: This step involves obtaining information about the Individual's self-perception, attitudes, and feelings about communication, as well as their emotions regarding stuttering. Understanding these aspects helps tailor therapy to the client's needs.
Setting Specific Goals: The client and the SLP work together to set personal stuttering treatment goals, such as reducing disfluencies, improving communication confidence, or managing specific speaking situations.
This comprehensive evaluation process allows the SLP to accurately diagnose childhood fluency disorders and develop a tailored treatment plan to address each client’s unique needs.
Strategies to Improve Speech for Individuals Who Stutter
Reducing the rate of speech and inserting pauses
Slow down your speech and insert pauses between phrases, after sentences, and wherever it feels natural.
Speaking quickly can make fluency harder to achieve. Pausing gives your speech muscles a break before producing more words, which improves fluency.
Reducing the volume at the beginning of speech
Start speaking at a lower volume and gradually increase it.
Beginning at a lower volume requires less effort and pressure on the vocal folds. Gradually increasing the volume can help ease into more fluent speech.
What Happens During Speech Therapy for Stuttering
Following a detailed speech evaluation, specific goals will be created to improve both fluency and communication confidence. These goals may also target particular speaking situations that pose challenges. A speech-language pathologist (SLP) typically employs a combination of fluency shaping and stuttering modification techniques to help you achieve these goals.
Fluency Shaping Techniques
Fluency shaping techniques aim to enhance overall speech fluency. These strategies include:
Slowing Down Speech: Encouraging a slower rate of speech and incorporating pauses to reduce stuttering.
Easy Onset: Starting speech gently with a soft onset of voice to prevent blocks and prolongations.
Continuous Phonation: Maintaining continuous vocal cord vibration to minimize disfluencies.
Stuttering Modification Techniques
Stuttering modification techniques focus on reducing the severity of stuttering during the moment of stuttering. These strategies include:
Voluntary Stuttering: Practicing stuttering on purpose to reduce fear and anxiety associated with stuttering.
Cancellations: Pausing after a stuttered word and then repeating it more fluently.
Pull-Outs: Learning to ease out of a stuttering moment smoothly.
Addressing Emotional Aspects
During therapy, emotional aspects of stuttering are also addressed. Techniques such as Cognitive Behavioral Therapy (CBT) may be used to tackle negative thoughts and feelings surrounding stuttering. Desensitization strategies can help manage avoidant behaviors often associated with stuttering.
Practical Application
You will have opportunities to practice these strategies in real-life scenarios, such as making phone calls (e.g., ordering a pizza). Additionally, homework assignments may be given to encourage the use of these techniques outside of therapy sessions when you feel comfortable.
Family and Support Involvement
Speech therapists often involve parents or loved ones in the therapy process to educate them about stuttering. They may also help you connect with support groups where you can meet others in similar situations and share coping strategies.
This comprehensive approach ensures that therapy not only improves fluency but also builds confidence and reduces the impact of stuttering on daily life.
What is Cluttering?
Just as no two individuals who stutter are alike, no two people who clutter are the same. Cluttering presents differently in each person, with varying symptoms and manifestations.
Cluttering is a multifaceted speech disorder characterized by a range of symptoms, including:
Disorganized Language: Difficulty organizing thoughts and expressing them coherently.
Fast Speaking Rate: Speaking too quickly, though a fast speaking rate alone does not qualify someone as a clutterer.
Jerky or Irregular Rate: Awkward pauses in unnatural places or no pauses at all, unlike typical speakers who pause at the end of sentences or phrases.
Excessive Typical Disfluencies: This can include incomplete words, revisions, filler words (such as interjections), and repetitions of phrases or words.
Collapsing Sounds/Syllables or Whole Words: Speech may sound mumbled, with words running together as if produced too quickly, leading to dropped sounds.
Atypical Pauses, Stress Patterns, and Speech Rhythm: Abnormal speech patterns such as difficulty with volume control, word or syllable stress, and intonation. Challenges in managing breath and speech simultaneously can also be present.
Disorganized Language Use: Struggling to produce language that is easily understood, monitor one's own speech, and interpret listeners' reactions.
Causes of Cluttering
Possible causes of cluttering include:
Difficulty with Language Processing and Self-Regulation: Challenges in processing and regulating language output.
Inhibition Problems in the Basal Ganglia: Issues with executive functioning, particularly self-regulation and monitoring.
Co-occurring Diagnosis: Cluttering may be a symptom of another condition.
How Common is Cluttering?
About 1.1-2.1% of school-age children clutter.
There is a 4:1 male-to-female ratio.
Research estimates that at least 1/3 of children and adults who stutter also present with some component of cluttering.
Cluttering is more common when co-occurring with stuttering.
Cluttering is more common when co-occurring with other disabilities, especially when the disability impacts attention or language.
Co-Occurring Disorders of Cluttering
Common disorders that occur alongside cluttering, but are not the cause of cluttering, include:
Stuttering: A speech disorder where a person has disruptions in the flow of speech, such as repeated sounds, syllables, or words.
Articulation Disorders: A type of speech sound disorder that impacts speech production and can reduce speech clarity.
Attention Deficit Hyperactivity Disorder (ADHD) or Attention Deficit Disorder (ADD): A disorder where a person has trouble focusing and paying attention.
Learning Disabilities: Issues such as a language disorder that make it hard for a person to read, write, or do math.
Central Auditory Processing Disorders: Difficulty understanding and processing sounds and spoken language.
Asperger's Syndrome: A form of autism where a person has difficulty with social interactions and may have focused interests and repetitive behaviors.
Apraxia: A motor speech disorder where a person has difficulty planning and coordinating the movements needed for speech.
Dysarthria: A speech disorder caused by muscle weakness, making it hard to speak clearly.
How Cluttering Can Impact Daily Life
Communication Challenges: Difficulty expressing oneself clearly can lead to frustration in conversations.
Relationships: Misunderstandings may strain relationships with family, friends, and colleagues.
Educational and Professional Settings: Cluttering can impact academic and professional performance, affecting classroom participation, job interviews, presentations, and other communication-related activities.
Self-esteem: Persistent speech difficulties may reduce self-confidence and impact overall quality of life.
Despite these challenges, individuals with cluttering often develop strategies to cope, such as avoiding specific speaking situations, modifying their speech patterns, or seeking support from speech-language pathologists.
Challenges Reported by People with a Cluttering Diagnosis
Challenges for people with a cluttering diagnosis vary, but here are common ones:
Racing Thoughts: Struggling with a rapid flow of ideas that can be difficult to manage.
Difficulty Organizing Thoughts or Getting to the Point: Trouble structuring thoughts coherently and concisely.
Words Sounding Like They Are Running Together: Speech may sound rushed and unclear.
Frequent Starts and Stops: Interruptions in the flow of speech with frequent pauses and restarts.
Excessive Use of Interjections: Overuse of filler words that disrupt the natural flow of speech.
Limited Awareness of How Speech Sounds to Others: Difficulty perceiving how their speech is received by listeners.
Difficulty Slowing Down When Requested: Challenges in moderating their speaking pace, even when asked to do so.
Tendency to Interrupt Conversational Partners: Interrupting others, often without realizing it.
Words or Ideas Coming Out Differently Than Intended: Miscommunication due to the disorganized production of language.
Managing Fluency Disorders: Strategies to Improve Speech for Individuals with Cluttering Disorders
Effective strategies to Improve speech with a cluttering diagnosis include:
Reducing Speech Rate: Incorporate pauses in natural places and speak at a slower pace.
Over-Articulation: Exaggerate each sound in connected speech, which is especially helpful if you experience collapsed syllables.
Developing Awareness: Recognize cluttering episodes and apply strategies in real time.
The Speech-Language Pathologist's Assessment of Cluttering
To thoroughly evaluate cluttering, we ensure a comprehensive assessment of all dimensions of communication and related disorders commonly associated with cluttering. Some individuals who clutter may exhibit slowed speech during evaluations due to awareness of being assessed, particularly in structured situations. We conduct assessments over extended periods to prevent misdiagnosis or overlooking potential diagnoses.
Gathering Relevant Information
Questionnaire: We may ask you to fill out an intake form to describe your or your child's speech, including when the difficulty was first noticed, how speech has changed over time, self-awareness of the challenges, how communication breakdowns are handled during conversation, and what situations are more or less challenging.
Case History: We collect pertinent information regarding the purpose of your evaluation, including developmental history, onset of symptoms, and prior treatment experiences.
Family History: We inquire about any family history of speech or language disorders, including fluency disorders.
Medical History: We explore medical or neurological conditions to identify potential contributing factors.
History of Learning and Behavioral Problems: Given the potential coexistence of cluttering with disorders such as ADHD, learning disabilities, and auditory processing disorders, we assess any history of learning and behavioral difficulties in school or work settings.
Obtain Subjective Rate of Speech: We may ask family members or close friends for their perception of the client's rate of speech, as our perception during the evaluation may not reflect their usual speech patterns.
Evaluation of Speech
Variety of Speaking Situations: We may prompt clients to speak in diverse situations, including spontaneous speech, conversation, narrative, and expository discourse. In some cases, involving additional conversational partners may alter the frequency of speech breakdowns. We assess various components during these speaking situations, including organization, stress patterns, rhythm, disfluencies, rate of speech, and articulation.
Oral Reading: Clients may be asked to read aloud during assessments.
Assessment of Articulation/Language: Articulation and/or language screeners or assessments may be administered to determine the presence of an articulation or language delay or disorder.
Evaluation of Writing
Samples of written work from school assignments may be collected, or prompts may be provided during the evaluation process. Oftentimes, those who clutter tend to write how they speak. They may also have difficulty writing; in which case, they may need to be referred to an occupational therapist.
Self-Awareness
What Happens During Speech Therapy for Cluttering Disorders
After the evaluation, you and the speech therapist will work together to set specific goals for your therapy. The next steps typically include:
Implementing Speech Techniques to Improve Speech Fluency
Reducing Speech Rate: You will practice speaking more slowly by incorporating natural pauses and pacing your speech.
Over-Articulation: You may use techniques to exaggerate each sound in connected speech, which can help improve clarity and prevent syllables from blending together.
Exaggerating Sounds: Practicing exaggerated pronunciation can aid in making your speech more understandable.
Improving Awareness:
Recognizing Cluttering Episodes: You will work on becoming more aware of when cluttering occurs and apply strategies to manage it in real time.
Organizing Your Thoughts:
Pre-Speaking Preparation: You’ll learn to organize your thoughts and plan your speech before engaging in specific speaking situations.
Using Visual Aids: Tools like graphic organizers may be used to help structure your thoughts and improve speech coherence.
Managing Disfluencies:
Handling Interruptions: You’ll work on strategies to reduce frequent starts and stops in your speech.
Minimizing Filler Words: Techniques to reduce the use of filler words and interjections will be practiced to improve the flow of your speech.
Involving Family Support:
Family Involvement: Family members may be included to provide additional support and practice at home, reinforcing the techniques learned during therapy.
Throughout the process, the speech therapist will regularly assess your progress and adjust the therapy goals and techniques as needed to ensure effective improvement in managing cluttering.
Stuttering vs. Cluttering : The Difference Between Stuttering and Cluttering
Stuttering | Cluttering |
Language planning is typically more complete. | Language planning is often incomplete |
Struggle or tension is evident when producing the intended message. | Rapid speech that is often disorganized, with minimal tension. |
Disfluencies may increase with focus on speech due to heightened emotional response. | Disfluencies often decrease when focus and awareness shifts to their own speech (this is because they may organize their speech better, thus decreasing disfluencies) |
With speaking experiences, there tends to be more behavioral or emotional responses | With speaking experiences, there tends to be minimal to no fears |
Disfluencies include part-word repetitions, blocks, sound prolongations, whole-word repetitions with tension | Disfluencies include interjections, phrase repetitions, revisions, and whole-word repetitions without tension |
Struggle or tension is evident when producing the intended message. | Minimal to no tension, linguistic issues present, no secondary behaviors present |
Frequently Asked Questions
Where Can I Find More Information Regarding Stuttering and Cluttering Disorders?
The International Cluttering Association is an excellent resources for those that clutter. The Stuttering Foundation website is a great resource for those that stutter. They also have a cluttering brochure. There are also virtual support groups for kids, teens, and adults here.
Does My Child Need Additional Speech Therapy if They Already Receive It From the Public School System?
Additional therapy may be beneficial depending on individual needs and progress.
How Long Will Speech Therapy Take?
Speech therapy requires practice, but the more invested you are, the more quickly you will gain skills.
Speak with Stephanie: Gain Confidence in Your Speech Again
As a speech-language pathologist, I specialize in helping individuals with fluency disorders regain confidence in their speech. I offer personalized stuttering and cluttering treatment programs focused on improving fluency and reducing symptoms.
In-Person Speech Therapy for Cluttering and Stuttering Near Skokie, IL
For those who clutter and/or stutter, the goal often extends beyond simply being understood; it is about achieving effective and confident communication in all aspects of life. I am committed to helping you or your loved one reach this goal through a holistic and empathetic approach to therapy.
I provide In-person speech services in Skokie and nearby Illinois neighborhoods.
My approach focuses on several key areas:
Improving Speech Fluency: We work together on strategies and techniques to make your speech smoother and more controlled. This includes exercises to regulate speech rate, enhance articulation, and increase overall clarity.
Managing Emotions: Fluency disorders can be accompanied by feelings of tension, anxiety, or fear related to speaking. We address these emotional components through supportive and therapeutic methods, helping you feel more relaxed and confident when communicating.
Building Confidence: Developing a positive attitude towards communication is essential. Our sessions include activities and exercises aimed at boosting your self-esteem and encouraging a proactive mindset towards speaking in various settings.
Expanding Capabilities: Stuttering and cluttering should not limit your opportunities. We focus on expanding your communicative capabilities, ensuring that these fluency disorders do not hinder your personal, educational, or professional aspirations.
Reducing Negative Impact: Minimizing the adverse effects that stuttering and cluttering might have on your daily life is a crucial part of our therapy. We work on practical solutions to overcome challenges, such as techniques for handling difficult speaking situations and strategies for effective self-advocacy.
By combining these elements, my therapy sessions are designed to provide comprehensive support tailored to your unique needs. Whether you are seeking to improve your own fluency or that of a loved one, I am dedicated to helping you achieve clear, confident, and effective communication.
Online Speech Therapy for Cluttering and Stuttering in Illinois, New York, and New Jersey
In addition to in-person speech therapy, I also offer teletherapy for those who clutter or stutter in Illinois, New York, and New Jersey.
Additional Speech Therapy Services at Speak with Stephanie
At Speak with Stephanie, we offer comprehensive speech services tailored to the needs of both children and adults. For children, we address language disorders (including language difficulties and delays) and articulation disorders (including speech production challenges such as lisps), For adults, we address a range of communication issues, including language disorders, articulation issues, and aphasia.
We are committed to delivering personalized care that ensures effective improvement in communication skills. Our holistic approach supports significant progress, helping clients excel in their daily interactions and achieve their communication goals.
About the author:
Stephanie Jeret is a Speech-Language Pathologist and the owner of Speak with Stephanie LLC. She obtained her Bachelor's and Master's degree from the City University of New York. She has practiced speech therapy in a number of settings including outpatient rehabilitation, telepractice, skilled nursing facilities, schools, and a private practice. She specializes in the evaluation, diagnosis, and treatment of a variety of communication disorders including articulation disorders, receptive/expressive language disorders, and fluency disorders. Information is available by emailing her at stephanie@speakwithstephanie.com or by visiting www.speakwithstephanie.com.