Cluttering Fluency Disorder

Cluttering speech disorder was an area I felt unprepared to diagnose and treat when I started working in the schools.

I had learned about stuttering in college, and I remembered hearing a little about cluttering.

Then I had a student who turned my world upside down. I’ll call him John. I had worked on some articulation and language goals, and I was ready to discharge him from therapy. I contacted his teachers, only to learn they found him very difficult to understand.

After a comprehensive reevaluation, we discovered that John exhibited many signs of a cluttering speech disorder.

One of the most difficult things about John’s case was that he rarely exhibited cluttered speech during the highly structured therapy activities we had been doing. It came out more during conversational speech.

Since diagnosing John, I have learned to recognize the signs of cluttering.

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Know the signs

According to St. Louis and Shulte (2011), the minimum symptoms needed to diagnose cluttering are:

fast or “jerky” sounding speech

Plus at least one of the following:

an excessive amount of “normal” dysfluencies (false starts, phrase repetitions, or interjections such “um” and “like”)
collapsing or deleting syllables to a degree that it impacts the clarity of the message
unusual pauses, syllable stress, or speech rhythm

These symptoms need to be present in conversational speech in order to consider a cluttering diagnosis, but they don’t need to occur all of the time.

In addition, people who clutter may:

have problems with attention
have a language disorder
stutter

Evaluate thoroughly

You never know when a student with cluttering might enroll at your school. I have diagnosed fourth and fifth graders who clutter, so you can’t expect that it will be caught at an early age every time.

Interview teachers, parents, and the student

Parents and teachers might describe the child’s speech as “mumbling.”

In my experience, the teacher often describes what initially sounds like an articulation problem. It’s a red flag when the articulation scores are normal or mild, yet the teacher reports the child’s speech is nearly impossible to understand.

Make sure to avoid using jargon when interviewing teachers. Most teachers haven’t heard of “cluttering” and associate the word “fluency” with oral reading skills. You’ll have to specify that you’re talking about “speech fluency” and not “reading fluency”.

Parents may also notice cluttering, but tend to have an easier time understanding the child. In my experience, many parents are used to the way their child speaks.

Cluttering rating scales

I created a teacher/parent rating scale (available on my TpT site) that I use for evaluations and for writing goals on the student’s Individualized Education Program (IEP). I made this because I needed something that a non-SLP could understand.

I give it to teachers and ask them to fill it out and return it to me. Because I avoid jargon and give lots of examples, they are usually able to answer most of the questions. If anything gets marked “not sure”, I go back and ask the teacher about it.

The questions at the end of the rating scale focus on how cluttering affects the student’s participation in school activities, and will give you an idea of the educational impact of the cluttering problem.

I also created a student self-report form (available on my TpT site) to learn what my students think of their own speech. I sit with the student and explain each question, letting the student mark the rating. Keep in mind that students aren’t always completely aware of their speech problems, especially when it comes to cluttering.

To check out my Cluttering Rating Scales, click on the picture below. It will take you to my TpT site, where you can download a free preview.

Assess a speech sample for cluttering

Obtaining a conversation sample

Since you might not be able to observe cluttered speech during articulation or language testing, you’ll need to obtain a conversational speech sample.

It cannot be overemphasized that the cluttering speech sample must include conversational situations in which the child can speak freely and naturally. Audio or video recordings are very useful because they can be analyzed later. I aim for at least a five-minute conversation.

Cluttering conversation sample analysis

I created my own form for analyzing a speech sample for cluttering (available on my TpT site). I wanted something that allowed me to go through each component of the diagnosis criteria for cluttering, make a note about whether or not the student exhibited that particular symptom, and evaluate the impact on intelligibility.

As you analyze the speech sample, listen for fast or jerky speech, excessive “normal” dysfluencies, etc., and if you notice that a symptom is present, ask yourself whether it impacts the clarity of the message.

To learn more about the Cluttering Conversation Sample Analysis form that I made, click on the picture below. It will take you to my TpT site, where you can download a free preview.

Here are some additional resources I’ve used in the past that are also available online.

The Predictive Cluttering Inventory (David Daly, 2006) can be downloaded in the Resources section of the International Cluttering Association (ICA) website. It’s a great rating scale for you as the SLP to complete. Teachers might find the jargon confusing (mine did).

The Cluttering Severity Instrument (CSI), (Bakker and Myers, 2011) can be downloaded in the Resources section of the ICA website, on the Software downloads page. It’s a free program that helps you to assess a speech sample. You can determine the percentage of cluttered talking time, and rate the child on several different measures of intelligibility and naturalness.

Assess other speech and language skills

Stuttering

Anytime I suspect cluttering, I also do a stuttering assessment. There’s no one right way to assess stuttering. I use the Stuttering Severity Index-4.

In addition to helping me evaluate stuttering, this assessment has a speech naturalness scale that is useful for cluttering. My state guidelines mention naturalness as one of the components of a fluency disorder, and cluttered speech can sound quite unnatural!

Articulation, language, and voice

As you would with any speech-language evaluation, you’ll also want to screen for voice, articulation, and language problems.

Your articulation screening results will be helpful in determining whether the student is deleting weak syllables in conversation (common in cluttering) or only has a problem with specific phonemes (articulation disorder).

I’ve also noticed that some of my students who clutter have difficulty with language skills. They might put words in the wrong order, interrupt others during conversations, or abruptly start talking about a new topic without giving any background information.

Put it all together

After you’ve consulted with parents and teachers, analyzed a speech sample, and conducted a full speech-language evaluation, you should have plenty of data. Now you’ve got to figure out what the data means.

Man drowning in paper

No worries! You’ve got this.

Summarize the data

First, you’ll want look at whether the data supports a cluttering diagnosis. If it does, consider whether the cluttering negatively impacts the student’s education and whether it requires specially designed instruction (speech services). Remember that eligibility is a team decision.

Review the symptoms

I created a form for reviewing the cluttering symptoms (available on my TpT site). This form helps me summarize all of my cluttering data in one place and gives me a starting point for the discussion I’ll have with parents and teachers at the evaluation results meeting.

To see what my Cluttering Symptoms Review form looks like, click on the picture below. It will take you to my TpT site, where you can download a free preview.

What if I’m still not sure whether it’s cluttering?

One of the reasons I like to get info from multiple sources is that it helps me with borderline cases. If you’ve got a borderline case, go back to both your speech sample and your teacher report, and compare them again to the criteria for diagnosing cluttering.

If you can understand every word the student says throughout the entire conversation sample, it might not be cluttering. You might just have a teenager who talks quickly and says “um” and “like”.

Likewise, don’t dismiss symptoms just because they come and go. If a student is exhibiting symptoms of cluttering and is difficult to understand for any portion of the conversation, consider it a red flag. The cluttering diagnosis criteria doesn’t require that symptoms be present all of the time.

Cluttering treatment

Therapy goals

I’ve tried lots of different cluttering goals, some of which were harder to measure than others. For general advice on goal writing, I really like this article.

I focus my cluttering goals on big ideas that I hope will transfer outside of the therapy room. I want my students to understand what a communication breakdown is, why it happens, and what can be done to prevent and repair it. Here are some examples.

Katie will identify at least 4 reasons why a communication breakdown may occur, including identification of at least 2 of her own behaviors that may result in a communication breakdown.
In a 30-minute session, Max will demonstrate at least 3 strategies he can use to prevent or repair a communication breakdown, for two-plus sessions.

Speech therapy activities

Getting started with cluttering treatment

Since most students who clutter don’t know what cluttering is, I usually begin by focusing on education. The ICA offers a cluttering brochure for children, created by SLP Nina Reeves and her students.

Next, I have my students identify cluttered speech. I will purposely exhibit cluttering and have them take turns being a detective and spotting my cluttered speech. Also, I like to record them talking about a topic of interest for at least a minute, and then we listen to it together and identify cluttering in their speech. Throughout the process, I praise them for “finding the cluttering” in the speech sample.

If they have trouble talking for a full minute, try using conversation starters you can find online or read my post about using animated short videos in speech therapy. I also find that it sometimes helps to either set a timer for one minute and let the student look at the timer while he or she talks, or let the student spin a fidget spinner and talk until it stops spinning. Read my article about using a fidget spinner in speech therapy for more information.

Once we can identify cluttered speech, we work on decreasing it. I will have them try saying a sentence over again, without cluttering. During each session, I emphasize to them that we work on increasing our fluency so other people can understand us better.

I also recently started incorporating the lessons from the book Managing Cluttering: A Comprehensive Guidebook of Activities, by Kathleen Scaler Scott and David Ward, into my therapy sessions. I really like how this book focuses on building motivation for students to want to work on their speech skills.

One thing I learned from this book is that you might get more buy-in from students if they discover that using the strategies you teach them will mean that they don’t get asked to repeat themselves as often. Before reading this book, it never occurred to me how frustrating that must be for a person who clutters.

Carryover activities

To make lasting progress, you need your students to use their fluency strategies outside of the therapy room. This is especially hard with cluttering because most teachers and parents have never heard of it.

Parent handout

Here’s a free speech therapy guide for teachers and parents that explains cluttering and other communication disorders. I would recommend bringing the guide to a meeting and discussing it in person if possible.

Speech action plan

Something I just recently started using with my students who clutter is a speech action plan. It allows me to work together with students to track progress toward their goals. The speech action plan is an editable Google Docs template you can access it in my freebie library if you’re on my email list.

Speech therapy pocket sized homework

Another way I target carryover is with speech therapy homework. I’m not talking about lengthy assignments here. I give my students pocket sized sheets that take maybe 10 minutes tops, and they have a chance to win a prize from the dollar store if they bring it back with a signature.

If you want to check out my cluttering pocket sized homework, there is a free preview available at my store.

Save on cluttering resources with the cluttering bundle

If you’re interested in getting four of the resources I have discussed in this article (rating scales, conversation sample analysis, symptoms review, and homework) in one download, you can do that with my cluttering bundle.

Reference:

St. Louis, Kenneth & Schulte, K. (2011). Defining cluttering: The lowest common denominator. Cluttering: A handbook of research, intervention and education. 233-253.

Disclaimer:Tween Speech Therapy does not warrant or make any representations concerning the use, accuracy, reliability, or validity of the information in this publication. Consider your local, state and federal requirements when applying this information.