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.Need to learn more about cluttering? This guide has you covered.Click To Tweet
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
- a language disorder
You never know when a student with cluttering might enroll at your school. I have diagnosed fourth and fifth graders who clutter, so you cannot 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
Keep in mind that you may not be able to observe cluttered speech during articulation or language testing. You’ll need to obtain a conversational speech sample.
Measuring the percentage of cluttered talking time
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.
I don’t like using this program to measure the percentage of cluttered talking time because it wants you to edit the speech sample (to remove any time in which the child isn’t actually speaking), and import your recording into its built-in media player.
I prefer to calculate the percentage of cluttered talking time a different way.
To measure the percentage of cluttered talking time without using the CSI program, all you need is a recording of the student talking and a stopwatch. If you’re using your phone for the stopwatch, you’ll need a different device to play back the sample.
I highly recommend downloading and reading the CSI user manual (it’s free) even if you’re not using the software to measure the percentage of cluttered talking time, because it explains of the rationale for doing this type of assessment.
Your recording should probably be at least two minutes long, and needs to be naturalistic. Remember, cluttering doesn’t usually appear until someone “lets their guard down” and talks the way they do in real-life.
While listening to the recording, use your stopwatch to time how long the student actually talks. Pause the timer anytime the student isn’t speaking. Write down this number. This is the total talking time.
Play back the sample again, and use your stopwatch to time how long the student clutters. Only activate the stopwatch when the student exhibits his or her first instance of cluttering, and pause it as soon as that instance ends. Keep starting and stopping the stopwatch in this manner. You’re adding up the time that the student clutters.
When you’re finished, write this number down. This is the total time cluttered. You might want to practice this a few times first, just to get comfortable doing it.
In the final step, you will calculate the percentage of cluttered talking time by dividing the total time cluttered by the total talking time. You should get a decimal less than one. Multiply it by 100 to convert it to a percent.
For example: If my total talking time is 200 seconds, and my total time cluttered is 25 seconds, my percentage of cluttered talking time is 25/200=0.125, or 12.5%.
Analyzing the characteristics of cluttering
The Cluttering Severity Instrument (CSI), (Bakker and Myers, 2011) program (which I discussed above) also lets you rate the child on several different measures of intelligibility and naturalness. I really like this part of the program, and use it every time I do a cluttering evaluation. You don’t have to import any recordings to use the rating components.
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).
Writing speech therapy goals for students who clutter
Individualize the goal for the child. Here are some areas I have targeted:
- describing characteristics of cluttering
- identifying cluttering in a recorded speech sample
- reducing the percentage of cluttered talking time
- improving a specific aspect of cluttering (such as rate)
Speech therapy activities
Since one of the characteristics of cluttering is a lack of awareness of one’s own dysfluencies, speech therapy activities should first focus 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.
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. 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.
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. You can read more about pocket sized homework here.
If you want to check out my cluttering pocket sized homework, you have two options. First, you can check it out by clicking on the picture below. There is a full preview available at my store.
You can also scoop up my FREE homework sample, which includes a sheet from the cluttering homework packet. Click below to see the sample.
Thanks for reading!
I hope this article has been helpful to you! Please feel free to share it with other SLPs!
St. Louis, Kenneth & Schulte, K. (2011). Defining cluttering: The lowest common denominator. Cluttering: A handbook of research, intervention and education. 233-253.