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From: Lisa LaSalle
Date: 08 Oct 2009
Time: 22:46:45 -0500
Remote Name: 69.222.77.73
Hi Katherine, An answer to your first question, "With the clients who have both cluttering and stuttering, is it difficult for the clinician to distinguish between the two disorders in the clients speech?" is Yes. What the two disorders have in common are repetitions and a fast rate, but the rate of people who stutter (PWS) is a "making up for lost time spent stuttering" type of fast rate, whereas the fast rate in people who clutter (PWC) is intermittent or festinating (like in Peter K's speech) -- like rushes of fast speech and often means that weak syllables are deleted. In terms of the repetitions, PWS will often report a loss of control and their repetitions may be accompanied by blocks and physical tension, whereas PWC repeat and maze (produce long revisions, unfinished utterances, etc) and they benefit from recorded playback of their repetitions so they can learn to identify that they do produce them. (A clinician can then move from online rather than only offline/recorded-playback identification). So, when the disorders co-occur - in a PWC+S, then we need to combine Tx approaches and techniques that address these various features. So, yes it can be difficult, and the adult PWC+S needs to tell us -- as Joseph has done in these Q/A posts -- what his own goals are for speech improvement as that increases motivation and progress. Your second Q is "Is it known why the prevalence of cluttering is so high in individuals with Down Syndrome?" A simple answer is No. Good thesis topic, maybe? :~) Prues (1972) studied 47 persons with Down Syndrome, those that had intelligible enough speech to be evaluated. He found that a third of them were pure clutterers, judging the primary features. But he also found that about half of them were pure stutterers. (But the predominant type of stuttering was whole-word repetitions. When he excluded thhose, only a third were classified as stutterers.) And for whatever reason, he found no comorbidity of ST+CL in these individuals with Down syndrome. So the important point is that cluttering AND stuttering are more prevalent in people with DS than in the general population. This is also true for people with Fragile X syndrome. I think that the prevlaence of cluttering might be higher in DS individuals due to genetic loading and/or speech/language gains that are made a variable rates due to therapy, special education services, well-meaning and often unavoidable communicative pressure, etc. I'm not sure. It would be interesting to hear what others in this ISAD conference think :~)