In working with many clients with cluttered speech, I have found that a key reason many are unaware of how their message is coming across is that they fail to tune in to listener feedback. We all can recall at least one time in our lives where our listener provides a quizzical look, and we revise our message. We as the speaker have to figure out whether the quizzical look was due to what we said orhow we said it. Did we provide enough background information? Did we speak loudly enough? Clearly enough? When a child with cluttered speech learns to watch for and respond to listener feedback, several things are accomplished: 1) the speaker becomes aware of how s/he is coming across; 2) the speaker learns to quickly assess online whether the miscommunication is due to how or what s/he said; 3) the speaker practices revising messages in a naturalistic context, thereby increasing changes for independent monitoring and generalization of skills.

Building the rationale: I have good things to say!

Getting the client to buy in to the strategy is the most important step in this process. If the client sees a reason to tune in to listener feedback then s/he will. If the client thinks that the reason is to please his/her speech-language pathologist, teacher, and/or parents, independence and long term use of this strategy will be unlikely. The first step in securing buy-in is to get the client to view the quizzical look and/or the request for clarification differently. After numerous requests for clarification, the client may begin to become frustrated, and to think the problem is with the listener and not them. Explaining to the client the reason that people ask for clarification is because they are interested in and want to hear what the speaker has to say brings forth a new perspective: "Someone is really interested in what I have to say." Educating the client about being proactive and making repairs before being asked for clarification empowers them with an ability to self-regulate the clarity of their speech. This can become a game the client plays with his/herself: i.e. "Yesterday I got 5 puzzled looks. Today I won't get more than 3."

Getting started

Start by having your client brainstorm reasons why a speaker may not be understood. Divide your list into "how I say it" (e.g. too soft, too fast, syllables run together) and "what I say" (e.g. not enough background information, message in wrong order). Focus at first on reasons anyone may not be understood, then help the client to tune in to his/her specific reasons. Play games where you and your client take turns purposefully making your message unclear by applying one of the items from the "how" or "what" list, and trying to guess where your partner's communication broke down.

Creating a new response pattern in everyday situations

Once the concept of reading your listener's face (either to confirm s/he is following you, or to make adjustments if s/he is not) is mastered in structured games and conversations, move to reading the listener's face in more naturalistic activities: e.g. reading aloud, telling mom or dad about a movie, talking with peers. The beauty of this strategy is that it is something we all do, and nothing that will single a client with cluttering out. Instead, it opens a new world to the person with cluttering to enjoying rather than dreading conversations, and realizing that they do indeed have valuable things to say. Miscommunications are just bumps in the road that can be easily repaired.

You can post Questions/comments about the above paper to the author before May 4, 2010.