|About the presenter: Isabella Reichel, Ph.D., CCC-SLP/A, is an associate professor at the graduate program in speech-language pathology at Touro College. She is a Board-recognized specialist, Fluency Disorders. She has been specializing in this field for over three decades. Her research on the topics of emotional intelligence, stigma, stuttering, clutterring, and international collaboration among professionals has been published and presented worldwide. She is the Chair of the Committee of International Representatives of the ICA.|
| ||About the presenter Klaas Bakker, Ph.D./CCC-SLP, associated with Missouri State University since 1990; specializes in fluency disorders; research focus on fluency disorders (assessment and diagnostic evaluation of cluttering and stuttering); develops new technologies for the assessment and measurement of clinical aspects of speech (dys)fluency; Associate Editor for the Journal of Fluency Disorders; Chair of the Website development for the International Cluttering Association.|
| ||About the presenterFlorence Myers, Ph.D., CCC/SLP is a Professor at Adelphi University, Garden City, New York. She has published widely in the areas of cluttering and stuttering. Her current interests include the nature of cluttering and how it relates to stuttering, as well as treatment approaches to cluttering. She was co-chair of the executive committee to organize the First International Conference on Cluttering held in Bulgaria, May 12-14, 2007.|
With the advent of the 21st century and increased globalization, there is increased interconnectedness among individuals around the world. As a result of enhanced international communication, speech therapists, researchers, and people with cluttering (PWC) banded together in 2007, on the occasion of the First World Conference on Cluttering, to create what has become known as the International Cluttering Association (ICA). In the three years since the ICA was founded, data have been collected about the status of cluttering awareness, understanding, and clinical services as to PWC around the world. For example, an International Cluttering Survey (ICS; Reichel & Bakker, 2009) provided initial input from the ICA's international representatives of 25 countries. The present article continues to build on the initial Reichel et al. survey, but the new survey approached the respondents with new questions to make some inferences about the status of knowledge and awareness of cluttering worldwide in the hope that this will indicate how the ICA can effectively advocate for those with cluttering, encourage effective research and education and promote forms of help consistent with local circumstances.
Responses to the survey analyzed in this article were submitted by respondents from Africa, Asia, Eastern Europe, and South America. The countries and individuals represented are: Brazil (rep. Claudia de Andrade), China (Steve An Xue), India (Maya Sanghi), Indonesia (Muhammad Ishom), Japan (Shoko Miyamoto), Jordan (Maisa Haj Tas), Lithuania (Vilma Makauskiene), Nigeria (Ademola Grace), Poland (Jolanta Goral- PoB rola), and the Sudan (Sami Awad Yassin). The representative of Sudan actually polled 27 people (psychologists and special educators), and the representative of India polled 6 speech therapists. This survey describes a composite of their responses.
Disclaimer. While the following information and tentative conclusions are very important and represent the best information available, this information was not collected in a standardized or controlled way. Country representatives sometimes are speech therapists (and may be connected with universities) but in other situations they may be other professionals or family members of PWC (or perhaps PWC themselves).We have no guarantee that the respondents all view cluttering in the same light. Some of the questions are out of the areas of expertise of the respondents so that the responses may be impressions and views rather than based on facts or research. Finally, some countries are so large that there is no guarantee that answers provided may necessarily apply to an entire country and its (sub-) cultures.
Results and a brief interpretation of the responses to the survey follow.
There is a sizable body of literature on the subject of distinguishing cluttering and stuttering. Also, a major mission of the ICA is to heighten awareness of cluttering in the international community. This awareness in turn can lead to advances in research and clinical treatment of individuals who clutter. A logical starting point to raise awareness is to point to behavioral features that are associated with cluttering. Cluttering is often considered a fluency disorder. Fluency disorders are marked by the message not having an onward flow of speech and language. Cluttering may be related to but is not the same as stuttering. It should be noted that there are individuals who have cluttering only, stuttering only, and a number of individuals who exhibit both cluttering and stuttering. What are some features that distinguish cluttering from stuttering? While we still need a great deal of research to substantiate the distinctive features between stuttering and cluttering, clinicians and consumers cannot wait for this research to come forth before treating PWC.
Cluttering is often perceived to be a rate-based disorder. That is, listeners perceive the speech of PWC to be excessively fast and/or irregular in rate. The perception of fast rate may in fact be due to an excessively rapid execution of speech (especially when the speaker is talking in an informal setting on an exciting or complex topic), or it may be influenced by the fact that the speech is not always easily understood and therefore perceived to be "faster than the listener can handle." The perception of rate irregularity may be influenced by the speaker pausing in the middle of a thought at an unexpected juncture, to be followed by a subsequent spurt of speech; or by the injection of fillers, incomplete phrases with subsequent revisions. In this sense, that the message is not ongoing or does not flow based on listener expectations, cluttering may rightfully be considered a fluency disorder. As a theoretical notion, in part based on comments made by PWC themselves, it may be that the PWC is trying to process multiple thoughts that seem to "bombard" the speaker; however, for whatever reason, the PWC does not modulate his rate or manner of production to organize and/or sequence his thoughts into coherent and cohesive messages. When the urge to output the messages outpaces his ability to plan and execute the speech and thought units (manifested through language), a number of problems can show up at various levels of the communication system that give rise to the disorganization (or dissynergy) that is often seen in cluttering.
In addition to the behaviors discussed above, cluttering may be perceived based on other characteristics that result possibly from speaking faster than one can handle. At this point, we are only speculating that the PWC is speaking faster than his capacity. However, strong clinical evidence that at least indirectly supports the demands-capacity notion is that the various characteristics of dissynergy are markedly improved once the speaker slows down.) One behavior may be that the PWC leaves out sounds and syllables, or may "shortchange" a sound or syllable. For example, instead of articulating each syllable in the word "telephone," the speaker may reduce the word to "te-phone" by omitting the unstressed syllable. Vowels are not spoken distinctly. The overall effect is that the person seems to be mumbling, so that from time to time it is difficult to understand the speaker. The PWC may also exhibit disfluencies. However, the "pure" clutterer exhibits disfluencies that can be distinguished from those of the "pure" stutterer. Specifically, the disfluencies of PWC reflect what is often called "linguistic maze" behaviors such as interjections and revisions. These disfluencies may reflect issues with language planning. The disfluencies associated with stuttering reflect motoric struggle behaviors, greater fragmentations of intended words such as sound- and syllable repetitions, and physiological tension and effortfulness -- especially at the level of the vocal folds which "lock" so that the sound that comes out is distorted or no sound comes out at all during the momentary blockage of the larynx. Many PWS view the vocal folds as a major repository of physiological discoordination; this laryngeal tension generates voice qualities that reflect phonatory aberrations. PWC do not seem to have this laryngeal tension and struggle. We often know what the PWS wants to say, and in fact are waiting for a syllable to be produced in an intended word known to both speaker and listener (e.g., What a lovely be- be- be-baaaaby!). This is in contrast to listening to a PWC. At times we don't know what they are saying because their messages are unclear and seem to be "splintered" (e.g., many revisions that may lack focal points that tie the storyline together). Perhaps a related distinction between cluttering and stuttering is in the arena of intentions. The PWS has full cognizance of the intended message -- often to the point of scanning ahead in order to substitute a feared upcoming word, abbreviating a response or not talking at all to avoid stuttering. The PWC may have multiple and simultaneous intentions or may momentarily still be trying to formulate the intentions but does not appear to have the inclination to scan, organize, and modulate. Research is still needed to study these clinical insights offered by some PWC.
Another possible difference between cluttering and stuttering is that the PWC may not be fully aware that their messages are not clear, whereas PWS often are keenly if not painfully aware that they are having difficulty in getting the intended word out. The blocks that PWS experience result in feelings of embarrassment, anxiety, and attempts to hide the stuttering. Some PWC are, however, aware that others cannot understand their messages. This awareness can also cause feelings of anxiety and may, over time, influence the quality of life of PWC as it does PWS. Other PWC seem not to be fully aware, so that there is no evident attempts to modify one's output toward increased clarity, coherence, and cohesiveness of the message. In still other instance, some PWC describe a basic inclination to rush through things and to do several things, including talking, at the same time. In these instances, the onus is on the listener to try to decipher what is being said.
It seems that the recognition and treatment of cluttering are not necessarily dependent on the recipient's level of economic development. For example, there is virtually no recognition in China and very little in Japan; however, there is recognition for it in Sudan and Nigeria where the economic resources are expected to be more limited. In other words, cultural attitudes can interact with options for PWC more than economical wealth. The fact that cluttering is known and that there is a term for it does not guarantee the availability of actual services.
The process of cross-cultural and multinational partnering to discuss and develop services for PWC among professionals continues to contribute to create a worldwide panorama on cluttering. This serves as a foundation to promote theoretical paradigms, international research, and exchange of resources and intervention methodologies for managing cluttering. After all, the views expressed by respondents from the ten countries considered in this article will, it is hoped, encourage readers of all nationalities to engage in dialogue and learn from each other, while valuing and respecting their differences and adapting to the needs of people from diverse cultural, linguistic, and socio-economic situations.
Reichel, I., & Bakker, K. (2009). Global landscape of cluttering. Perspectives on Fluency and Fluency Disorders, American Speech-Language-Hearing Association, 19, 62-66.
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