Cluttering and Writing

From: Vanessa V.
Date: 20 Apr 2010

Comments

This article is very informative. It is stated in this article that poor handwriting is one of the earlier behaviors associated with cluttering and some clutterers use print as a compensatory strategy. Does this suggest that clutterers can improve their self awareness and monitoring by improving their handwriting skills because writing is a higher developmental stage of speech and language development?

 

From: Florence Myers
Date: 21 Apr 2010

Perhaps...although one's penmanship seems to be pretty ingrained in most of us. The act of printing slows down the writing process (as it is not script and thus have to write each letter separately, perhaps analogous of having PWC accentuate each syllable in a multisyllabic word), thus increases intelligibility. Peter K, who was one of the PWC who attended the Bulgarian conference, built a contraption for himself so that he'd have to be more deliberate in typing on the computer keyboard in order to slow his typing. Interesting, huh?

 

Oral Reading Assessment

From: Josephine Hernandez CSU Northridge
Date: 20 Apr 2010

Comments

Hi, This paper was very informative and provided great ways to assess cluttering. I also liked the idea of comparing how a client reads a passage with and without preparation. Do you feel that a client will show more cluttering behaviors without having preparation for a reading passage? Or would that depend more on the passage's complexity? Thank you so much.

 

From: Florence Myers
Date: 21 Apr 2010
I think it can go both ways. A couple of variables other than the "complexity" you talked about include: the rate at which the person is reading (does the rate exceed their capacity so there are breakdowns in articulation and fluencyh) as well as the reading level of the passage.

 

Question from a student

From: LM
Date: 21 Apr 2010

Comments

Thank you for sharing this article it was very infomative. I have one question for articulation assessment I understand that short and structured tasks shold come first and then you should continue on to longer and less structured tasks. I was wondering if assessment tools, for the short and strucured task section, such as CAAP (for younger children) and other regular articulation tests (older and younger) could be used for this portion of the task with a clutterer? Or if there are specific tasks or tests that assessment of cluttering is limited to and should be administered instead? Hope to hear from you soon : )

 

From: Florence Myers
Date: 21 Apr 2010

It has been my experience that you are more likely to capture misarticulations in longer and spontaneous utterances. Likewise, you are more likely to capture language and narrative anomalies in conversational speech rather than standardized language tests. However, starting from the shorter and more structured tasks and leading up to longer and less structured tasks gives you a "gradient" to see the client's threashold for breakdowns. I hope this makes sense.

 

Video Usage & Spontaneous Speech

From: Vanessa Zuniga, CSUN
Date: 21 Apr 2010

Comments

Hi, I had a question concerning the digital video portion in the case history of a client. Do you recommend trying to use the digital video as a way to show the client their progress, which would portray them before and after therapy? I read in an article earlier that self-awareness really worked and benefited one client in many ways. I also want to ask you if you recommend during the spontaneous speech portion of assessment to bring in something more familiar like family photos? The main idea in spontaneous speech is to have the child talk so that their cluttering behaviors become more evident. I have found that while working with children that if they have a prop or picture they are more willing to talk. What do you suggest? Thank you so much!

 

From: Florence Myers
Date: 21 Apr 2010

Comments

All your ideas are good! Having visuals that are meaningful to the client, like family photos, are very helpful to get discourse and monologues going. The more at ease, informal, and spontaneous the talk, the more likely you're going to see cluttering. Sure, video clips would be helpful for before- and after- type clips hopefully that demonstrate progress...like collecting artifacts for the client's therapy portfolio.

 

Question regarding self-assessment

From: Kelly Martinez- CSU Northridge
Date: 21 Apr 2010

Comments

Hello, this article was very informative about assessing cluttering. However, I have a question regarding self-assessment. I was wondering if the client would be more inclined to exaggerate their responses on the self assessment questions because they would know that they would be going over them with the clinician? I did not know if this was a problem that was encountered a lot especially when the client is given a rating scale to rate their speech? Thank you. Hope to hear from you soon.

 

From: Florence Myers
Date: 21 Apr 2010

Comments

Kelly - It's been my clinical experience that most PWC are quite "sincere" about their ability to self-assess and self-monitor (especially as they speak). Some clients simply don't seem to have a clue that they are speaking too fast, whereas others "normalize" readily for a very short spurt when they feel the need to. I think an important part of one's assessment is to tap into their meta-cluttering behaviors. Many of us feel that the ability to self-monitor is key to changing behavior. And a key to self-monitoring is to do a task analysis of the components of cluttering behavior (e.g., disfluencies, rate, intelligibility, language, pragmatics) so the client appreciates the behaviors that lead to the perception of cluttering. Hope this helps, and thanks for asking the question!

 

Cluttering as a Result of Another Disorder

From: Nicole Ahdoot
Date: 22 Apr 2010

Comments

Thank you for this take on the assessment of cluttering, it was extremely enlightening. The article mentions that "cluttering usually co-exists with other disorders such as stuttering, articulation disorders, ADD/hyperactivity disorders, and learning disabilities." Do you think cluttering can be considered as a disorder as a RESULT of these disorders or (in your opinion) would you say that it is just an accompanying disorder?

 

From: Florence Myers
Date: 22 Apr 2010

Comments

Nicole, this is a very good question. And, actually, in some exchange David Ward and I had earlier today (not on the conference line), this question was posed. We both feel that cluttering emanates from some deeply rooted etiologies, possibly related to the basal ganglia and executive functions of our brain. Time and research will eventually shed light on this fascinating hypothesis.

 

Stuttering and Cluttering

From: Melanie T.
Date: 24 Apr 2010

Comments

Thank you so much for writing such an informative paper. You mentioned stuttering as one of the several disorders that usually co-exists with cluttering. If a client is diagnosed to be a PWS and a PWC, would a decision have to be made on which disorder to begin working on first, or would you begin working on both at the same time? If a decision had to be made, how would you go about making this decision? Thank you!

 

From: Yvonne van Zaalen
Date: 24 Apr 2010

Comments

That is an important question I have thought about for years now. And it is hard to give a definite answer. It is even possible that it is different for kids and for adults. In adults I prefer to start with reduction of speed because it has a good effect on both stuttering and cluttering. Depending on the effect of speed rate reduction the decision about the next step in therapy can be made.

 

So much subjective analysis : (

From: Heather E, CSU Northridge
Date: 26 Apr 2010

Comments

"Because of the multidimensional nature of cluttering, we need to supplement assessment of the individual dimensions such as rate and fluency with a means to rate the overall severity of cluttering based on the trained clinician perception". Clinician perception varies-- thank you for mentioning/reminding us in the closing of your article that more empirical data is needed, and this excerpt is a good example of the reason why. This is so interesting, thank you for establishing assessment guidelines so clearly.

 

From: Florence Myers
Date: 26 Apr 2010
Heather, you are so on-target in your comments. Cluttering is so multidimensional that it is likely to be captured singly by just looking at the frequency count of disfluencies, or just the rate, etc. This is not to say the latter are not important as these behaviors are likely, "as a package," to feed into the diagnosis of cluttering. However, some of us feel that cluttering is largely a perceptual phenonmenon, and TRAINED clinicians who can give a rating of its overall severity--in addition to the perceptual ratings of severity of fluency, speech intelligibility etc-- is an important step toward assessment. Thank you for your input. Dr. Bakker and I are currently developing some sound clips of cluttering for the CSI. We may need trained judges to try out the CSI with the training clips.

 

Overall Assessment Question

From: Stephanie Mosseri- Touro College
Date: 02 May 2010

Comments

Hello, thank you for writing such a clear and informative article. The article helped me understand the various aspects of communication which can be effected by cluttering. I do have a few questions regarding the assessment of cluttering. How can the severity of cluttering be determined? And how can you determine if the presenting symptoms/communication difficulties are a result of the cluttering vs other coexisting disorders? I appreciate your article, it really opened my eyes to the multidimensional assessment process for people who clutter.

 

From: Florence Myers
Date: 04 May 2010

Comments

Hello Stephanie - You posed a very good and clinically practical set of questions. Regarding cluttering severity, my response would include the following. Since cluttering (even in using a "lowest common denominator" definition as proposed above by Dr. St. Louis) is a multifaceted disorder, I would recommend using a severity rating scale to give a perceptual rating of overall severity. In fact, Dr. Bakker and I are developing just such a rating scale (Cluttering Severity Instrument), as posted below. While a frequency count of disfluencies, for example, can contribute to diagnosis it alone is not sufficient as our emerging data seem to indicate that some PWC may not necessarily have more disfluencies than typical speakers. One also needs to look into the types of disfluencies, as PWC have more typical disfluencies (e.g., interjections, revisions) and PWS have more atypical disfluencies such as prolongations and tense pauses. Your second question is an interesting one, about determining if presenting symptoms are the result of cluttering or other coexisting disorders. The answer to this question of course rests on coming up with the (ultimate) set of valid defining features of cluttering. We are, I don't believe, anywhere near this goal yet. However, as a clinician, you should work on whatever symptoms are presented. A number of individuals in this conference are noted master clinicians and you can look up their works. Florence Myers