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From: David Ward
Date: 21 Apr 2010
Time: 12:06:50 -0500
Remote Name: 134.225.114.26
Thanks for your post, and I’m glad you enjoyed the paper. I also thank you for bringing a very interesting question about diagnosis into sharp focus with your question, here. For the moment there may be disagreement regarding which aspects of cluttering are prerequisite to a diagnosis of cluttering, but for me, at least, the ‘clinical reality’ is that therapy must be directed at the presenting clinical issues, rather than governed by any strict operational definition of the disorder. In other words, from a purely clinical perspective we look at the people we see in our clinics and do our best to address the issues they present with. Clinicians may differ as to the number of symptoms they might regard as ‘cluttering related’ but the significant symptoms would be treated, none the less. By way of example, Kathy Scaler Scott and I presented a paper at ASHA in 2008 on a child who was co-diagnosed with cluttering and autism spectrum disorder. This child presented with some high level language issues, which might be seen as a part of cluttering spectrum, but would fall outside the lowest common denominator definition. Therapy targeted language difficulties alongside the co-presenting rate and articulatory problems that most experts agree is typical of cluttering. As such, the issue of whether the language problems were related directly to the clutter or not was seen as an irrelevance from a clinical perspective. There was clearly a clinical need for intervention in this area, and that need was met in therapy. With current levels of understanding about cluttering this seems to me a reasonable approach, but in one sense this current situation is less than ideal. To take a hypothetical example; imagine if research were to eventually link certain language issues exclusively to cluttering. Armed with that knowledge, it is likely we would go about managing those issues in a different (and more effective) way to the manner in which we might currently deal with the exact same language symptoms but not necessarily recognize as a part of cluttering. David