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From: David Ward
Date: 05 May 2010
Time: 08:25:52 -0500
Remote Name: 220.127.116.11
Hi Jane - very good points. I agree with Ken that working toward a unified definition must be a major aim for those working within the field of cluttering, and continuing research into those areas rightly identified as signifying cluttering under the LCD definition should be a priority. I also believe that that research into some areas currently not included in that definition (such as language processing) is essential, to potentially (and I stress potentially) avoid underdiagnosing the problem. I accept and understand Kenís concern about the need for an agreed diagnosis, but my concern is that adopting a very narrow definition perspective might result in a focus only into those areas contained within it, and valuable information might remain undiscovered. In my definition paper, I mentioned migraine as one example of a spectrum behavior. This disorder may present as headache, nausea, oversensitivity, language disturbances, oversensitivity to light, in addition to a host of other symptoms. They are all recognised as strands of the same disorder because they are linked by common, specific (though transitory), neurological changes relating to constriction changes in the vascular system. When viewed from this perspective, the symptoms, which all potentially implicate different neural systems make sense as appearing under one umbrella definition. By analogy then, it is hard to see what an LCD definition of migraine might look like. In sum, my concern is that in adhering to a very narrow definition, whilst providing a welcome starting point for clinicians who are diagnosing the disorder, we may miss the point as to where the underpinnings of cluttering really lie. Also, until much more is known about the underpinnings about the disorder, I believe a spectrum approach provides a sensible way of dealing with the significant problem of measuring severity in a disorder that (even under the LCD definition) is characterized by the interaction of a range of behaviours that exist to some degree part amongst perfectly normal speakers. Of course the spectrum approach has its weaknesses, and some participants have very elegantly raised some of these on this very forum. I also accept Kenís point that many symptoms outside the LCD definition might well be related to other disorders. But while we are not sure, this again is where a spectrum approach can be useful; the idea being we can acknowledge the existence of symptoms whilst at the same time not asserting for sure that the issue is directly related to cluttering. I believe that while we work toward uncovering the lowest common neural denominators of the disorder, a cluttering spectrum approach provides a useful perspective from which to describe the range and severity of cluttering both within and beyond an LCD definition.