In my experience of working with students who clutter, I have realized this disorder presents special challenges to my clinical problem solving and creativity skills. In many ways, I have found it necessary to "hone" the way in which I present concepts in therapy.

Children who clutter often need assistance in defining and refining their communicative abilities in a variety of settings. Many times, we select goals for enhancing self-monitoring skills, managing rate, organizing language, normalizing prosody, and increasing clarity of spoken messages. Children who already have difficulty understanding why "others" have a problem understanding them can quickly become overwhelmed at the number of "things we have to work on."

Background

The concept I am relating for this article is entitled "Two Thumbs Up" because, for the students I have used it with, it depicts streamlining a myriad of communication goals into two of the most helpful for each student. We choose two goals which, when addressed simultaneously or cyclically, will create the greatest positive impact on communicative effectiveness.

For the two students with which I have used this "nugget," along with the speech behaviors associated with cluttering, (rapid rate, co-articulation of multisyllabic words, inappropriate pausing and prosody, etc) they presented with coexisting issues (pragmatic language deficits, stuttering, volume regulation ("trailing off" during ends of sentences), etc. It became clear that there were so many aspects of communication that needed addressing; the students were quickly becoming overwhelmed and feeling defeated, especially given the fact that neither student saw communication as a problem.

Through a series of discussions, the students were lead in problem solving activities designed to choose TWO goals to work on at any given time in therapy. Interestingly, even though each child presented with different speaking patterns and co-existing conditions, both chose the same TWO goals to begin addressing their cluttered speech.

One Thumb Up: Increased self monitoring skills

Activities: At first, I asked the students to discriminate differences in my speech production. Then, audio and/or videotaping were used to increase the students' abilities to discriminate their own communicative differences. Following this, therapy activities were designed to increase monitoring of "real-time" speech in the structured therapy setting. Of course, home practice and community challenges were a part of the therapy plan, in order to increase carryover of the skills learned in therapy.

Results: This goal was a major underlying impetus for gains in all areas of the students' communication differences. As the students became better observers of themselves and their communicative partners, they enhanced proprioceptive awareness, pragmatic skills, and language organization.

Two Thumbs Up: Regulating Rate

Activities: Both students were reluctant to discuss "rate management," because they had both been told to "slow down" for so long, they had an aversion to anything related to what they perceived as unnatural slowing of their speech. Therefore, activities were directed toward appropriate and natural pausing with additional discussions and practice of "pacing" speech. Both students were more amenable to these concepts, and the result was an indirect reduction of rate through experiencing their natural abilities of taking a "little" bit of the extra time they needed for creating clearer messages. All of the skills were learned, practiced, and transferred through hierarchies of difficulty, with carryover of paramount focus.

Results: As the students learned to manage rate, gains were made in decreasing spurts of speech, regulating more normal prosody, increased language formulation and organization, and (significantly) enhanced clarity of messages.

Summary

Clinically, the results of this type of focused therapy have been striking, as the "synergistic" nature of issues surrounding cluttering (Myers & Bradley, 92) proved true in these cases. Both students continue in therapy, and we work to "tweak" previously learned skills, add therapy objectives that emerge as each student communicates in a wider variety of settings, and continue to support their families and school personal in their understanding of the disorder of cluttering.

Reference

Myers, F.L., & Bradley, C.L. (1992). Clinical management of cluttering from a synergistic framework. In F. L. Myers & K. O. St. Louis (Eds.). Cluttering: A clinical perspective (pp. 85-105). Kibworth, Great Britain: Far Communications. (Reissued in 1996 by Singular, San Diego, CA.) Available for download at: http://associations.missouristate.edu/ICA

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