CONTENTS

This is a threaded discussion page for the International Stuttering Awareness Day Online Conference paper,
A Synopsis of Cluttering and its Treatment by Ken St. Louis and Florence Myers. 

A "Backwards Stutter?"

From: Barb Ennis, British Columbia, Canada
Date: 9/18/98
Time: 11:02:08 PM
Remote Name: 204.174.236.205

Comments

Thank you for your informative paper. I have only just heard of cluttering as I am just beginning to really
make an effort to learn more about stuttering. My five year old son has just finished his preschool therapy
for his disfluency and some artic delays and will now only receive limited therapy through his school if
space becomes available. I believe the most significant help he will receive will come from me. 

Because some of his disfluency is not typical of stuttering and some are apparently typical of cluttering I
have wanted to learn more about cluttering. While I know that I can not diagnose him, nor could you
without seeing him, I was wondering if you are familiar with any cases of stuttering occuring more at the
end of words than the beginning? His first therapist put it down to his difficulty regulating his breathing, but
I'm not convinced that that is all. His older brother also often repeats end sounds of words, though not as
much as he did as a 4 -5 year old, but has never had trouble regulating his breathing or a serious disfluency
problem, was never assessed. If you have seen this "backwards stutter" as I have called it I would be
interested to know. 

I will be passing on your info to our school SLP. Thank you.

Re: A "Backwards Stutter?"

From: Florence Myers
Date: 10/4/98
Time: 7:10:48 PM
Remote Name: 207.198.250.151

Comments

We appreciate your inquiry regarding cluttering, as it relates to your five-year-old son. First, I am in
complete concurrence that we cannot presume to diagnose him without seeing him. How- ever, we can offer
some hopefully helpful diagnostic questions which you can share with his clinician which may shed light on
his fluency problem. On the surface, it would appear that disfluencies "occurring more at the end of words
than the beginning" is not typical of either stuttering nor cluttering. What types of "dis- fluencies" does he
exhibit? You indicated that your older son sometimes repeats end sounds of words, but not seriously enough
to be considered for therapy. Does your younger son also repeat these end sounds? Would he say, as a
prevailing pattern of speech, something like... "I lik-k-k-k my mommy-y-y-y." It would be helpful to be
more specific about the nature of the disfluencies? For example, are they repetitions of sounds and syllables?
Are they revisions of a phrase, possibly following an initial incomplete phrase? Are these disfluencies
produced with a great deal of effort and physiological tension, which is often the case with more severe
stutterers but not clutterers? Another potentially telling questionis to observe his rate of speech? Does it seem
to be faster than he can handle, or jerky and irregular? In regard to the latter, perhaps you and his clinician
can observe how well he manages to coordinate his thought patterns with his language and speech skills--at
least to the extent that one would expect from a five-year-old. You mentioned his articulation problem? Some
clutterers (as well as stutterers) have delays in articulation/phonology in addition to their fluency problem.
However, many clutterers have reduced speech intelligibility (that is, how clearly they produce their speech
sounds) largely due to speaking at a rate faster than they can handle--in that sense, they may drop off the end
of words or delete unstressed syllables in a multisyllabic word. Many older clutterers are not aware of their
disfluencies and overall reduced effectiveness of their communication, in contrast to many older stutterers
who would be aware that they have difficulty getting a word out, even though they know fully well what the
word is that they wish to speak. This dis- tinction may be less definitive for the younger child
clutterer/stutterer. Lastly, we must acknowledge that individuals can have components of both cluttering and
stuttering. I realize that this response contains more questions, but perhaps these questions--supplemented
by an accumulating set of recent publications on cluttering--can help you and your child's clinician make a
more focussed assessment of your son's disfluencies. I would recommend some of the readings listed at the
end of our ISAD Conference article. Florence 

Re: A "Backwards Stutter?"

From: Les Anderson
Date: 10/16/98
Time: 10:31:43 PM
Remote Name: 209.167.123.228

Comments

Barb, 

It is very gratifying to see your name in here. All too many parents dismiss their child's speech problems.
Many parents feel that if they don't recognize their child's dysfluencies as a problem it will eventually
disappear. It is also wonderful that you have taken the initiative to research the problem on your own and to
gain some understanding of its complexities. If I may suggest, video tape your son or sons, while they are
involved in spontaneous conversation and forward the tape to an SLP or a clinic that specializes in the
treatment of speech disorders. As I have mentioned to you before, not all university speech and language
programs have curriculums that specialize in the treatment of stuttering. There are however, SLPs and clinics
in BC and Alberta that do deal specifically with the treatment of stuttering. The Victoria Stuttering Clinic is
one. Probably the most famous clinic in Canada is The Institute for Stuttering Treatment and Research in
Edmonton. I would suggest that you send a video tape of your sons to one of these places. As Florence
Myers stated, it is very difficult to diagnose through some one's letter. If you wish you can contact me and I
will forward to you, the names, addresses and phone numbers of names and places that you can contact. 

All the best to you, Les Anderson 


disfluent breathing during nonspeaking times

From: Susan Logan
Date: 10/9/98
Time: 10:55:32 AM
Remote Name: 134.29.30.79

Comments

Can you tell me anything about periods of breathing disfluency (unconsciously holding one's breath for
10-20 second that occur during quiet times such as reading or sleeping)? 


Re: disfluent breathing during nonspeaking times

From: Florence Myers
Date: 10/12/98
Time: 4:00:55 PM
Remote Name: 207.198.250.187

Comments

Hello, Susan--Thank you for your question re- garding disfluent breathing during nonspeaking time. I am
afraid I don't know much about this area, particularly in the context of cluttering. 

"Unconsciously holding one's breath for 10-20 seconds" seems lilke a very long time. Perhaps someone
else attending this conference can help shed light on this area. Florence 


Re: disfluent breathing during nonspeaking times

From: Ken St. Louis
Date: 10/12/98
Time: 4:21:35 PM
Remote Name: 157.182.15.69

Comments

Dear Susan, 

I, too, am not at all an expert in breathing irregularities. In addition to the possibility of asking some of the
other paper authors, I might suggest that you look into the literature for respiration or respiration therapy.
Perhaps you will find some information there.

Re: disfluent breathing during nonspeaking times

From: Julie Peterson
Date: 10/14/98
Time: 12:48:39 PM
Remote Name: 209.18.244.27

Comments

I don't any particulars about this but it sounds more like a medical condition - perhaps sleep apnea - I'd
consult a physician if you haven't already

Atypical Stutterer

From: Judy Kuster
Date: 10/16/98
Time: 11:11:20 AM
Remote Name: 134.29.30.79

Comments

Ken or Florence, Do you have any additional references besides Ken's book The Atypical Stutterer:
Principles and Practices of Rehabilitation, published by Academic Press in 1986, that would give guidance
for working with the dysfluencies seen in those with developmental disablities. 

Re: Atypical Stutterer

From: Ken St. Louis
Date: 10/19/98
Time: 12:33:25 PM
Remote Name: 157.182.15.69

Comments

Hi Judy, 

"Developmental dysfluencies" in those with developmental disabilities is a pretty broad topic. Other than the
"Atypical Stutterer," which is getting a bit dated, there are a number of resources. Let me first toot our own
horn and say that Flo and I have a number of chapters and essays that deal of course with cluttering. And
cluttering-like symptoms can accompany a number of other disorders. Perhaps our best treatment of the
subject (one that also deals with stuttering and coexisting problems) is the chapter in Curlee & Siegel's 1997
book entitled "Nature and Treatment of Stuttering: New Directions." In that chapter, we show graphically
how many of the coexisting problems come together. Let me also mention an ASHA monograph that I
coauthored with Ruscello & Lundeen entitled, "Coexistence of Communication Disorders in
Schoolchildren." This describes a number of studies carried out with a National Speech and Hearing Survey
database and tapes (originally done in 1968-69). What our fairly exhaustive review shows is that coexisting
disorders are for more common than we previous thought. The reference is ASHA Monographs, #27, 1992;
it can be ordered directly from ASHA. Otherwise, may I suggest some work by Don Mowrer, e.g., a couple
of articles in the May, 1998 issue of JFD on atypical stutterers. Perhaps the most widely developed treatment
of phonology and fluency comes from the work of Conture, Edwards, and Louko. They have a number of
publications. Hope this helps. Ken


Re: Atypical Stutterer

From: Elizabeth Moyer
Date: 6/9/00
Time: 8:10:11 PM
Remote Name: 24.2.236.122

Comments

I am curious about Atypical Stuttering. My 5 year old son has been seen by several Pediatric Speech
Pathologists. The diagnosis have become progrssively worse over the last couple of years. My sons biggest
problem is repeating syllables and whole words when trying to tell a story. 

Here is an excerpt: 

"Molologue: This section was difficult for John. During story telling, his rate and volume increased and his
intelligibility was significantly reduced (less than 50%). He demonstrated WWR's and PWR's. The prosody
of his speech was affected in the areas of stress, intonation, and pitch. John's sentences were long and
complex." 

Does this represent what you refer to as an Atypical Stutter? 

Thank You for your time. Elizabeth Moyer omoyer@home.com

A Fluency Disorder

From: Chuck Goldman
Date: 10/18/98
Time: 10:20:22 AM
Remote Name: 152.163.206.194

Comments

As someone whose two major areas of clinical interest is stuttering and verbally based learning disorers, the
phenomenon of cluttering is clearly at this intersection. I see the disfluencies and rapid rate in cluttering to be
the oral manifestation of the language disorder. It is probably true that some of the clients we work with that
we call stutterers more clearly have this language base to their fluency difficulties than others. It is also likely
that many individuals classified as ADHD, learning disabled, Tourette's may have significant cluttering
aspects to their symptoms. Differential diagnosis may be helpful in planning effective interventions but on
another level I'm always suspicious that we may be responding to different parts of the same "elephant".

Re: A Fluency Disorder

From: Ken St. Louis
Date: 10/19/98
Time: 12:53:48 PM
Remote Name: 157.182.15.69

Comments

Chuck, You are absolutely right about the overlap of all sorts of "cluttering-like" conditions. And, yes, we
have found more of the proverbial blind descriptions of an elephant than the originator of the metaphor
(Aesop???) ever probably could have imagined. Your thinking about language-based stuttering and cluttering
is quite similar to that of Lois Nelson. I respect her work a great deal; you should talk to her. You may be
right about language being the basis of rate and disfluency problems in some cases, but it seems to me that
you need to be able to show how one measured language problem results in rate problems for example and
how another very similar one does not. That is why I prefer not to talk too much about underlying problems.
Whenever I think I have an explanatory model that makes sense, I turn it on its head and ask, "Is this both a
necessary and sufficient explanation for cluttering?" I find it generally is not; there are so many exceptions.
For example, Flo and I described two case of cluttering in the 1996 special edition on cluttering of JFD. One
of them had all sorts of coexisting problems; the other had very few. To me, cluttering is, first and foremost,
a speech problem characterized by a fluency problem that is not stuttering. Secondly, it is one that has an
abnormally rapid or irregular rate. Of course, most clutterers have stuttering, language problems (especially
pragmatic problems), and many also have LD, ADHD, and who knows what else. But if anyone with one of
these conditions does not have a fluency or rate problem, he or she would never be regarded as clutterers.
This is not so say that cluttering is primary. It is only to say that certain characteristics must obtain in order
to make a diagnosis. Thanks for your insightful comments. It would be great to have a face-to-face debate at
ASHA sometime about some of these things, wouldn't it? Ken 


Assessing cluttering

From: Teri Stock
Date: 10/19/98
Time: 4:01:06 PM
Remote Name: 137.28.184.145

Comments

I am currently a graduate student and am currently taking a fluency seminar course. I am not very
knowledgeable about cluttering and have a some questions I would like to ask you. The first question is how
do you assess cluttering? Do you use observation or are there certain procedures that are beneficial to assess
someone who is a suspected clutterer? The second question is are the therapy techniques that were addressed
in the article useful for very young children or is cluttering a disorder that is most commonly seen in the
adult population? 


Re: Assessing cluttering

From: Ken St. Louis
Date: 10/20/98
Time: 4:41:58 PM
Remote Name: 157.182.15.69

Comments

Dear Teri, Lots of people are unclear about what to do with clutterers. In fact, there is simply not enough
information "out there" for us to be sure that we have a consensus on how to diagnose or treat. May I
suggest that you go back to our paper and look up some of the references we listed at the end. Those are the
best I can recommend at this point. Good luck. Ken

Cluttering

From: Kristin Moon
Date: 10/26/98
Time: 11:10:47 AM
Remote Name: 209.30.136.57

Comments

I enjoyed reading your paper very much and feel that cluttering may be our son's problem. I am curious,
though. Can cluttering affect a person's writing abilities as well as his speech? If this can affect writing, how
do we help our nine year old with this aspect of cluttering? I apologize for this being sent to you past the
deadline. I would truly appreciate even a small response. Sincerely, Kristin Moon e-mail:
krmach1s@flash.net