Suggestions for Treating Cluttering

A handout by David A. Daly, University of Michigan, from a workshop on Cluttering, reproduced below with permission, May 6, 1997.

Weiss (1964) contends that cluttering is the "mother load" of stuttering. He believes that in most cases, the child's stuttering began with cluttering. Early literature reports a poor prognosis for clutterers, however, success has been reported using various techniques and strategies.

1. Focus on self-awareness. Most clutterers are unaware of their repetitions deletions, and transpositions. Audiotape and videotape them to teach self monitoring. A patient, but direct clinician is needed.
2. Tachylalia is not obligatory for cluttering diagnosis, but it is common. Instructions to "slow down" are worthless. Try finger tapping to teach syllable stress. Model desired behavior. Clinician must slow rate too.
3. Froeschels (1946) recommended reading aloud one word at a time. Placing a cover sheet with a hole over the page to reveal one word at a time is suggested to help the clutterer focus.
4. Test for articulation errors and dyslalia is common. We have used a delayed feedback machine to help cluttering clients "over-articulate" their slower rate of speech. Encourage client to "feel" tactile cues.
5. Poor memory abilities are common in cluttering. Practice telling and retelling stories trying to include more and more details. Use sequence picture cards if necessary. Such abilities can be enhanced.
6. Relaxation and visual imagery exercises may be useful for reducing impulsivity and distractibility. Attention deficits are common. Auditory comprehension activities found useful for learning disabled students or aphasic adults may be most appropriate for cluttering clients.
7. Some clutterers have motor coordination, rhythm, and speech melody impairments. Exaggerating various rhythmic patterns and speech prosodic patterns may be helpful. E.g., some clutterers show very monotonous voice patterns-vary their prosody-change the stress pattern. We use exaggeration as auditory imperceptiveness is usually present.
8. Reading and writing difficulties are typical. Authorities recommend teaching cursive writing not printing. Help clients write a one paragraph story. Assistance may be needed to follow a train of thought. Reinforce generously. Read and discuss the "story." Then try for a one page story. Patience and persistence are needed. Examination of written work will help clinicians understand the clutterer's language confusion.

....I think the suggestion to help the clutterer become aware of his cluttering really is the way to go, but very difficult. I finally took a suggestion from Charlann Simon's "300 Developmental Language Strategies for Clinic & Classroom", Communi-Cog Pub., Tempe Arizona, 602 839-5507 (I've also seen the book in other S/L catalogs). She suggests playing an audiotape which demonstrates using different communication styles (disorganization & mazing, too fast, cluttering, normal, etc.) and have the child evaluate each passage. We then build step by step from naming pictures, making up sentences about pictures, making up complex sentences about pictures, answering easy questions, answering hard questions, retelling stories of progressive length and complexity, etc., using the child's words ("too choppy", "too back and forth") to review the tapes. That way also, we can evaluate where and when the speech breaks down. I also transcribe the samples using slash marks and highlight the breakdowns. That way we can review together what is happening and keep track of the number of breakdowns. It's hard and it's slow, but it seems to work.

The Oral Exam went really well. I prepared well, and the final days I mostly relaxed to prevent extra stress. Right before I went in to i took some slow deep breaths (it's supposed to help fright of flying, but I find that it helps stress in general), and read backwards for a few minutes (an exercise I learned in speech therapy that really works for me). When I entered the room one of the persons that would question me told me that she had informed the others about my cluttering problem, laid down a pink post-it-note that I had asked for, and told me that she would point at it if I spoke too fast. It went great, not a single cluttering word came, and I got the best grade in my group.