This is part one of a two part series. Episode 68 covers nine areas to assess when treating cluttering, while part two covers the M.O.R.E. treatment technique. In part one the following assessments areas are discussed:
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Stop Playing Whack-a-Mole with Stuttering Therapy
Music: Simple Gifts performed by Ted Yoder, used with permission
68 MORE Success with Cluttering Therapy, part 1
Welcome to The Speech Umbrella, the show that explores simple but powerful therapy techniques for optimal outcomes. I’m Denise Stratton, a pediatric speech language pathologist of 30 plus years. I’m closer to the end of my career than the beginning, and along the way I’ve worked long and hard to become a better therapist. Join me as we explore the many topics that fall under our umbrellas as SLPs. I want to make your journey smoother. I found the best therapy comes from employing simple techniques with a generous helping of mindfulness.
Hello, all you marvelous SLPs out there and hello to anyone else who is fascinated by all things speech and language who has dropped in.
I’m your host, Denise Stratton. Thanks for joining me on episode 68 of The Speech Umbrella, this podcast is going to be in two parts due to recent surgery that I’m recovering from. I decided to take it easy on myself and break it up. Today’s topic is brought to you from a fellow SLP, Devany. Devany emailed me and asked, do you have thoughts on improving the rate of speech with a teenager on the spectrum?
He speaks so quickly, he’s hard to understand. We have addressed the rate of speech for about six months now as part of social skills therapy and our plateau at sentence and reading level. First of all, thanks for your question, Devany, I’m a huge believer in being vulnerable. It’s only when we’re brave enough to say, I’m not sure what to do, or maybe we even say I have no freaking idea what to do, and that’s when we learn.
And despite our master’s degrees, we are vulnerable, perhaps especially when it comes to fluency, it’s sad, but true that fluency therapy can take a backseat to articulation and language therapy techniques at the university level. Now speaking too fast falls under the diagnosis of cluttering, which in turn falls under fluency disorders.
And believe me, if we don’t learn much about stuttering in school, we probably learn even less about cluttering. I’m going to read some of what the stuttering foundation says about cluttering, and I’m gonna intersperse it with comments of my own. There’s a lot to it, so hang in there. So like stuttering, cluttering is a fluency disorder, but they’re not the same. Cluttering involves speech that sounds rapid, unclear, and or disorganized.
And so when I listen to someone who clutters, sometimes it’s like I’m a passenger in a car where the driver is constantly accelerating and braking. I’m reminded of the old Star Trek episodes where everyone would almost fall out of their seats when they accelerate or decelerate or whatever, it kind of feels like that, the rhythm is just not great with someone who clutters, but not in the way of stuttering. A person who clutters may also sound like their language is disorganized and they’re not sure what they want to say, while a person who stutters typically knows exactly what they want to say, but is temporarily unable to say that. But to make matters even more confusing, you can have stuttering and cluttering co-occur. So that’s interesting. And often parents will call me when they have someone who is cluttering and describe them as stuttering, because they really don’t know what’s going on.
It sounds a little bit like stuttering, but it’s not stuttering as we speech therapists know stuttering, really sounds like where you have so many repetitions or prolongations at the beginning of words. Now the most commonly agreed upon definition of cluttering has these basic criteria, which all experts agree you have to have to meet the definition. And that is that the speaker sounds fast to the listener, at least some of the time. Now, the idea is that the speaker may not be speaking faster than average, but they’re speaking at a rate that is too fast for their system to handle. And it results in a communication breakdown.
I’ll have to put in a little note here that I do have clients sometimes who speak super fast, and they have one sound they’re working on like an R or an S and they’re speaking so fast they can’t accommodate that new sound, and I don’t call those clients clutters. They’re not cluttering. They’re just speaking too fast to accommodate that new sound in their system, but they’re understandable.
Cluttering is different in that there is a communication breakdown. It’s not just a sound that’s missing, but there’s a communication breakdown. You can’t understand what they’re saying, but I could also add sometimes you understand them, but the language is disorganized. So there’s that piece, which some clutters have, some clutters don’t, but essential for a diagnosis of cluttering is the rate of deviations.
So that’s our number one thing we’re looking at, you know, speaking too fast, or you speak in this kind of way where you sound like a tape recorder that’s been stretched out: too slow, too fast, too slow, too fast, and never really that feeling of we’re just moving along at a nice, easy rate with our speech, which is easy to listen to.
That’s what I miss with people who clutter, but you also see these things with cluttering often, little or no apparent physical struggle in speaking, which is different from stuttering, whatever they’re doing, it comes along easily without the physical struggle. As long as they don’t have stuttering and cluttering together. You also might get confusing disorganized language or conversational skills, a limited awareness of their fluency and rate problems, which is again different from stuttering, and that stutterers are anxious about their fluency problems and clutterers aren’t even aware of it. Clutterers can have temporary improvement when asked to slow down or pay attention to their speech or when you’re recording them. And this could explain Devony’s experience with her client plateauing, because he has a certain amount of awareness, but he can’t keep that awareness going, and also there may be a learning disability present.
So you see, cluttering can be a hot mess of symptoms, a Gordian knot that clients need help to understand and unravel because there are so many pieces to this cluttering. So for part one, I’ll be talking about assessment and in part two, we’ll get into treatment.
So here are the themes that I look at for assessment. I look at syllable collapse, articulation errors, revisions, lack of a underused complex language, run on sentences, not providing enough context for the listener, syntax errors, prosody and finally rate of speech. Those are nine things to look at and you notice rate of speech I put at the end, and that’s because as you start working on rate of speech, all these other things start bubbling up to the surface and you’re like, oh my goodness, what is going on here?
So I have never had a client whose only issue was speaking too quickly. Never ever. At the minimum, I’ve had clients with articulation errors who speak too quickly, like I talked about. At the other end, once I evaluated a child with cluttering and stuttering and ASD and a learning disability to boot. So there’s quite a spectrum there, and in my experience, I’ve always found underlying issues with cluttering. The rate of speech is the tip of the iceberg to use a common stuttering analogy. And this is really important to keep in mind as we assess, your assessment will be ongoing. Things will bubble up to the surface and you’re gonna need to reassess a little bit. Okay. What’s going on now? What have we uncovered? So look at the mechanics, what happens alongside or because of them speaking too quickly? Let’s talk about syllable collapse. So syllable collapse is when they squish the words together and syllables drop out. For example, saying the word hydrogen like ‘hugen’. They just go so fast and the syllables just collapse.
And one of my clients described it as the sounds being eaten. After he listened to recording himself, he was like, oh, my sounds are being eaten. Now you can have articulation errors and there’s a decision to be made there. Are you gonna treat the artic errors first? Are you gonna treat them last? Are you gonna treat them concurrently?
With one client, I found that he could say all R words, R was his only articulation error. He could say a variety of R words correctly at the conversational rate when I gave him a timed reading test. And so I decided great, I’m just gonna focus on cluttering. And as he became more aware of how he spoke the articulation problem corrected itself.
Now, I probably would’ve treated that differently if he had motor issues with saying the sound quickly enough, Revisions mid-sentence with no benefit. Okay, so everybody revises. When I’m doing this podcast, I’ll revise mid-sentence sometimes because we want to clarify something, we realize we could have said it better, but the clients I’ve worked with who clutter don’t add any value when they revise.
They stop what they’re saying mid-sentence and they start to say something a different way and it doesn’t add any value. It’s not any better. It’s always in the middle of their sentence. It’s always distracting. And what I’ve noticed is it interferes with them forming more complex sentences, which leads us on to number four, lack of, or underused complex language. I like to call this the, and is overused, and that because is never used. I had one client who was extremely bright and well read. And yet he talked at length to me about a plot of a favorite show and he didn’t use the word because once. He hardly used any subordinate conjunctions at all, but he used and extensively.
And you might guess when you overuse and, that leads to yep, number five, run on sentences. Run on sentences don’t require complex language. You don’t get nice, neat bundles of cause and effect explanations or higher order thinking with run on sentences. And what I’ve also noticed with clients who stutter and clutter, this is true for both of them, you don’t get a chance to reset. So when you’re just speaking and your sentences just run together, you tend to have more errors, more disfluencies, I should say, pile up. See, that was my mid sentence revision, but that was because I explained it better. You get more fluency errors piling up as a sentence just goes on and, and on because there’s no end in sight and they don’t get a chance to reset themselves.
So I really pay attention to those run on sentences. Now number six, when relating experiences, they often don’t provide enough context for listeners. For example, not identifying the characters by name or describing the setting. I’m not talking about a lengthy setting description, like it was a beautiful day and the sun was just rising, and I got on the bus. No, they don’t even say at school today before they launch into their story. Something as simple as that, that would just give you a little clue about what they’re talking about. Often those are just left out. Syntax errors and missing words. Generally, this happens because the person who clutters is speaking too quickly, it’s not because of poor grammar. It’s a little bit like syllable collapse, only sometimes entire words collapse, and they’re just left out of the sentence. Number eight, the prosody is not quite right. So prosody, intonation, that’s the icing on the cake, right? Well, it’s really hard to ice the cake when all this other stuff is going on. And I can’t even think about prosody because all this other stuff is going on with their language and their speech rate and their lack of self-awareness.
Finally, the rate is speech is uneven, and you might start addressing that first, because that might be the only thing you see. But you need to start incorporating these other things as they start to become obvious. Oh, and so with some of my clients, I might start working on rate of speech, and then when something else bubbles to the surface, I might set rate of speech aside just a little bit and address something else.
You can’t address them all at once till the very end, you just can’t. With most of my clients who clutter, there’s just too much going on. So we’ll kind of have to nail some stuff down here. Okay. We’re working on this. Now, let’s work on this. Now, let’s see if we can integrate these two things. And now let’s see if we can add another, um, it’s quite a process, and if you don’t see these symptoms at first, don’t be surprised if they start popping out of the woodwork. When the rate of speech slows down, which is why ongoing assessment is so important. Now you might have a client whose only issue is rate of speech, but I’d be surprised. But if, so, these techniques will still work.
We’re still helping them become aware of their communication and their need to be a good communicator. There would be just less to untangle if they didn’t have these associated language organization issues. That’s a whole lot to think about. Just remember, you don’t have to discover this all at once and you probably won’t. These issues tend to rise to the surface as you start working on related issues. I recently feel like I cracked the cluttering code with a client I had, who had a very successful outcome. And I’m really excited to talk to you about that next time. Before I decided to split this podcast into a two-parter I came up with the most awesome name, because I have this awesome acronym for treating cluttering.
And I’m calling this podcast MORE Success With Cluttering Therapy, Part One, and the M O R E is in capitals because that’s my acronym. This is my method for treating cluttering and the M stands for motivation, the O stands for ownership, the R stands for recognition, and the E stands for earned as an earned fluency.
So that’s what we’ll get into next podcast, I’ll go into the MORE technique for treating cluttering. Now there is still time to get 10% off all R products on The Speech Umbrella till the end of September, use the coupon code elementary at checkout I’ve just revised and added to the R card deck. Now it has 15 pictures for 10 vowel specific R context. That’s 15 words to start with ‘rah’, 15 words that start with ‘ray’, for our total of 150 cards. I love treating R with vowel specific words, because I can really dial in on a context a client is successful with and get lots and lots of correct practice. And we do so many things with these cards, you can play go fish, you can play memory games. The options are endless. These are print out full color, laminate yourself cards that you can physically play with. Go to The Speech Umbrella.com and put in a coupon code elementary for that 10% discount. Thanks so much for tuning into The Speech Umbrella and be sure to join me next time for part two of MORE Success With Cluttering Therapy.
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