Salomi's SLP accounts http://speechy.posterous.com Most recent posts at Salomi's SLP accounts posterous.com Sat, 28 Jan 2012 21:49:00 -0800 My first clinical encounter with 'Cluttering' http://speechy.posterous.com/67425897 http://speechy.posterous.com/67425897

Fluency disorders has always been an area of interest for me professionally.  As a speech-language pathologist, practicing for 5 years, I've worked with many kids who present with 'Stuttering' or 'Stammering' (as it is called in the UK).  But only last week, did I have my first encounter with-- Cluttering, a fluency disorder, that SLPs learn about in school but very few have the privilege of experiencing clinically.  I evaluated a young girl, 8 years old, who was referred by her parents because she 'stutters'.  Did she have a fluency disorder of some kind, definitely!  But it wasn't stuttering. When I met her in the waiting area of the clinic, she responded to my greeting and immediately initiated a conversation about her playdate from that morning. I was pleasantly surprised by how outgoing she was and also a little alarmed about her social skills.

Assessment and Diagnosis

A great resource for Cluttering Assessment and Diagnosis is 'Online Resource on Cluttering- the Other Fluency Disorder' by Judy Kuster: http://www.mnsu.edu/comdis/ica1/papers/yvonne2c.html

I used the following tools:

1) The Stuttering Severity Instrument SSI-- very popular standardized test in the world of fluency disorders. Scores revealed sub-clinical to mild amounts of stuttering. But there were a significantly high number of non-stuttering like disfluencies, such as, interjections ("um", "but well", "well, then"), revisions (initiating phrases and then re-phrasing them over and over again), whole word repetitions and inappropriate pauses/breaths (taken in the middle of words).

2) The Stuttering Inventory-- not standardized, but this a great tool that looks into both stuttering and non-stuttering like disfluencies. Once again, scores demonstrated a high number of non-stuttering like disfluencies. Very few part-word repetitions, blocks, and prologations, which are all typical of stuttering.

3) Informal language and articulation assessment (I would recommend doing standardized language testing if you have time though)

4) Detailed case history (including information on academics)

I started suspecting Cluttering. My suspicion was confirmed by:

- history of mild reading challenges (she attended a reading group at school)

- writing difficulties (teacher described that student often started a topic but had a difficult time organizing her thoughts and completing her writing assignments)

- limited ability in maintaining conversations, poor self-monitoring, dominating conversations, going off on tangents, disorganized language

- student's lack of awareness of fluency issues

Definitions

American Speech-Language-Hearing Association (AHSA), described Cluttering as follow:

http://www.asha.org/docs/html/GL1999-00063.html#sec1.3.11

The Stuttering Foundation, also has helpful guidelines on Cluttering:

http://www.stutteringhelp.org/default.aspx?tabid=82

Management

Once again, the 'Online Resource on Cluttering- the Other Fluency Disorder' by Judy Kuster, is a  great resource for information on treatment-- http://www.mnsu.edu/comdis/kuster/cluttering.html

 Therapy was focused on increasing awareness through video and audio feedback. The student was very open to exploring the differences in her speech and came up with names to describe the various characteristics, such as, "breaking up the word" (inappropriate pauses), "adding words" (interjections), "speeding" and "doubling up" (word and sound repetitions).  Some other techniques I modified and enjoyed using are:

- http://www.mnsu.edu/comdis/ica1/papers/nuggets/myers2c.html-- we gave out speeding tickets.

http://www.mnsu.edu/comdis/ica1/papers/nuggets/potemrac.html-- we used 'dot talking' to slow down rate of speech.

- 'Talk bubbles' were helpful to keep track of conversations and encourage turn-taking. Each time someone starts a topic, write it their 'talk bubble'. Review the bubbles from time to time to see if they are fairly balanced, so that each person had a chance to intiate topics and take turns.

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