Cluttering: Functional Strategies for Management HandoutsThis program examines cluttering in...

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Kathleen Scaler Scott, PhD, CCC-SLP, is an assistant professor in the Department of Speech-Language Pathology at Misericordia University and a Board Recognized Fluency Specialist. She has been a practicing clinician for over 16 years in hospital, school, and private practice settings.

Dr. Scaler Scott has authored and co-authored several articles and book chapters in fluency disorders, and is co-editor of the forthcoming textbook, Cluttering: A Handbook of Research, Intervention, and Education with Dr. David Ward. Dr. Scaler Scott was editor of a special issue of Perspectives on Fluency and Fluency Disorders (July 2009) focused specifically on cluttering. Her current research projects include analysis of cluttering characteristics, examination of working memory in cluttering, and exploration of fluency patterns in autism spectrum disorders. She has presented numerous papers nationally and internationally in the areas of fluency disorders and social communication disorders. A certified special education and elementary school teacher, Dr. Scaler Scott is also coordinator of the International Cluttering Association.

Cluttering, a fluency disorder characterized by a speaking rate that is perceived to be abnormally rapid, irregular, or both, can be difficult to distinguish from stuttering. This program examines cluttering in children and young adults aged 8–21 years, exploring symptoms, assessment, and approaches to intervention with attention to the possible negative effects of cluttering on children’s academic performance.

Learning Outcomes You will be able to: • define cluttering • list three areas to examine when assessing cluttering • list three treatment strategies for clients with cluttering, and two practical strategies for goal carryover • discuss considerations for treating cluttering with concomitant communication disorders

Cluttering: Functional Strategies for Management

Faculty

The seminar lasts two hours. The live

broadcast begins at:

3:00 p.m. Eastern2:00 p.m. Central

1:00 p.m. Mountain12:00 noon Pacific

ModeratorSharon L. Willig, Associate Director of Clinical Issues in Speech-Language Pathology, ASHA

ManagerJack Coursen, Educational Program Manager, ASHA

This course is offered for 0.2 ASHA CEUs (Intermediate level, Professional area).

LIVE REGISTRATION

Live broadcastThursday, May 20, 20103–5 p.m. Eastern time

ON DEMAND REGISTRATION

Available On Demand through May 20, 2011

Web/Telephone Seminar Completion FormLive Broadcast 1013/On Demand 4930

Cluttering: Functional Strategies for Management To receive ASHA CEUs or professional development hours, complete this form and return it within five (5) days of completing your Live Broadcast or On Demand.

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ASHA 1013 / On Demand 4930Cluttering: Functional Strategies for Management

Kathleen Scaler Scott, PhD, CCC-SLP

Live Broadcast May 20, 2010, 3:00 – 5:00 p.m. Eastern time

Table of Contents:

1. Presentation PowerPoint

2. References and Resources

3. Additional Handout 1: Assessment Tools for Cluttering

4. Additional Handout 2: Addressing Cluttering Throughout the School Day


ASHA Web Seminar 1013/On Demand 4930 1

Functional Strategies forManagement

Kathleen Scaler Scott, PhD, [email protected]

Cluttering

22

Goals� Simplify the definition of cluttering� Simplify the identification, diagnosis, and

treatment of cluttering� Understand ways cluttering can impede other

areas of communication



33

Goals

� Understand how to separatecluttering from other diagnoses

� Understand how to treatcluttering alone and incombination with other disorders

� Design treatment plans that takegeneralization and carryover intoaccount at the outset of therapy

44

Evolving Definition� Weis (1964): “Central language

imbalance”� APA for DSM (1987): included lack

of awareness; removed from DSMin 1994; included with stuttering innew revisions

� WHO (1992): rate, phrasing,disfluency

� ASHA Special InterestCommittee (1999): associatedphonological, language, attentionsymptoms



55

Evolving Definition� Daly and Burnett (1999): “The cluttering umbrella”� St. Louis et al. (1992; 2003; 2007): “Lowest

common denominator” (LCD)� St. Louis & Schulte (in press): current LCD

66

Current Definition

Cluttering is a fluency disorder wherein segments ofconversation1 in the speaker’s native language2

typically are perceived as too fast overall3, tooirregular4, or both. The segments of rapid and/orirregular speech rate must further be accompaniedby one or more of the following: (a) excessive“normal” disfluencies5; (b) excessive collapsing6 ordeletion of syllables; and/or (c) abnormal pauses,syllable stress, or speech rhythm.

St. Louis and Schulte (In press)



77

Current Definition

1 Cluttering must occur in naturalistic conversation,but it need not occur even a majority of the time.Clear but isolated examples that exceed thoseobserved in normal speakers are sufficient for adiagnosis.2 This may also apply to the speaker’s mastered andhabitual non-native language, especially inmultilingual living environments.3 This may be true even though syllable rates maynot exceed those of normal speakers.

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Current Definition

4 Synonyms for irregular rate include “jerky,” or“spurty.”5 These disfluencies are often observed in smallernumbers in normal speakers and are typically notobserved in stuttering.6 Collapsing includes, but is not limited to, excessiveshortening, “telescoping,” or “over-coarticulating”various syllables, especially in multisyllabic words.



99

Accurate Diagnosis

� Cluttered speech vs. cluttering� Avoid the “broad net” and its pitfalls

� Such practice also provides answers to the age-oldquestions:� Does cluttering really exist, anyway?� Isn’t it really just a language disorder?� Isn’t it really just an articulation disorder? Maybe

hypokinetic dysarthria?

10

To ask a question:

Live Web access Type your question into the Q&A panel and click send.

Live Telephoneaccess

Press *1 on your telephone keypad to signal that you wish to aska question.



11

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Assessment Strategies

� Gather the information

� Be sure that your speechsamples include�Rote tasks (counting: fast,

regular, slow)�Reading�Conversation�Expository discourse



1313


� What are you looking for?

�Rapid and/or irregular rate

�Fluency

1414


� What are you looking for?

� Intelligibility

�Phrasing/prosody

May want a writing sample(though this is NOT part of definition)



1515


�Determining educational impact�Academics and learning�Class participation�Reading aloud�Group/partner projects�Written language

1616


�Determining educational impact�Social-Emotional Functioning�Socialization: The spectrum� From Ignore/exclude

oWhen does this begin?oWhere does this lead?

� To Tease/bully



1717


�Determining educational impact� Independent Functioning�Consider what may lie beneath outward

behaviors/impressions� Social and academic responses to a

communication difficulty� Impact of these responses on overall

academic and social performance over time

1818


�Determining educationalimpact�Communication�Remember that if you can’t

communicate well, this will havenegative impact upon yourability to use communication tonavigate through your schoolday



1919


� Other questions(NOT specifically part of thecurrent working definition)�What is the level of awareness?�What is their ability to self-

monitor, self-regulate in otheraspects of their life?

�What is their motivation tochange?

2020

Assessment Interpretation

� Differential diagnosis�Rate�Remember rapid

�OR irregular qualifies

• How fast is too fast? Does rate have afunctional impact?



2121


� Differential diagnosis�Fluency� How do the NSLDs compare to the

SLDs?� Is it cluttering alone? Concomitant

stuttering? Covert stuttering?o Follow up: SSI-4, interview,

checklists for attitudes and feelingso Formulation vs. habit vs. stuttering

avoidance: analyze patternsaround the NSLDs

2222


� Differential diagnosis� Intelligibility

� Consider all speaking situations and reports of alllisteners (variability)

� Production of individual sounds vs. collapsing ofsyllables

�Prosody� The grey area



2323


� Others� Is language also disorganized?� Follow up: writing sample

�Multicultural considerations (St.Louis & Schulte, In press; Shipley,2009)� Patterns of second language

acquisition� Interpersonal vs. cognitive/academic

language proficiency

2424


� Impact of concomitant problemson cluttering� e.g., attention’s impact on

independent strategy use�Consider referrals for other

evaluations as needed



25

To ask a question:




2626

Principles of Treatment

� Client must buy in to rationale for treatment� Strategies must be functional and offer naturalistic

reinforcement� Treatment should remind that we are all on a

spectrum of intelligibility to help normalize strategyuse

� Treatment should focus on recognizing client’sstrengths and the desire to hear about these inoral communication (“I have good things to say.”)



2727

Treatment Activities

�Building rationale�The whats and hows of

speech�Brainstorm: reasons people

might not understandsomeone when they arespeaking

2828


� How I say it�Family quizzes�The science experiment�Great things I have to say



2929


� How I say it�Exercises for�Smooth vs. choppy�Clear vs. mushy�Loud vs. soft� “Regular rate” vs. fast

3030


� How I say it�Number lines for�Volume on last word�Choppy vs. smooth�Mushy vs. clear�Slow vs. fast

�Activities: war, crazy eights, go fish



3131


� Building rationale�The whats and hows of speech�Brainstorm: reasons people

might have a miscommunication

3232


�What I say�Family quizzes�What requests for clarification

really mean



3333


� What I say�Problem-solve to try to figure out

why my listener is confused� Too much information?� Not enough background

information?� Out of sequence?� Non-specific pronouns?

�Multicultural considerations forthis approach

3434


� Putting it all together� Looking for listener feedback: how and what

flowcharts…� Reading aloud� Who’s Doing What? with books� Telling jokes with eye contact and pausing� Would you rather? with eye contact and pausing



3535


� Putting it all together�Poetry for self-regulation:� Self-regulation: getting to understand how it feels and

sounds to have a communication breakdown

3636

Carryover

� What works�Pausing

� Looking forfeedback

�Problem solving howor what I said

�Self-regulatingactivities

� What doesn’t�Tell child slow down

�Delayed/alteredauditory feedback

�Verbal reminders



3737

Carryover

� What works�Providing the

rationale

�Synergisticapproach (Myers andBradley, 1992)

� What doesn’t�Providing activities

w/o rationale and/ornot monitoringcomprehension ofrationale

�Treating individualsymptoms

3838

Home Practice

� Carryover Bingo boards� Watch for examples of

communication breakdowns andadjustments in others (TV, movies,real life)

� Functional phrases� Play natural reinforcers!� Keep it up: it’s got to be a focus until

it comes naturally� Multicultural considerations



3939

Concomitant Disorders� ADHD

� Considering monitoring and self-regulation

� Autism Spectrum Disorders� Principles of engagement

� Low cognitive levels� Keeping it simple and natural

� Resistant to change� Meeting them where they are

4040

Summary

� Keep it clean and simple� Look at the whole picture and how

communication is impacted� Analyze patterns over time to gain

information� Make it functional and naturalistic so

that buy in and carryover are ensured� More resources and info to

come…keep your eyes and earsopen!



41

To ask a question:




4242



4343

Feedback

To help us improve our educational programming, pleaseevaluate this web/telephone seminar online at:

www.asha.org/elearning/apdeval.htm

Please use Course NumberLive registration: 1013

On demand registration: 4930

Thank You!

www.asha.org/shop

ASHA 1013 / On Demand 4930

Cluttering: Functional Strategies for ManagementKathleen Scaler Scott, PhD, CCC-SLP


References and Resources:

Greenspan, S. I. (2001). The Affect Diathesis Hypothesis: The role of emotions in the core deficit in autism and in thedevelopment of intelligence and social skills. Retrieved August 31, 2007 fromwww.floortime.org/downloads/affect_diathesis_hypothesis.pdf

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 in1996 by Singular, San Diego, CA.) Available for download at: http://associations.missouristate.edu/ICA

Scaler Scott, K. & St. Louis, K. O. (2009, July). A perspective on improving evidence and practice in cluttering. Perspectiveson Fluency and Fluency Disorders, 19(2), 46-51.

Scaler Scott, K., Ward, D. & St. Louis, K. O. (in press). Cluttering in a school-aged child. In S. Chabon and E.Cohn (Eds.).Communication Disorders: A Case-Based Approach: Stories from the Front Line. Boston: Allyn & Bacon. Due: Fall 2010

Ward, D. & Scaler Scott (in press). Cluttering in a school-aged child. In S. Chabon and E.Cohn (Eds.). Cluttering: Research,intervention, education. East Sussex, UK: Psychology Press. Due: Fall 2010

Tetnowski, J. A. (2009). Cluttering in the communicative disorders curriculum. Perspectives on Fluency and FluencyDisorders, 19, 52-57.

Adams, C. (2009). “Cluttered” parenting. Perspectives on Fluency and Fluency Disorders, 19, 58-61.

Reichel, I. K., & Bakker, K. (2009). Global landscape on cluttering. Perspectives on Fluency and Fluency Disorders, 19, 62-66.

Kvenseth, H., & Sønsterud, H. (2009). Exciting collaboration turns fascinating: A story told by a person who clutters anda speech and language therapist from Norway. Perspectives on Fluency and Fluency Disorders, 19, 67-71.

American Psychiatric Association (APA). (1987). Diagnostic and statistical manual of mental disorders, 3rd ed., revised.Washington DC: American Psychiatric Association.

American Psychiatric Association (APA). (1994). Diagnostic and statistical manual of mental disorders, 4th ed.Washington DC: American Psychiatric Association.

American Speech-Language-Hearing Association, Special Interest Division 4; Fluency and Fluency Disorders. (1999,March). Terminology pertaining to fluency and fluency disorders: Guidelines. ASHA, 41 (Supplement 19), 29-36.

Daly, D. A., & Burnett, M. (1999). Cluttering: Traditional views and new perspectives. In R. F. Curlee (Ed.). Stuttering andrelated disorders of fluency, 2nd ed. (pp. 222-254). New York: ThiemeMedical Publishers.

Myers, F. L., Bakker, K. & Raphael, L. J. (2007). Understanding and treating cluttering. In Conture, E. & Curlee, R. (Ed.),Stuttering and related disorders of fluency (pp. 297-325). New York: Thieme.

St. Louis, K. O. (1992). On defining cluttering. In F. L. Myers & K. O. St. Louis (Eds.). Cluttering: A clinical perspective (pp.37-53). Kibworth, Great Britain: Far Communications. (Reissued in 1996 by Singular, San Diego, CA.)

ASHA 1013 / On Demand 4930

Cluttering: Functional Strategies for ManagementKathleen Scaler Scott, PhD, CCC-SLP


St. Louis, K. O. & Schulte, K. (in press). Defining cluttering: The lowest common denominator. Cluttering: Research,intervention, education. East Sussex, UK: Psychology Press.

St. Louis, K. O., Raphael, L. J., Myers, F. L., & Bakker, K. (2003, November). Cluttering updated. The Asha Leader, 8-21, 4-5& 20-23.

Shipley, K. G., & McAfee, M. A. (2009). Assessment in Speech-Language Pathology: A resource manual, (4th ed.). CliftonPark, NY: Delmar, Cengage Learning.

Weiss, D. (1964). Cluttering. Englewood Cliffs, NJ: Prentice Hall.

World Health Organization (WHO). (1992). The ICD-10 classification of mental and behavioural disorders: Clinicaldescriptions and diagnostic guidelines. Geneva: World Health Organization.

Assessment Tools for Cluttering

Rate� Language Sample� Stopwatch

Fluency� Stuttering Severity Instrument-4� Disfluency counts (Stuttering-like vs. Non-stuttering-like)

Intelligibility� Articulation tests if warranted� Oral mechanism exam� Multisyllabic words in isolation and in context

Prosody� Subjective rating scales for speech naturalness*� Interview feedback on function

o SLPo Teacher(s)o Caregivers

Severity Ratings**Cluttering Assessment Program

*Martin, R. R., Haroldson, S. K., & Triden K. A. (1984).Stuttering and speech naturalness. Journal of Speech andHearing Disorders, 49, 53–58.

** Bakker, K., St. Louis, K. O., Myers, F. L., & Raphael, L. J. (2005 a). Computer aided assessment of cluttering severity. Paperpresented at the 8th International Stuttering Awareness Day On-Line Conference. October, 2005.http://www.mnsu.edu/comdis/isad8/papers/bakker8/bakker8.html

Developed by Kathleen Scaler Scott, Ph.D. April 2010 for ASHA Cluttering Web/Telephone Seminar

Addressing Cluttering Throughout the School Day

� Individual/small group sessionso “How” Strategies: pausing, word ending focus, all syllable focuso “What” Strategies: background information, relevant details only

� Practice “how” and “what” strategies with curricular materials� Reading� Expository discourse

� Look for others’ feedback� Reading� Conversation

� Focus on curricular area readings and discussions

� Visitors to session or visits to other sessions

� Train peers in each others’ goals and reinforcement

� Coordinating with classroom teachers

o Read alouds

o The secret signal

o Being a detective in class

o Fostering independent problem solving

Developed by Kathleen Scaler Scott, Ph.D. April 2010 for ASHA Cluttering Web/Telephone Seminar

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