The basics for cluttering therapy

Cluttering speech therapyDoes cluttering speech therapy work? A frequently asked question. Not surprisingly though: it can be frustrating for cluttering speakers to (more or less) know what to say and not coming across effectively to the listener.

To answer that question: yes, there is absolutely hope; cluttering is definitely treatable if you have the right mindset and focus. Those who clutter and speech language pathologists who treat speech disorder cluttering will definitely know. But what does cluttering speech therapy look like? And when is it successful? In this article we will share with you the basics of cluttering speech therapy.

How is cluttering diagnosed? 

Before you engage in treatment for cluttering, it’s important that your client is diagnosed correctly. The first thing you need to do is determining if there are any other communication impediments besides cluttering that lead to difficulties in the client’s speech. If any, these problems ask for reports from other professionals, such as special educators, psychologists and the like.

Your efforts should not only include an evaluation of the fluency disorder. You could also carry out a more comprehensive assessment, like a writing or reading test, if you see a school-aged client for example. Even an intelligence test is advisable. This helps mapping out whether or not cluttering is present and whether or not this co-exists with stuttering or problems in language, learning or social interaction. Want to know more? We created several video’s about diagnosing cluttering.

Approach to cluttering speech therapy

Cluttering speech therapy approach

It is common sense that it is best to approach each cluttering speaker as a special case. After all, every person who clutters shows a unique set of cluttering speech characteristics. There are, however, several general guidelines that apply to everyone. As a speech language professional you can take these into account when approaching cluttering speech therapy for one of your clients.

The complete story

First of all it is important to get a comprehensive picture of your clients’ track record. This includes their behavior at work or school, previous engagements in cluttering or stuttering therapy, the severity of their cluttering, and so on. Make sure that this is covered before entering the therapy for cluttering.

Enhancing awareness

Clients who are aware about their speech patterns better understand the necessity for cluttering speech therapy. This is especially important, since they sometimes may not realize they are cluttering, or they don’t see the severity of it. In other words, self-awareness is key!

Preparing for therapy

Make sure that your clients fully comprehend their situation. Also, layout the path ahead of them. By doing so, your clients are better equipped to approach their treatment program with a more positive outlook. 

It can be very helpful for some of your clients to add counseling to their treatment. As a speech-language pathologist you don’t need to look at your client’s speech only, but can also talk to them about how they’re feeling about their speech. In other words, get to know them. For example: are they having trouble in class or at work, are they subject of bullying, etcetera. Try to really learn about how their cluttering speech problem impacts their quality of life. Treating the whole person can be of utmost important; the counseling aspect can be a true game changer for them.

Reassurance and after care

Some clients, if not most of them, will benefit from cluttering speech therapy but can ultimately fall back in their old speech patterns. Make them understand that they can always come back for cluttering speech therapy with you, or that you can refer them to another cluttering expert.

Cluttering speech goals

Because cluttering therapy needs to be tailored to the client’s needs, many therapy approaches have been suggested throughout the years. Research shows that a lot of them work well with particular cluttering speakers. Let’s take a closer look at them.

Self-awareness and heightened monitoring

As said, enhancing the self-awareness of your clients is the absolute number one in cluttering speech therapy. Most people with cluttering are too little aware of how their own speech sounds to others. Listening back to recordings can trigger the inner drive they need to work on their speech intelligibility and fluency.

Cluttering speech therapy goals

This is important because many clutterers find it difficult or uncomfortable to review their own speech. People with cluttering frequently need to practice controlling their speech. It helps to analyze conversations that have been recorded on video or audio. Clinicians can discuss the clients’ worst, average and most clear speech samples.

Then it comes down to encouraging them to listen to recordings on a daily basis. There is a “but”, though: for some clutterers listening to recordings of their speech could be a traumatic experience. It then may be best to build rapport with the client over several sessions and really work on that trust, before playing recordings for them.

Slowing down speech rate

Slowing down is very effective in cluttering. Clients can get rid of a broad set of symptoms of cluttering. This isn’t easy for them, though. Bear in mind that a clutterer has a considerably harder time achieving and maintaining a lower tempo of speech than a typical speaker. Telling a client to “slow down” is not helpful and might even be harmful.

Talking at a lower pace requires the client to use the skills learned to achieve heightened monitoring. But this all depends on the specific situation that clients are in: when they aroused or in an emotional state of mind, clutterers find it even harder than normal to control their speech rate.

Phonetics and naturalness of speech

It speaks for itself that clinicians should give feedback to their clients in order for them to sound more natural. For example by focussing on the stressing of syllables, intonation, pitch and volume. The way the message comes across phonetically is an important aspect of speech.

Working on the client’s articulation

A positive side effect of slowing down is that if often leads to a more articulated and clear speech. If not, the client needs additional treatment. There are several techniques that can be used to target often seen, systematic patterns in speech that result in misarticulations.

Language organization

Speech-language therapists could also work on the content and form of a client’s story. The problem in some clutterers’ speech is not their intelligibility per se but their fluency. Some clutterers need to practice a lot to be able to tell a story in a logical way, using the right sequence, and so on.

Too many disfluencies

If clients still show cluttering disfluencies after targeting rate, monitoring, articulation, and language, fluency shaping techniques can be used to lower the frequency of disfluencies to a manageable level.

Listener interaction

An often neglected part of cluttering speech therapy is the interaction with listeners. The result of cluttering are communication breakdowns, so it is important to keep the listeners reactions in mind when treating cluttering speakers. The goal is to recognize cues offered by listeners, like frowning, and start practicing with turn-taking; giving each other enough time to express one’s thoughts.

Cluttering speech techniques

Cluttering speech techniques

It can be difficult for your clients to completely get rid of their cluttered speech. However, there are some strategies that can help them to speak more intelligible or fluent and to slow down, for some even up to a point that the cluttering seems totally absent (temporarily).

Taking pauses

One way to achieve a slower rate is to insert pauses in natural places. For many cluttering speakers this is not part of their natural ‘system’. This means that most of them must be taught to pause deliberately, since they do not always know where to do that. It may help to let your client transcribe from a recording some unintelligible sentences (from his own speech). First without spaces between words and then with normal spacing.

Slowing down by stretching words

For some clutterers it can be helpful to stretch out their words and sounds, as if they are walking through syrup. By doing this, they gain more time, which is a prerequisite for talking in a more controlled manner. There are some tools that can benefit the person who clutters, like delayed auditory feedback. Speech language pathologists can also act as models for the client to imitate. Or they can use and play recordings that their clients should repeat at the same speed. Also they could give instant feedback to the clutterer by giving them “speed tickets” for exceeding the limit.

Syllable tapping

Many people with cluttering are condensing their words. They are slurring syllables together, mostly in multisyllabic words. Reading out loud these multisyllabic words when tapping a finger along with each syllable written down can help the clutterer to articulate all the necessary sounds. Later on, this technique can be used in live conversations as well.

Clear articulation

Most (phonological) clutterers speak in a rather mumbled way. To avoid this, they can practice and improve their articulation skills by “overarticulating”; deliberately expressing words and sounds in a 200% clear manner.

Intonation

Stressing syllables in longer words (like “com-pe-ti-tive”, “ex-ag-ge-ra-ted”, “pre-li-mi-na-ry”, or “si-tu-a-tio-nal”) helps the clutterer in speaking clearer and with more intonation. It also helps articulating all the un-stressed syllables in a word or sentence.

Language organization

Sometimes it is necessary to train the clutter’s ability to tell a narrative in a structured way. Some people with cluttering are better off thinking not only about the key words in a message but also way it should come out. To give an example: first they practice in expressing the most relevant information (“Telephone is down. Need to recharge. Call you back”.) Then they find more words to glue these key words or group of words together: “Unfortunately my phone is not working any more, I’d probably need to charge it. If that is done, I am gonna call you back. You’ll get my answer as soon as possible”.

Using your true, relaxed voice

Many people who clutter try to compensate their unintelligibility by speaker louder. Fast and loud speech, however, should not be used together. As it puts less strain on their vocal cords, developing a relaxed inner voice can be an effective strategy to prevent cluttered speech from happening. This will get rid of the tension that obstructs them from pronouncing their words and sentences properly.

Lowering your pitch

Many cluttering speakers are enthusiastic or temperamental by nature. Speaking at a lower pitch can help to prevent them from losing their control too easily. For example when something triggers them to react fast in certain situations.

Interaction with others

The clutterer can learn a lot from routinely checking with the listener by eliciting feedback. For example, they could ask their listeners whether they got their message, or whether they should repeat what they’ve just said. Besides that being open about their cluttering diagnosis can help people who clutter feeling less awkward, anxious or ashamed about their speech.

We can not repeat enough that every cluttering client (truly) is unique and requires some level of engagement to become more intelligible or fluent. Bear into mind that progress usually comes in small steps.

Cluttering speech disorder: coaching

There is much more to say about treating cluttering. See, for example, the video’s in which several experts on cluttering share their insights and experiences. Are you a person who clutters instead of a speech-language professional? And are you looking for help from a fellow clutterer? Then you can always request for personal coaching with us.