Cluttering

Did You Know?

• Cluttering can occur with Parkinson's disease.
• Clutterers often have reading and writing disabilities, especially sprawling, disorderly handwriting that poorly integrates ideas and space.
• Weiss claimed that Winston Churchill and Otto von Bismarck were clutterers, and that they may have excelled because of, rather than in spite of, their cluttering.

Signs and symptoms

Cluttering is sometimes confused with stuttering, but the two are distinct. A stutterer has coherent thoughts but difficulty expressing them vocally, while a clutterer has disorganized thoughts during speaking. Stutterers are typically dysfluent on initial sounds and become more fluent toward utterance ends; clutterers are clearest at the start, with rate increasing and intelligibility decreasing toward the end. Cluttering is effortless and characterized by slurred speech, dropped or distorted sounds, and monotone speech that starts loud and trails into a murmur.

Causes

No genetic studies of cluttering exist, but a substantial genetic influence is assumed because many cases have relatives with cluttering, stuttering, or a general tendency toward high speech rate. Research on neurology is limited, but a theoretical model by Alm (2011) views cluttering as related to automatic regulation of speech rate, largely based on basal ganglia functions. The basal ganglia interact with cortical areas such as the supplementary motor area and anterior cingulate cortex. When conscious attention is directed toward speech, the cerebral cortex can control movements; when the speaker relies on automaticity from the basal ganglia, speech rate becomes high and uncontrolled. This model may also explain associated symptoms like attentional problems, hyperactivity, and interrupted sentences, as the same circuits are central to attention, inhibitory control, working memory, and cognition. The model gained empirical support from a functional magnetic resonance imaging study.

Treatment

Common treatment goals include slowing speech rate, heightening monitoring, using clear articulation, using organized language, interacting with listeners, speaking naturally, and reducing excessive disfluencies. Slowing rate can be achieved through delayed auditory feedback, giving out written reminders called 'speeding tickets', or recording speech and having clients transcribe it to mark where spaces and pauses are needed. Constant verbal reminders to slow down do not help and can hinder progress. Many people who clutter are unwilling or unable to monitor their speech, especially in casual settings; strategies such as visualizing speaking slowly before speaking, and using video or audio recordings to show breakdowns, can increase monitoring. If articulation does not improve with rate reduction, additional treatment includes practicing short sentences with over-articulated speech and reading multisyllabic words while focusing on each sound. Some individuals need help learning to tell stories logically and sequentially, starting with simple short sentences and building to longer ones; clinicians may transcribe cluttered speech to show run-ons and ramblings and ask clients to state only the most important information.

History

The earliest record of cluttering is battarismus, named after the legendary Libyan king Battaros who spoke quickly and disorderly. In the 1960s the disorder was called tachyphemia, from Greek for 'fast speech', but this term is no longer used because fast speech is not a required element. Deso Weiss described cluttering as the outward manifestation of a 'central language imbalance'. The First World Conference on Cluttering took place in May 2007 in Razlog, Bulgaria, with over 60 participants from North America, Europe, the Middle East and Asia.