Cluttering? What’s that?

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Episode

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Kate Grandbois: Welcome to SLP Nerdcast. Today, we are talking about a, an under discussed topic in our field. We are here to talk about cluttering with one of our field's leading content experts, Dr. Kathleen Scaler [00:02:00] Scott. Welcome, Kathleen. 

Kathleen Scaler-Scott: Thank you so much. 

Kate Grandbois: Before we get started, can you tell us a little bit about yourself?

Kathleen Scaler-Scott: Sure. Hi, everyone. I'm so excited to be here today. Um, I'm Kathy Skaler Scott. I'm a professor at Missouri Cordia University. That's in Dallas, Pennsylvania. We call that the little d. If any of you watch The Office, it's near Scranton. That's usually how people know us. Um, and this is my 13th year there. I've been in the field for In the field of speech language pathology for 30 years, I was a clinician for 13 years and then decided to go back and get my doctorate and I focused that on cluttering and atypical disfluencies and, um, I've been working at Misericordia ever [00:03:00] since, but I do do just a very limited private practice Um, just to keep my hand in it because it really informs my practice.

So I kind of feel like in my heart, I'm, I'm a researcher. I've written articles and books on cluttering, but I am a clinician first. And, um, I see lots of clients with, um, especially cluttering or cluttering and or stuttering and concomitant disorders. 

Kate Grandbois: Well, we're so glad to have you, uh, prior to hitting the record button, we reviewed all of your accomplishments and the books that you've, that you've written and the podcast that you have.

And I'm really, really excited to unpack all of that for our audience. Um, we're also here today with our resident SLPD, Anna Paula. Welcome Anna Paula. Thank you so much. Do you want to tell our audience a little bit about you? 

Ana Paula Mumy: I am a program director and associate [00:04:00] professor at a small private university in East Texas, and I, um, also, um, I say happened into the world of stuttering, um, through my own personal experience with my son and some other family members who, um, stutter and, um, have just Um, become immersed in the stuttering community through our nonprofit Sparrow Stuttering.

Kate Grandbois: So I've already disclosed to both of you, and now I will disclose to our audience that I know absolutely nothing about this. And I'm very much looking forward to Anna, having you here, Anna Paula, to elevate the conversation and, and really kind of unpack this very under discussed, but very important topic of cluttering.

Before we do get into the conversation, I need to read our learning objectives and disclosures. Learning objective number one, list at least two characteristics of cluttering. Learning objective number two, list at least two myths about cluttering. 

Learning objective number three, describe at [00:05:00] least two best practices for treating cluttering. Disclosures, Kathleen's financial disclosures. Kathleen received an honorarium for participating in this course. Kathleen also receives book royalties from authored books, including The Source for Stuttering and Cluttering, Fluency Plus, Managing Fluency Disorders in Individuals with Multiple Diagnoses, Managing Cluttering, a Comprehensive Guidebook of Activities, and Cluttering, a Handbook of Research, Intervention, and Education.

Kathleen's non financial disclosures. Kathleen is the co host of a podcast titled Cluttering Conversations. Kate, that's me, my financial disclosures. I am the owner and founder of Grand Blanc Therapy and Consulting LLC and co founder of SLP Nerdcast. My non financial disclosures, I'm a member of ASHA SIG 12 and I serve on the AAC Advisory Group for Massachusetts Advocates for Children.

I'm also a member of the Berkshire Association for Behavior Analysis and Therapy. And [00:06:00] Apollo, would you like to read yours? 

Ana Paula Mumy: Anna Paula, that's me. I received compensation from SLP Nerdcast.

For my work as ASHA CE Administrator and as the SLPD On Demand, I am employed at East Texas Baptist University. In my non financial disclosures, I am the co founder and president of Sparrow Stuttering. I'm a member of ASHA and TISHA, and I serve on TISHA's University Issues Committee. And I'm also a member of the following ASHA special interest groups, uh, Fluency and Fluency Disorders, SIGFOR.

Issues in higher education, SIG 10. Administration and supervision, SIG 11. And cultural and linguistic diversity, SIG 14.

 Kathleen, if you could just begin by telling us what is cluttering, just starting with maybe a basic definition or traditional definition of cluttering. And then what I'm really interested in is just, um, having you expand on this definition, because based on your experience and your [00:07:00] work, I think that's a wonderful contribution that you have is just how you refined or expanded it.

Kathleen Scaler-Scott: Great question. Thank you for kicking us off with that. Um, You know, depending upon when you received education about cluttering in your, in your clinical journey toward becoming an SLP, um, or if you got any information about cluttering in graduate school, you may have all kinds of varying definitions.

And it used to be a really broad, confusing definition. And thank goodness to Dr. Ken St. Louis. and Katrin Schult from Germany who scaled it down in 2011 to the lowest common denominator. It's probably the most commonly used definition. It's the one that I find so straightforward for treatment and for diagnosis, especially for diagnosis.

So in the LCD, uh, definition, what they did was they [00:08:00] said, okay, there's not There's not a hundred percent of symptoms that cluttering experts agree upon, but these are the ones that they do agree upon, that if, if I think about cluttering, these things may be possible. So, the first is that the person's rate of speech sounds rapid, um, or irregular, meaning rapid sometimes, not rapid other times.

And it's It's important to note like it sounds rapid. So it's a perceptual definition. We know now that it's not necessarily always measured as faster than average, but it sounds fast to the listener. And if that person has that, um, where sometimes they're sounding fast to the listener, doesn't have to be all the time or in all situations, but sometimes a teacher, a parent, uh, you know, a friend, a significant other, Okay.

gives feedback to the person, Hey, you sound really [00:09:00] fast. Um, then that's kind of your go signal to explore if cluttering might exist. So that's the mandatory criteria to further explore diagnosis. And then we have fast talkers, right, who have no breakdown in communication. But in order to be diagnosed with cluttering, you have to have at least one of the three symptoms.

after that in the LCD definition. And one is, um, excessive overcoarticulation. So we all know what coarticulation is, where the sounds blend overcoarticulation, the sounds blend too much. So it sounds like the speech might sound like there's sounds missing or syllables missing. Um, And so a lot of times, perceptually, people will say their speech sounds kind of mumbled or mushy or unclear.

So they're missing the, the word, um, like what is that actual word that you [00:10:00] said, or that phrase, I missed the actual word. Um, so that's one. The second one. is excessive. In the definition, it says normal disfluencies. What that means are what we know as non stuttering disfluencies. So interjections, ums and uh, fillers, phrase repetitions or revisions of thought.

I want a sandwich. No, I think I'd rather just have a glass of water. Those types of things that we all experience when we're trying to put our thoughts together. So, and the whole definition is perceptual. It requires clinical judgment. So, excessive There's no number or cutoff for excessive normal disfluencies.

But the way I look at it as a clinician, most, most of our clinicians, even if they've never worked with cluttering, if you've worked with [00:11:00] language disorders, you know these speakers when you work with them. And I usually say, does, is it that the speaker's communicating a message? And I, I understand their message, ultimately, but it just seems very inefficient because there's so many stops and starts before they get to their final point.

Um, so that would be the second criteria that might diagnose cluttering. The third is a typical pauses, and that's pauses in places grammatically. So, it might be like, I'm going to the store to get some Halloween candy. Um, you wouldn't expect the pause to be there. I'm going to the store to get some Halloween candy.

Now that is like a very basic example. But what happens is if someone does that in lots of places in connected speech, the speech [00:12:00] spurty. So, that's. The basic LCD definition that I work with, um, and through the International Cluttering Association, they're working on some other pieces to expand the diagnosis, but it's tricky because again, if we go too broad, in my opinion, it's going to end up being confusing, but they are working through that.

For me, just now, um, you know, One of the things about cluttering is that there's a myth out there because back in the day, awareness, people thought awareness, like lack of awareness, was kind of a diagnostic criteria for diagnosing cluttering, that clutterers are not aware. That their speech, you know, might not be clear to the listener.

So this lack of awareness has been out there, um, as a myth. [00:13:00] And, um, okay, right now I'm going down a rabbit hole. So let me just see. We want rabbit 

Kate Grandbois: holes. We encourage rabbit holes around. You do go for it, 

Kathleen Scaler-Scott: but it's the, well, no, it's just more, I want to make sure I'm staying on point, but the lack of. Um, awareness piece, um, is, is something that was a myth and now that we're hearing more from adults who clutter, especially through social media, different outlets, and they're telling us our experiences, just like we've learned so much from adults who stutter, we're learning so much from adults who clutter and, um, you know, The myth was that you're not aware, so there's no life impact.

There's no negative listener reactions like there are for people who stutter. There's not people giving them negative feedback, but in fact, when you talk [00:14:00] to adults who clutter, they recount very similar experiences from listeners. The differences, the key differences, a lot of the people Who clutter what they, the feedback that they were getting, they didn't necessarily understand because they didn't have a diagnosis like people who stutter might.

So cluttering was so confusing. They They hear feedback, like, ah, you need to improve your communication, or, boy, you talk really fast. They were aware of that feedback, and sometimes the feedback was insulting, like, because of the overcoarticulation. It would be like, are you drunk? Are you stupid? So the same kinds of negative things that Um, stutterers might hear, but they didn't even have, they just didn't have a label to put on it.

So, now that we know that life impact is, um, is, is important to cluttering, [00:15:00] that's something that I definitely look at too, expanding, like, what's the life impact? What's your experience of cluttering? That's a huge way that I'm trying to expand my view. Um, and then I'm also kind of looking at Where are they on their readiness journey to 

Kate Grandbois: talk more about a readiness journey?

What is that? 

Kathleen Scaler-Scott: So it's not new to the field of stuttering, but it is to cluttering. Um, in terms of that, um, the first person was Trisha Zabrowski and a lot of her students in the field of stuttering. They discovered the trans theoretical model. By discovered, I don't mean that they are the ones who created it, but they discovered how it could be applied to stuttering.

So the trans theoretical model, I think it's Prochaska and DiClemente. It was their work [00:16:00] in the area of addictions literature. So They developed this model to show that everyone, when they're thinking about making any change in their life, goes through different stages. And they start with like pre contemplation where you're not even really thinking about making the change and moving all the way through till, okay, you're really ready to make a change.

And people move in and out of those stages. Um, And their work was mostly like with like quitting smoking and things. So Trisha Zabrowski and her colleagues took this and thought, huh, this really applies to, you know, teens who stutter who might not be ready yet, um, you know, to do something about stuttering.

And, um, Trish has done a ton of work in For Teens Who Stutter, and I've learned everything I know from her work. I'll just say that, um. [00:17:00] So she, not just in this and everything and stuttering, um, but they, she applied it more to like the journey and like, um, and then Naomi Rogers, who was one of, um, Trisha's doctoral students and now is, uh, a professor in the field, she has applied it specifically to teens and is developing like a clinical tool to use for, um, um, for looking at when a teen is ready to make a change.

And so once I heard about this tool, I started using it with different clients, cluttering, stuttering, but I started to really think about its application to cluttering because in cluttering, a lot of times what happens is That teens can be really defensive, teens and sometimes like young school aged kids, and so their response is often, [00:18:00] um, if someone says, you know, I don't understand you, you talk too fast, the response often is, my friends understand me, my parents have something wrong with their hearing.

You know, like what's wrong and when we've talked with adults who clutter, they will say, looking back on their teen years, they just felt like sometimes they were kind of aware that some, they were having challenges with something, but they weren't ready to fully embrace it. I mean, that makes sense with the age anyway, so.

We have reports of adults who clutter who say, like, when someone used to say, talk slower, they'd be like, you need to listen faster. So, this can be a big source of frustration for speech pathologists, especially, like, in the schools. They're like, okay, hey, I finally know what this cluttering is. I know what to do with, with, um, you know.

And I've identified it, but now the [00:19:00] kid is like, nope, nope. And the parent is like, please, you need to do something. And the kid's like, nope. And then therapists are left like, what do I do now? So this is like a work in progress, but we've kind of got two things in progress. One is that my student and I were working on trying to adapt this stages of change to cluttering, and it will be a really long process, but it's just more.

You know, how can we start to have the conversation with kids and see if maybe they're misinformed about what cluttering treatment is, about what we're going to do, and also how can we educate parents? Because the big frustration a lot of the time is that parents are looking for us to treat. And then make their child sound like, you know, Oh, I can understand them 100 percent of the time.

[00:20:00] And if, you know, they find times, Oh, I still can't understand him sometimes when he's at home and he's excited. It's hard for them because they're looking toward the future and they're anxious about people are going to misunderstand them and misjudge them. And that does happen, right? We've talked about that.

So their concerns are valid. But what we need are the tools as speech pathologists to be able to have the discussion with them and say, it's okay. Like they've learned some things that maybe they want to use now so their listener can understand them, right? Just so that their message doesn't get lost.

And that's something very different between stuttering and cluttering. Like in stuttering, you know, If you choose not to monitor your speech, the listener, it is on the listener, they need to give you more time, and that's, you know, totally valid, like, the stutterer [00:21:00] doesn't need to change their speech for the listener's comfort, right?

And in cluttering, it's the same thing, like someone who clutters doesn't need to change their speech for the listener's comfort, but where a difference may lie sometimes is that in cluttering, if I choose not to monitor my speech, and I have a very good listener with the best of intentions, but I over coarticulate, then they may miss my message.

And, um, we have stories from people who clutter who say, I was in a work meeting. I presented this idea to the group, and they all just kind of smiled and nodded. Two minutes later, my co worker presented the exact same idea, and everybody said, Great idea! So like, there's the potential that things could get lost, but that doesn't mean they need to monitor their speech all the time.

It means we have to have conversations with them about how do you want to navigate this. What, [00:22:00] you know, what could happen in this situation? What's a situation that's important to you or not? And I think if we had this official, you know, application of the tool, um, speech pathologists could feel more comfortable.

At least this has kind of been my journey working with parents. I've always said to parents, Hey, they're on a journey, you know, and it's okay. Like they know when they want to monitor their speech now, they're not going to do it all the time. So we need to just let them go fly on their own. And if they need more support, let them know the door is open.

And it's hard for parents. And I feel like they would look at me like, really, but I wasn't using this trans theoretical model where now I can say, this is normal. This is where they are in their readiness, and they've done this much, but they might move back a little bit on their journey, and they're going to [00:23:00] move forward later, and it's going to be okay, and we want to leave the door open, you know, that, so that just has, like, Been a game changer for me, because I feel like as we develop this, maybe I don't know.

I mean, maybe I shouldn't have to have this, but I feel like it'll be like, I can say there's this model. This is everyone. And it will feel like it has more. To the parent, like, this is a legit thing. This is not just her saying, taking my kid's side and saying, like, oh, they need more time. It's like, this is legitimately what happens when people are making a change for anything in their life.

So that's one thing. And then also, um, One thing I, uh, wanted to mention is that you probably, I think on your podcast, you've had Nina and Scott Yarris, Nina Reeves, and they've talked about, um, the OASIS. So that's probably been something you've discussed. That [00:24:00] was a huge game changer in stuttering, right?

To be able to document the life impact. So Scott and I are working on the, applying that to cluttering to have the OASIS SEC. So that's something down the line. 

Ana Paula Mumy: That's exciting. So just a follow up question in terms of, um, are there other misconceptions that you would say play into? Whether it be like the parents understanding of cluttering or even the SLP's understanding of cluttering, like, what are some other things that maybe get in the way of our ability to approach it with maybe more understanding?

Kathleen Scaler-Scott: Yes. Okay, great question. Um, I feel like from all of these sides, there's things that if we could kind of get rid of the misinformation, it would help a lot. So just even from. The SLP perspective in terms of what's been out there in the universe, right, that may [00:25:00] confuse them in diagnosis. One is what we covered, like, that you don't have to speak faster than average, you just sound fast.

But also, this keeps coming up. You don't have to clutter all of the time, and you're not going to clutter every time you open your mouth. And I think we know that. We've learned that in stuttering. Like, just because a person doesn't stutter during your evaluation doesn't mean they're not a person who stutters.

In cluttering, I still find a lot of times people are like, yeah, but he didn't clutter during the evaluation. I didn't hear anything. And I'm like, that's because it's situational, just like stuttering. So, I've only worked with very small number of people who their, their rate of speech was rapid, like all the time.

Um, or rapid sounding. So that's one, it's situational. Um, the other, we talked about like life impact, that there's not, there is. and [00:26:00] can be a life impact. With awareness, there are some people who clutter who are not aware, but many are aware, but they just might not have a name for it, but they're aware they're having challenges, or they're aware they're getting feedback that someone doesn't understand them.

And also, sometimes people are aware that they clutter. But our research shows they're not aware in the moment that they clutter. So, like, those are some of the things that I think make it challenging when people look to make a diagnosis. They're like, but are they a clutterer because they don't do it all the time?

Yes, they could be. Um, And then from, I guess, even the parent side, and this is probably something that we really just have to do so much more education about, is we experience this in all kinds of things, right? Articulation, other things like, okay, [00:27:00] if you give them more exercises, eventually, this is just going to resolve.

And we don't have any research to support, like even in stuttering, how we have rates of recovery at different ages. Maybe we just don't know enough in cluttering, but we don't have any reports of spontaneous recovery in cluttering. And so what we think is that this could always be a tendency for someone and so it's something that they just kind of learn to manage.

Like, hey, this is a tendency that I have and when it's important to me, I might make a These changes to my speech just to make sure that my message doesn't get lost, but it's not something that. Usually goes away or I don't even want to say it that, that bluntly, but like more like it's just something that, [00:28:00] um, they're probably always going to be on a cluttering journey.

They're always going to have to just monitor when they want, um, like something that they always have to think about, but not that you can magically fix. And not that it's so easy for them to just change their speech and monitor their speech all the time, just like we know that in stuttering, like, that's exhausting to have to think about your speech all the time, same in cluttering, so I think that's something to really educate parents about, for sure.

Kate Grandbois: I'm wondering about The prevalence. Is this a, is this something that happened? I'm, you know, I'm reflecting on my own experience in this field. I went to graduate school in 2005. It was an eternity ago. And I, no one even mentioned this to me. And I had a great stuttering professor. Um, I love, um, and I'm sorry, Ahmed, if you did [00:29:00] mention it and I'm just completely forgotten, but it doesn't matter in my, in my experience as a clinician, this is not something I've ever encountered.

I'd never heard of it. Or maybe I had and I didn't know what it was. Is it, is it that there, the definitions are, you mentioned 2011 as a, as a timeframe when things kind of started to solidify, right? I'm wondering if this is. a low incident issue or if it is higher than we think and we just don't maybe have the tools to clearly identify it.

Kathleen Scaler-Scott: I think it's probably a little bit of both and I think the research is still emerging. Um, I know that Like we always kind of said, and this was just anecdotal, like there's not, there wasn't enough known and here, like even just to take a step back because cluttering was such a big open definition, the old research would [00:30:00] say this study had eight people who clutter diagnosed by a fluency specialist.

So what criteria did they use? You know, like everyone could have been using different criteria. Were they cluttering? Did they have something else going on? Did they have both? You know, so it was a little bit messy. So now it's better defined in the research going forward. Um, but it used to be just focused on anecdotal and we used to say, like, for every.

Um, I think it was for every three people who stutter, maybe two might also clutter, but let me just tell you, that just gets really messy, in my opinion. And now, like, even some of the characteristics of stuttering, like a part word repetition, an easy whole word repetition. I'm finding many people who clutter have that, but they don't report the same things as people who stutter.

So, like [00:31:00] now, sometimes I question all these people that we said were clutter stutterers, did we just not understand? Um, you know, that there are some things that might be unique to cluttering. I think the latest Incidents reports in their small studies are like maybe it's some of them say anywhere between less than 1 percent to maybe 2%, but again, I feel like it's based on very small samples.

So I feel like there's so much more we need to know before we get good hard facts on that. But I guess what I would say in general is I feel that cluttering is more common than we think. You know, so because you can find it going along with a lot of times with other things. It does not have to. There are people who just clutter, but you can find it [00:32:00] like I identified it in my dissertation and is a very small sample once again.

but more in children with autism spectrum disorder. But it doesn't work in reverse where, oh, if you clutter, you definitely have autism spectrum or you definitely have ADHD. But I've seen it more in kids with learning differences, kids with autism. So we just have to be aware that it could be there, you know,

Ana Paula Mumy: can you talk a little bit more about, um, just when it does co occur with settering, you know, what are the things that you see, um, because of course that muddies the water even more, right? It's already a little bit confusing. It's already, um, sometimes inadequate, um, coming to these conclusions or that differential diagnosis piece.

So what have you seen when it does co occur? 

Kathleen Scaler-Scott: Yeah, yeah, those are great questions. Um, I'm just like, thinking about when it does co occur, I'm thinking about some of my clients I'm working with, like teens and [00:33:00] adults. And so what I'm often seeing is that if it's co occurring, then I'm seeing some of those symptoms that we talked about in the cluttering.

Typically, the stuttering, when they're describing stuttering, they're experiencing the stuttering blocks. So, a lot of times if there's just There's cluttering and that's kind of predominantly what's going on that's having the life impact for the client, you know, just, um, intelligibility, getting their message across so that others understand them.

Um, then you're, you might also hear, like I said, some of those part word repetitions, whole word repetitions, but. You know, first of all, a lot of times in stuttering, those might be things that we say, Hey, let's, you know, do you want to do anything about that? Or do you want to just let it go? Um, and in cluttering, like a lot of times, [00:34:00] When that happens, um, I have seen cluttering is like the only thing in speech pathology where if you regulate your rate, because we believe that a speaker is speaking at a rate that's too fast for their system to handle, that's why they might not be faster than average.

They're too fast for their system. So that results in the communication breakdown. So, if we want to make the cluttering symptoms disappear, we just have someone regulate their rate, and usually they disappear. If you have dysarthria, you can slow down, but your speech still will not, like, normalize, quote unquote normalize, like it would in cluttering.

So a lot of times what I find is if someone is cluttering, but let's say they have these other things that might be like a part word repetitions, whole word repetitions, but very easy, no tension or struggle. [00:35:00] Um, and I'm asking them about blocks and getting stuck and some of the things that people who stutter experience, and they're saying, no, no, no, I don't experience that, and I have them regulate their rate, they just go away.

Now, I know that can happen in stuttering too, um, but it just makes me think that, okay. If there's stuttering here, it might not be something we have to address, but when we do usually address it is they're reporting blocks like people who stutter experience where it's like, I can't move forward. I have all this tension and struggle.

I know exactly what I want to say, but I can't get that word out. I feel like in my experience, that's the more common. What I'm saying when they both co occur, 

Ana Paula Mumy: so would this be a good time to talk about, you know, how, how do you address it in terms of, you know, how, how do you, um, handle one, I guess, maybe starting with the rate component.

And then there is that feeling of being [00:36:00] stuck and just not knowing how to move forward. Yeah. 

Kathleen Scaler-Scott: And I will say that I'm, I'm a very pragmatic person. Like I just have a very pragmatic, functional approach to how I treat things. So I always get the question, what about DAF to slow down? What about a pacing board?

What about, you know, anything like tapping out the syllables? You can do those. They will help a person pace, but in my experience, like they don't transfer over. So my whole goal in treatment. Is first to just kind of normalize what I call the communication breakdowns that occur in cluttering. And I feel like that helps break the defensiveness in the teens and the kids who might be resistant, you know, and maybe they're just not ready yet, but sometimes they are ready, but they're really defensive because they've gotten all this feedback like, Oh, I can't understand anything you're [00:37:00] saying.

Like, you just have to slow down. And, you know, um, So we talk about how everybody has breakdowns and it has communication breakdowns and if you look around you'll see sometimes someone says a word and they're like, you know, a lot of times kids would go, like, Oh, that didn't come out right, you know, um, or you say something to, you know, Your significant other and they're like, wait, well, I didn't hear that.

And so you have to say it louder or slower or something, right? So we talk about how everyone has communication breakdowns and then we talk about, we don't say everyone clutters, but we say everyone has communication breakdowns and sometimes they might happen more often for you and that could be frustrating.

But we talk about, okay, if your rate of speech is Well, I don't want to just tell you to slow down because you're going to be really [00:38:00] annoyed. That's easier said than done, but we do have some research, just a teeny bit that helps us. We, um, know that clutters don't pause as much as your average speaker. So, if we teach them to put natural pauses in their speech, you know, where you would expect them, then that helps them.

regulate their rate in a more natural way. And so that's one thing that I do to help regulate rate. And it's just teaching them what we all do in our speech. And they may not do as much. Um, and some clutterers don't necessarily, like, know the places to put the pauses. Like, I worked with a gentleman who said he didn't know that he cluttered.

But he knew that people weren't understanding him and someone said to him one time, you know, you go really fast. You should pause. [00:39:00] But then he's like I would just put pauses. I didn't know I didn't know where to put them. And so he said then people would go what's wrong with you? Like, like the pauses would sound awkward and when we taught him he's like Wow, this is so simple.

It makes such a difference, but like it wasn't intuitive for him to know where to put the pauses. I'll say some cluttering clients, it's, it is intuitive, but they just don't do it. So that's one way to regulate rate. Then your client could be putting in those pauses, but then they could be talking really fast in between the pauses.

So there you're still hearing like the, Yup. Mumbled sounding speech, so then I was like, okay, well, what is the functional everyday solution? If I was talking to my spouse and he was like, what? What was that word you said? Right? I would say, I said information. So I would emphasize it a little more, but not in a [00:40:00] crazy robotic way like information or tap it out or anything.

I just emphasize my sounds a little more. So we talk, I talk with my clients about emphasis if they, if they need it, if the pausing is not enough and everybody has Words like some of my words are unusually, I really have to slow down to motor program unusually and teaching research message methods, statistically significant, like everyone has those words that can be tricky.

So like we learn about those and just be aware of those words. Um, so I do kind of natural things in that way. 

Ana Paula Mumy: Yeah, that's great. 

Kate Grandbois: I'm not one of my words is advertisement. I can't say it no matter, no matter how many times. Um, I really appreciate that you talk about the concept [00:41:00] of normalizing the communication breakdowns.

I mean, just from having interviewed Nina and Scott and several, several of our other stuttering specialists, this is, you know, something we're clearly embracing as a field as part of the stuttering community. So it's very logical that we would map. that on to our treatment with stuttering. Uh, I wonder if you could talk to us a little bit about the lived experiences.

So as part of your podcast, you interview individuals who clutter. And I'm wondering if you can tell us a little bit about Um, what important takeaways you've learned, uh, obviously this conversation can't replace the actual lived experience of a person who clutters. And we actually have an interview scheduled for later in the season, um, with a person who clutters, which we can link to in the show notes as well.

But What, what have you learned as a clinician that are important takeaways from those lived experiences that we can share? 

Kathleen Scaler-Scott: Yeah, um, so much [00:42:00] But I'll try to unpack just a few. One huge piece is that everyone's journey is different. And I know maybe people would say, Well, of course it is, but I don't know if it's intuitive to people to think that way, you know, so we, um, kind of get into the habit of like, Okay, this is this is what applies to stuttering.

And sometimes I've seen it applied broadly to cluttering, and it's not always the same. And so we've interviewed some people who say, I want people to ask me to slow down adults, right? And that's not what we would expect as like a listener reaction. Um, we did a whole interview with leaders in the cluttering community, and that's a perspectives article that.

Would be available to people. We could probably link that as well. That's where they talked about some of the differences for them. But, you know, [00:43:00] some people say, I want you to tell me to slow down. Other people are like, No, I do not want you to tell me that, you know, so. Everyone's kind of got different lived experiences.

Some people like to use strategies and monitor their speech. Some people don't. A lot of people pick the situations that are important to them. And they talk about that. Um, they also, um, one common theme among the people we've interviewed is just the fact that Many people are aware. It's really just busting a lot of the myths that we talked about that.

Yes, I am aware But there's other things too where they talk about disclosure Right, and so in stuttering there's a lot of talk about disclosing stuttering and some people who clutter have said I disclose But I don't use the word clutter and it's [00:44:00] because there's Misconception and people as soon as they hear the word cluttering they think hoarding so like their story after story I never would have thought of that but that makes perfect And watch for it.

Eventually, I think there's going to be a movement. The last person on our podcast, episode 15, talks about making a movement for this, but she's not the first to say it about making a movement to change the, the. Word cluttering to something else, but they'll say, I don't tell people like clutter. Like somebody might say, Hey, I stutter.

You know, they just say, sometimes I talk fast. And if you can't understand me, please ask me to repeat and like all these things. I'm like, yeah, that's kind of brilliant. Right? You're still disclosing. You're still advocating for the feedback that you want or the response that you want from your listeners.

But is it's not important that you do it. You know, say the term. Now I do have a teen, a [00:45:00] young man, who he will educate the entire world about cluttering. And he's like, hey, I clutter and this is what it means. And I also stutter and this is what it means, you know, but everybody's different. So, yeah, but life impact is there.

Caregivers talk about impact. They talk about misunderstanding from teachers. 

Ana Paula Mumy: Do you find that a lot of the, um, lived experiences that have been reported, at least, you know, through your podcast, um, have there been a lot of individuals that were misdiagnosed early on or that were, Um, you know, where stuttering was suspected and there just was that misdiagnosis piece and maybe how their journey changed over time, you know, just when they finally got a correct diagnosis, like, what does that look like?

For some of the people we've worked with. Yeah, 

Kathleen Scaler-Scott: yeah, for sure. People reported, like, once they finally got an accurate diagnosis, they're like, wow, this makes sense. That's [00:46:00] what it is. And that's definitely a common theme. Because of all the confusion with the definition in the past, um, Yeah, so they, many report kind of a sense of relief and a sense of, okay, yeah, like almost validation of what's going on.

Kate Grandbois: For anyone listening who is now reflecting on their own caseloads and thinking, oh my goodness, I think so and so might be a clutterer, or oh my goodness, I wonder if I've been treating this as X, but it's really Y.

What other resources, so you've mentioned your podcast, we have hyperlinks to your books and show notes. What other resources or words of advice would you have for a clinician who is kind of having that first light bulb moment or understanding this conceptually a little bit deeper for the first time?

Kathleen Scaler-Scott: Yeah, I mean, first of all, yeah, every time I give a [00:47:00] presentation on clutter and people come up to me afterwards and say, I think I missed this one. Like now looking back, I think I missed this one. I probably say don't beat yourself up because it was so confusing, but just know it going forward or if you have someone now that you can, you know, kind of work out the diagnosis with and, um, Yeah.

Some of the like resources that you mentioned, like the fluency plus book will help with diagnosis. Um, because I've kind of got like a step by step in that. Um, so that's a resource. Um, I love, love. Rucker Wilhelm's website, Too Fast for Words. He's the author of Too Fast for Words. I get no royalties. I say this at every talk, like I get no royalties for this book, but I find the book so valuable that I recommend it to my clients, to SLPs.

Um, it's called Too Fast for Words. Um, but he [00:48:00] talks about, um. The impact, but like getting to what people could do about diagnosis, one of the things I think is also confusing out there and I encounter it with my students, they go out onto the internet and they're like, Okay, I'm Oh, Dr. Scott, I found a video on cluttering.

And I don't know who is posted it. You know, it's the wild, wild west. And I'm like, No. It's not cluttering. Like, at least there, what I'm seeing is not an example that fits the definition. Um, but on Too Fast for Words, they have lots of good examples of legitimately cluttering. So, like, if you just want, like, a video example, that's there.

But do keep in mind, everyone is different. You know, in terms of their presentation, some people have more of the overcore articulation. Some people have more of the atypical pauses. Some people have more of the, um, excessive. Uh, non stutter dysfluency. So everyone won't [00:49:00] look the same, but just maybe by reviewing some of those videos and different resources, it might be able to help you.

And you can always reach out if you have questions, too. 

Ana Paula Mumy: You also want to talk about the Fluency Bank resources, um, for cluttering? Oh, yes, yes. 

Kathleen Scaler-Scott: Yes, because the fluency bank, um, I know has some examples of cluttering, um, for if people want to use in class, but then also may be some. videos and things of people who clutter.

So that might be another resource to use as well. If you just really feel like, I feel like people are always itching to get, I need, I need to see that video. And it's been hard, I think, throughout the years with our presentations, because you don't, a lot of the people we work with are our kids and like parents weren't always [00:50:00] reluctant to.

Or sometimes we're a little reluctant to put things out there, you know, so there's not, so those are some resources and Annapolis, they're open, but I feel like they're kind of more secure in a way, right? You may know more about that. 

Ana Paula Mumy: We have to register, but I think as long as you go through the registration process, it is free.

Um, I find that it's really helpful because like you mentioned, you know, it is variable. And so you almost have to, you know, calibrate your ear to hear that cluttered speech versus stuttered speech. Right. And just kind of, you know, hearing this. And I think it's just nice to hear those different examples.

I think there's audio and video there. So. You do have to register, but I don't know that they would ever, like, deny someone unless you have a legitimate reason to, you know, request that. Right. Um, so that's a really nice, um, way [00:51:00] to just, um, hear what it might sound like. Right, right. 

Kathleen Scaler-Scott: Right. And it's nice because it adds that extra layer.

And of course, those are all legitimate samples too. So great place to go. Yeah. 

Ana Paula Mumy: Yeah. I don't know that there are any, I know, um, there are both child and adult, um, videos and audios for stuttering. I don't know about children. Samples for clubbing, I 

Kathleen Scaler-Scott: know on too fast for words, there's at least a teen, you know, and I think, I think as the field is evolving, we'll start to see more stuff out there.

I'm hoping, you know, people are coming forward and even like with the podcast, wanting to share their stories. Um, so hopefully we'll see more and more of it. 

Ana Paula Mumy: Can I plug one that you haven't mentioned? Yeah. Just, uh, one of the Asha Leader live articles that you [00:52:00] wrote. The one, um, called Debunking Myths about.

Yes. Thank you . And I just, I found, um, that to be so helpful and I just like how you really go through the myths and talk about. Um, and how we can address them as barriers and how that might impact, you know, you look at centering and, or excuse me, cluttering and understand it. And then also kind of just the, the, the counter of overcoming those barriers and just how to approach, um, making some changes in how we.

Um, look at it and how we understand it. And so that's a, a great one that was really a huge help for me. 

Kathleen Scaler-Scott: Yeah. Yeah. Thank you. Kate knows from our previous conversation, I forget. Oh yeah, wait, there's that too. 

Kate Grandbois: Well, I'm sitting here frantically taking notes. So the only thing I was going to say earlier was that, you know, you've listed so many great resources here and I have just been frantically taking notes the whole time.

Binding links, all of this will be [00:53:00] listed in the show notes. So anybody who's driving, walking, folding laundry, what have you, all of those will be written down, um, in our, in, you know, in, in the show notes, as I mentioned, I'm wondering if there are any other, you know, really important takeaways that you would like to share for, for anyone listening, whether they're, you know, new to this field or, um, or otherwise.

Thanks, guys. 

Kathleen Scaler-Scott: So I would say if you're seeking information, you know, one of the things is that it's out there and it's there more and more and more. There's the International Cluttering Association website, but there's also for lived experience, there's a Cluttering Facebook group. I think it's called cluttering speech.

I should know these things, but I told Kate like all the ideas swim around in my head. Um, but I think it's called cluttering speech that was started by Sister Carol Mary Nolan. She's amazing. [00:54:00] So she's a person who clutters and she was the one who kind of moved. The field forward, in my opinion, when she started that Facebook group, because that just started getting stories out there more and more in discussions among people, clutter, SLPs, parents.

Um, so, you know, if you're looking for resources. It's kind of like, you know, people are like, well, there's not much out there. Like, and years ago, that was true. But I'm telling you, you just need to look for it. There's all kinds of resources out there for you now. If we have any faculty who happen to be listening, we also put together, my students and I, students previewed a bunch of different resources.

Um, to help them learn about cluttering and they rated them. So like if you're thinking, what do I put in my cluttering curriculum? If you're teaching it, that's going to be at ASHA. We'll have that, but I'll [00:55:00] send the link also to Kate as well. It's just. Um, a link to a living document that we're going to continue to update, but it's like a resource for you to know, oh, there's all these other things out here too that I can access.

So just look for it. Look for our presentations at ASHA and elsewhere and, um, it's there and we're going to keep pushing it forward. 

Ana Paula Mumy: So let's talk a little bit about assessment and differential diagnosis, because I know that's a difficult thing at times, especially like we've already mentioned when there is a lot of misinformation and we don't have a whole lot of, uh, training background in stuttering and or cluttering and, um. And we've talked about the muddied waters and all of that.

So if you could just talk a little bit about how you approach assessments. Um, are there like favorite tools that you use in terms of, um, [00:56:00] actual, you know, assessments, um, whether they be, um, more, you know, uh, list or survey type or just what, what do you use when you are, um, approaching an assessment? 

Kathleen Scaler-Scott: Yes, um, for assessment, I really do stick to first just looking for, is there cluttered speech, right?

So someone might have other diagnoses as well with cluttering. They may or may not, but I kind of just zone in on just focusing on the speech. And there's a reason for that, because with all the big wide definition and misinformation in the past, people would just get themselves so confused. And they might call something that might be, say, a symptom you might experience in autism as cluttering, right?

So I I have just found the LCD definition so helpful. So I really just go through it step by step and I say, okay, right now I'm just [00:57:00] focusing on does this person check the boxes for cluttering? So I, you know, talk to caregivers, significant others, the person themselves, have they gotten feedback that their speech is rapid?

Do they feel their speech is rapid? Does it sound rapid to me? And if it checks that box, Then I'm doing more just kind of, um, samples, like getting a monologue sample. from them just to talk about topics they're passionate about, they know a lot about, those tend to bring about more cluttering symptoms. Um, and through that sample that I'm looking to see, because remember it's like a perceptual definition, so do I feel like There's examples of over coarticulation, right?

Are there examples of excessive non stutter disfluencies that make maybe them, you know, lots of revisions where they're having a hard time [00:58:00] getting their point across efficiently? Or I'll analyze the sample for like, are there a lot of atypical pauses and look at that. But keeping in mind that just because they don't clutter with me, they still make clutter, you know, I go by.

Kind of what I see there, but then I also go by their report, a parent report, a teacher report, you know, and look for patterns, obviously, not just one person who says I can never understand them and everyone else doesn't report it. But, you know, to give you an example, I had a clutterer I worked with and he, um, He reported that he had overcore articulation, never heard it till well into when we were working together and the situation brought it about.

He, we worked more on the non stuttered dysfluencies because he had a hard time expressing himself efficiently, but I still believed him that the other symptoms were [00:59:00] there. So then in terms of like differential diagnosis, what you have to think about are with those three symptoms. What else could be causing them?

So if it's overcoarticulation and the speech sounds mushy or mumbled, we have to rule out an articulation disorder, a phonological process disorder. Is there anything going on with even like a dysarthria? You know, just making sure we rule out that that's not what's resulting in the overcoarticulated speech.

And then the non stutter disfluencies get even more tricky because we need to really figure out. Could a person have excessive non stutter disfluencies because they're avoiding stuttering, right? So is that they could stutter and clutter, but why is that happening? Do they have a language disorder or do they speak more than one language and they're just trying to find words?

So like we have to [01:00:00] consider all of those factors too. Like I just think about those three symptoms and I think about what else could be causing those symptoms that's not related to, um, when they get going too fast for their system to handle. And then that helps me try to rule out, is this just cluttering?

Is it something else? Is it cluttering and something else? Or is it something else all together? And I feel like one thing for people to know with this, too, is I feel like, especially when you're trying to tease apart stuttering and cluttering, and there may be some avoidance, some fear, um, things like that, it may take time to work with the client and just really asking for their feedback.

Like, hey, do you ever have times when you change words and, you know, having conversations with them ongoing? Sometimes you don't figure it all out right. In the evaluation. It's an ongoing journey. [01:01:00] 

Ana Paula Mumy: Can you, I know you mentioned that there's no percentage when it comes to the excessive disfluencies. Um, how do you determine what's excessive?

Like, how, what are you looking for when there's not maybe that, you know, percentage. Um, or a threshold that is maybe standard. 

Kathleen Scaler-Scott: Right. And I'll say I used to say, well, you know, we don't have the research yet for the percentage, but I do think that, and I think Dr. St. Louis put this bug in my ear, but I don't want to put words in his mouth that, you know, everyone may be a little different too, in terms of what's, you know, their percentage.

But, um, what I do is, yeah. Just think about is the person, you know, and I might ask for feedback from significant others or from them themselves, um, is it that they are, um, it's taking them [01:02:00] longer to get to their point. And not because motorically they can't, but just formulation wise they can't. And to give you an example, one of the clients I worked with, I asked them to tell me something that happened to them over the weekend.

They told me, and I was early on working with them, and I let it go, 23 minutes to tell me this story. And I said, Um, okay, I just want to summarize back for you to make sure I got your story and I summarized it in about two minutes and he looked at me and said, how did you do that? And now he can do it.

And that's a very extreme example. So I don't think like all of your clients are going to be that inefficient. But it's that where you just feel like, I get your message, but I feel like you could communicate it more efficiently and not because of you can't get the words out, but because you, you're having a hard time formulating the idea [01:03:00] efficiently.

Ana Paula Mumy: Yeah, that makes a lot of sense. And in terms of impact, what are you using to determine impact? 

Kathleen Scaler-Scott: That, thank you, because I meant to say that before. Um, in terms of impact in my evaluation, until we officially get the OASIC rolling, what I'm using now is more just really interviewing the client than any significant others and saying, how do you feel about your speech?

Thank you very much. How do you feel it's going? And then also asking about, excuse me, how do you feel about others responses to your speech? So sometimes what you'll get at with school age kids and teens is They feel fine about their speech, they're not worried about it, but what really makes them mad is when people tell them to slow down or tell them they talk too fast.

So, I feel like [01:04:00] that gets at some of the life impact at their stage, you know? So, it's really just more asking them how they feel about it, how's it going, how they feel about others reactions, and exploring that, and that is like an ongoing conversation as well. 

Ana Paula Mumy: Do you find that there's, uh, communication apprehension like we do with people who stutter where they're, um, anticipating, um, whether it's a small group discussion or something, um, and there is that apprehension to participate or to voice their, um, thoughts or ideas?

Is that common in cluttering as well? 

Kathleen Scaler-Scott: Yes, thank you for bringing that up. I mean, for some, it might not be, but absolutely, for many others, they'll talk about, you know, I really want to tell that joke, but nobody ever understands my jokes when I deliver them, or I've had clients who say, [01:05:00] I just keep it short.

Because I'm, I'm safer that way. So they're not really expressing themselves what they really want to express. And they are just kind of holding back because they're apprehensive about the reaction 

Ana Paula Mumy: or how it will be 

Kathleen Scaler-Scott: received. Yeah. 

Ana Paula Mumy: Have you ever used the personal report of communication apprehension as a tool with?

Kathleen Scaler-Scott: I have not. I need to look into that. Well, I'm going to put it in the 

Ana Paula Mumy: show notes. I'm going to Google 

Kate Grandbois: it. 

Kathleen Scaler-Scott: Thank you. What is it, Ana Paula? 

Ana Paula Mumy: It's called the Personal Report of Communication Apprehension, and I've used it. It's a, I forget now how many items there are, but it just talks about how or asks Um, and then it asks, uh, questions related to how they approach, um, a small group discussion or one on one conversation, and there's just different parameters, and then it gives you the score, which it's very, you know, subjective, but it just, for me, has been helpful to just get the conversation started about, are you [01:06:00] experiencing any apprehension as you're going through the process?

Um, communication, um, uh, exchanges or interactions with others. And so it's just sometimes it's just a nice, um, conversational, uh, just a starting point, right? To, to talk about this, um, and, and how they might be avoiding or like you said, saying less. Um, because they're concerned or something like that. So that's one that maybe could be used for cluttering as well.

I haven't used it, um, for that, but I'm thinking to myself, as you were talking, I'm like, maybe I could. 

Kathleen Scaler-Scott: Yes, it sounds like it. I'll be checking that out. Thank you. 

Kate Grandbois: And I've Googled it. It looks like it's it looks like it's a free PDF. It is. Oh, we will have the link in the show notes. Excellent. I so appreciate your time.

I have learned so much. I started this conversation, uh, wildly unprepared and uninformed. So I, I really feel like you've done such a wonderful job explaining the rough edges of what this is, but [01:07:00] also what action steps we can take, what resources are available. Um, we so appreciate your time. In our last minute, do you have any final words of wisdom that you would like to leave our audience with?

Kathleen Scaler-Scott: Please just never stop looking for information on cluttering. Never stop learning. It's out there. When I first learned about cluttering was I had a little boy in my first job that I didn't learn about it in grad school either. I was like, what is this? It's not stuttering. And I found an old article and, you know, from there it went on, but you're getting so many more resources.

So please keep looking. You're never too late to stop learning. 

Kate Grandbois: I love that message. That's a very nerdcast friendly message. That's wonderful. Well, thank you so much for being here. We're really grateful for your time and we're, we're all, we are all, we are all smarter for it. 

Kathleen Scaler-Scott: Thank you for having me. 

Kate Grandbois: Thank you. [01:08:00] Thank you so much for joining us in today's episode, as always, you can use this episode for ASHA CEUs. You can also potentially use this episode for other credits, depending on the regulations of your governing body. To determine if this episode will count towards professional development in your area of study.

Please check in with your governing bodies or you can go to our website, www.slpnerdcast.com all of the references and information listed throughout the course of the episode will be listed in the show notes. And as always, if you have any questions, please email us at info@slpnerdcast.com

thank you so much for joining us and we hope to welcome you back here again soon.

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