It’s common for children with autism to have one or more speech-language problems, from delayed first words to childhood apraxia of speech. One you might not have heard of is a fluency disorder called “cluttering.”
What is cluttering in speech?
Fluency disorders cause problems with the rhythm, speed, and flow of speech. Stuttering, the most common and well-known fluency disorder, involves repeating parts of words, dragging out syllables, and getting “stuck” on certain sounds. Such speech characteristics are called “disfluencies.” Cluttering is related to, but different than, stuttering.
Symptoms of stuttering and cluttering usually appear during the preschool years, but cluttering isn’t as easy to identify and often goes undiagnosed.
Symptoms of cluttering
- Rapid rate of speech
- Abnormal pauses between words
- Excessive interjections like “um” and “uh”
- Skipping or merging syllables
- For example, a clutterer might say “tevision” instead of “television”
- Skipping entire words
- For example, “I had a great time at the party” might come out as: “I had great time at party”
- Repeating words or phrases
- Incomplete sentences
- Mixed-up word order
- Starting new sentences before the previous one is finished
- Disorganized thoughts
- A person who clutters may take a while to get to the point
- Frequently interrupting others
- Potential difficulties in reading and writing
Conversation with a clutterer can be confusing because of the fast speech rate and slurred words. Unlike stutterers, people with cluttered speech often have limited awareness of their own disfluencies unless someone else points them out. And, because cluttering isn’t well-known the way stuttering is, parents may chide their child for speaking too fast without realizing that he/she has a speech disorder.
The difference between stuttering and cluttering
Some people stutter, some people clutter, and some people do both! Although the conditions often co-exist, and may be mistaken for each other by non-professionals, there are differences between the two:
- Stutterers are usually aware of their mistakes
- Their communication isn’t as disorganized
- They have a slower rate of speech
- They don’t typically slur their words
- Clutterers can sometimes temporarily control errors, unlike stutterers
- Clutterers don’t exhibit “blocking,” which is when the first syllable of a word is hard to get out
- They also don’t have “prolongations,” which is when a sound is dragged out
The difference between cluttering and pressured speech
It’s worth noting that cluttering can sound very similar to pressured speech, a separate speech condition. Unlike cluttering, pressured speech is associated with psychological states like mania, psychosis, or severe anxiety. It’s considered a thought disorder instead of a fluency disorder and is most often found in people with bipolar disorder or schizophrenia.
Cluttering is an ongoing problem that will be evident in the person’s everyday speaking. Pressured speech, on the other hand, will most likely only occur during a manic or psychotic episode, and the person will probably show other symptoms of the psychological root cause.
If you’re worried that pressured speech may be behind your child’s rapid speaking, it’s best to consult a mental health professional.
Is cluttering speech common in autism?
Right now, there isn’t conclusive research about how many people clutter. It’s a rare disorder overall, but it has been identified in patients with autism. Cluttering and stuttering occur in plenty of neurotypical people, though autism, attention hyper-deficit disorder (ADHD), learning disabilities, and auditory processing disorders are common co-morbid conditions among people who clutter.
Getting a cluttering diagnosis
As mentioned above, cluttering often goes undiagnosed in children. Since it typically appears during toddlerhood, parents can mistake it for the normal errors kids make as they learn to speak. Despite communication issues, people who clutter can usually make themselves understood, so the parents see no need to access speech services. As they grow, others may view their speech patterns as a simple quirk rather than a fixable problem.
Dr. David Ward, a specialist fluency clinician and author of Stuttering and Cluttering, writes that “often, adult cluttering referrals come via work colleagues and line managers who are concerned that the individual’s chances of promotion are being compromised due to that person’s lack of clarity in speech. Quite often, the clutterer is surprised that others have difficulty understanding them…”
Keep an eye out for any speech-language problems so your child can get help before adulthood. Listen to his/her speech rate to determine if it’s too fast or irregular. Observe for any disfluencies like skipped syllables, incomplete sentences, and more.
Children on the autism spectrum are usually monitored for communication problems, anyway, so you might already have a speech-language pathologist on your team. If you don’t, reaching out to one will be your first step in getting a cluttering diagnosis.
Speech-language pathology
This is a field of therapy that treats people with speech difficulties, from babies to adults. Professionals are known as speech-language pathologists (SLPs) or simply speech therapists.
SLPs are trained to help people with a wide variety of problems, from articulation, to controlling one’s speaking rate, to understanding the social norms of conversation, and more. Ones who specialize in fluency disorders will be best able to treat people who stutter or clutter.
If you don’t know where to find an SLP, try…
- Asking if any are employed by your school district
- Connecting with early intervention services in your area if your child is under three years old
- Asking your child’s pediatrician for a referral
- Seeing if any local colleges have speech therapy programs that assess children
- Checking with your insurance company to see if they have a network of providers
- Looking in the American Speech-Language-Hearing Association’s professional directory
Assessments for cluttering
An SLP will want to have lots of information about your autistic child before making a diagnosis or developing a treatment plan. Be prepared to explain parts of your child’s history, including…
- Any speech disorders in your family
- When you first noticed cluttering symptoms
- Other related concerns, such as delays in linguistic development
- Performance at school
- Medical history, including medications your child may take
- Any prior speech therapy
From there, the therapist will assess your child’s language skills. He/she may have your child read from a passage, retell a story from memory, and/or simply chat. The SLP will be listening for an irregular rate of speech, unclear articulation, excessive disfluencies, and other characteristics of cluttering or stuttering. These assessments will probably be recorded so certain metrics, like syllables per minute, can be measured.
Treatment for cluttering
Therapy will be tailored to the individual child based on his/her age, strengths, and weaknesses. According to Dr. David Ward, strategies for treating cluttering could include…
- Monitoring and self-awareness: the patient will listen to a video or audio recording of him/herself to understand how he/she really sounds
- Reading: he/she will read passages to practice slowing down and pausing at appropriate times
- Nursery rhymes and poetry: these can be used to help the patient practice typical stress, rhythm, and intonation
- Articulation: the patient will repeat sounds and phrases in an exaggerated way to produce crisper vowels and consonants
- Retelling stories: clutterers often struggle to maintain trains of thought, so the therapist may help him/her understand narrative structure. For example, the patient may reassemble cut-up cartoon strips and then tell the story from memory
- Recognizing social cues: the patient will learn to identify nonverbal clues that his/her conversation partner hasn’t understood him/her
There’s no “cure” for cluttering, just like there’s no cure for stuttering. But children can be taught to have awareness of their speech disfluencies, and conscious use of techniques and strategies learned in speech therapy will improve their intelligibility. Irregular speaking should be addressed as early as possible, so the child gets used to these techniques and uses them naturally.
People who stutter often need ongoing therapy to manage their condition, but people who clutter can usually discontinue speech therapy once they’ve hit their goals. Still, some SLPs may invite clients back for “tune-ups” every so often to make sure they haven’t slipped back into old habits.
In conclusion
Cluttering may seem less severe than other speech disorders, but it can create barriers for your child with autism as he/she grows up. Clear communication is essential for making friends, succeeding in school, and thriving in adulthood.
If your child clutters, help is available. Reach out to speech-language pathologists in your area to find the right fit for your family. With time, effort, and patience, your autistic child can improve his/her intelligibility and make his/her voice heard.
References
ASHA. (n.d.). Who Are Speech-Language Pathologists, and What Do They Do? American Speech-Language-Hearing Association. https://www.asha.org/public/who-are-speech-language-pathologists/
Lieman, B. (2013, July 17). Focus On Cluttering. National Therapy Center. https://www.nationaltherapycenter.com/the-stuttering-source/focus-on-cluttering
O, C. (2013, August 30). Where to Turn: 8 Tips for Finding a Speech Therapist in Your Area. Speech Buddies. https://www.speechbuddy.com/blog/speech-therapist/how-can-i-find-a-speech-therapist-in-my-area/
Ward, D. (2006). Stuttering and Cluttering: Frameworks for understanding and treatment. Psychology Press. https://gagueira.files.wordpress.com/2012/12/stuttering-and-cluttering-ebook.pdf
