Stuttering and Cluttering
Wednesday mornings I get dressed all fancy and participate in a stuttering diagnostic clinic. Diagnosing stuttering is pretty easy: either a client does it or they don’t. The classic signs of stuttering, known as core behaviors are repetitions (part-word and whole-word), prolongations (holding a sound extra long, like “mmmmmmmom”) and blocks (moments where no sound is produced, despite effort). Stuttering is accompanied by secondary behaviors: things the person who stutters does to get out of the dysfluent moment. Secondary behaviors can include signs of tension in the face, avoiding eye gaze, hard eye blinks, hand movements, head jerks, irregular breathing, using filler words, circumlocuting … Secondary behaviors are reactions to the person’s discomfort with stuttering- they happen because the person is painfully aware of their dysfluency.
Once you’ve confirmed that a client exhibits core and secondary behaviors, diagnosing stuttering boils down to a measure of severity- and there are scales to quantify severity, so that’s easy enough.
But what about when someone sounds like they’re stuttering, but they’re not exhibiting core and secondary behaviors? That was our client this morning: his words came tumbling out rapidly; he tripped over them and repeated sounds and words. He didn’t have secondary behaviors, with the exception of facial grimacing that occurred unrelated to speech contexts. Further, unlike people who stutter, this client reported that he was unaware of his rate of speech. On an objective level he knows that he speaks quickly because other people have told him so. However, he is not aware of his rapid rate while he is speaking.
This client has a disorder that is even more rare than stuttering, called cluttering. Cluttering is characterized by a rapid rate of speech, dropped sounds and generally low intelligibility. Stuttering is a speech disorder; cluttering is more accurately described as a language disorder that affects speech. Because language is disrupted, cluttered speech can also have an erratic rhythm and syntactic errors.
I mentioned above that people who stutter are very aware of their stuttering; people who stutter often feel embarrassed, ashamed and angry. People who stutter avoid speaking situations because they are uncomfortable talking. People who clutter, in contrast, are almost always unaware of their dysfluency: they don’t have secondary (avoidance) characteristics because their dysfluency doesn’t bother them.
Our client reported that he never realizes how dysfluent he is- unless he hears a recording of himself. When he hears a recording he can barely understand himself. He hears that he speaks too quickly, but when he tries to speak more slowly (what most people would perceive as a “normal” rate), he feels like he’s going so slow that he’ll forget the next word he wants to say.
The problem here is one of sensory integration. The client has intact perception; there is nothing wrong with his hearing. The problem is that he isn’t integrating his perceptions of himself online into his productions. And that’s when I started connecting cluttering to Parkinson’s disease.
