Cluttering causes classification symptoms diagnostic correction
Cluttering is a disorganization of the tempo, rhythm and fluency of a speech utterance of a non-convulsive nature. It is characterized by excessively fast, slurred, monotonous speech, repetition of words and syllables, articulatory disorders, lexical and grammatical errors, incorrect placement of logical stresses and pauses. Speech disorder is accompanied by general motor disinhibition, memory and attention deficit, uncriticality in relation to one’s speech and behavior. The violation is recognized during a speech therapy examination using traditional and special techniques. Corrective intervention is aimed at normalizing the tempo of speech, developing language skills, and improving sound pronunciation.
Cluttering (translated from English – clutter, clogging) is a communication problem characterized by accelerated, dysarrhythmic, non-fluent speech. Along with bradilaliey , tachylogia and stutter refers to disorders of tempo and rhythmic aspects of speech. Cluttering syndrome is more common in males. Usually detected at the age of 7-8 years.
In foreign speech therapy, it has been actively studied since the second half of the last century, which led to the creation in 2007 of the International Cluttering Association, of which 18 countries became members. In Russian speech therapy science, cluttering does not stand out as an independent speech disorder. In the clinical and pedagogical classification, the term “half-day” or “stumbling” is the closest to it. Meanwhile, some domestic experts consider cluttering in the framework of neurosis-like stuttering .
Professor D. Weiss, who published the first textbook on this problem in 1964, identified primary (pure) and secondary forms of speech disorder. He classified genetically determined cases of cluttering as “pure” forms, describing the autosomal dominant inheritance of pathology in some generations of the same family. It is not excluded that in some cases spontaneous mutations occurring “de novo” take place. In addition, cluttering is one of the specific signs of fragile X-chromosome syndrome – a sex-linked hereditary disease, also characterized by mental retardation, autistic behavior, and hyperkinesis . In primary forms of cluttering, speech features are noticeable from childhood. Cluttering causes classification symptoms
Non-convulsive hesitation and non-smooth speech can accompany various neurological disorders: encephalitis , pseudobulbar paralysis, chorea , Parkinson’s disease , oligophrenia , etc. In these cases, we are talking about secondary cluttering syndrome, which develops in people with previously normal speech against the background of underlying pathology. In general, the etiology of this speech problem has not been studied enough, it is the subject of scientific discussions and further research.
There are also many “blank spots” in understanding the mechanism of speech defect. It is believed that cluttering is part of the general disorganization of psychomotor development – motor activity, behavioral sphere, speech communication. This indicates a disruption in the activity of the striopallidal system and the regulatory influence of the cortical divisions of the central nervous system. As a result of dysfunction of the brain structures, the organization and voluntary control of general motor skills, mental functions and speech are weakened. The structure of the speech defect consists of a disorder of the smoothness of the speech flow, a violation of the planning of the oral message and its tempo-rhythmic characteristics. Apparently, the pathogenesis of cluttering has many features in common with stuttering, since it is often combined with the latter.
There is no universal classification of cluttering, which is explained by the poor study of the problem. The variants of systematization of disorders described in the literature reflect the internal heterogeneity of the group of patients with this logopathology. Taking into account the predominantly impaired link of speech, there are 2 types of cluttering:
- Motor . It is characterized by an accelerated rate of speech and articulatory disorders, leading to numerous metathesis, elimination of syllables or sounds. At an early age, children have RRR , in school years – difficulties in reading and writing ( dyslexia , dysgraphia ).
- Touch . First of all, the fluency of speech suffers, which is due to reduced auditory control and the difficulty of choosing the right words. Stretching of vowels is typical, interruption of speech with various exclamations, reflecting the complexity of the formulation of thought.
Depending on the results of examination of persons with speech flow impairments, it was proposed to divide into three groups: patients with “pure” cluttering, with a combination of stuttering and some signs of cluttering, with cluttering complicated by neurosis-like stuttering.
In children with this speech disorder, the peculiarities of oral speech, mental processes, and motor skills are noted. The key feature is accelerated intermittent speech with constant repetitions of sounds, words, phrases. Speech is replete with embolic words, unintentional pauses. Often, articulation disorders are detected, accompanied by distortion and elision of sounds, erroneous reproduction of words with a complex syllable structure, and non- articulation of endings. Cluttering causes classification symptoms
The sequence and logic of expressing thoughts is broken; each new phrase is pronounced in isolation from the previous one. The utterance starts out loud, but towards the end degrades into a quiet murmur. In general, speech is incoherent, indistinct , “littered”. One gets the impression that the rapid flow of the speaker‘s thoughts is ahead of the expressive utterance.
At school, children have difficulty mastering grammatical and syntactic rules, which leads to specific disorders of academic skills. They have sloppy, hard-to-read handwriting, make numerous mistakes and misspellings in words, do not finish writing letters, and express their thoughts incoherently and incoherently. This feature is called “disintegrated writing“. When reading aloud, some of the words are skipped or distorted, the endings are “swallowed”. There are disorders of musical perception: dislike for singing and music, inability to reproduce the simplest rhythm.
The psychological portrait of a patient with cluttering is characterized by such definitions as sloppy, impulsive, nervous, wordy, fussy, uncontrollable. The range of attention is narrowed, lack of concentration, frequent distraction are typical. Reduced memory capacity of various modalities (visual, auditory, motor, etc.). Motor disinhibition, uncontrollable behavior is characteristic. Awareness of their speech defect in children and adults is often absent.
First of all, cluttering is a communicative disorder, therefore, it mainly affects the communication function. A person who incoherently and indistinctly expresses his thoughts, does not respond to comments, cannot be perceived by others as an interesting and pleasant interlocutor. A cluttered child runs the risk of misunderstanding and becoming an outcast in his social group. Often these children exhibit deviant behavior .
A speech defect significantly narrows the range of professional realization of such patients, excluding from it public spheres of activity, as well as specialties related to verbal communication, service, and training. School failure further restricts development prospects and condemns to “failure” in adulthood. Cases of cluttering complicated by stuttering are especially difficult and difficult to correct.
Currently, there are no generally accepted criteria for the diagnosis of cluttering; their development and discussion is conducted by logotherapists around the world. Certain difficulties are also associated with the fact that this speech pathology is often confused with stuttering, which makes it difficult to start the necessary corrective work in a timely manner. The diagnostic algorithm consists of the following main stages:
- Speech therapist consultation . Peculiarities of prenatal and early development of a child, the age of stuttering in speech, the presence of similar defects in family members are clarified. Concomitant diseases are specified, the conclusions of a pediatrician , psychologist , pediatric neurologist , the results of medical examinations ( EEG , MRI of the brain , etc.) arerequested.
- Speech research . The assessment of the tempo-rhythmic contour of speech, the characteristics of the voice, sound pronunciation, syllable structure, the formation of grammatical categories and coherent utterance, the state of auditory-speech memory. Reading skills are studied in schoolchildren, written works are analyzed. In cluttering, in contrast to stuttering, there are no speech convulsions, logophobia , speech and motor tricks.
- The study of mental characteristics . With the help of testing, observation and experimental techniques, psychomotor functions, personality traits, and cognitive development are assessed. Attention is drawn to the child’s criticality to his own behavior and speech. Based on the data obtained, intellectual disability and ADHD are excluded .
In the framework of the differential diagnosis of cluttering and stuttering, the Dali method is used. It is a collection of statements divided into 4 categories: pragmatics, speech motor skills, cognitive and language development, handwriting and motor coordination problems. Each statement is evaluated on a 6-point scale: the more points scored in each category, the more likely it is that there is a “pure” form of cluttering.
Speech and psychological characteristics of persons with the logopathology under consideration dictate the need to build special correctional work. First of all, it should be aimed at controlling the tempo-rhythmic organization of speech, the formation of the correct sequence of statements, the development of mental functions. The development and generalization of practical experience in cluttering correction continues. The main areas of speech therapy work are:
- Normalization of the rate of speech . In the classroom, slow, fluent speech is used. Following the speech therapist (reflected repetition) or together with him (conjugate repetition), children learn to pronounce words and phrases slowly, clearly. To streamline oral speech, a given rhythm is used. Work is underway on the expressiveness, emotionality of the statement. It is useful to include elements of speech therapy rhythmics.
- Improving speech skills . It includes working out the ability to clearly and logically express your thoughts. At this stage, the techniques of building a story from pictures, conducting a dialogue, memorizing poetry, slow reading with retelling, and an independent story are connected. The child is taught to plan his utterance, i.e. first formulate a judgment “to yourself”. Cluttering causes classification symptoms
- Improving articulatory motor skills . Essential in the context of the formation of intelligible speech. It involves carrying out articulatory gymnastics , the development of a smooth speech exhalation and sound switching. In the absence of sounds, their setting and consolidation are performed, in case of distortion, pronunciation correction is performed.