International Cluttering Association

The T.r.a.d.e.
Treatment, Research, Awareness,
Diagnosis, Education

http://associations.missouristate.edu/ICA/

Volume 7, Issue 2 June, 2017

Welcome IN THIS ISSUE:

By Charley Adams Welcome
Dear ICA friends around the world, ....................................1
As you may know, there has been a lot of activity in the world of cluttering. If you were
not aware of this, I expect that by the time you nish reading this newsletter, you will be.
I am especially proud of the work of a special group of colleagues who have been
working very hard to generate a functional, actionable denition of cluttering. This group Cluttering Defined
was spearheaded by Florence Myers and Klaas Bakker. You can read more about this on ....................................2
page 2, after which I hope you will join me in expressing great gratitude to the committee,
and especially to Flo and Klaas. Their unique approach has resulted in a tool which will be
widely used for years to come.
For those of you who follow us on social media, look for a big announcement coming International Highlights
soon about the World Congress in Hiroshima (July 2018). Check the ICA Facebook page ....................................3-4
on June 21 for a sneak peek at the World Congress logo!
Announcements will be made about the Hiroshima World Congress at a couple of
upcoming events related to uency disorders: The National Stuttering Association Annual
Conference in Dallas, Texas (U.S.), in July of 2017, and the Oxford Dysuency Consumer issues
Conference in Oxford, UK in September of 2017. Members from all three international ....................................5
associations will join in these announcements the International Cluttering Association
(ICA), the International Fluency Association (IFA), and the International Stuttering
Association (ISA). Cluttering & Telepractice
In the previous newsletter, we told you about the ambitious project, Fluency Bank. For
information on how to donate samples, see pages 8-9 of this issue. ....................................6-7
Also in this issue, you will nd great information about new literature on cluttering,
research on cluttering, and even on treatment of cluttering over the internet via
telepractice.
Finally, I'd like to ask for your help with another project. In future issues of the TRADE, Research Update
we would like to include photographs of our members from around the world. Ideal ....................................8
photos will show you doing something that you enjoy! Please send your photos to Kasia
Wsierska, ICA Secretary and Newsletter Editor extraordinaire, at
(katarzyna.wesierska@us.edu.pl ). To launch this initiative, here is a picture of two ICA
board members at a recent 'summit' meeting in the hills of Virginia, US
Donations
for FluencyBank
Sincerely,
....................................8-9

Charley Adams, Chair

New Books
on Cluttering around
the World
....................................9
Charley Adams, ICA Chair,
and Susanne Cook, ICA Chair-Elect

Volume 7, Issue 2 June, 2017

1
 Cluttering Dened from
the outside in and inside out

Dr. Florence Myers, the committee Coordinator

and Dr. Klaas Bakker, Co-Coordinator

The committee members: Dr. Susanne

Cook, Dr. Isabella Reichel, Dr. Kenneth
O. St. Louis and Dr. Yvonne Van Zaalen

Survey results were shared by the ICA Board at an ICA meeting on the occasion of the last meeting of
the American Speech Language and Hearing Association in November 2016. On the agenda was
a discussion of the survey results which clearly showed that a good deal of the membership isnt
comfortable working with available scientic denitions on cluttering. Such denitions have the tendency
to be somewhat removed from how cluttering is dealt with clinically. The Board appointed Florence
Myers to lead this effort, to form an ad hoc committee to develop an updated denition of cluttering. It
was concluded that to attempt to replace existing denitions already published would not be appropriate.
For an updated denition of cluttering, the committee chose instead to develop a translation of essential
scholarly information into a more accessible and perhaps more widely-accepted form, referring to it as
a conceptualization of cluttering to capture its dening features. This has come to be referred to as the
TPA-CC, a three-pronged approach to the conceptualization of cluttering. Namely, the committee came
up with a different approach, to offer a means to dene and conceptualize cluttering using information
available through multiple pathways: (1) verbal descriptions with written examples of representative
symptoms, (2) audio clips to illustrate these features, and (3) representative comments made about
cluttering problems by consumers or their signicant others.

The nal version of the written portion of this document will be made available to the membership at
various easy-to-reach locations which are still under discussion. Attempts will be made to spread this
information among as many ICA members as possible. Various individuals in the international uency
communityincluding consumers and their family members, clinicians, students, academicians,
researchersmay also access the document. Over time a signicant number of validated auditory
exemplars can hopefully be added.

The conceptualization of cluttering appears well received so far. It is of course a work in progress as new
information and insights into cluttering become available.

Volume 7, Issue 2 June, 2017

2
 International Highlights
By Isabella Reichel

Dear International Representatives,

Please see news from Africa, Asia, Europe, South America, and the USA. We are so far apart
geographically but we feel close to each other in our efforts to share our ideas about cluttering so that
all of us, regardless of where we are on the globe, can provide better services to our clients and their
families. Thank you for your wonderful contributions.

Argentina
Beatriz Biain de Touzet published a book, in Spanish, entitled Tartamudez y cluttering: Estudio y recuperacin de las alteraciones
de la Fluidez.Editorial Paidos (2017). Buenos Aires. Barcelona. Mxico. See also page 9.

Czech Republic
Karel Neubauer reported that a team of 20 authors is working on a handbook entitled Compendium Medical SLT
(Neubauer, at al.). It will include a few chapters on fluency disorders. The book is scheduled to come out at the beginning
of 2018.

Netherlands and U.S.A

Titia Pleiter, Isabella Reichel, and Yvonne van Zaalen presented a poster at Touro College Annual Research Day, in New York,
entitled Cognitive and affective aspects of cluttering, in April 2017.

The website for the book by Yvonne van Zaalen and Isabella Reichel, Cluttering: Current views on its nature, assessment, and
treatment, has now been activated at:http://www.nycsa-center.org/

Nigeria
Grace Ademola-Sokoya informed us about:

(1) the Speech Therapy Department of the National Orthopaedic Hospital, Igbobi (Lagos) presented an exhibition in order
to educate school-aged children about stuttering and cluttering.

(2) A support group for people with cluttering meets twice a month to practice, share information and encourage one another.

(3) A radio talk show on coping with fluency disorders was aired on a popular radio station in Lagos, Nigeria. The leader of the
stuttering and cluttering support group answered questions posed by journalists.

4) The hospital speech department is presently sending letters to local school districts to get permission to establish speech
support groups in schools, thereby helping children with fluency disorders in the classroom. The idea is to create a pilot
program that will involve students and demystify speech challenges. It will further serve to advertise the availability of speech
therapy services.

5) Preparations are underway for the International Stuttering Awareness Day, which takes place on October 22, 2017.

Volume 7, Issue 2 June, 2017

3
 Poland
Maria Faciszewska presented a seminar on cluttering in Kazimierz Wielki Univeristy in Bydgoszcz, which was entitled
Assessment and therapy for people with cluttering, in May of 2017. This seminar was organized by the Polish
Logopedic Society (PTL) and Kazimierz Wielki Univeristy in Bydgoszcz. More than 35 SLPs and students attended the
seminar. For some of them, it was their rst exposure to cluttering.

Katarzyna Wsierska reviewed a book on cluttering by Yvonne Van Zaalen and Isabella Reichel in Forum in Linguistics,
Poland: Wsierska, K. (2016). Giekot Zagadnienie wci sabo znane.Gos po lekturze ksiki Yvonne Van Zaalen i
Isabella ReichelCluttering:Current Views on Its Nature, Diagnosis, and Treatment [Cluttering - disorder still poorly
known.Thoughts after reading Yvonne Van Zaalen and Isabella Reichel's book Cluttering. Current Views on Its Nature,
Diagnosis, and Treatment], Forum Lingwistyczne, 3,151-158.

Portugal
Jaqueline Carmona and other speech and language therapists are organizing a symposium on cluttering and stuttering at
the University of Aveiro on June 24th. The program is described at:
http://jornadas-perturbacoes-fluencia.institutoepap.com/

Puerto Rico
Edna J. Carlo described her successful cluttering intervention with two clients, using telepractice. See her detailed report
on pages 8-9.

Taiwan
Shu-Lan Yang co-authored the following article in Mandarin:
Yang, S-L. & Yi, Y-Ch.(2016).A study on the comprehensive speech-rate reduction intervention for a junior-high-school
student with cluttering.Special Education Quarterly, 139, 9-18. Shu-Lan also co-presented a poster with the same title at the 30th
IALP Congress.

Volume 7, Issue 2 June, 2017

4
 CONSUMER ISSUES
By Rutger Wilhelm

Writing history with

international Skype group
Imagine you would bring together people from different continents; not in real life, but online. They are thousands
of miles apart, and only share a line through a tiny camera on their PC. A mixture of men and women, young and
older, born and raised in totally different eras of time, and educated by various cultures and religions. Everyone,
also, with his or her own story in life. Together, however, they share one distinctive similarity: they all stutter or
clutter (or display an exceptionally rapid speech rate - ERS - that impedes the listeners processing of the message).
Curious about what happens then?

Albeit on a small scale, I think Ive been witnessing an historical event recently: an international online meeting
among a dozen of mainly PWS and PWC(S), scattered over several countries and continents: the United States of
America (North America), Israel (Middle East / Asia) and the Netherlands (Europe). The seed for this special
initiative had been a meeting between Dr. Florence Myers and Benny Ravid (former chairman of the Israeli
Stuttering Association), who both gave keynote lectures last summer at an international conference on stuttering
and cluttering largely organized by our own Kasia, ICA secretary, in Katowice, Poland.

Dr. Florence Myers and Benny Ravid

in Katowice, Poland

Not much later, their paths sort of

coincidentally crossed again in New York,
where Florence invited Benny to lecture for
a group of students at Adelphi University.
There he got to know Joe, the Universitys IT
technician (very coincidentally also a PWS)
who was helping Benny with his powerpoints.
Joe attentively listened to Benny's life story and was very much affected by it. The same was true for Kristen,
Dr. Myers graduate assistant. Kristen has been affiliated with American support groups for people who stutter for
more than a decade, and told that this was the single most important factor that had helped her. That day a special
bond developed between the four of them. The idea came up of staying connected and, by way of experiment,
setting up an international online self-help group. More people were gathered, and so it happened.

The international online session was an experience on its own. Although separated by different oceans and time
zones, it seemed like we were all in the same room. Digital technology had almost literally brought us closer. It was
heartwarming to see how everyone spoke so openly about the impact that the stuttering, cluttering or rate issues
have had on his or her life. In addition to these difficult sides also the "positive" sides of our fluency problems
were discussed, thereby putting our issues in a somewhat different perspective. Despite the initial differences on
many fronts, this online encounter led to a very special kind of vibe and positive energy between participants.
We all understood that - although stuttering and cluttering clearly are distinctive disorders - PWS and PWC(S)
share important similarities at the emotional level. It has been ths common characteristic that transcended every
single difference, raising the awareness that in the end were all the same.

The online session exceeded even my highest expectations. I am glad to have been part of this wonderful
experience and cant wait for the next to come. To Florence and Benny, as the 'parents' of these sessions: thanks
very much!

Comments to: clutteringspeech@outlook.com

Volume 7, Issue 2 June, 2017

5
 Cluttering Intervention and Telepractice,
Some Initial Thoughts
By Edna J. Carlo

I would like to share with the ICA community some ideas we are exploring at the University of Puerto Rico to
serve people with cluttering. We have a small uency clinic that is part of the Speech-Language Pathology Program
teaching clinic and at this time four of our twelve clients present cluttering. This year we started a telepractice
program and included two of our adult clients with cluttering due to their inability to attend clinic on a weekly
basis. I would like to discuss some of the potentials and limitations of using this service modality for cluttering
intervention based on our recent experience this past semester. For the sake of this writing, I will focus on the
telepractice aspects of the intervention shared by both clients rather than a focus on their individual
communication proles and goals.

We were reluctant at rst to include clients with cluttering in the telepractice program presuming it would result in
limited channels to practice self-awareness and self-monitoring, but we had no other choice if we wanted to keep
the recommended frequency of interventions. We did not nd anything in the literature specically against or in
favor of the use of this alternative with cluttering clients. Therefore, we initially relied on available evidence for
telehealth intervention for adults who stutter and in the area of language disorders. The clients were willing to try
this for the rst time with us. The clients, the student clinician and I met weekly for one-hour sessions through
video conferencing three times a month and we met face-to-face for one session a month. Following the
International Classication of Functioning framework we considered activities and participation, as well as
environmental, contextual and personal factors in each case.

Entrance to the Clnicas de Salud

(Health Clinic) of the School of
Health Professions, Medical Sciences
Campus, University of Puerto Rico

Case one was an adolescent transitioning to his first year of college. He presented a moderate cluttering disorder
with no stuttering. Case two, was an adult male working as a sales representative in the area of technology. He
presented mild cluttering with no stuttering. Goals included working on increased awareness, increased self-
regulation for articulatory precision and speech rate reduction, increased understanding of their responsibilities as
speakers, increased understanding and familiarity with available technological applications to increase self-
monitoring. Benefits of the videoconferencing technology we used included being able to use self-recording for
later analysis and reflection. We resorted at times, with the client's knowledge, to video or audiorecording of
sections or to the entire therapy session for several purposes: to focus on our nonverbal features, to increase

Volume 7, Issue 2 June, 2017

6
 awareness of speech rate control, and for clinical education purposes. Another benefit was increased attention to
the auditory signal with the use of earphones. The clients could differentiate among variations of volume,
prosody and articulation with better precision using earphones during therapy. In addition, the convenience of
immediate Internet search allowed for the use of dynamic activities and reading exercises. Another potential
feature was the use of shared screen. This allowed for increased feedback when using diagram presentations and a
self-evaluation scale. Immediate on-the-screen visual feedback could also be provided, for instance, when using a
delayed auditory feedback software.

Some of the limitations and challenges we experienced were related to opportunities for communication and the
technology itself. In terms of communication skills, videoconferencing as used for this therapy did not provide
for real life communication practice and much practice with others, although there was always room for role
playing. In addition, there was a degree of unnatural visual contact as one viewed the speaking partner using a
two-dimensional screen. In terms of technology, we experienced at times during sessions variations in the
Internet signal strength affecting image and sound quality. Additional measures had to be taken as expected for
back up. In addition, the clinicians were new to the experience of telepractice and there were some technological
challenges to overcome, such as record keeping, data managing, and safe recording, that were all corrected with
continuous practice. In conclusion, we were surprised how both gentlemen were able to benefit from the
technology, even with their self-monitoring difficulties. At the end of this intervention term, they reported
satisfaction with the gains made, and the intervention modality, which they found convenient and manageable for
their schedule. They also expressed willingness to continue intervention for an additional semester cycle. We are
aware that some of the potentials of telepractice could also be possible through face-to-face intervention.
Nonetheless, the possibility of having distance intervention with dynamic resources, alternative feedback
channels, yet comparable communication gains and client satisfaction merits further examination. Several studies
have presented evidence of benefits of using telepractice with children and adults who stutter. This modality
could be an alternative also for people with cluttering. Perhaps other clinicians are already using telepractice with
various results and are willing to share their impressions and suggestions. We find the use of this modality as a
promising one also for people with a cluttering disorder. If you would like to start a conversation please write to
edna.carlo@upr.edu
Acknowledgement: A word of appreciation and recognition to Stephanie Roman, UPR graduate student, who
was willing to explore several technological options, and to carefully plan intervention with an added level of
clinical challenge by trying something new with her clients and supervisor.

Volume 7, Issue 2 June, 2017

7
 Research update
Study on cluttering
By Paul Blanchet

My colleagues and I recently published an article based on a cluttering study conducted here at Baylor University
during the spring of 2015. I was assisted in the data collection by eight undergraduate research assistants majoring
in Communication Sciences & Disorders. The purpose of this study was to examine the effects of video education
about cluttering on students' perceptions of a person who clutters. A total of 193 undergraduate students served
as participants; 95 were provided with written denition of cluttering; 98 were provided with video education.
Students then rated a person who clutters on speech skills and personality characteristics.

Results revealed signicant group differences in ratings of speech intelligibility, speech rate, ease of listening, and
competence. That is, the students who viewed the educational video rated a person who clutters signicantly more
negatively along these dimensions than respondents who read a denition only. However, participants who did not
view the video reported knowing signicantly more people who clutter. Our ndings suggest that this particular
form of video education might provide students with "realistic" exposure to cluttering. Further research is needed
to assess effects of exposure to and interaction with a person who clutters on perceptions of cluttering.

Blanchet, P. G., Farrell, L. M., & Snyder, G. (2017). University students' perceptions of a person who clutters with
or without video education. Perspectives of the ASHA Special Interest Groups, 2 (SIG 4), 28-40. doi:
10.1044/persp1.SIG4.28

Donations of cluttered speech for FluencyBank

By Florence Myers

As announced in the January 2017 issue of the T.R.A.D.E. newsletter, Brian MacWhinney (Carnegie Mellon
University) and Nan Bernstein Ratner (University of Maryland) received funding from the U.S. National Institutes
of Health and the National Science Foundation to establish and curate a FluencyBank within TalkBank
(www.talkbank.org). The FluencyBank serves as a repository of audio/video recordings of fluency samples
submitted by volunteers from various international language communities, to be used primarily for educational
purposes to train students and clinicians-in-training. Dr. Ratner contacted the ICA Executive Board regarding this
initiative, who in turn contacted the Ad Hoc Committee on Defining Cluttering. The co-chairs of the Ad Hoc
Committee, Florence Myers and Klaas Bakker, shared with the committee their draft of a protocol to be used by
donors of cluttered speech. The protocol, submitted to Nan and Brian May 1, comprised two parts. The first part
is a set of items to be rated by the donor on a 3-point rating scale about their communication when speaking
informally (e.g., uses rapid and/or irregular rate of speech, leaving off the ends of words, limited awareness of
how my speech sounds to others). The second part consists of open-ended questions to which the donor responds
by recording their insights about their speech (e.g., Do you feel that sometimes you dont quite say what you mean
or mean what you say? Is your speech different when speaking in shorter sentences compared to when you have to
provide a lengthy explanation of something? Do you think you have both stuttering and cluttering and, if so, what
aspects of your speech reflect stuttering and which aspects would reflect your cluttering?). Donors are encouraged
to give examples or elaborate on their responses. The rationale for these questions is to hear from the consumers

Volume 7, Issue 2 June, 2017

8
 themselves about the nature of their communication, as
well as listening to how the donors explain their insights.
Importantly, the protocol stipulates two disclaimers, that
neither ICA nor the Administrators of the FluencyBank
can make statements regarding the diagnosis of the
donors. A complete evaluation by a qualified speech-
language clinician would be needed to make diagnostic
statements. The second disclaimer is that the speech in
the recordings may or may not be fully representative of
the donors speech, especially when speaking in relatively
unguarded naturalistic settings when not being recorded.
Comprehensive diagnosis of fluency disorders requires
multiple and varied samplings of communication
conducted by qualified speech-language clinicians.
Donors are asked to contact Nan Ratner
(nratner@umd.edu). An ICA committee will also be
formed to interface donors and Drs. Ratner and
MacWhinney, the Administrators of the FluencyBank.

NEW BOOKS ON CLUTTERING

AROUND THE WORLD

Book on stuttering and cluttering was published in

Spanish: Tartamudez y Cluttering: Estudio y recuperacin
de las alteraciones de la fluidez, by Beatriz Biain de
Touzet, publisher: Grupo Planeta - Argentina, 2017.

If you have interesting works to share with ICA, please contact Katarzyna Wsierska, the ICA Secretary
and newsletter Editor at: katarzyna.wesierska@us.edu.pl

Volume 7, Issue 2 June, 2017

9