All Things Cluttering with Dr. Kathleen Scaler Scott

[Music] Hi everyone and welcome to the Stuttering Foundation podcast. This is Sarah McIntyre recording from Philadelphia and this is the last episode of season six which will be airing in December 2024 and so I'm really excited to welcome Dr. Kathleen Scaler Scott as our guest today. Hi Kathy and welcome. Hi Sarah thanks so much for having me. Thank you. I'm super excited as I am every month I know I say that but I really am excited for this month's conversation. We're going to be talking all things cluttering and it's a topic I'm I'm hoping in 2025 and beyond to do a more thorough job in archiving more resources and information to just better equip us all to understand cluttering and to support those who who clutter that we may work with. So before we kick off today's episode I'm going going to read Kathleen's bio and then we will do some introductions and then get right into our conversation today. Dr. Kathleen Scaler Scott is a practicing speech language pathologist board certified specialist in stuttering, cluttering and fluency and professor of speech language pathology at Miseracordia University. She has been a practicing clinician for 30 years in hospital school and private practice settings. Dr. Scaler Scott's research interests are largely in cluttering atypical disfluency and child language and literacy disorders. She has spoken nationally and internationally and authored peer-reviewed articles, book chapters and books on the topic of fluency, literacy and pragmatic challenges. She was the first coordinator of the International Cluttering Association and is the recipient of the 2018 Dezo Weiss Award for Excellence in the Field of Cluttering and the 2018 Professional of the Year Award from the National Stuttering Association. In 2020 Dr. Scaler Scott received the Judge Max and Tilly Rosen Excellence in Teaching Award from Miseracordia University. In 2022 she became a fellow of the American Speech Language Hearing Association. She is co-editor of cluttering a handbook of research intervention and education, co-author of managing cluttering, a comprehensive guidebook of activities, author of fluency plus, managing fluency disorders and individuals with multiple diagnoses and a co-author of the recently released second edition of the Source for Stuttering and Cluttering. She is also co-founder and co-host of the podcast Cluttering Conversations, a free podcast available on SoundCloud and we will link within the description to that for listeners. We'll welcome Kathy and it's safe to say that if we're doing an episode on cluttering, we chose the right person. Thank you for being here. Thank you again for having me. It's my favorite topic or one of my favorite topics to talk about. I wondered if, and this is something that we ask, "Memumu, many guests," because I think it's really interesting and maybe something that's special to the podcast sphere versus maybe a more formal presentation that we get a chance to get to know the guests and how they got to where they are now. And so one of our favorite questions is, "What brought you into this field?" And if could you walk us through and tell us a little bit more about your story before we start today's episode? Yes, for sure. My story of how I cut "Dispute Pathology" is pretty boring. I looked up, I took out a book from the library on jobs and thought it could be interesting and it was either this or optometrist and then I tried it out and it worked out really well. I'm very fortunate, but for cluttering, I think it's a little more interesting of a story. So in my grant program, I did have a course on, you know, then was titled "Fluency Disorders," but I don't think we ever talked about cluttering. Then I went to my first job at a school for kids with learning differences and I was working with this little boy and thinking, "What's going on here? This is not stuttering." So I did my own research and I found an article on cluttering and I'm like, "Whoa! That's what this is!" And I just found it so interesting and to illustrate how interesting I found it. So at the school, we would have parent-teacher conferences and the way the school was set up, you know, the parents would come in to meet about their child and all of the teachers would be sitting around a table and they let me go first because I think they figured speech would just be a quick thing and then we could get on to reading and math and science and I don't think I had spoken with the parents before about cluttering. So not sure why I decided to do it there, but I did say, "Well, you know, I think what's going on is there's this thing called cluttering." I know I must have been going on a little too long because one of my co-workers said, "Miss Scaler, I know you're excited to share this news with the family, but we do need to move on to some of the other subjects." So yeah, I guess something just sparked in me. I had always been interested in stuttering, but I really didn't know a lot about cluttering and then I went and that was my only cluttering case I went and worked with pediatric brain injury. So no cluttering cases there and then I went back to work at a private practice and no one wanted to work with the stuttering and cluttering cases so they all came to me and when I went back for my doctorate, I think prior to going back for my doctorate, I had had some conversations with Dr. Ken St. Louis because they were starting to like bring cluttering more into the forefront of information at Asha and I couldn't make the Asha presentation. So we had a lot of correspondence. I think I bought cassette tapes. This is dating myself that we're recording of their program in Asha and Dr. St. Louis and I kind of started a conversation. Then I go for my doctorate and we were headed to at the time it was IFA in Dublin and I had said to my mentor John Tetnowski, "I need to meet Dr. Ken St. Louis." He probably heard that from me like a thousand times and then we got to the opening reception in Dublin and I was like, "Okay, where's Dr. St. Louis to meet him?" So then he and I finally met in person and I was fortunate enough. I mean first I was fortunate enough in my doctorate that that John Tetnowski really let me explore cluttering as my dissertation topic and then that Ken once we met and we kind of had this ongoing back and forth then they were hosting the First World Congress on cluttering and he asked me if I would be willing to be the chair of the ICA and I feel like all of these things I'm just so grateful for because that kind of got everything rolling right the different collaborations with different researchers and book chapters and it just sparked from there so I stand on the shoulders of giants that's for sure. We all do for sure but I know I feel like cluttering in particular in terms of presence and getting out there is even we all talk and stuttering about how late we are to understanding certain elements of the experience etc but I would say cluttering is even more unique in that I think we're getting more of the conversations out out there now and knowledge forward and so I would I look at you as a pretty pretty pretty big cluttering pioneer and so we're really lucky to have you today. Thank you. I wondered if we could start off in giving a bit of an overview on cluttering just to kind of meet everyone where they might might be and also interested in how you might might overview cluttering as things stand today. Yeah yeah I went for my doctorate kind of thinking that cluttering was a language disorder it was what I had found in the research literature and just kind of what I thought and it was interesting because when I did finally me can we had this conversation about it and he said well the thing is that everyone we meet who clutters doesn't necessarily have you know language symptoms or a language disorder so it's kind of not a unifying thing and that really made me think and I knew at the time he was working with Katrina Schulte and he'd really been working with like other pioneers, flowmires, Klaus Bocker, Larry Raphael, like they'd been working on kind of scaling down the definition of cluttering because the problem was it was just so broad that people just didn't know. Like some of the things it was first painted as a syndrome, right? And so, Dezo Vice was the first one to really write about it and called it a language imbalance. So there's that language piece and then painted it like a syndrome and talked about characteristics of clutters like that they're kind of rude in the inter-conversation and they're clumsy. And so what are we even talking about here? Is this someone who has difficulty with motor coordination? Is that cluttering? But I thought cluttering was speech. So what Ken and Katrina Schulte did in 2011, that for me was a game changer, was that they finally published the LCD definition, the lowest common denominator definition of cluttering. And I think everything is a work in development still. You're learning all the time, things will change all the time. But I think this is the one that most people are using now as the definition of cluttering in research and in therapy. And for me as a clinician, like it really has been a game changer to just be able to say, does my client meet this definition or not and not like separate out all the unrelated things? Okay, maybe they do have trouble with motor coordination or interruptions and conversation. But we could probably even take a deep dive into why that might be later. But like in terms of the LCD, that definition, just what they did was they tried to scale it down to, what are the common factors that experts in cluttering agree upon? But if you hear these, you think they're characteristic of cluttering. So there are things that people disagree on, they're not in this definition. So the LCD just says that a mandatory criterion for diagnosis is that the person has to sound fast to the listener, but it doesn't have to be all the time. So we used to think it was that, oh, the speech rate was always faster than average, but we found it's not always measured as faster than average. But there's something about it that the listener says, oh, that's a really fast speaker. They speak really quickly. So that's kind of the mandatory criteria and that if that happens sometimes and not all the time, it doesn't have to be all the time, then you can go forward and say, okay, potentially there is cluttering here. And then according to that definition, there has to be some breakdown in the message getting across to the listener. And so according to the definition, it either it can be one, two, or three of the three symptoms that they set that were laid out in the LCD. So the first is excessive what they call normal disfluencies, which are really just more you're non-stuttering disfluencies. So lots of revisions or interjections, phrase repetitions, word repetitions. So and then the whole definition is perceptual. So the idea is you're not going to get numbers that give you a diagnosis or not. And even though I know that can be difficult, at times it might be much more straightforward to just say, just give me a number. Can I plug in things and give me a number? I feel like it really speaks to how everyone is different in cluttering. But what I always say to clinicians is that if what defines excessive normal disfluencies, well, most of us really know that when we hear it, where we have a person communicating something and it just takes them a really long time to get their message across. Maybe they're revising and restarting so much that either you lose the thread of what they're saying, or you get the thread, but you feel like they could say it in a more efficient manner. They're kind of struggling to say it efficiently. So that's one potential symptom that if a person sounded fast and met that criteria, then they could be diagnosed with cluttering. The second is excessive overcoordiculation. So where the sounds get blended too much together. So this might sound like sounds or syllables are left out. So and probably perceptually what people would say is, oh, it sounds like they're mumbling. And then the third is atypical pauses. So pauses and places that you don't expect them grammatically. And it would be like a very basic example would be, I'm going to the store to get milk. Right, you don't expect that pause there. I'm going to the store to get milk. You would expect it grammatically where I put it in the second example. That doesn't really like just doing in an isolation probably doesn't help a lot. But if you if someone does that a lot, then their speech can kind of sound jerky or spirty. So those are the characteristics. And I think for me as a clinician, what I do is then say, okay, if someone, you know, I'm doing an evaluation and trying to determine if a person is cluttering, then I'll just look at their speech in a sample and does it meet these characteristics. And I feel like that really helps me. They may have a language disorder too, but I'm not really considering that right that I'm just looking at do they meet the definition for cluttered speech. And then I'll look at the other stuff later. Thank you for that overview. And I think part of what we want to do today is blend a little bit of maybe how we used to think about cluttering to now how we're currently thinking and continuing to evolve. So I think that that was a really nice way to start us off. I think it might be really neat next to start off with some myths about cluttering from your experience. And here, here you take on the rationale and also start to blend and emerge into our more current way of looking at cluttering based on some of those myths. Does that sound like a good next step? Yeah, it does. Thank you. I feel like the other reason I really like the LCD is because if you look at it, it takes away some of the things that may have created the myths. When cluttering was such a big broad definition, right? Well then there were part of that big broad definition had to do with awareness. So it used to be a statement that clutters really just walk around oblivious. No one understands what they're saying, but because of that, there's no life impact. And they're just oblivious to that anyone can't understand them. And so in meeting lots of people with cluttering and oh, by the way, I just wanted to throw in there that kind of like with stuttering, we've surveyed people who clutter and we found like there's a mixed range like some people prefer clutter or some people prefer cluttering, some people prefer people with cluttering as opposed to who clutter. So I'm going to try to use them interchangeably. But in terms of like awareness, that's something that we know. Like we've talked with many people and many more people are coming out with their stories, you know, because of social media and the advances there where they are aware that they're having a challenge in communication or and they may just not know what the diagnosis is, but that doesn't mean that you lack awareness. And so a research shows that a lot of people even if they're aware of their diagnosis, they may not be aware in the moment that they're cluttering. And I think that's pretty, I mean, to me, that that makes sense because I tried to tell parents if you say, "I'm a lot," you still might not know, "Oh, you might know, oh, I say I'm a lot," but if I said, "Do you realize you just said I'm seven times?" Most of us are not aware of those things in the moment. There's a lot going on when we're talking. But I feel like that awareness, I've had people say to me that, "Okay, well, they're not aware." So that's why I think they're cluttering. Well, first of all, there's a continual level awareness. But if you look at the LCD, there's nothing in there about awareness. So some people may be aware, some people may not be aware. So that's not like an end-all be-all, the awareness, right? So that's one thing. I've also had people say, you know, like I've had people reach out to me and say, oh, I have this client, I think they're cluttering. But, you know, they don't speak quickly. Like when I did my evaluation, they're not speaking quickly. And then we talk about how I feel like it's taken lots of time. But I feel like it's more and more understood that, well, if someone doesn't stutter during your evaluation, does that mean they're not a stutterer? And I feel like everyone's gotten their head around them. But I feel like people are still expecting when they evaluate someone who clutters, that the minute they open their mouths, they're always going to speak really rapidly or sound really rapid. And I will just say in my clinical experience, that's probably about 2% of the people I've met, that you would hear that rapid rate or rapid sounding rate all of the time. For the most part, I don't want it situational, but if you look at the LCD definition, it's got footnotes. And it says, this perception of rapid rate of speech does not have to happen all the time or even a majority of the time. It just has to happen in situations that it has an impact upon the person. So that's another one, the awareness, the rapid rate, all of the time. And then of course, what kind of dovetails with the awareness is there was always the thinking that if you're not aware, you can't have any negative impact. And we know that more and more people who clutter are talking about the impact that cluttering has had on their life and that there's very similar impacts to stuttering. So we had one gentleman who Peter Cassagalus from the UK, and unfortunately he passed away, but he was one of the first people who cluttered who I met. And he was so desperate to get the word out there about cluttering that before he passed, 'cause he knew he unfortunately had cancer, but he knew he was passing and he said, email me and said, use everything because I want people to understand cluttering. But he talked about because of his over-courticulation, people would say, are you drunk? Are you stupid? He said that people would say, his father would say, don't speak to me unless you can speak properly. He talks about how his boss said, well, no, you can't really advance in your career because of your communication. So things we've heard from people who stutter as well and more and more people who clutter, we're hearing that information. So it's not like there's no impact, unfortunately. But that I think, we definitely need to look at and measure separately just knowing that those things aren't in the LCD definition. - That's making me think back to an earlier episode, this season on cluttering, where we had Rutger Wilhelm as a guest. - Yeah. - What really struck me during that conversation, and I don't know if I, I mean, I thought about it, but I don't really think I thought about it until after he was sharing. - Yeah. - About how little the general public knows and understands about cluttering and how that complicates disclosure or all the things, I didn't necessarily wanna do a compare contrast stuttering cluttering today back and forth. - Right, right. - I think that that's the lens in which many listeners and click-clin and niches more intuitively look, just to be honest. - Yeah. - We have learned, but yeah, I wondered if you could talk a little bit on that. - I think it's really interesting because I think as time marches on, we may see more of a movement, the more and more people I talk to on our podcast cluttering conversations, the more I hear the theme of, we really don't like the word cluttering, we wanna change the word. And especially because among the public, it's thought of as hoarding. Like that's what people think of. So it's got a very negative stigma, people don't understand. And I remember that Ken St. Louis even told me years ago he put an ad in the paper for a stuttering and cluttering support group at his university and people who were hoarding showed up. So like it just shows that, and then I've had clients who've said in terms of disclosure that sometimes they'll say, well, I don't really say I clutter because people don't understand it. So instead I choose to say, sometimes I speak quickly and if you can't understand me, please let me know. I mean, on the flip side, I do have a teen who stutters and clutters and he is hardcore about like educating his teachers. This is what cluttering is, this is what stuttering is. But I do think it's kind of an uphill battle to get people to understand what is meant by cluttered speech. - For sure, I could definitely see that name of all thing at some point. - Yeah, yeah, there's definitely been people on the podcast who have said we need to start a movement, we need to change the name. So, stay tuned. Now, this might not necessarily fall into the myths realm, but it kind of coming to my denim curious. I feel like an older assumption was that a majority of people who clutter also stutter. I was wondering if you could maybe speak to that one. - Thank you for bringing that up. I mean, we don't really have any hard data, but it has kind of always been said by experts that they commonly go together. And it is really interesting to me because over the years, I'm just starting to think differently about it. So, I mean, it even began with some people may know Joseph Dewey and he's got a YouTube channel. He was the first adult to really talk about his experiences with cluttering, going way back. He had an online Yahoo support group for cluttering. So, I always call him the ambassador of cluttering, but I remember he put up a sample and I was a doctoral student and I listened to it and I was like, wow, I think he's stuttering too. And I called Ken St. Louis and I said, hey, does he stutter too? And he's like, well, Kathy, that's very interesting. You know, we've talked to Joseph and Joseph says, you know, he's adamant, he does not stutter. He's talked to many people who stutter. He doesn't feel like he experiences the same symptoms. And I feel like back then, you know, like in our minds, we were all like, yeah, you know, Joseph's probably just not fully aware. But I mean, flash forward, I've worked with other clients who say the same thing. And I feel like it's, you know, we always thought we knew better. I'm like, no, no, no, we need to get the information from the experts, the people who clutter themselves. And I really do think like if you listen to Joseph on his YouTube channel now that it's not stuttering, I think some of it may have been in that sample that a lot of people listen to like frustration and trying to get his message across that kind of came through. But then also I'm meeting lots and lots of people who clutter who might have some part word repetitions, like repetitions of words, usually not with a lot of tension. But then people are putting that in the stuttering box. But and I know I would have two years ago, but I'm really starting to think that maybe that isn't stuttering. It's just a part of cluttering, you know? - Yeah, no, I'm thinking of one client in particular as well where from an overt perspective, displace and I'm kind of quote unquote that the stutter like disfluencies as well as more, more typical disfluencies. However, I think what we've learned and evolved in our understanding of stuttering is that it's not as simple as just identifying with a sorting of overtly because it's more about that internal speakers experience and loss of control and then their subsequent choices and response to that. - Yeah. - And so I think similarly in cluttering, I don't, I mean, we wouldn't be the gold standard from an overt perspective while we could maybe from a skilled listener perspective be able to make a strong educated assumption. But it is ultimately a speakers experience. And I do wonder if that loss of control is something that is experienced, is it experienced differently? Is the coping different because of their profile as individuals? to clutter, like some of the other experiences, but anyway, I digress. Right. No, no, I mean, I definitely think there's differences about maybe the source of it. Like that's when I'm starting to think about more and more lately, so that we just had a case with this where people were like, "Buddy has part-word repetitions." But I don't think it's stuttering. Like you said, he's not having that same experience, and now his mom is like, "No, it's just not. It's really the cluttering." But I think when I think about some differences, it reminds me of some of the differential diagnosis, like how stuttering could be overdiagnosed in someone who's bilingual, and how like some of I remember like Courtney Bird's research, one of the differentiating factors was, you know, is there tension or struggle, or is it just more easy repetitions? And I find it similar to that, and a lot of the clients that I'm thinking about like this where people go, "Oh, it's stuttering and cluttering." And I also find like, and I know this could happen with stuttering too, but you know, kind of a hallmark of cluttering is that we feel that someone is speaking on a read that's too fast for their system to handle. So if they can regulate their rate, and I'm talking about like in a natural way, just more with natural pauses, because we know people who clutter might not pause as much, then those things tend to disappear, like those repetitions tend to disappear. So you don't even really have to, I mean, not that you always would anyway, but you don't have to do anything direct to address them. I just wonder if it has to do with the whole regulating piece, or it's a continuing thought in my mind. Definitely. I know that there are other components of the cluttering experience, or other ways that cluttering might be impacting an individual. Yeah. You know, I know that you know, it's a little bit on language. Right. I wonder if maybe we could talk a little bit about some of those other potential areas? Yeah, I think that that makes a lot of sense. And that's, you know, where we're trying to move forward with more understanding of the impact. So, apparently, a lot of you may know about the OASIS, the OASEC is in development. We hope we'll be able to finally say it's done soon, but looking at the speaker's experience of cluttering, and it's not exactly the same as stuttering. There is overlap, but then there's things that tend to be different. And so sometimes you could talk with a teen who stutters, and they're aware of, you know, negative list of reactions, and they fully kind of understand what's going on in terms of their stuttering. But with someone who clutters, sometimes teens are not aware, or sometimes they're aware, that they're really not kind of wanting to embrace it, which makes sense. But maybe they're not aware of the symptoms that they're experiencing, but they are acutely aware of people who are annoying them by telling them to slow down, or, you know, I can't understand what you're saying. So I feel like there's that that we definitely need to talk with our clients about, you know, not just what is your experience in terms of symptoms, and how does that affect you, but how do listener reactions have an impact upon you? Because they can lead to the same kinds of things as stuttering, like, of weight-ins. I'm thinking of someone recently that I talked with who says, "Yeah, I just try to keep it short." I try to keep it short, because then there's less likely for me to have trouble. But yet, you know, there's probably so much more that they want to say, but they're feeling held back by that. And I feel like the organization of language is also something that we're seeing a negative impact. So one of my recent students, Lisa Jufre, she did her master's thesis interviewing people who cluttered, and she, you know, some of the people talked about things like our theme was, "I can't show what I know." Like I know it in my head, but I'm not communicating it to my professor, and then they feel that I don't know it, or I'm not prepped, or I'm not organized. And I can think of an example recently where I knew a person with cluttering who hadn't been diagnosed yet, but wasn't presenting with a lot of, like, the over-court articulation, which I feel like is easier for people to get their heads around. And honestly, I, cluttering didn't really cross my radar too much. I did ask about, like, do people tell you to speak fast? And at the time they were like, "No, but then I observed and saw a moment of over-court articulation just randomly." And I was like, "Wait a second." It made me start thinking about all the organization and executive function that people thought this person was just really didn't care. Like, was just lazy, was over-committed, and in fact, they really did care, but they just didn't know why they were struggling so much. So, yeah. While we're touching on life impact, something I think that stands out as kind of different than cluttering versus the stuttering experience in my conversation with, with retker, or earlier this year, stood out was his experience of working pretty hard in increasing his intelligibility where it counts for him. Yeah. Verses, versus in times where he gives himself a break and just speaks authentically. So I wondered if maybe you could share a little bit from your perspective on that. Yeah, definitely. From, you know, people I've talked with in the cluttering community and people I've worked with, it's kind of a whole range, right? So there are people cluttering who I feel like they say, "Look, people just need to wait for me and be patient." But one of the things I see is kind of differentiating it from stuttering. Again, like, it's not purely black and white, that difference. But in stuttering, you know, for the most part, the listener needs to be patient and just wait, and they're going to get the words. In cluttering, we could have a case where someone's a very patient listener and really, you know, trying to understand the message and they might miss it. So Rucker even has a fabulous example in his book from someone who says that they were at a work meeting. They presented an idea. Everyone just kind of nodded and smiled and then that was it. And then two minutes later, somebody else presents the exact same idea and everyone goes, "Wow, that's a fabulous idea." So like I always try to talk with my clients about, you know, it is a ton of work to sit there and monitor your speech all the time and parents need to understand that too, right? And you may not want to do that all the time. And you have people like I work with lots of clients who say, "Yeah, my friends get me. I don't really want to like think about my speech at that time. They get me." And then, you know, they choose certain situations where they want to monitor their speech more because to them it matters very much that the message gets across clearly. And I think like it's an ongoing conversation like you could even talk about if someone, you know, maybe someone who clutters me say, "You know what? I don't want to monitor, but I do want people to of course to ask me if they don't understand." So the way I'm going to navigate it is I'm going to go out there and I'm going to say to whoever I'm speaking with, "Hey, if you ever are not following me, please let me know. I'm going to say that at the outset and then I'm not going to worry about it." And then, you know, I put it out there and then they can ask me for clarification. Like that's one approach and another way is I want to be proactive in trying to regulate my rate or my clarity at the time. And I feel like what I'm doing more and more with my clients is just having this discussion. What do you want? What works for you? But making sure like you understand all of the factors, you know? Absolutely. I mean, just thinking about a contrast with the stuttering experience, what I would hope more generally understanding of, and stuttering like the more someone tries to exert control, yeah. Actually, likely the greater impact starting might have, like the greater the struggle or reactivity or response, like kind of paradoxical nature where and please correct me if I'm wrong, but it's not paradoxical per se and cluttering. I'm not oversimplifying the act of making changes to our just really automatic, spontaneous communication. But that paradoxical nature I think is different. Yes, I mean, I'm looking at that in some of my research now to try and illustrate how just that difference, a situation may be equally stressful, but it's not the more that I focus on it, the more that I have trouble. It's actually often quite the opposite, yeah. Some other areas of impact within cluttering, like such as pragmatics, language, some of those pieces I wondered if we could touch on maybe. Yeah, you really need to look at cluttering in terms of, or at least the way I look at it. I look at that someone could have a lot of trouble with that organization of language and that can come across as, okay, there's a difficulty here in pragmatics, but sometimes it's more complicated than that. Like sometimes a person who clutters might not get someone else's feedback on their face that they're confused, maybe they're not looking them in the eye, but it's often not. I'm sure everyone's an individual, but it's often not because they have trouble with eye contact, but what I've noticed is sometimes they're trying to think of what they want to say, and so that kind of makes you look a way a little bit while you're organizing your thoughts. So then does that result in something you might see as pragmatic, but the root of it really is the language organization. Or like if someone might interrupts more, and that may go back to the very early days when they talked about that, when Dezelva has talked about interruptions, it's not a true pragmatic like, oh, you know, I have no awareness of conversational turns. It could be that maybe they're thinking they're gonna forget something. So they wanna interject it, or it could be just like the rhythm of the conversation they're having trouble with, but they're not intending to interrupt people. So it could definitely be like a working memory thing, it could be a rhythm thing. - I wonder if it could be influenced, and this could take us on a different tangent though. There is a higher rate of co-occurring diagnoses in cluttering with some other differences, and I'd imagine that then influences how one's cluttering experience is as well, and they sort of blend. So if someone has co-occurring ADHD, - Yeah. - For, - M, M, M, P, P, P, P, P, P, P, P, P, P, P, P, P, P, Pulsivity, or writing engine skills. - Cluttering are likely interchanged. - I feel like that for sure, right. - Or it would be because of something going on that's comorbid, but then also, some of the things we've found with cluttering is like something called response inhibition, which is very similar to impulsivity, right? Where things just come out before they're ready, even if they don't have like a formal diagnosis of ADHD or ADHD has been completely ruled out. It seems like sometimes that things coming out quickly might be more characteristic of cluttering, right? And it's not at its core, a pragmatic disorder, you know? - Yeah. - What we're learning about and what we're looking into in relation to cluttering is definitely continuing to emerge. - Yeah. - Are there some areas of research that you're seeing that are happening or maybe even future areas of research that you see the field of cluttering looking at? That might be important. - Yeah, I mean, I definitely think in the area of the executive functions we've already talked about, like how some of those can have an impact on conversation, like working memory, like response inhibition, and then also looking at other areas I've been very interested in is looking at syntax because I found that doing some work on that, not even again, saying that my clients have a language disorder they're not meeting that criteria, but sometimes like the syntactic work has helped with the organization. So that's kind of an ongoing area I'm looking at as well. - And then you had mentioned about some stages of change. - Yeah, yeah, so maybe we'll. (laughing) - So my student and I are kind of working on how can we apply the stages of change model to cluttering just like Trish is the browse key and Naomi Rogers and colleagues did that so beautifully apply that to stuttering and I felt like it's been so helpful for me as a clinician to have that application, but I feel like as we talked about earlier how some of the needs are different in cluttering, something where we can apply it to that. My student and I are really looking into that now too. - And I know that we talked a little bit about the year ahead and season seven, I can't believe it's season seven coming up and having another episode dedicated to working with cluttering and therapy, not that all that we just talked about wasn't relevant actually. Most of that would be at the core of structuring your therapeutic plan, but speaking a little bit in more detail what might support helping to increase monitoring skills or what might helping to support advocacy skills or understanding. So if that's something you would still be interested in we'd love to have you. - That would be fabulous. - Given today's episode was a let's get us all up to speed on understanding cluttering, dispelling myths. It would make sense I think to leave listeners with some resources for further learning. - So I do think this actually kind of fits into the myths because we've been so used to saying, well there's nothing out there about cluttering, there's nothing out there that we, I kind of hear that a lot now and I'm like, no, no, no, wait, there's like a lot more out there. Yes, we definitely do need to put more and more out there. But first of all, we have the podcast, the cluttering conversations and my co-host, Paul and I, we started off by just talking about cluttering and what it is, but then all of our episodes after like the second one I think have been interviews with people who clutter, caregivers of children who clutter and we're continuing to expand and that is really helpful because it just, I feel like it shows how everyone's different, you know? And it helps you to get your head around the differences in what the impact of cluttering can be, how different people decide to navigate cluttering. So that's free on SoundCloud. And my students and I recently, I had them try out different ways to learn about cluttering and then give their perspective. And what made me think about that was because I often get contacted, you know, at the beginning of semesters, college semesters and someone says, I'm teaching stuttering, I want to incorporate cluttering and I'm so happy to hear that. And they'll say, you know, I'm gonna do this and this or what do you have recommendations for what should I include? And I don't know why, but Adanda, me last year with my students like, there are a lot of choices out there and unfortunately, you have limited time in your semester. And I was just curious like what the students are changing, right? Our student population is changing. So reading a research article might not resonate as much with them as it did in the past. So what kind of things do they find the most helpful? So I had several of my students go through a bunch of different things like listen to one episode of the podcast, have just a traditional lecture on cluttering, read two fast for words, look at the two fast for words website, look at Joseph Dewey's YouTube channel, all of which are great resources. And then one another one was meet a person who clutters and interview them and talk about their experience. And what they did was for our world conference on stuttering and cluttering in Austin, they compiled their opinions, their student perspective about what they got out of each thing. And they did get something and good things out of everything. But they talk about what they got out of it. And so they presented it as a poster. A lot of people came up to them at the conference and said, "Oh, wow, I'm going to be teaching cluttering. I didn't even know about some of these resources." So then what they decided to do was we did more of a literature review on cluttering education and the need for more. And then they compiled the resources and descriptions and then put a chart that kind of summarizes what they got out of it. So I feel like US faculty then could say, "This is what I want my students to get. Maybe I can choose these two things for my course." And that is, I'll send you the link so you can put it in Sarah, but we're hoping that to be like a living document. Like we presented it at Asha this year and we're we wanted to be a living document that asks things change and cluttering will add to it, but it's just a free PDF for people who might be teaching. And then wow, there's just so many things out there. But also like if you just kind of want to level up on cluttering research, David Ward and I co-edited the book cluttering research, intervention and education. So that's one because that has all of the, you know, things are continuing to evolve since then. But that's kind of the, I say the year when the LCD definition came out. And like a lot of information about cluttering if you really want to understand it from its source in one place. And then because I get so many requests for I have a client who can you help me with this client and you can't always reach everyone, I developed the workbook managing cluttering and that's also with David Ward. And then I did Fluency Plus, which also like deals with cluttering stuttering in a typical disfluency, but all the concomitant disorders too. I designed that hopefully, like it has research in it. But then also to go from classroom to clinic where as students are new in their learning about different disorders, they have some guided activities in there. So it could be for clinicians, it could be for students. And then Glenn tell us and I just did the second edition of the source for stuttering and cluttering. We'd wanted to do that for years because in my early years as a doc student I had conversations with Dave Daly who was like the pioneer in writing the first workbook, the source for stuttering and cluttering. And he told me at the time he was retiring, he's like that all needs to be revised. Like there's things in the original source that were things that we don't use anymore like oral motor exercises. So we wanted to level that international cluttering association, their website, right? So I just feel like I want people to know there's probably more out there than you think, you know? Yep. And we'll link in the description to all of these resources for further learning. Also, you have done a couple virtual learning by stuttering foundation webinar sessions at our archive. So we'll link to those. And then we'll be definitely having you back on this coming season to dive a little bit deeper into working therapeutically with cluttering and doing so in the most effective up-to-date way and talking and interweaving those that stages of change research as well. So I'm looking forward to that. Thank you. I am as well. Thank you so much for being with us today and for sharing all that you have shared and really looking forward to speaking and hitting record again with you soon. Thank you Sarah, to you and for the stuttering foundation. Thank you to listeners for tuning in and looking forward to being with you all again next month. Bye. (upbeat music)