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Cluttering
Psychologic Aspects of Pediatrics CLUTTERING RuTH MorRIS
BAKWIN,M.D., AND HARRY BAKWIN,M.D. NEW YORI~, N. Y.
L U T T E R I N G , by which is meant rapid, confused, and j u m b l e d speech, though one of the commonest and most distinctive speech defects, has not been recognized widely in America. I t is often mistaken for stuttering. The peculiar speech may be associated with abnormal clumsiness and with characteristic changes in behavior and personality. The defect persists throughout life but it can be satisfactorily eontrolled by p r o p e r treatment.
t!m speaker gropes for the proper ones. Syllables and words are often omitted, in reading and writing as well as in speaking. The position of words is confused, some b e i n g inserted too early, others too late. I n telling stories, there are often incomprehensible repetitions and the point of the story is lost. The clutterer has great difficulty in finding the right words and he may, consequently, get panicky while talking. Hoarseness and stammering episodes are frequent. Articulation is slurred. Overeompensation, as evidenced by unusually slow and deliberate speech, is occasionally seen. Cluttering is unique among speech disorders in that it represents simply an exaggeration of the errors of speech made by the norlnM person. The intensity of the speech defect varies. All degrees are found from speech which is simply rapid, repetitious, and slightly jumbled to almost complete ineomprehensibility. Moreover, in some persons, defects in articMation like slurred s p e e e h and faulty pronunciation are more promL nent, in others defects in syntax, in still others word-amnesia, and so on. Unlike stutterers, clutterers improve their speech when they are careful and pay close attention to what they want to say. The confused speech is much less evident with strangers than under familiar circumstances with family or friends. The clutterer can remedy his
C
CLINICAL
CHARACTERISTICS
The clinical characteristics of cluttering are (1) the distinctive speech, (2) motor awkwardness, (3) changes in personality and behavior, (4) association with other language defects, (5) alterations in lateral dominance, and (6) the family history. 1. The speech of the s t u t t e r e r is hurried, even precipitate (tachyla]ia), the words seeming to tumble over one another. It is confused and difficultly comprehensible. The c h i l d s t a r t s a sentence in several different ways before he can proceed. Finally, having gotten started, he continues to mix his words and thoughts so that he ends up with a different idea from the one with which he started. Words, phrases, and even short sentences are repeated while Prom the .Department of Pediatrics, College of Medicine, New York University-t~ellevue M e d i c a l C e n t e r , a n d t h e D e p a r t m e n t of P e d i atrics, New York Infirmary. 393
394
THE JOURNAL OF PEDIATRICS
defect if he makes a special effort. When delivering a public address he may speak flawlessly, often to the astonishment of his familiars; in contrast with stuttering, psychogenic factors play a minor role. The late Senator Wherry of Nebraska was apparently a clutterer. According to Time (Dec. 10, 1951) his "words came so fast that he frequently lost control of them. A succession of 'Wherryisms' made him the Sam Goldwyn of Capitol Hill. He once promiscd another Senator 'opple amportunity' to make a speech, called Oregon's Junior Senator Wayne Morse, 'the distinguished Senator from Junior.' Other Wherryisms ' Chief Joints of Staff,' 'bell door ringer.' " Probably the person best known for his cluttering was the Reverend W. A. Spooner, Warden of New College, Oxford, who had an unfortunate, or fortunate, penchant for mixing his words. The word confusions of Spooner have come to be known as spoonerisms. A spoonerism is defined in the Oxford Dictionary as "an accidental transposition of the initial sounds, or other parts, of two or more words." Some famous spoonerisms are: "The two great English poets, Kelly and Sheets." "The Lord is a shoving leopard," instead of " T h e Lord is a 1 o v i n g shepherd." To the usher at the church wedding, " S e w her to a sheet," instead of "Show her to a seat." 2. Motor awkwardness or abnormal clmnsiness (developmental apraxia) is frequently associated with cluttering as well as with other language disabilities. The apraetic individual has sometimes been referred to as being ambilevous, implying that he has two
left hands or is equally awkward with both hands, in contrast to the ambidextrous person who, having two right hands, is regarded as being equally skillful with both hands. The clumsiness is evident in efforts at carrying out complex movements of the hand, :foot, and body. It may be associated with delayed motor development, difficulty in learning to manage buttons, tie shoelaces, handle a spoon, and other tasks. 3. Certain behavioral and personality traits have been described as characteristic of the clutterer. These resemble in many ways the deviations observed in children with cerebra] damage. The clutterer tends to be hurried, easy going, erratic, and poorly organized. There may be distractibility, hyperactivity, impulsiveness, forgetfulness, untidiness, emotional instability, and ready suggestibility. The handwriting is poor and childish. By contrast the stutterer is likely to be overcareful and anxious, rigid and formal. A feature sometimes seen in the clutterer is a striking ability to memorize poetry and even prose pieces. 4. Cluttering is frequently associated with other disorders of the ]anguage function, e.g., delay in beginning to speak, reading disability, spelling disability, and so on. 5. Alterations of lateral dominance are frequent in clutterers. There may be ambidexterity, left-handedness or crossed dominance, e.g., right-handedness and ]eft-eyedness. 6. Family history. It is usual to find several clutterers in the same family and this occurs even when the afflicted members of the family have never met, thus eliminating the possibility of imitation. In tMs connection
PSYCHOI,OGIC
ASPECTS
Froeschels has pointed out that cluttering is the most difficult type of speech defect to imitate. Other types of language disability and alterations in lateral dominance are also frequent in members of t h e family. Cluttering, like other disorders of the language function, is much more common in boys than in girls. A speech defect quite like cluttering occurs in some children following meningitis or encephalitis. I n these cases no family history of other language disorders or of alterations in lateral dominance is found. PATHOGENESIS
According to Weiss cluttering is a constitutional anomaly of the language functions and is therefore to be regarded as "organic."" His view is based, principally, on the hereditary nature of the deviation. He looks upon stuttering, in the majority of eases, as a f u r t h e r development of cluttering and therefore one finds clutterers and stutterers in the same family. But only the cluttering is hereditary, the stuttering representing the reaction of a clutterer to an unfavorable environment. Weiss points out, further, that in many clutterers thinking' proceeds without words. The patients often have the feeling that a thought process is complete before the appropriate words are pre~:ent. The time interval between the appearance of the impulse to speak and the recall of the necessary words leads to tile well-known repetitions and may be the origin of the various reactions which lead to the clutterer 's impatience. The early speech of children shows m a n y of the characteristics of cluttering. Repetitions are frequent. Such
OF
395
PEDIATRICS
expressions as ma-ma, da-da, na-na, rata are typical and are characteristic up to about 4 years of age. The repetitions are of syllables rather than of letter sounds (as in the stutterer) and are unassociated with any strain. The large majority outgrow their repetitious speech b u t a small percentage remain as clutterers or stutterers or a combination of both. R E L A T I O N TO STUTTERINCx
The most striking difference between cluttering and stuttering is that the clutterer improves his speech when he concentrates on it, indeed the defect may be completely overcome, while the stutterer 's speech becomes much worse when his attention is directed to it. Consequently the elutterer speaks better in strange surroundings where he is on his guard, and he has his greatest difficulties when he is among his familiars and relaxed. The reverse is true of the stutterer who becomes tense in the presence of strangers with worsening of his speech defect; the stutterer is acutely conscious of his difficulty. Allowing the clutterer to t r y again makes his speech better, the s t u t t e r e r ' s worse. A number of cluttering children become stutterers. This is believed to take place when tension and anxiety are superimposed on the already unstable speech mechanism. TREATMENT
Though cluttering speech is not as serious a difficulty as stuttering, it should not be regarded merely as careless or indistinct speech. The child needs to be helped to overcome his confusion. Treatment is easier the earlier it is begun. It consists of training for self-
396
THE JOURNAL OF PEDIATRICS
control and precision, in speech and in social behavior. Overattention to the physiologic repetitions of early speech should, however, be avoided since it may lead to parental preoccupation with the child's speech and fixation of the repetitions. Specific points in treatment are the following: 1. Itelping the child to concentrate on the details of speech and to say every word carefully. 2. Teaching the child to read every letter and not permitting substitution by association. This is best done by the reading of nonsense syllables or by reading through a small opening which permits visualization of only one letter at a time. Later this can
be changed to permit visualization of one syllable or word at a time. 3. Having the child enunciate each word while writing tends to slow speech and call attention to detail. REFERENCES
Davis, D. M.: l~elation of Repetitions in Speech of Young Children to Certain Measures of Language M a t u r i t y and Situational Factors, Y. Speech Dis. 4: 303, 1939. De Hirsch, K., and Langford, W. S. : Clinical Note on Stuttering and Cluttering in Young Children, ]Pediatrics 5: 934, 1950. Freund, tI. : Ueber die Beziehungen zwischen Stottern und PolterJa, Monatschr. f. Ohrenheilk. 12: 68, 1934. Froeschels, E.: Cluttering, J. Speech. Dis. I i : 31, 1946. Weiss, I). A. : I)er Zusammenhang zwischen Poltern und Stottern, Folia Phoniatrica 2: 252, 1950.
BAKWIN,M.D., AND HARRY BAKWIN,M.D. NEW YORI~, N. Y.
L U T T E R I N G , by which is meant rapid, confused, and j u m b l e d speech, though one of the commonest and most distinctive speech defects, has not been recognized widely in America. I t is often mistaken for stuttering. The peculiar speech may be associated with abnormal clumsiness and with characteristic changes in behavior and personality. The defect persists throughout life but it can be satisfactorily eontrolled by p r o p e r treatment.
t!m speaker gropes for the proper ones. Syllables and words are often omitted, in reading and writing as well as in speaking. The position of words is confused, some b e i n g inserted too early, others too late. I n telling stories, there are often incomprehensible repetitions and the point of the story is lost. The clutterer has great difficulty in finding the right words and he may, consequently, get panicky while talking. Hoarseness and stammering episodes are frequent. Articulation is slurred. Overeompensation, as evidenced by unusually slow and deliberate speech, is occasionally seen. Cluttering is unique among speech disorders in that it represents simply an exaggeration of the errors of speech made by the norlnM person. The intensity of the speech defect varies. All degrees are found from speech which is simply rapid, repetitious, and slightly jumbled to almost complete ineomprehensibility. Moreover, in some persons, defects in articMation like slurred s p e e e h and faulty pronunciation are more promL nent, in others defects in syntax, in still others word-amnesia, and so on. Unlike stutterers, clutterers improve their speech when they are careful and pay close attention to what they want to say. The confused speech is much less evident with strangers than under familiar circumstances with family or friends. The clutterer can remedy his
C
CLINICAL
CHARACTERISTICS
The clinical characteristics of cluttering are (1) the distinctive speech, (2) motor awkwardness, (3) changes in personality and behavior, (4) association with other language defects, (5) alterations in lateral dominance, and (6) the family history. 1. The speech of the s t u t t e r e r is hurried, even precipitate (tachyla]ia), the words seeming to tumble over one another. It is confused and difficultly comprehensible. The c h i l d s t a r t s a sentence in several different ways before he can proceed. Finally, having gotten started, he continues to mix his words and thoughts so that he ends up with a different idea from the one with which he started. Words, phrases, and even short sentences are repeated while Prom the .Department of Pediatrics, College of Medicine, New York University-t~ellevue M e d i c a l C e n t e r , a n d t h e D e p a r t m e n t of P e d i atrics, New York Infirmary. 393
394
THE JOURNAL OF PEDIATRICS
defect if he makes a special effort. When delivering a public address he may speak flawlessly, often to the astonishment of his familiars; in contrast with stuttering, psychogenic factors play a minor role. The late Senator Wherry of Nebraska was apparently a clutterer. According to Time (Dec. 10, 1951) his "words came so fast that he frequently lost control of them. A succession of 'Wherryisms' made him the Sam Goldwyn of Capitol Hill. He once promiscd another Senator 'opple amportunity' to make a speech, called Oregon's Junior Senator Wayne Morse, 'the distinguished Senator from Junior.' Other Wherryisms ' Chief Joints of Staff,' 'bell door ringer.' " Probably the person best known for his cluttering was the Reverend W. A. Spooner, Warden of New College, Oxford, who had an unfortunate, or fortunate, penchant for mixing his words. The word confusions of Spooner have come to be known as spoonerisms. A spoonerism is defined in the Oxford Dictionary as "an accidental transposition of the initial sounds, or other parts, of two or more words." Some famous spoonerisms are: "The two great English poets, Kelly and Sheets." "The Lord is a shoving leopard," instead of " T h e Lord is a 1 o v i n g shepherd." To the usher at the church wedding, " S e w her to a sheet," instead of "Show her to a seat." 2. Motor awkwardness or abnormal clmnsiness (developmental apraxia) is frequently associated with cluttering as well as with other language disabilities. The apraetic individual has sometimes been referred to as being ambilevous, implying that he has two
left hands or is equally awkward with both hands, in contrast to the ambidextrous person who, having two right hands, is regarded as being equally skillful with both hands. The clumsiness is evident in efforts at carrying out complex movements of the hand, :foot, and body. It may be associated with delayed motor development, difficulty in learning to manage buttons, tie shoelaces, handle a spoon, and other tasks. 3. Certain behavioral and personality traits have been described as characteristic of the clutterer. These resemble in many ways the deviations observed in children with cerebra] damage. The clutterer tends to be hurried, easy going, erratic, and poorly organized. There may be distractibility, hyperactivity, impulsiveness, forgetfulness, untidiness, emotional instability, and ready suggestibility. The handwriting is poor and childish. By contrast the stutterer is likely to be overcareful and anxious, rigid and formal. A feature sometimes seen in the clutterer is a striking ability to memorize poetry and even prose pieces. 4. Cluttering is frequently associated with other disorders of the ]anguage function, e.g., delay in beginning to speak, reading disability, spelling disability, and so on. 5. Alterations of lateral dominance are frequent in clutterers. There may be ambidexterity, left-handedness or crossed dominance, e.g., right-handedness and ]eft-eyedness. 6. Family history. It is usual to find several clutterers in the same family and this occurs even when the afflicted members of the family have never met, thus eliminating the possibility of imitation. In tMs connection
PSYCHOI,OGIC
ASPECTS
Froeschels has pointed out that cluttering is the most difficult type of speech defect to imitate. Other types of language disability and alterations in lateral dominance are also frequent in members of t h e family. Cluttering, like other disorders of the language function, is much more common in boys than in girls. A speech defect quite like cluttering occurs in some children following meningitis or encephalitis. I n these cases no family history of other language disorders or of alterations in lateral dominance is found. PATHOGENESIS
According to Weiss cluttering is a constitutional anomaly of the language functions and is therefore to be regarded as "organic."" His view is based, principally, on the hereditary nature of the deviation. He looks upon stuttering, in the majority of eases, as a f u r t h e r development of cluttering and therefore one finds clutterers and stutterers in the same family. But only the cluttering is hereditary, the stuttering representing the reaction of a clutterer to an unfavorable environment. Weiss points out, further, that in many clutterers thinking' proceeds without words. The patients often have the feeling that a thought process is complete before the appropriate words are pre~:ent. The time interval between the appearance of the impulse to speak and the recall of the necessary words leads to tile well-known repetitions and may be the origin of the various reactions which lead to the clutterer 's impatience. The early speech of children shows m a n y of the characteristics of cluttering. Repetitions are frequent. Such
OF
395
PEDIATRICS
expressions as ma-ma, da-da, na-na, rata are typical and are characteristic up to about 4 years of age. The repetitions are of syllables rather than of letter sounds (as in the stutterer) and are unassociated with any strain. The large majority outgrow their repetitious speech b u t a small percentage remain as clutterers or stutterers or a combination of both. R E L A T I O N TO STUTTERINCx
The most striking difference between cluttering and stuttering is that the clutterer improves his speech when he concentrates on it, indeed the defect may be completely overcome, while the stutterer 's speech becomes much worse when his attention is directed to it. Consequently the elutterer speaks better in strange surroundings where he is on his guard, and he has his greatest difficulties when he is among his familiars and relaxed. The reverse is true of the stutterer who becomes tense in the presence of strangers with worsening of his speech defect; the stutterer is acutely conscious of his difficulty. Allowing the clutterer to t r y again makes his speech better, the s t u t t e r e r ' s worse. A number of cluttering children become stutterers. This is believed to take place when tension and anxiety are superimposed on the already unstable speech mechanism. TREATMENT
Though cluttering speech is not as serious a difficulty as stuttering, it should not be regarded merely as careless or indistinct speech. The child needs to be helped to overcome his confusion. Treatment is easier the earlier it is begun. It consists of training for self-
396
THE JOURNAL OF PEDIATRICS
control and precision, in speech and in social behavior. Overattention to the physiologic repetitions of early speech should, however, be avoided since it may lead to parental preoccupation with the child's speech and fixation of the repetitions. Specific points in treatment are the following: 1. Itelping the child to concentrate on the details of speech and to say every word carefully. 2. Teaching the child to read every letter and not permitting substitution by association. This is best done by the reading of nonsense syllables or by reading through a small opening which permits visualization of only one letter at a time. Later this can
be changed to permit visualization of one syllable or word at a time. 3. Having the child enunciate each word while writing tends to slow speech and call attention to detail. REFERENCES
Davis, D. M.: l~elation of Repetitions in Speech of Young Children to Certain Measures of Language M a t u r i t y and Situational Factors, Y. Speech Dis. 4: 303, 1939. De Hirsch, K., and Langford, W. S. : Clinical Note on Stuttering and Cluttering in Young Children, ]Pediatrics 5: 934, 1950. Freund, tI. : Ueber die Beziehungen zwischen Stottern und PolterJa, Monatschr. f. Ohrenheilk. 12: 68, 1934. Froeschels, E.: Cluttering, J. Speech. Dis. I i : 31, 1946. Weiss, I). A. : I)er Zusammenhang zwischen Poltern und Stottern, Folia Phoniatrica 2: 252, 1950.