9.11 Underdeveloped zones: empty lots and ramshackle houses.
The six-layered model helps the speech-language pathologist out of a confusion that exists with regard to the syndrome of cluttering. It is defined as a deficiency in speech and/or language skills in otherwise normally gifted or even exceptionally intelligent persons. Since cluttering runs in families and since men are 4 times more often affected than women, there is a hereditary factor involved. The manifestations of cluttering are diverse and differ from individual to individual. Cluttering is not so much a disease entity as a set of more or less related symptoms. The layered model enables us to identify zones of (hereditary + acquired) weakness of function, on the 'receptive' side of the speech/language system as well as on the 'productive' side. A summing-up is found in this paragraph.
Clutttering is indistinct speech with typically several of the following characteristics:
the rate of speech is too fast, timing is irregular, words and parts of sentences are repeated
intonation is inadequate, the quality of voice not under control
articulation is blurred, there are phonemic transpositions, omissions
grammar and syntax are deficient,
the speaker fails to empathize with the listener, his thinking is inconsistent.
The symptoms have been ranked in such order that they are recognized as deficiencies in the growth-circles of speech and language as represented in Map 9.10.1 In this way we bring order in the confusion about cluttering.
Level 1. In the central area where language is generated, attentional deficit as well as anxiety and being over-aroused interfere with proper development of speech and language. The attention span may be too short to retain sequences of sounds and regularly returning features of word and sentence construction. Frequent spells of attentional deficit or anxiety may prevent the clutterer to develop a firm grasp of the world: his internal image of the world is confused, and this may cause his relations with other persons to be disordered. It can lead to a disarranged and insecure adult personality. Anxiety, hastiness and lack of concentration can cause fluent speech to deteriorate and to become dysfluent, in children as well as in adults.
Level 2. Just as the gift of musicality is partly inherited and partly amplified by training, so recognizing and reproducing the melody of spoken language is the outcome of inborn talent and later training. Speech may become difficult for those who are either not gifted or have missed the opportunity for training. When it is due to particular circumstances after birth, e.g. periods of conductive hearing loss, one can call this a developmental a-musia and dysprosodia: not being able to use the intonation-cues which help to bring order in the confusing sound-sequences of spoken language. A dull voice may result from incompetency to perceive intonation patterns. A lively intonation and a melodious voice suggest a clear state of mind and free expression of the verbal message. Absence of this quality may cause a listener to be uncertain about the speaker's state of mind. Communication will be unsatisfactory without the clutterer being aware of it.
Level 3: trouble with perceiving the duration (length) of sounds, rhythmic patterns, and the number of syllables in a word give rise to lack of control of articulatory skills: omission, substitution and reversal of syllables. When the rate of speech grows uncontrollably high this will add to the listener's problem. Hasty speech can be based on insecurity and fear of silent intervals.
Level 4. Inability to distinguish articulatory features (discrimination of speech sounds) can be a source of later articulatory problems (developmental dysarthria). When the cause is primarily encoding difficulty for speech movements and lack of fine motor control, we would use the term developmental dyspraxia or verbal dyspraxia (column on the right).
Motor speech performance is part of overall sensomotor performance. Control of body movements develops in steps : through phases of crawling to standing balanced on two feet (later also on one foot), walking, running. When sensomotor skills are underdeveloped, the chances are that the ability to discriminate duration, rhythm and number of repetitions is also behind schedule The relation between these cognitive skills and the development of spatial orientation has been demonstrated.
It is recommended for children with physical handicaps, but also for normal children, that they be stimulated by play to work their way through a complete cycle of motor activities: crawling on all fours should always precede walking. In the schedule of motor development the spinal and bulbar coordination precede the functions that are based at the cerebello-pontine level, the midbrain and the forebrain.
When hearing is temporarily diminished during the critical period of developing auditory discrimination skills, this can have a long lasting effect. Prolonged periods of otitis with middle ear effusion give rise to developmental auditory agnosia, an inability to recognise characteristic sounds. As a rule the effect rubs off and is not noticeable after a few years. Episodes of hearing loss are not the only cause of a developmental auditory agnosia. Episodes of hospitalisation, regression during illness, affective neglect, attention problems caused by epilepsia are adverse conditions for learning the cognitive skills needed for speech.
Level 5. When a person has only a dim apperception of the grammar and syntax rules with which language utterances are structured, he can easily misunderstand the precise meaning of a more or less complex message. This would be a form of developmental receptive dysphasia. It is called dyslexia if the disability includes the interpretation of the visual stimuli of written or printed language. If the interpretative decoding is sufficiently developed but the encoding in well-structured language is at fault, the appropriate diagnosis would be: developmental expressive dysphasia. Currently the hereditary weakness and developmental dysfunctions at this level are attributed to a peculiar distribution of language-related functions over both halves of the brain (hemispheres). An incomplete dominance of the left half of the brain is usually accompanied by behavioural features that are advantageous for the individual and his "tribe", therefore the property is not an abnormality but a variation. Thus the deficiency in speaking skill is often outweighed by a talent for music and/or mathematics.
Level 6. A systematic lack of judgment of the social context in which the conversation takes place, can be a source of confusion. The clarity of a message also suffers by a lack of logical thought and lack of expressive imagination. For want of a practical term we call the thus affected person a dyslogic clutterer.
In summary: with the term cluttering we designate an unclear or confused manner of speaking by a population of men and women who, in the presence of normal intellectual abilities, have poor control of speech or language, or of both. We distinguish three main varieties: the dysrhythmic (abnormal tempo), the dysarthric (that includes verbal dyspraxia) and the dysphasic clutterers. The latter partly overlap with the dyslexic population.
It was once thought that cluttering was the gateway through which one entered stuttering. This is true for about 20% of the stuttering population. In these cases a developmental dysphasia or a dysarthric speech-motor disadvantage has been at the bottom of dysfluent speech. In many stutterers however the roots of their peculiar speech behaviour reach deep down into the innermost spheres of the personality. They have been victims of circumstances which have left them basically insecure. Therapists who have guided stuttering clients in exploring repressed area's of their emotional life can attest to that. C.Van Riper has remarked that whoever lifts the lid of the stuttering problem will see all the evils that trouble mankind.
10. FAILING VOICE AND BLOCKED SPEECH