Perspectives on Fluency and Fluency Disorders 19 62-66 July 2009.
doi:10.1044/ffd19.2.62 Copyright 2009 by American Speech-Language-Hearing Association
Global Landscape of Cluttering
Isabella K. Reichel
Graduate Program in Speech and Language Pathology, Touro College
Brooklyn, NY
Klaas Bakker
Department of Communication Sciences and Disorders, Missouri State University
Springfield, MO
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Abstract
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The global emphasis of the International Cluttering Association (ICA) is manifested in multiple dimensions. This article focuses on two of them, namely, resources available through the ICA Web site and the results of an International Cluttering Survey (ICS), which had been presented to 25 members of the Committee of the International Representatives of the ICA. The answers of the representatives to questions regarding awareness of cluttering, definitions, professional preparation, goals for education about cluttering and approaches for achieving goals, are compared and analyzed.
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Introduction
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The International Cluttering Association (ICA) was established during the First World Conference on Cluttering, which took place in 2007 in Katarino, Bulgaria. Attendees from 18 different countries met to share scientific findings, clinical insights, and consumer viewpoints. The ICA had an international start from the "get go," while building into its design the perspectives of scientists, clinicians, educators, and people with cluttering. All of the activities of the ICA continue to be implemented by volunteers from a wide range of countries, thus maintaining the ICA's international character and independence from any commercial interests.
Today, approximately 2 years after the ICA's establishment, it continues to grow. The ICA now has representatives from 28 different countries, maintains a quarterly newsletter, and has materials online from several crucial committees, including the Consumer Issues Committee, Research/Academic Committee, Clinical Issues Committee, Membership Committee, Organizational Development Committee, Website Committee and, most relevant to this article, the Committee of International Representatives. The organization as a whole is headed by Kathleen Scaler Scott with the help of an Executive Board, consisting of all committee chairs of the ICA.
Immediately after the Conference in Bulgaria, a Web site was established for exchanging knowledge and sharing resources about cluttering for the benefit of consumers, their families, and professionals in countries throughout the world. The site serves as a crucial vehicle for those with an interest in cluttering to "meet," learn, compare, and initiate the process of spreading the ICA's efforts to even more countries. Among the Web services available are a database of self-referred clinicians with a background in cluttering, clinical materials (tests and assessment software), literature (a book and articles), useful links, and bibliographies on cluttering in several languages. For those educating students about cluttering, there are a number of video- and audio-based samples to demonstrate examples of what cluttering sounds like. The global focus of the ICA is clearly reflected in its efforts to make essential portions of the site available in multiple languages; translations of some content have now been completed in Arabic, Bulgarian, Chinese, German, Dutch, Indonesian, and Russian. The site is designed and managed by Klaas Bakker and can be found at www.associations.missouristate.edu/ICA
In exploring the state of awareness and understanding of cluttering across countries, one inevitably encounters significant variations in experience with, knowledge of, and approaches to the management of cluttering, the sharing of which is mutually beneficial. In order to ascertain views about cluttering and to chart the global landscape of cluttering from country to country, Isabella Reichel created and circulated a survey among 25 members of the ICA Committee of International Representatives.
The survey consisted of nine open-ended questions and was presented to the representatives of Argentina, Australia, Belgium, Bulgaria, Canada, China, Denmark, England, Faroe Islands, Germany, Iceland, India, Indonesia, Ireland, Israel, Japan, Lithuania, Netherlands, Nigeria, Norway, Russia, Sudan, Sweden, Thailand, and the United States. These countries are those which had representatives on the ICA at the time. Twenty of the participants were speech therapists, one was a speech therapist and psychologist, one was a speech therapist and audiologist, one was a clinical psychologist, and two were consumers (or people with cluttering).
The term speech therapist is used in this survey to identify professionals who provide services to treat people who clutter. It is important to note that, in various countries, speech therapists may be referred to by different job titles even in discussions confined to English. That is, speech therapists may be referred to as speech-language pathologists, logopedists, or orthophonistes, depending on the country and language of origin.
The following is a summary of the responses from the international representatives and a first interpretation of the findings. Many of the total percentages in the survey exceed 100%, because, in responding to some of the questions, the representatives gave more than one answer. Conversely, some of the totals did not add up to 100%, because some of the questions were not answered by some of the respondents.
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Awareness and Understanding
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Awareness of cluttering ranges from complete lack of awareness in some countries to strong awareness in others. Thirty-two percent of respondents indicated that speech therapists are unaware of cluttering in their country (Argentina, Indonesia, Japan, Lithuania, Netherlands, Russia, Sudan, and Thailand). Forty percent of respondents reported that speech therapists are aware of cluttering, but not knowledgeable about symptoms, assessment, and intervention methods in their countries (Australia, Belgium, Bulgaria, Canada, Denmark, England, Faroe Islands, Israel, Sweden, and the United States). Speech therapists are reported to be well aware of cluttering in 28% of the countries (China, Germany, Iceland, India, Ireland, Nigeria, and Norway).
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Definitions
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There is little consensus regarding the definition of cluttering worldwide. More than half of the representatives (52%) responded that in their countries there are no unique definitions of cluttering (Argentina, Australia, Belgium, Bulgaria, Canada, China, Denmark, Faroe Islands, India, Ireland, Israel, Japan, and Nigeria). The definition proposed by St. Louis, Meyers, Bakker, and Raphael (2007; also see Scaler Scott & St. Louis, this issue) is used in 28% of the countries (England, Germany, Netherlands, Norway, Russia, Thailand, and the United States). Representatives of 24% of the countries suggested definitions that originated in their countries (Germany, Indonesia, Netherlands, Russia, Sudan, and the United States). The representatives of Iceland and Sweden said that the clinicians in their countries use a very similar definition to the one proposed by St. Louis et al., the World Health Organization's (WHO) ICD-10 definition (F98.6) of cluttering (2007): "A rapid rate of speech with breakdown in fluency, but no repetitions or hesitations, of a severity to give rise to diminished speech intelligibility. Speech is erratic and disrhythmic, with rapid jerky spurts that usually involve faulty phrasing patterns."
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Professional Preparation
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The emphasis on and amount of time devoted to professional training in cluttering ranges from complete lack of emphasis to specialized coursework and/or clinical training. Cluttering is discussed in training programs or during stuttering courses in more than half of the countries (52%; Argentina, Australia, Belgium, Bulgaria, Canada, China, Denmark, England, India, Ireland, Sweden, Thailand, and the United States). In 20% of the countries (Germany, Israel, the Netherlands, Norway, Russia), a special course in cluttering is offered, but courses vary among countries in their format and length. Three representatives mentioned that some programs teach cluttering in a clinical setting (Germany, Norway, and the United States). Cluttering is not discussed in 28% of the countries' training programs, according to the respondents in the survey (Faroe Islands, Iceland, Indonesia, Japan, Lithuania, Nigeria, and the Sudan).
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General Goals
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Across the world, representatives of the ICA see the need for improving upon research, awareness, and clinical methods in the area of cluttering. The goals suggested by the largest percentage of representatives were improving awareness and education about cluttering (suggested by 44% and 40% of countries, respectively). Creating materials for education, support, and advocacy were proposed as means to accomplish this goal. Improving diagnosis and treatment were also considered priorities by 36% of the representatives. Individual suggestions, such as creating a screening instrument for cluttering, were made. In terms of treatment, 16% of respondents favored the development of self-help groups for cluttering. Along with improved diagnosis is the creation of an internationally accepted definition of cluttering, which was expressed as an area of need by 20% of representatives. Overall responses reflected a spirit of international collaboration, with suggestions for collaborative research, professional development events, and exchange of clinical ideas.
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Goals Specific to Country or Culture
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Whereas no culturally based or country specific goals were suggested by 40% of the representatives (Argentina, Bulgaria, China, England, Germany, Iceland, Ireland, Russia, Sudan, and Sweden), several representatives had specific interest in certain goals, such as professional and public awareness of cluttering. Representatives of 28% of the countries suggested professional development programs, educational conferences, online courses, and publications (Australia, Faroe Islands, Israel, Norway, Thailand, and the United States). A need was expressed for increasing public awareness about cluttering by 20% of the representatives (Denmark, England, Nigeria, Norway, and Lithuania). Assessment and treatment needs in the school setting were also valued as important. Collaborating with teachers in schools was suggested by 12% of the representatives (India, Japan, and Norway). India's representative suggested conducting screenings in schools. Japan's representative suggested creating a checklist for cluttering for teachers in special education classes. Other individual representatives felt their focus should be upon translation of information into native languages, improving diagnostic tools, and improving treatment practices in general. The representative from Lithuania recommended publishing materials on cluttering in Lithuanian. Indonesia's representative suggested creating a new word for cluttering, graya. The representatives of Belgium and Indonesia suggested creating assessment instruments differentiating cluttering from stuttering. The representative from Faroe Islands expressed a need to improve treatment practices in general.
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Approaches for Achieving Goals
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Once representatives indicated what their goals were in relation to their respective countries, they elaborated about how they felt these goals could best be achieved. Responses again cut across the areas of raising awareness, conducting research, and increasing clinical training. The responses varied based upon how much was currently known and being done in the area of cluttering in each country. For example, in Nigeria, where there are few resources regarding cluttering, a goal was suggested for increasing the awareness of cluttering in the general population. The representative from the Faroe Islands suggested increasing the number of speech therapists in general in his country. In areas where there is more cluttering awareness, approaches seemed to focus upon research and training. Conducting international research was viewed by 20% of the representatives as an important initiative (Iceland, India, Ireland, Norway, and the United States). Publishing articles focusing on the topic of cluttering in journals and newspapers was recommended by representatives of 20% of the countries (Germany, India, Ireland, Lithuania, and Norway). Increasing time for teaching cluttering in academic programs for speech therapists was suggested by 20% of the representatives (England, Israel, Netherlands, Sweden, and the United States). The representative from the Netherlands emphasized clinical training in cluttering for speech therapy students.
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Communities to Target for Education/Awareness
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Both professionals and nonprofessionals were considered important to target by the country representatives surveyed. The primary group to be targeted for education in cluttering was speech therapists, according to 52% of the representatives. In addition to targeting current therapists, 12% of respondents suggested focusing upon speech therapy students. Twenty-four percent of respondents advocated targeting professional organizations, and another 24% advocated targeting the general public. Targeting self-help groups was advocated by 16% of the representatives (Faroe Islands, Lithuania, Nigeria, and the Sudan). Other suggestions included targeting teachers and psychologists.
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Dissemination of Information in the Media
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Use of the media ranged from a lack of resources for making such connections, to an expressed interest in developing media awareness, to taking initiatives to distribute information in this manner. Representatives of 36% of the countries expressed an interest in contacting the media (Australia, Belgium, Canada, Faroe Islands, India, Ireland, Nigeria, Norway, and the Sudan). Representatives of 16% of the countries had publicity on TV, radio, or DVD (Bulgaria, China, England, and the United States). Awareness through journals and Web sites was less common. Regarding journal publications, 8% of the representatives published articles on cluttering in their countries after the ICA was created (Norway and the United States). Only 8% of the representatives posted or planned to post information about cluttering on a Web site (Lithuania and the United States). Still others stated that they lacked the contacts to develop media awareness programs. The representatives of 36% of the countries had no contacts in the media or did not answer the question (Argentina, Denmark, Germany, Iceland, Indonesia, Israel, Japan, Russia, and Sweden).
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Translations of ICA Web Content
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The majority of respondents felt that translation of the ICA Web site content was important for reaching those in their countries. With respect to the translation of important segments of the ICA site, 32% of the representatives responded that doing so is important for their countries (Bulgaria, China, Germany, Japan, Lithuania, Norway, Russia, and the Sudan). The representatives of 20% of the countries responded that they do not require a translation of the site content.
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Conclusion
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Based on the responses of the international representatives, it is apparent that there is an expressed and shared need worldwide for spreading awareness about cluttering, creating a universal definition, conducting collaborative research, increasing professional preparation, and improving clinical exchange, as well as supporting and educating consumers and cluttering support groups. Despite differences in available resources for and opinions regarding theoretical views, professional preparation, clinical services, and awareness and education campaigns, the results clearly show that cluttering is on the minds of individuals across countries, cultures, and language groups. While there may be a recognized path in the management of cluttering in some countries, the involvement of pioneers may be needed in others.
The results of the survey are preliminary in a number of ways. First of all, the country representatives who were available for the survey were self-selected in that being a representative of the ICA is a voluntary position. Furthermore, since the ICA is still in the early stages of its evolution, the survey at this point does not yet include respondents from countries whose primary language is French or Arabic. For these reasons, response bias is present with underrepresentation of some significant language groups and countries. Because the number of countries represented in the ICA is steadily growing, the present results can only be viewed as a preliminary report of the global picture of cluttering. The picture will need to be further developed, as part of an ongoing effort to collect information as the size of the ICA expands.
The dialogue about cluttering among speech therapists, allied professionals, and consumers worldwide proves once more that an understanding of the global landscape of cluttering may expand "the world as a global classroom" (Shapiro, et al., 2000, p. 505). The creation of the ICA shows that people around the world can learn from each other about cluttering through multinational dialogue, exchanging ideas, and narrowing the gap between those countries that have professional resources and those that do not. Through providing varied perspectives, advancing common discoveries, and creating shared solutions, the answers to the global quest for better understanding of cluttering, one of the most perplexing communication disorders, will hopefully be found and celebrated across nations, cultures, and languages.
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References
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Shapiro, D. A., Molt, L. F., Lundberg, A., Reichel, I., Ohashi, Y., Simon, A. M., & Wahlhaus, M. M. (2000). Multinational understanding through stuttering intervention: Diverse influences and global lessons. In H-G Bosshardt, J. S. Yaruss & H. F. M. Peters (Eds.), Fluency disorders: Theory, research, treatment, and self-help (p. 505-512). Nijmegen, The Netherlands: International Fluency Association/Nijmegen University Press.
St. Louis, K. O., Myers, F. L., Bakker, K., & Raphael, L. J. (2007). Understanding and treating cluttering. In E. G. Conture & R. F. Curlee (Eds.), Stuttering and related disorders of fluency (3rd ed.). New York & Stuttgart, Germany: Thieme.
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Abstract
Introduction
