The Speech Pattern That Often Gets Mistaken for ADHD

When Seattle high schooler Sofia Martinez-Zakrzewska chatted with friends and family, the words sometimes tumbled out so quickly they couldn’t understand her. Waiters often asked her to repeat her order. Teachers requested she slow down. 

“I thought I was talking normally,” she says. “I didn’t realize to everyone else I was an F1 driver.”  

She also collapsed long words, paused irregularly when speaking and struggled with large, sloppy handwriting. It wasn’t until meeting with a local speech-language pathologist that Martinez-Zakrzewska learned her challenges had a name: Cluttering.

People who clutter speak at a rate that’s unusually rapid, which can lead to communication strain. Often, sounds and syllables are smushed together, saying “bas-ball” for “basketball” or “catpiller” for “caterpillar.” They may also pause in unexpected places, leading to “jerky” speech. Unlike stuttering, people who clutter often don’t realize their speech is difficult to understand until the listener responds. 

Elyse Lambeth, a speech-language pathologist at Seattle Children’s, once heard a panelist liken the cluttering experience to a video call that keeps breaking up. 

“You feel like everything is really clear, but you look at the people and they obviously didn’t get your whole message,” Lambeth says. “Someone is going in and out. That’s the best analogy I have ever heard of cluttering.”

Just like with a spotty video call, it’s important to tell someone you’re not understanding them; pretending to understand cluttered speech can result in even more frustration. Instead, speech therapists advise waiting for a natural pause and then using reflective listening to show a speaker exactly where you lost the story thread. 

Understanding cluttering and its impacts

In the past decade, awareness of cluttering has grown, but misperceptions and confusion about the fluency disorder persist, even among speech therapists. Yet accurately identifying and treating the condition can be instrumental in helping a child address the often substantial social and educational impacts. 

“Within schools, they may receive lower grades because they can’t participate in discussions as easily,” says Susanne Cook, Ph.D., a certified cluttering therapist and the chair of the International Cluttering Association. “They can feel this high social isolation of not belonging that affects all areas of life.”

A client once explained cluttering to Cook as the sensation of 20 thoughts exploding at once in their brain. As a result, the speech system feels overwhelmed and people talk more quickly than they can manage. The rapid speech even exceeds the naturally quicker pace of tweens, teens and young adults, she added.

In addition to spoken communication, some people who clutter may move their hand too quickly in written communication. That can lead to large, uncoordinated handwriting — and the mistaken perception that they’re not trying hard enough, explained Tiffani Kittilstved, the leader of the National Stuttering Association’s Seattle Family Chapter. People who clutter may also struggle to maintain a clear, organized storyline especially when sharing complex stories. 

“When you’re telling a story, you overexplain something,” she says. “It’s like you’re in a maze — you go into these little side quests. It’s challenging to know what’s important.” 

Kittilstved, who became a speech therapist in part because of her own stuttering, only recently realized she clutters, too. While working at a summer camp on the Oregon coast for kids who stutter, a colleague shared her observations about Kittilstved’s possible cluttering. The diagnosis felt really validating — and resonated with her own experiences. 

“The treatment is different, so accurate diagnosis is really important,” she says.  

Improving identification and awareness

In children, cluttering typically becomes noticeable as their language develops and becomes more fluent. But it’s often mistaken for other conditions, even when parents seek professional support. While cluttering can exist on its own, it often co-occurs with conditions such as ADHD, autism and stuttering, Kittilstved noted. 

That can make it hard to distinguish even among speech-language pathologists. Within speech language pathology training, cluttering makes up a very small portion of the overall curricula, Cook said. She’s worked on research that found a huge number of students who graduated from these programs don’t feel confident working with a client who clutters. 

The International Cluttering Association and other advocacy groups are working to improve education for speech therapists as well as raise awareness in the broader community. 

“We want to really fulfill that mission so that people know more about it and it’s not as stigmatized,” Cook says. 

Finding the right tools 

While children might develop their own strategies to address their rapid, unclear speech, identifying and finding support is critical, experts say. Children who clutter aren’t being lazy; they need tools that work.  

“You can’t tell them to work harder; you have to work through the strategy and give them support,” says Heather Grossman, Ph.D., the executive director and a board-certified specialist in stuttering, cluttering and fluency disorders for the American Institute for Stuttering.

Speech therapists use a variety of strategies to help people who clutter, including using graphic organizers to map out stories before speaking. They also practice traditional over-articulation and stretching out multisyllabic words, as well as adding deliberate pauses in speech. 

In Cook’s work with students who clutter, she asks them to imagine a set of gears. One might be a high rate of speech; another might be using multisyllabic words. One effort simultaneously affects other gears. She and her young clients also work on recognizing when people don’t understand their speech and what kind of repair strategy could help.

Grossman recalled a child she worked with who learned useful strategies, as well as the confidence to advocate for herself. She ended up making an important speech in her school, using visual techniques like underlining syllables and inserting line breaks on her written script to assist. 

“It was a big triumph for her,” Grossman recalls. “I think people underestimate how much work it takes to change how you speak.”

As for Martinez-Zakrzewska, the Seattle high school student, having a name for her experience helped her understand how her brain works — and educate others, too. She even made a slideshow for one of her teachers explaining cluttering with cited sources. Now, Martinez-Zakrzewska participates more in class, and projects more confidence when she needs to present materials. 

“I do still talk fast and pause, but I still speak,” she says. “After the diagnosis, I feel less self-conscious. I might as well contribute to the class discussion.”