Cluttering

Checklist of Cluttering & 1 2 3 Reported but Seen at
not observed assessment

DOB___________
Associated Features
Test date_________ Name________________
Stuttering
Speech rate &
Perceptually overly rapid speech rate
speech fluency Short bursts of fast speech
Unable to maintain natural speech rhythm
Inappropriate speech rhythm / pausing
Inappropriate breathing patterns
Phoneme repetition
Part word repetition
Word repetition
Phrase repetition
Mumbling/low volume indistinct speech output
Articulation
Excessive cooarticulation/overcoarticulation
Cluster reduction
Weak syllable deletion
Festinant speech (speech becomes faster and
more mumbled over a sentence or phrase)
Transposition of phonemes (spoonerisms)
Anticipatory coarticulation errors
Mispronunciations
Speech characterized by a lack of physical
tension
Confused wording
Language and
Revised sentences/phrases
linguistic fluency Word retrieval difficulties
Use of non – specific words “thing”
Use of interjections and fillers, e.g., “um, er,
well, you know, like”
Poor syntax
Empty speech/maze behaviour
Repetition and revision of words and phrases
Semantic paraphasias (e.g., magazine for paper)
Unfinished sentences
Possible high-level comprehension difficulties
Reduced ability to sequence significant events in
Disorganized a story (also may give prominence to
thinking unimportant details when storytelling)
Gives inappropriate level of detail
Goes off-topic/tangential speech
Unaware of fluency/speech/language errors
Untidy handwriting
Writing
Written errors mimic speech errors.
This may include: missing or transposed
characters, lack of consistency in letter height
Careless spelling errors

Short attention span
Attention
Easily distracted
Forgetful
Poor gross motor control
Other nonverbal Poor fine motor control
attributes Other
Checklist of Cluttering & Associated Features
Purpose and notes for administration

COCAF-4 is a revised version of an earlier checklist; COCAF (Ward, 2017). Its purpose is to provide the clinician with
a quick and easy to administer guide as to the presence and the extent of features that can be regarded as core to
cluttering, alongside those which may be commonly be seen as concomitant to it. The checklist adheres to the lowest
common denominator (LCD) definition of cluttering (St Louis & Schulte, 2011, pp 241-242) as below:
‘Cluttering is a fluency disorder wherein segments of conversation in the speaker’s native language typically
are perceived as too fast overall, too irregular, or both. The segments of rapid and/or irregular speech rate
must further be accompanied by one or more of the following: (a) excessive “normal” disfluencies; (b)
excessive collapsing or deletion of syllables; and/or (c) abnormal pauses, syllable stress, or speech rhythm.’
Note also: ‘Cluttering must occur in naturalistic conversation, but it need not occur even a majority of the time.
Clear but isolated examples that exceed those observed in normal speakers are sufficient for a diagnosis.’
Notes for completion of COCAF-4
Scoring – for each feature listed, place a cross or tick in the appropriate column:
1 = within normal limits
2= appears more commonly than expected
3 = strong feature
This simple 3-point scoring system can help the clinician arrive at an indication of cluttering or cluttering spectrum
behavior (Ward, 2017) but further examination on the core characteristics will be needed to confirm a diagnosis of
cluttering. The checklist cannot provide an exhaustive list of possible factors and clinicians are encouraged to expand
on responses across all areas noted on the checklist and consider other factors not listed. COCAF-4 should, therefore
not be used as a stand-alone tool for the differential diagnosis of cluttering. COCAF-4 includes sections which might
also have implications for consideration of (amongst others): attention deficit disorders, language disorder,
phonological disorder, dyslexia and dyspraxia. COCAF-4 is suitable for use with both children and adults.
For an indication of cluttering to be made under the LCD definition, the client’s profile on COCAF-4 must show deficits
in 1) At least one of the two darker shaded areas, and 2) At least one of the lighter shaded areas.
(Note: The LCD definition provides a narrow, but secure, account of cluttering. However, there is ongoing debate as to
which features can be considered core, and which ones are concomitant to the disorder. It is possible that under
different definitions, further areas probed on the COCAF-4 but not indicated by shading, may be seen as core.)
In addition to the three columns (as above), there are two further columns: ‘Reported but not seen’ and ‘Seen at
assessment’. When scoring for presence /absence for each feature (in the first three columns), clinicians might wish to
use different colours to indicate whether the check marks refer to ‘Reported’ or ‘Seen’ behaviours.
Some apparently ‘associated’ features may well have ramifications for core LCD behaviours. For example, word
retrieval, which is not an LCD feature in itself, could result in abnormal pausing, or increase in normal non fluency
through adding filler words: e.g., ‘um’, ‘er’, both of which are, when used to excess, core cluttering characteristics
under the LCD definition. Such potential interactions should be explored at assessment.
The clinician can complete the COCAF-4 with the client to gain their self-perceptions. If so, it is recommended that the
clinician also compiles their own version independently. The match or mismatch between the two data sets can be
helpful when determining the direction and focus of future therapy.
COCAF-4 may be freely copied and distributed

d.ward@reading.ac.uk (© 2019)
References:
• St Louis, K.O. and Schulte, K. (2011) Defining cluttering: the lowest common denominator, In D. Ward and K. Scaler Scott
(Eds.) Cluttering: a handbook of research, intervention and education (pp 233-254) Psychology Press: East Sussex
• Ward, D. Stuttering and Cluttering. 2nd edition (2017) Routledge, Psychology Press, East Sussex

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Checklist of Cluttering & 1 2 3 Reported but Seen at

not observed assessment

Careless spelling errors

Purpose and notes for administration

Notes for completion of COCAF-4

COCAF-4 may be freely copied and distributed

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