With the aid of therapy provided by the Scottish Rite, a child moves from anxious silence to happy speech.

No matter how long we work with children, there are always those special few that touch our hearts in ways that create lifelong memories. Rachel Aguilar is one of those children. Tiny and timid, she arrived at the San Diego Scottish Rite Clinic for Childhood Language Disorders almost one year ago. Despite her petite and dainty stature, she seemed to have the anxiety of an adult. At just age three, she was already biting her nails and apparently worried well beyond her years. Undoubtedly, the cause of these problems was that Rachel could understand everything around her, but she was unable to communicate.

"She can say some words," her mother stated on that first clinic visit, "she just won't." This type of comment led the clinic's therapists to investigate the possibility of Developmental Apraxia of Speech (DAS). This was Rachel's eventual diagnosis.

DAS can occur when nearly everything within a child's communication is developing normally. The understanding of words and sentences is good. Their strength and range of motion of all the muscles and structures in their mouth and face are what they should be. These children are even able to make as many different sounds as other children their age. Why then was Rachel struggling? DAS is a motor-planning problem for commanded motor execution. For example, Rachel could say "hi" automatically, but when commanded to, she was unable. What is remarkable about this condition is that she could cough or blow on command (a non-speech task), but could not say words that involved essentially the same kind of motor movement, like the word "who" or the storybook character "Pooh." DAS is not just being shy. It is a neurological and/or linguistic problem that needs specific intervention.

What we do for DAS in speech therapy is to train non-speech vocalizations and gradually shape these into words. This "bridge" provides immediate success for the child. Rachel was trained to blow colored feathers from her fingertips in a fun, non-speech game. Because of months of built-up anxiety about speaking, speaking tasks are not ever required of the child with DAS for the first few months of therapy. Speaking must be a purely voluntary experience for them. We continued this blowing game with tissues, cotton balls, and more feathers. Gradually the game became not just blowing with air, but with little puffs of the p sound. "Puh" was used for a while, then gradually "pooh." At that point, the Winnie the Pooh puppet helped us. Then a "Pooh" game was introduced. Now Rachel had the word "Pooh" and was using it when commanded. Letter-name sounds were trained as well. These help a child with DAS because they are still a non-speech sound movement. Fun hand signals were developed for each sound, and easy game-like sound patterns were practiced. Animal sounds were also trained and shaped into words.

Rachel's progress was most successful because of her strong family support. Parents and siblings understood how best to help Rachel and worked with her in a fun way and on a consistent basis. Rachel's readiness for communication also helped with the success in therapy. After several months in individual therapy, Rachel worked with an age-matched peer for carryover of her new communication skills.

Three-year-old Rachel Aguilar works with her therapist, Christy Himstreet at the Scottish Rite Clinic for Childhood Language Disorders in San Diego, California.

Success with communication has allowed Rachel to "come into her own," as her mother says. Rachel is now happily communicating with children and adults as appropriate for a child her age. She tells long stories about preschool, her friends, and her family. She has developed a sense of humor and something of a leader-ship personality. Now she even tells the therapist what to do in therapy! Rachel still comes to therapy once a week and continues to work on sound and syllable patterns. We expect Rachel will be graduated from the San Diego clinic in the next six months. We are proud and excited for Rachel and her family.

Thanks so much to Scottish Rite for allowing this excellence in service delivery and attention to specific communication problems like Rachel's DAS. Without proper diagnosis and treatment, Rachel may not have been able to succeed with communication, and she might still be that shy, timid, over-anxious little person we met a year ago.