Karen Nystrom, MS, CCC-SLP
Children's Speech Therapy Center*
225 West Oak Street, Fort Collins, Colorado 80521

Because of help from the Scottish Rite, a child whose native language is Arabic is overcoming severe learning, speech, and behavioral problems.

Now eleven years old, Asmaa Eldeiry enjoys coloring as part of her speech therapy.

About three years ago, the Children's Speech Therapy sign outside the Fort Collins, Colorado, Masonic Center caught the attention of a passerby, Ahmed Eldeiry, who inquired about speech therapy services for his eight-year-old daughter, Asmaa ("Az-Meh"). At that time, Asmaa, who had minimal speaking skills and significant behavior problems, received speech therapy at school. However, she was only seen for a half-hour each week. School speech therapists in Colorado usually need to see 50-70 students each week and cannot devote much time to high-need students like Asmaa.

When she began therapy, two half-hours a week, at the Masonic Center in September 1999, Asmaa only used about 10 single words and relied on gestures or simply took things she wanted. She could not do simple pre-school tasks such as recognize colors, numbers, or letters. While her birth in Egypt had been normal, all areas of her development were greatly delayed, and there was no specific medical diagnosis as to why. Getting Asmaa to focus longer than 5-10 minutes at a time was a challenge in the early sessions. She was very impulsive, often grabbing at things within reach and ripping them up. She made many loud noises, laughed, and cleared her throat forcefully throughout these sessions, which caused further disruption. Her teacher at school reported that Asmaa had bitten people when she was frustrated. Frequently she would stretch both arms out in front of her and tighten them as if to release tension.

At the very beginning of therapy, Asmaa was only able to imitate 10% of the one-syllable words she was asked to repeat, so the therapist began teaching her to use a picture symbol communication system that Asmaa could point to in order to express her wants and needs. Because Scottish Rite funding allows flexibility in how services can be given, the therapist was able to visit Asmaa at school and at home to assess what she needed to be able to say in order to cope with routine daily activities.

By September 2000, Asmaa could focus on one activity in school for nearly 30 minutes. She also began using two-word or four-word stock phrases, such as "that mine" and "look at this," she had heard over and over at school. The therapist then observed Asmaa giving a long monologue in nonsense words using normal voice intonation and hand movements. She clearly was imitating conversation and wanted to talk, a hopeful sign that one day she would.

Her family and teacher helped draw up a list of 30 functional three-word phrases that would help them both (e.g. "I want touch"; "I want eat"), and an intensive effort began to train Asmaa to use these phases. A reward system (giving her "goldfish" crackers) was instituted every 15 minutes to manage her voice volume and throat clearing. Asmaa could now work for 45 minutes, so the session length was increased.

Within four months, she was using 13 of the 30 target phrases. Once-a-week home visits began on a regular basis when it was observed that Asmaa spoke a lot more at home than she did in therapy sessions at the Center. This also made it easier to show Asmaa's parents what they could do at home to encourage more speech, rather than simply interpret or accept her one-word utterances. Around this time, Asmaa began creating her own spontaneous phrases (e.g. "I feel hungry eat") using words from a combination of trained phrases. Very gradually, she began grabbing things less often and making loud noises less frequently.

A simple calendar was introduced using a different color for each day of the week, picture symbols for school-day activities, and other symbols for weekend days. Asmaa had mastered two-syllable words, so the names of more challenging school lunch items were introduced (spaghetti, burritos, and, her favorite, chicken nuggets). Over and over, she practiced ordering lunch with plastic food items so she could learn to ask questions (e.g., "Can I have chicken nuggets?") instead of just pointing and saying "I want." Other social questions were introduced at this time (e.g. "How are you?; "What's your name?"), as Asmaa was very outgoing and wanted to hug everyone she met.

In the spring of 2001, Asmaa led the therapist by the hand to a flowerbed outside her family's apartment and said, "Look at one flower." It was one she had planted. This was a real breakthrough-a novel statement using a combination of parts of speech from her trained phrases. A few months later, she made a spontaneous statement using five words and had memorized her phone number and address. Now age 11, Asmaa has learned all of the basic colors and numbers and is doing better in school. By the time she was discharged from therapy, she was able to ask, for instance, a 6-word question involving time: "Can Lynette come home next week?" This is a remarkable accomplishment for Asmaa, and it is clear she will continue to improve beyond anything that could have been expected of her a few years ago. Intensive therapy funded by the Scottish Rite Foundation of Colorado undoubtedly played a role in her remarkable progress.

"Look at one flower," Asmaa said. She is that flower, growing and blooming. Thank you, Scottish Rite!