With guidance, Santino placed his book bag in its proper place. He was in good spirits and eagerly gathered his current favorite objects within his reach. Seated at the table, Santino was given a puzzle activity requiring him to match pairs of objects based on their relationship to one another. This is an activity that can be completed based on visual perceptual abilities or knowledge of objects and their associations. We worked on assembling the puzzle sets together as I narrated how they were associated (e.g., the bird goes with the nest, the baseball goes with the mitt). Occasionally, Santino repeated a word after me, but his repetitions were mostly spontaneous and self-directed. My overall objective was to have him seated in the chair and focused on the activity on hand. Santino was somewhat interested initially, but turned his attention to some musical instruments and picked up a guitar. He verbalized the word 'guitar,' and examined the instrument carefully from all angles, occasionally plucking a string. I echoed the sounds he made on a tambourine, and we engaged in a back and forth exchange of rhythmic sound patterns. Santino then handed me his bottle and proceeded to sit on the floor, watching as I filled it with Pediasure. He took off his shoes, lay back, and drank his bottle as I read a book to him. He was very relaxed, vocalized contentedly, and was refreshed and alert when his next teacher arrived to teach the next class.