I worked with Santino again, after his OT session with Christina. We began working where we left off, on a puzzle activity, only this time we worked with a number puzzle, which Santino was able to complete independently. He remained on task for 5 minutes but grew distracted when he heard sounds emanating from an adjacent room, so we took a short break after completing the puzzle. Santino continues to do best when allowed fairly frequent short breaks. He has been increasingly able to tolerate sitting at the classroom table for up to about ten minutes if engaged in a task, or if it is sufficiently challenging without becoming frustrating. Santino is reinforced with verbal praise and physical/sensory-stimulating techniques, minute walks around the room, use of an exercise ball or other physical outlet, and/or allowing him to view or listen to short music apps in which he has demonstrated prior interest. When he is given a signal that we must resume work, he is expected to return his attention to the task at hand and re-directed in a firm voice, if necessary. We went back to working at the table with a large piece of paper and markers to improve Santino's fine-motor coordination and pre-writing skills. He was tasked with using a marker to connect dots to form 3 - 4 inch vertical lines. Santino required hand-over-hand assistance to improve accuracy and to start on top in the correct place on the paper. He persevered on the task until satisfactory completion. He appears to making steady progress and strengthening and improving his visual-motor, bi-manual, and fine-motor development. Furthermore, he understands expectations and is less resistant to working at the table for longer periods of time. His comfort level with me has also steadily improved with time and familiarity to routine, expectations, and structure. Santino indicated he wanted to drink and presented me with his bottle. I used the visual communication book to show him how to string together three - four pictures in order to express his needs (e.g., I want more juice/pudding/puzzle time); however, he did better today when presented with two beverage options, pointing to his desired choice. This pairing between action and image (e.g.; pictures on the board) is hoped to facilitate and foster his language development and sight language cognition. After drinking his bottle, Santino was seated at the table and engaged in some water play. I set up a few objects by the tray filled with warm sudsy water and asked him to put each in the water upon request. Santino did so with a plastic animal, a balloon, a marble, and a cup. As he is manipulated the objects in the water, I provided narration about the properties observed. ("Look, Santino the pig is floating; Look Santino; the marble sank to the bottom.") Santino's mom arrived at the tail end of this activity and Santino helped put on his shoes and socks with minimal verbal and physical prompts, tightening the Velcro closures upon request and thus marking the end to a productive session.