Santino was seen for session 10 of 10 with this Speech-Language Pathologist (SLP) in the "East" classroom. He exchanged photos successfully on his daily, visual schedule with prompts from
Miss Janis, but appeared visibly upset as he transitioned away from what appeared to be an iPad...Goals for the session remained consistent and included the following... 1. to engage in forming a relationship with Santino that includes regulation, and shared attention and interest 2. to enter into two-way, purposeful interactions with gestures and intentional communication 3. to determine highly motivating/favorable, cause and effect activities, so that Santino may develop a feeling of control and predict/anticipate what will happen next 4. to imitate predictable action sequences and communication patterns through cause and effect activities 5. to develop single-word requesting via eye-gaze, picture exchange and/or verbalization...Bubbles were presented immediately upon the start of the first 20-minute session as a means to redirect Santino from the device. Shared attention and interest were fleeting. Santino selected an alphabet puzzle from a shelf independent of direction, then sat on the carpet in the "circle-time" area and spelled, "pigy" and "yelow". In an attempt to join and extend his interest, this SLP presented additional letters ("g" and "l") "borrowed" from another puzzle nearby and added them to his words his to create, "piggy" and "yellow". Santino promptly protested and removed the rogue letters, off to the side, with each recurring attempt by this SLP. Signs of frustration were acknowledged and validated followed by removal of the errant letters by this SLP...Santino presented the green beverage container. Water and a vanilla drink were presented as choices. Santino requested the water via eye gaze and gesture (tapping). A successful two-way, purposeful interaction with gestures and intentional communication ensued to open the bottles together. Given requests and designated "wait-time", the water was transferred from the bottle to the green container independent of assistance from Santino as he did not seem to show interest in helping with the task. (At dismissal, Ingrid indicated that the green container is for the "milk" beverages, only.) Two new books with predictable story patterns were presented as options to read while he held the green container. Santino requested via eye gaze and gesture (tapping) for "Where's Spot?" As the predictable story pattern was read aloud, Santino lifted flaps spontaneously at the appropriate time throughout the story sequence for 8 out of 8 opportunities and turned the pages successfully for 11 out of 11 opportunities with both verbal and visual prompts...At the end of the story, Santino stood and looked at the array of planned activities displayed at the center table. He was enticed into another interaction with the "Ball Launcher" which progressed successfully in the same manner as indicated in previous sessions for 5 out of 5 opportunities. At one point, Santino seemed to have difficulty locating the ball and walked away from the area. The ball could not be reached no matter how much this SLP "strained" to grasp it. Each "plea" for help brought Santino closer and closer, while engaging in eye contact. He would turn away then come closer, observing, "wheels turning", planning...Given time, Santino "came to the rescue", got down on his knees, stretched his arms and grabbed the ball from deep, deep under the bench, and placed it back in the "launcher"! This time, the roles reversed and he "launched" the ball! For one last time, Santino helped locate the ball when this SLP "could not"!..The session came to a close in the usual manner with side-to-side-rocking in-time with the "Good-Bye" Song and successful photo exchange on his daily visual schedule using both verbal and physical prompts by this SLP...Continue as planned with continued focus on single-word requesting via eye gaze, gestures, and/or picture exchange during highly preferred cause and effect activities.