Richard was really focused during our first session. We began with a phoneme manipulation task, in which Richard completed a word ladder by changing one letter at a time to create a new word based upon clues I read aloud. He did a great job with this and you could tell he was really working hard to figure it out. We continued with a self-rating speech scale to independently observe his growth and opinion of his speech. Richard feels communication partners almost always understand him. He does notice that sometimes he speaks too quickly and also self-reflected that he has the most difficulty with medial /th/ as it is hard for him to get his tongue into the right place in between other sounds of words. I was really impressed with his reflection and I agree with him! We finished with some oral motor exercises.