Nicholas had a homework assignment that should have been in his folder. While the folder was in his bookbag, there were no worksheets there. We therefore concentrated on doing exercises out of the Go Math book to practice math facts, specifically addition and subtraction of single digit numbers. According to his teacher, Ms. Miner's notes, Nicholas should be practicing counting up to 120; however he has difficulty understanding the concept of counting sequentially by tens. For example, he was able to correctly count up to 49, but he then leaped to 60, after which he began arbitrarily guessing numbers, with a default response of 30. We reviewed counting strategies such as using the first digit as a guideline by which to figure out the next ten in the series, but Nicholas appeared tired and had difficulty sustaining attention to the task at hand. He was permitted to take some time out to create a model using Lego blocks while we continued to work on addition and subtraction facts. Nicholas was excited to get some answers correct but required the occasional reminder that subtraction meant to take away. It would be beneficial for Nicholas to continue practice counting by rote at home, using an abacus if one is available to aid in his understanding of one-to-one number correspondence. He finished the session performing a visual-perceptual task using shapes to replicate a model drawing and performed very well on this task. Nicholas also demonstrated excellent dexterity and bi-manual coordination in replicating the model.