Santino readily accompanied this teacher to his classroom. He is aware of the routine and if directed elsewhere, or to a place he does not wish to go, he will express his displeasure via gestures (pulling his hands away) or through vocalizations that increase in frequency or intonation depending on the degree of his discontent. Today, Santino was agreeable when introduced to a magnetic game, and he experimented making different shapes. However, efforts to get him to identify some of the shapes upon request remained largely unsuccessful; Santino only verbalized the word 'cicle' during self-directed play and not following verbal prompts. Santino enjoyed working with a hangman board flipping over letters. While he has been observed saying letters, colors, shapes, and numbers when engaged in self-directed play, he rarely engages with teachers if uninterested in what is being presented to him. This activity sustained his attention for over 5 minutes but he resisted my attempts to intervene or guide his attention or focus. Santino has been encouraged and reinforced if he follows single-step directions. We continued working on his requesting my help to obtain a desired object or engage in an activity by saying the word 'hand' (offering my outstretched hand) or 'help'. At this point, however, we have just begun establishing the connection between word and action. It will require repeated trials to accomplish this as there are a limited number of acitivities Santino finds reinforcing enough to affect behavior change. Santino participated in performing the steps of hand-washing before the session concluded, and he enjoyed a big drink of water from the faucet to quench his thirst and hydrate him.