We began by sorting stackable cardboard boxes by size, from biggest to smallest. Santino enjoyed throwing them up in the air and watching them land haphazardly, but needed refocusing to order them by size. I took out some food options from which he could select which included yogurt snacks, Fruit Loops cereal, and 2 different drinks. He chose the yogurt snack and handed it to me for me to feed him. He was more tentative eating this snack today which may have been due to it being blueberry instead of the usual strawberry flavor he brings in; however after one or two small bites, he did eat more readily and was receptive to watching as I modeled how to grip the spoon. He also cooperated during hand-over-hand feeding. I attempted to work on a color-sorting activity with him next, using an assortment of four different colors, red, blue, orange and purple. I asked Santino to hand me the green block giving him a choice between blue and green. Santino required excessive prompts to focus on the blocks and repeatedly handed me both blocks. I identified the blue block and the green block after engaging his attention and asked him to hand over just one block - the green one, modeling as I went along. Santino continued to hand over both blocks. He repeatedly yawned and attempted to lie down on some pillows on the floor, but I continued to provide him with activities that might stimulate his interest. We sat at the table and used markers, crayons, and paints to connect dots and draw lines from numbers to words. Santino passively participated in this activity; he seemed tired and unfocused. He pushed away the remainder of his yogurt snack as he did with some pretzels that were offered to him. I introduced an activity using plastic animals to identify, but this, too was met with marginal success today. Santino hummed quietly to himself and remained largely unresponsive to prompting techniques and methods to engage his attention. I will reconvene with Santino in an hour, following his hour of OT with Christine. Santino was more alert during his second hour. It appears that he was responsive to the sensory stimulation afforded him, which we continued in an adjacent classroom, using a large ball with which to execute gross motor skills and activities, such as rolling. He was interested in manipulating some beads of various colors, gravitating towards the red ones and using them to play with, threading them through his fingers, feet, and toes. I asked him if he wanted to play with 'more ‘of them, showing him the different colored bead necklaces. Santino responded by clapping, which closely approximated the sign for 'more.' He remained engaged with the beads, complied with my request to follow me back into our original classroom, and requested a drink by bringing me his bottle. I gave him his PediaSure vanilla shake which he drank while lying on the floor. He enjoyed the sensory stimulation of feeling some light brush strokes on his arm while finishing his shake and I helped him put on his socks and sneakers as we prepared for dismissal.

Jack enjoyed listening to 'The Snowy Day'. We focused on sequence and descriptive words. He drew a picture of a snow bug and dictated a story to go with the picture. In phonics, we focused on the short e sound. When engaged, he did well blending CVC, short e words. Jack read a short book entitled 'The Pet Hen', which focused on short e vowel sounds and sight words. He now can read all the Fountas & Pinnell high frequency kindergarten words with automaticity. Jack enjoyed a listening activity in which he solved a riddle and then had to follow directions about what marking to use to identify the picture solution. He did well writing the numbers 0-7. Today, we worked on the number 8. In 'Math Seeds', Jack worked on addition and how to solve basic word problems.

Jack enjoyed listening to the beginning of 'Flat Stanley'. In phonics, we worked on blending one syllable, and short vowel (a, i, o, u) sound words. At times, he benefits from encouragement to slow down, and blend each sound (rather than guess based on the initial sound). He did well reading "Gus and Mom' and was pleased that he could read the whole booklet. Jack did well with his sight words. We continue to practice like, come and my. Jack is able to write numbers 0-7. We practiced adding single digit numbers. Jack joined the drama camp briefly and really enjoyed himself.

Santino started the session with his socks and shoes off after finishing his session with Christine, the OT. He said good-bye to her after a few repetitions of the word and received verbal praise as reinforcement for doing so. I asked Santino if he wished to eat or drink but did not receive a response. However, when I took out food and beverage options, Santino promptly handed me a strawberry yogurt snack and brought over my cell phone. We proceeded to get a spoon and napkin from the kitchen, and when we re-entered the room, Santino handed me the yogurt. He makes his needs known but has yet to verbalize requests. I encouraged him to self-feed, but Santino would hand the yogurt back to me; hand-over-hand assistance is as yet required to complete spoon-to-mouth self-feeding. Next, we moved to the table and used a large piece of paper to improve pre-writing skills using large markers to facilitate fine motor skills and manual dexterity. Santino required hand-over-hand assistance to help him successfully coordinate the skills necessary to connect dot-to-dot to form 2 - 3 inch vertical and horizontal lines. He was subsequently allowed a break to walk about the room for a minute or two before being re-directed back to the table. At this time, Santino handed me his bottle, indicating he wished to drink. As two options were available, I asked Santino to choose by pointing to the one he wanted to drink. I modelled the desired response for him to clarify expectations. Santino was afforded a choice between water and a PediaSure vanilla shake, but he averted his eyes and failed to respond. I repeated my request several times before sufficiently re-engaging his attention. He then attempted to go behind me to retrieve my phone; however I maintained my request for him to point to a choice in response to my request, in order to receive the phone and listen to songs. In other words, Santino needed to comply with my single-step command in order to receive the phone as reinforcement. Santino returned his attention to the two options and, after several repeated requests, he pointed to the vanilla shake. This desired response was met with a great deal of verbal praise, clapping, and a high five. He even repeated some of my exclamations (“All right!" and Here you go!"). He was reinforced with an opportunity to listen to 'The Wheels on the Bus' on my phone, which remains a primary reinforcer at this point in time. We finished the session with an activity requiring Santino to follow one-step requests/commands. I presented Santino with three stuffed animals, a fish, giraffe, and a bear. Santino was asked to hand me the stuffed animal upon request. After I initially modelled the desired response, Santino handed me the fish when asked after two verbal prompts and was afforded praise for following this single-step command. He was next asked to hand me the giraffe, but he handed me both stuffed animals. However, he did hand over the giraffe after several additional prompts/requests. Santino was in good spirits and repeated several catch phrases after me, usually echoing the last two or three words of the sentence. We cleaned up and washed our hands as the session came to a close, and Santino was asked to hand me his shoes and socks. He complied and helped put them on with moderate assistance. Santino said "see you' upon leaving after I said "See you tomorrow!" This ended a productive session.

Jack enjoyed listening to 'Clifford Grows Up'. We talked about things Jack can do now that he is not a baby. He drew a picture of 4 of those things. In phonics, we worked on the short u sound. Jack did well blending short u vowel words and circling the picture the word named. He also did well determining which two of three short u vowel words rhymed and then was able to come up with another word that rhymed. Jack enjoyed playing a short vowel game. With encouragement, he read, "The Gum', a short book that focuses on short u vowel sounds and sight words. Jack dictated another chapter of his train story. He practiced writing the numbers 0-6. The number 7 was introduced. Jack also worked on adding one-digit numbers. He enjoyed listening to a story with the campers in drama camp and playing outside with them briefly.

Jack enjoyed listening to 'When a Bear Feels Sick' . He dictated what his mother does to make him feel better when he is sick and drew a picture. In phonics, Jack did very well with reading short a, i and o vowel words and matching them to the picture they named. He was pleased that he could read a chapter in 'A Pig Can Jig'. We went over his sight words today and continue to practice the words come, by and like. Jack enjoyed dictating another chapter of his train story. Jack practiced drawing a line between two wavy lines to promote pencil control. Jack is able to write numbers 0-6. The number 7 will be introduced next time. We practiced adding single digit numbers. In 'Math Seeds', Jack worked on heavier/lighter, longest/shortest, shapes, and addition.

We used Mr. Potato Head to point to and name parts of the body. Santino needed physical prompts and refocusing techniques to engage and sustain his attention to this task. As today was an overcast, cooler day, we went outdoors for 15 minutes. I sprayed insect repellent on Santino and he helped water some plants in the garden. However, he was more interested in an exercise ball, so we practiced some gross motor skills and activities such as forward rolls and somersaults on it. Santino did not demonstrate much interest in utilizing the playground equipment, so we went back indoors and I gave him a drink. As soon as Santino came indoors, the classroom area seems to cue him to take off his shoes and socks. He began yawning a lot and lay down on the carpet, self-vocalizing and resting as I read him a story. Every so often, Santino repeated a word he heard, but these were arbitrary and random and not in response to verbal prompts that were given to him. After a few minutes, I attempted to work on an activity involving touching and tracing letter cards using a set of 26 kinesthetic-tactile alphabet cards. This is a useful tactile tool through which to help him learn the shapes of letters by allowing him to see, hear, and do. It is especially beneficial for Santino as he appears so responsive to the involvement and interplay of his senses. The directional arrows also allow for successful writing motions by allowing him to trace the indentations in the cards with his fingers. Additionally, using the cards also helps to establish left-to-right and top-to-bottom directional awareness. Today, however, Santino required moderate physical prompts to remain focused and successfully trace the letters in accordance to expectations. As he appeared tired, and yawned repeatedly while working with me, I allowed him to listen to some of his favorite nursery rhymes and music while encouraging him to sing along and repeat the names of the animals - reinforcing him when he did so. He frequently repeated the phrase, "Ready, steady go" and did so most often when I initiated an activity or said, "Okay, let's go!" As was done yesterday, I played Chopsticks on the keyboard and paired the syllables of Santino's name to the chords. Every so often I would leave off a syllable hoping that he would fill in the empty beat by adding in a syllable of his name. However, as this technique was only first introduced yesterday, it will require more practice and repetition before satisfactory results may be expected.

Santino was receptive and remained focused as he listened to me read a book to him at the onset of the session. We pointed to the different animals that were mentioned in the story. Whenever possible, I introduced similar plastic animals available to me that were named to reinforce the words and asked Santino to hand me the animal mentioned. I observed his eyes locating the correct animal from the assortment of 3 animals placed in front of him, but his success in handing the correct animal to me was inconsistent, with physical prompts needed to achieve more consistent attainment; however, he did consistently hand the pig over upon request, for which he was reinforced with verbal praise and high fives. Santino then handed me a bottle, indicating he wished to drink one of the beverages he had brought with him. He as yet does not use the communication board to point to the image (drink), but he will bring me the drink he wants when given his book bag. Today it was a vanilla shake, and we finished reading two books while he finished the bottle. We then proceeded to some musical activities. I played ‘ Twinkle Twinkle Little Star on the keyboard, which Santino seemed to enjoy, as evidenced by his effusive smiles. I then played chopsticks, adding his name repeatedly as I played three of the chords in 3/4 time. He giggled animatedly as I did so. I am hoping that after hearing the song played repeatedly, he might sing his name along as I play the chords. This will be introduced as an activity again during tomorrow's session. I then showed Santino his Fruit Loops cereal, which he proceeded to open adeptly and finger feed himself well. I let him listen to "The Wheels on the Bus," which he played on a loop in different languages. I changed him into a fresh Pull up and we washed our hands before leaving when his mom picked him up at the end of the day. Santino left in as good spirits as when he arrived to the program.

Jack enjoyed listening to the book, 'Little Dinosaur' which described what the dinosaur did in a day. We focused on sequence. With leading questions, Jack was able to list what he does each day. In phonics, we continue to work on short a, i and o. Jack needs to be reminded to blend all sounds in the word. He did very well in determining which two of three pictures rhymed and was able to come up with an additional word that rhymed. Jack was pleased that he could read a short book that used the short a, i and o sound. He enjoyed participating in bubble making with the children in science camp. He also joined them for snack. We reviewed writing the numbers 0-5. Writing the number 6 was introduced today. Jack did well on a listening activity. We played the card game 'War' and practiced counting on from the greater number to add. In 'Math Seeds', Jack worked on cubes and spheres, matching word form and standard form and pictographs.

I arrived a bit early and observed Santino working with the O.T. for a few minutes. He was working on identifying words, when prompted, but he was more interested in the pointer and required several refocusing efforts to attend to the task. The therapist asked if I could change him into clean, dry undergarments, so this was the first order of business when we switched hands. I changed Santino into a clean Pull-Up in the classroom. Although initially a bit resistant, he soon allowed me to change him, and complied when asked to pull up his shorts. We then began working on the concept of big and little, by putting plastic tools in order by size, playing with sorting and stacking toys, comparing shoe sizes, since Santino's shoes were already off, and sorting plastic toy animals. Efforts to elicit speech were attempted and modelled, with intermittent gains noted. We also ordered straws by size, compared big and small letters and traced them, and we finished off the activity using 5 stackable boxes to order from smallest to largest. Santino initially seemed interested working with the boxes but required assistance and physical prompting methods to complete the task in accordance to expectations. When done putting away the materials used for the day, we proceeded to the kitchen to wash our hands. Santino began the steps necessary, requiring minimal prompts to assist him to dispense the soap. Obtaining the towel from the dispenser was broken down via task analysis and Santino grasped the concept of pulling down on the towel to remove it from the dispenser. He required a bit more assistance to perform the steps necessary to dry his hands thoroughly. I offered him a drink of cold water from a paper cup and Santino drank sips of it as I held it for him. I tried bringing it to his lips but not tipping it enough for him to obtain any liquid, which successfully prompted him to independently tip the cup higher himself to procure the water, and he then drank it on his own with minimal assistance. Santino continues to make slow but steady gains in the area of self-help.