Santino arrived to school appearing very tired today. When his mother brought him in, she mentioned that he had woken up very early, had a very active morning, and said she would not be at all surprised if he needed to nap. As soon as Santino entered the classroom, he lay down, removed his shoes and socks, covered his eyes with his hands, and lulled himself to sleep in a matter of minutes. I had given him a pillow on which to rest his head, a bottle of Pediasure, and covered him up, and Santino quickly dozed off without ever even drinking from the bottle. When he awoke, he was still very groggy, but smiling and in good spirits, so I read him a few books while he continued to rest. We finished the session making crayon rubbings using various materials and templates. Santino sat at the table and used crayons to experiment with different surfaces. This allowed him to practice shapes and numbers, exercise the small muscles in his hands, and improve his eye-hand coordination. Santino seemed to enjoy this activity and he was afforded assistance with hand-over-hand prompts.

Santino and I worked in the classroom on educational games and activities. He continued to work on sorting objects based on shape and color, but we also introduced and added food items as a separate category. Santino repeated a few words as I narrated and assisted him with hand-over-hand guidance and prompts. Next, we worked on a puzzle activity requiring matching skills. I helped Santino pair objects with their match, such as bird with a bird nest. Santino enjoyed working with the cards and assembling the matching pieces. He demonstrated very good perceptual skills, visual motor abilities and bi-lateral and eye-hand coordination. I narrated what he was performing and verbalized the objects he was pairing together. I then had him work on a tracing activity. Santino was able to trace what I had written on construction paper using a crayon; however, he needed a bit of verbal and physical prompts to remain focused and complete the task. We finished our work together playing musical videos that reinforced some of the words used repeatedly today. Santino repeated a few articles of clothing in a clear articulate voice. As he appeared a bit tired today, I chose not to include any outdoor activities on the visual communication board, and we spent our time together in the classroom. Santino was afforded verbal praise and high fives when he sat focused and engaged in activities for a sustained amount of time.

After helping Santino place his book bag above its proper cubicle in the classroom, I identified some activities planned for today's session, using the visual communication book to outline them. We began with a matching activity, as sorting activities tend to appeal to his preference and need for order. Santino was tasked with putting like items in their respective containers, which he did when afforded physical assistance, as I verbally narrated what we were doing and identified how they were matched (e.g., color/shape). Next, I helped Santino use a crayon to execute the fine-motor skills necessary to trace the letters of his first name. This was followed by a musical activity using various sound-producing instruments and objects with which to focus and sustain Santino's attention and incorporate fine motor, listening, and sensory integration skills. We concluded the session by singing the "Clean Up" song, which alerted Santino that the activity and our time together was concluding. After putting all the materials back, Santino brought me his bottle, which I filled with Pediasure, and he spent the remaining few minutes comfortably drinking it as I read him a short story.

Santino engaged in various classroom academic activities for the first hour. First, I had Santino seated at a table and he demonstrated good visual perceptual skills and problem solving abilities in puzzle assembly and matching objects, given some minimal physical prompts. We next interacted by producing music with different instruments and spent a good bit of time engaged in musical rhythm imitation; Santino picked and strummed at the strings of a guitar as I banged on tambourines using a rhythm stick. I narrated throughout the session and Santino occasionally repeated my words and phrases, especially when they were spoken in a singsong voice. We spent some time outdoors for the latter part of our session time together, and Santino enjoyed having me hold his legs as he balanced moving back and forth on a on a wedge and assisted in completing a forward roll. He enjoyed this activity, especially as he grew more familiar with the movements he could expect. Once inside, we washed out hands and Santino handed me his bottle, indicating he wished to drink some Pediasure. He relaxed for the remaining few minutes of the session as I read him his favorite short stories.

Santino sat at the table and was afforded hand-over-hand guided instruction to trace the letters of his name. After doing so, he was given two different puzzles involving numbers, and he had to put the pieces together. Santino enjoyed this activity in the past and today was no different. He demonstrated very good perceptual and problem-solving skills, understood what was required, and looked from the picture of the symbol (the model) to the pieces, able to figure out how to align them correctly to form the number. Santino is able to sit for at least ten minutes while working on this task. We followed up with some outdoor movement activities, and Santino then helped me water the plant we had planted together and which had grown considerably. He touched and examined the leaves and the pot, which had cracked from the roots growing, and he listened as I narrated what had happened and why. When we went indoors, Santino washed his hands, vocalizing happily while playing with the soapy water. He got his clothes wet, and I was changing him into a dry pair when Ingrid arrived to pick him up. Santino was hysterically laughing at this point and enjoyed imitating movements I was making as if mimicking and dodging those he was making. Ingrid joined in the fun and Santino left in jovial spirits as a now dry and comfortable camper.

As Santino has been particularly receptive and responsive to music and sound of late, he was reinforced for reproducing several melodies and a few phrases after hearing me produce or repeat them. He was in good spirits and giggled and laughed frequently. I had him trace over his name on paper with a marker, which he was able to do when afforded physical prompts. He enjoyed manipulating the visual sensory pad next, and listened as I narrated the objects as they appeared on the surface. Santino has been more responsive to other students who attempt to interact with him and returned a hug and high five given to him. He spent several minutes at the sink practicing dispensing soap from the dispenser; as two hands are required, he as yet needs a bit of guidance to push with one hand while holding the other underneath to catch the soap, but he initiated the correct movements today and enjoyed making bubbles with the soap. He also has been doing a better job cleaning his hands and has been making a better effort drying his hands correctly with a paper towel. While at the sink, he repeated a few phrases sung to him, and this appears to be an effective technique by which to elicit and reinforce speech. Santino continues to be responsive to tactile stimulation. He enjoys getting his back rubbed, and he will take one's hand and place it on his back when he wants to be massaged and will do so repeatedly to indicate that he wishes the stimulation to continue. He has been making more contact with others overall and made gains in sustaining eye contact. Overall, Santino appears familiar and comfortable at the school and his routine, and he continues to warm the hearts of those who meet him.

Santino was vocally responsive today. I used verbal imitation and contingency strategies to increase his adaptive behaviors, compliance, and functional speech. As he was particularly vocal, I repeated the same sounds or words that he initiated, like an echo, which in turn stimulated him to vocalize more. I then introduced a few novel words to encourage him to repeat the pattern of imitation. While results have as yet been inconsistent, this type of engagement serves to engage his attention as well as shape speech. When inside the classroom, we worked on activities involving the systematic repetition of music and movement, and we continued the activities when we went outdoors for a brief time. Santino has been more responsive and readily compliant when shown an outstretched hand to return indoors and repeated, "Let's go," after me when I said, "Okay, let's go." When we returned indoors, Santino brought me his backpack and took out his bottle. After I poured in the Pediasure, I held it within sight but out of reach, attempting to elicit the word, "please, or the 'p' sound. I did this repeatedly without achieving the desired response; however, Santino did not grow frustrated as he used to when he first began in the school. I continued to hold the desired object out of his reach, hoping to elicit an approximation to the word 'please'. Finally, I said, "Come on now, say please," and Santino readily repeated the phrase, "Come on now!" He was reinforced with verbal praise, a hug, and a high five for his echoic verbalization. Santino appears to absorb a vast amount of information through imitation and repetition, therefore vocal imitation strategies will continue to be employed as an effective technique by which to stimulate and elicit speech and adaptive functioning.

After placing his book-bag in its rightful spot, Santino gravitated towards the objects and items he's been most interested in of late. These include a thin plastic piece of white bread, and a sensory pad. I was able to elicit the 'b' sound with repeated prompts, but Santino was louder and more vocal today and clearly very amused with himself after repeating several loud shrieks. We used the picture board to identify the activities to expect during the session, and when Santino chose a picture of the slide when presented with options, we went outdoors to the playground to reinforce the connection. Once outside, Santino jumped on a trampoline that was there, as it was new to him, and jumped up and down a few times, given physical assistance. I narrated his actions and repeated the words, ‘up’ and ‘down’ as he performed the movements to facilitate the association. This was also done when he went up and down a slide. When Santino attempted to climb up a slide, he gestured for my hand to assist him, but did not verbalize the request despite repeated prompts. Once back indoors, Santino satisfactorily washed his hands and made a very good effort to dispense soap from the dispenser; however, he handed the paper towels back to me to help him dry his hands. We finished the session producing musical sounds with various instruments, and Santino made an effort to duplicate the sounds of an ascending musical scale that I sang by imitating some of the sounds. He was reinforced with high fives, thumbs up, and verbal praise whenever he succeeded in doing so.

Santino had his shoes and socks off when I entered the classroom to begin the day's session. We began by engaging our senses with visual and tactile stimuli, squeezing a gel pad and verbally identifying the objects that appeared at its surface. The gel pad focused on the letter 'F,' which nicely segued into looking at the Beta Fish and reinforcing the sound the letter 'F' makes. We also read words to a song written on a chart to the tune of Jingle Bells. All the words beginning with the letter 'f' were circled and emphasized when pointed out to him. Santino repeated the word 'fish' once while engaged in this activity. After re-focusing him to the gel pad, I named the objects beginning with the letter 'f' that appeared when he squeezed it. These included, French fries, a football, and a fish. When he grew tired and laid down on the mat, I let Santino continue to explore the gel pad while reading him two books, 'The Foot Book', by Dr. Seuss, and 'I love you, Grumpy Bunny.' Santino seemed more refreshed after about ten minutes of reading so we moved onto an alphabet puzzle. He removed all the letters and re-arranged them, in correct order, on the rug. He then began to re-assemble the puzzle, but only got as far as the body of the butterfly and one or two letters before losing interest and re-focusing his attention elsewhere. I helped him assemble a few more letters with physical prompts and together we put the puzzle away while I sang the cleanup song. Santino finished the session engaged in a musical activity, strumming a guitar and hitting a drum. He enjoyed feeling the vibrations from the guitar and listened as I created different pitches using different parts of my hand and palm. He also enjoyed listening, watching, and feeling the strings vibrate. Santino left in good spirits when the hour was up.

Santino participated in the Easter egg hunt at the school today. Although encouraged to actively participate in the hunt, Santino preferred to watch the children search for hidden eggs and did not engage in the search, even when guided by this teacher. However, when Santino was given a few eggs by other students, he enjoyed opening the plastic eggs and listening to the objects rattle inside when he shook them. Using movement to filter out extraneous sensory information has been a beneficial strategy with Santino. It helps to calm, regulate, organize and orient him and also improves his focus. After we went back inside, Santino enjoyed manipulating a sensory simulation gel pad containing small beads and objects floating in a gel suspension. He drank a bottle of Pediasure and played with the pad, which engages his tactile and visual sensory skills with its bright and colorful objects he can touch, feel, and see in the suspension. It also involves his eye-hand coordination, finger strength, and helps improve manual dexterity while sustaining focus. I read a book to Santino (‘Hopper's Easter Surprise’), as he played with the pad, and drank his bottle. He appeared content, satiated, and comfortable for the remainder of the session.