Santino arrived in a terrific mood. He came in with a huge smile, and was very jovial, interactive, and happy throughout the session. We began by placing our book-bag in its customary location and planning our activities using a visual communication board. Santino and I went outdoors where he assisted me in watering the plants, given hand-over-hand instruction. We also planted a plant in a pot we found, using a spade to dig dirt, patting it down, and watering it. Santino participated in this activity but required prompts and guided instruction to perform successfully. His attention began to wander towards the playground equipment so I allowed him an opportunity to go on the seesaw with me and with another student who asked to join us. He also climbed up the ladders and went down the slides. We found a deflated yoga ball, in which Santino took an active interest, and we used it for various motor activities involving rolling, sitting, throwing and pushing it down the slide. Santino enjoyed these activities very much as they engaged his different modalities and the ball's physical properties piqued his curiosity and desire to experiment. We ended the session washing our hands and Santino initiated the correct motions to dry his hands using the towlette he was handed. Santino has been making slow but steady gains in and across several areas of his performance. For example, he engaged more actively with a peer in the playground today, was more responsive to requests to participate, and he clearly articulated "wash up,” as we went inside to wash our hands, following my prompt. I am suggesting that he wear a light pair of pants to school in order to minimize him getting bit by mosquitoes. Today, we used the bug spray on the exposed areas of his body, but he still got some additional bites. Mom has kindly offered to bring in more bug spray for Santino.

Santino was absent today

Santino was in good spirits today, April 1, 2019. He easily took my hand and allowed me to guide him to put in the code to open the front door. We placed his book bag on top of his cubby and left out some food and beverages should he wish to eat or drink anything during our session, which he indicates via gesturing or bringing the desired item to the teacher. Using the communication book, I paired Santino's picture with mine and showed him pictures of books, computer games, puzzles, slides, food and beverage, and a sink (for hand-washing), which were the activities planned for the day. I attached these pictures to the front of his communication book and verbally explained what we would be doing and the sequence in which we would be performing them. Santino was amenable and participated in most of the activities, when afforded guided instruction and prompts. He repeated a few phrases and words watching and listening to his favorite computer stories, and also did so when we assembled a puzzle based on a story as it was being read to him. Santino enjoys being outdoors and has been climbing the ladder to get to the top plateau of some playground equipment. We count the rungs as he climbs, and his directions are verbally articulated as he ascends or descends (e.g., 'Santino is going/climbing up up, up, "Santino is climbing/going down, down, down"). The word, "inside” is repeated whenever Santino goes inside a slide or tunnel, and the words "up" and "down' are repeated when we go on the seesaw. 'Hand' is articulated whenever Santino requests assistance climbing up the slide, and phrases such as 'please' and ‘thank you’ are used repeatedly during instruction. Santino was introduced to a new student today and returned his high five greeting. He was somewhat interested in watching him play badminton but preferred to watch "the Three Little Pigs' and "Mickey Mouse" on the computer, occasionally repeating some words and phrases, although these were self-initiated and not in response to prompts. Santino finished up the day washing his hands in the lunchroom sink. He continues to require practice to increase and refine his skills performing all the steps needed to perform this. Santino did not indicate he wished to eat or drink anything today and pushed away a bottle of water when it was offered to him. He transitioned to his next tutor smoothly after his hand-washing activity.

I followed Santino's interests today and allowed for and created situations on the playground which could facilitate increased social interaction and engagement with others. Santino has been sustaining increased eye contact and engaging with me more lately. In addition, his interest has also been piqued watching others play, and he will frequently be amused by their antics and giggle while watching. As of this time, however, he rarely engages in active play with others. We used Santino's visual communication board to sequence single-step actions and activities to allow him to familiarize himself with routines and understand what to expect in the course of the session. He does not show much interest in the board, but will occasionally focus on certain pictures and this is what I try to include in our activity list. We used animal toys and made animal sounds as a way to introduce and facilitate verbal communication and identify animals by the sounds they make paired with their name. Santino occasionally verbalized the sounds modelled by this teacher but as yet prefers to initiate activities that are self-directed. We proceeded to our hand-washing practice, and Santino demonstrated his recent skill acquisition but required some assistance in dispensing soap onto his hands and obtaining and using paper towels. When I offered him a cup of water and brought it to his mouth, he took 2 sips but refused further attempts to get him to drink more. We will continue to work on this skill in future sessions.

Santino easily adjusted back to his school routine after having been gone for a week during spring break. We settled in the classroom initially but went outside after he indicated through body language, eye movements, and vocalizations that he wished to start the day off outdoors. I used his communication book to indicate the 4 activities planned, and the order in which we would engage in them. Santino started out outdoors by pulling the rope tie that had been attached over the picnic table. As he pulled it, I repeated the word 'pull' with each tug. I repeated the word 'rope,' as well, to help him associate it with its word equivalent. While Santino did not say the word, he did look at the rope with his eyes whenever I said it. After we moved indoors, we continued pairing words with objects during puzzle assembly and story time. Santino repeated the 'oink' sound that a pig makes as he followed a story. He did the same with the 'meow' sound made by kttens make as he listened to the song, "Ten More Kittens Jumping on the Bed." These exercises familiarize Santino with speech, language, and phonetics, and he is verbally rewarded and given high fives when he either repeats a word, uses a word to indicate a want, or delivers/approximates a speech feature such as stress, tone, or word juncture that accompanies the speech to which he’s been exposed. Santino finished the session by gesturing that he wanted a drink, but he did not drink the PediaSure out of a cup, even when afforded assistance. He brought the cup to his lips on one occasion, but he did not tip it enough to allow the fluid to enter his mouth. We will resume practicing drinking from a cup or water bottle in the ensuing weeks.

Santino seemed a bit tired today. I tried to have him join in a small celebration in the kitchen with the other students on this last day before Spring break, but he was resistant and I did not make it compulsory. Instead, we put our book-bag in its usual place and obtained 2 puzzles, which Santino assembled - removing the pig and cow pieces at the appropriate time, given prompts, when either was mentioned in the story. He then listened to his current favorite, Three Little Pigs, on my phone app; he re-played it several times, saying a few key words and phrases arbitrarily that were self-initiated. Next, we went outside for a short while and Santino practiced his motor and balancing skills on various pieces of playground equipment. While engaged in activity, we practice saying the movements and spatial concepts exercised as we go up and down, over and under, through, inside, etc. While articulating the words, I modulate my voice up and down in accordance with the action, as if singing a musical scale. As Santino goes over or climbs up something, I increase my tone and scale, and when he descends, my voice will go down the scale. This is hoped to facilitate associations and connections between the words and their corresponding action. Santino washed and dried his hands when we came back indoors and requested a bottle via gestures. It was the second bottle of the day, and this time i gave him Pediasure. Santino finished up the session relaxing on some cushions as he listened to me read him two stories.

Santino was in a good mood and was attired in a dapper outfit today. He was agreeable and receptive to working with me on academic activities and tasks. He repeated a few words when prompted and when attainment of an object or game was contingent upon him articulating it or approximating the sound given as a prompt. When we went outside, Santino assisted me in watering some plants, but quickly turned his attention to the playground equipment and went down the slides and climbed up the wall using hand-grips. He has been engaging with me a bit more as well. He goes on the see saw and will look towards me to go on it as he likes being bumped. He also looked for my Evian sports water bottle and when I took it out of my bag, Santino remembered how to pull the cap open and he drank it. He needed to be changed out of his Pull-up after he soiled himself and I changed him into a fresh one and dry shorts (the shorts got a bit damp when he was drinking and during hand-washing). As I've noted before, Santino is a bit sensitive when Wipies are used, and he is neither happy or comfortable during the process. Today, he actually fell asleep right after I changed him and I allowed him to sleep for a while before Ingrid arrived to pick him up.

Santino played on the playground. When we came in he worked with the alphabet blocks and counted to 4 . His real interest was the train set which he spent time putting together.

At the onset of the session, I helped Santino identify the steps necessary to complete the routine task of putting his book bag in an assigned place atop his cubby in his classroom, assisted by and according to verbal and physical directives.(Florida State Standard SP.PK12.DH.2.1). He then sat down on the floor with a 6 piece wooden puzzle which he assembled as we listened to an app showcasing one of his favorite stories. Once this was done, we proceeded outdoors where Santino demonstrated his increased adeptness climbing up and down the slides and lifting himself up to the top platform using the handles on a vertical wall. He is extremely observant of depth and height - and other physical conditions that might affect his performance or success, and he does not take any unnecessary risks. Santino showed interest in a rope that was hanging over an iron table, and he figured out how to reach the rope by balancing on the table and grabbing onto a knotted appendage hanging from it. When he stood at a point where there was no overhanging ropes, I made attaining the rope contingent on him saying the word 'rope,' which he did for 2 or 3 different trials. We will continue to practice verbally shaping functional language in the hopes of reinforcing and consolidating acquired gains. We finished the session participating in what has become a now routine hand-washing activity, and Santino knows to go to the sink immediately after coming indoors from outside. He did not show interest in drinking from any water bottles today, but did take a sip of water from a dixie cup I gave him.

Santino was brought in by his mom today and readily took my hand and accompanied me to the classroom to put away his book-bag. After I showed him some of the projects planned for the session, using his communication board, we set out for outdoor activities. Santino enjoyed going up and counting the rungs as he climbed aboard the equipment leading to the slides, and he outstretched his hand when wishing to request assistance. I am attempting to facilitate and shape his verbalizations and speech so that he articulates the word 'hand' 'help', or 'please' when requesting assistance. Santino looked in my bag, which was open on a chair, and removed an 11.2 oz sport squeeze bottle of Evian water. I showed him how to open it, offered him a drink, and Santino drank from the bottle as I held it for him. We did this several times, and I then left the bottle on a table and pointed to it. I closed the cap and Santino untwisted the bottle and drank from it again. After I showed him how to flip open the top, which required a bit of strength, Santino was able to open the cap independently. He also figured out how to twist open the cap and drink from the bottle. Santino received accolades in the form of high fives, hugs, verbal praise and thumbs up by me and other teachers who witnessed him drinking so expertly. He then examined the bottle from different angles and experimented by taking some gulps, leaving the water in his mouth for a few minutes, and then spitting it out. In so doing, he got his shirt and shorts damp, but when we went inside, I changed him into a dry outfit and dried his clothes in the dryer. Santino finished the session listening to music and assembling a puzzle. He also gave me a bottle of Ensure indicating he wished to drink more. It was a very exciting and productive day, with Santino making huge strides in drinking from a bottle independently and engaging effectively with me.