Santino continues to be encouraged to use gestures and body language to communicate what he wants and how he is feeling. Today, as he often does, Santino communicated his basic needs by leading me to what he wanted, posturing his body (body language), gesturing and/or producing vocalizations to relay the emotional intensity of his need or desire. He communicated his displeasure through vocalizations and communicated his joy and pleasure through smiles, giggling, laughter, and sing-song type vocalizations. Santino was reinforced whenever he repeated a word relating to an activity or skill in which we were engaged. He has become more interactive of late, and will sustain eye contact with me for longer periods of time. In all our activities, I repeat basic commonly used words over and over again and use them in a variety of different contexts, saying the word itself many times and then using it in two-word combinations to show how it can be used (modeling it for Santino). While saying the word, I also demonstrate the way that I expect him to use it and set up temptations that will encourage him to use it. For example, today I removed an activity with which Santino was playing and placed it high up on a shelf so that he could see it but not reach it. When Santino indicated he wanted it, and reached or pointed to it, I asked him, "What? What do you want?” - giving him time to see if he'd say it by himself - and allowing for several seconds to make sure I've waited a sufficient amount of time for him to reply. After this wait time, I modeled the word as a question and asked, “Do you want the ball? Ball?” While this technique to shape and model functional language has not as yet yielded consistent outcomes, it is anticipated that with time and patience, Santino will understand expectations, make the association, and produce the word (speech production). We ended the session by engaging in a hand-washing activity. I am gradually fading physical prompts to assess and facilitate the acquisition of skills needed to eventually perform this skill independently.

We began today's session by having Santino sort objects into categories (e.g., shapes, foods) to gain a sense of the concepts the categories represent (Florida State Standard LK.5.A). Santino participated in this activity and afforded guided hand-over-hand instruction on the task. Next, I read him a book and had him sit with me as I guided his attention to the illustrations and verbalized the person, place, thing, or idea depicted in the pictures. Santino intermittently repeated one or two verbalizations and was reinforced with a high five whenever he did so. Santino did not sustain attention to this task too long, but I refocused him to a puzzle activity, paired with a related story, and Santino was supported and reinforced when he would look at the puzzle piece depicted in the story, given verbal prompts. Santino ended the session washing his hands in the sink, given physical prompts for dispensing the liquid soap onto his hands and drying his hands with a paper towel. When the session ended, Santino was transitioned to work with the OT.

Santino was very contented working on his alphabet using the alphabet blocks. When it was time to clean up he was very cooperative.

Santino arrived in good spirits and was receptive to following this teacher to his room to put away his book bag. As he did so, I verbally identified the steps necessary to complete this task according to directions. (Florida State Standard SP.PK12.DH.2.1). We then moved to the instrument station and used different instruments to produce sounds. Santino participated in following some rhythms and was prompted to clap his hands and count to the music. We then moved on to a puzzle activity, which Santino made a good effort to assemble; he grew upset and vocalized his displeasure, however, when I tried to intervene and offer my assistance. Next, Santino became engaged with a hopscotch pattern which had been outlined in chalk on the floor and walked up and down, counting forward and backward as he walked. Following this, we played catch with a large plastic ball which Santino enjoyed rolling off the table, giggling whenever I caught it and threw it back. If it went out of sight, I would call his name, point in the direction the ball went, verbally identify the location and give directions to bring it back. It is hoped that with repeated practice and experience, Santino will become more familiarized with expectations to follow directives. We identified and reviewed spatial concepts as we engaged in this activity and ended the session with a hand-washing routine. Although he as yet requires physical prompting techniques to complete some steps, Santino is increasingly aware of the skill sets necessary to complete the task in accordance with expectations.

Today was a productive day. Santino was in a good mood upon arrival and responsive to guided instruction when given opportunities to select activities. We paired assistive technology with academic games to reinforce number skills and letter recognition. The use of technology and assistive devices have been helpful to facilitate communication in a meaningful and functional manner. (Florida State Standard SP.PK12.US.4.1). Santino became interested in an Uno game, and we used it to pair numbers with the dimpled numbers on a domino set while simultaneously engaging different sensory modalities such as sight, touch, and sound. A similar pairing was made between a Scrabble game and Flip-to-Win Bingo; letters from each game were identified and paired in efforts to consolidate emergent gains in letter recognition and reinforce visual discrimination skills. Santino clearly enjoyed today's activities; he was very vocal and animated, enthusiastically skipping to rhythmic sounds and gleefully duplicating movement patterns.

Santino appeared a bit tired today, but he responded well to this teacher and was in good spirits. I read him a book about Valentine's Day and Santino looked at the pictures and repeated the word heart. He seemed to want to remain lying down, so I read him another book about Valentine's Day before moving onto an alphabet puzzle. We identified various words beginning with the letter he selected but he did not select or point to any of the letters requested by this teacher. We next moved onto an object sorting activity, using a wooden peg board. Santino was to sort objects by observable properties, such as size, shape, color (Florida Standard SC.K.P.8.1). He was responsive performing this activity but this was contingent upon the provision of verbal and physical prompting techniques. Our last collaborative endeavor involved movement activity paired with his favorite CoCoMelon song, which matches colors to fruits that start with the same letter. Santino grew very animated as he listened and began skipping along to the music. He slipped while he was skipping and bruised his cheek on the side of an easel. No cut or bleeding was observed, and Santino whimpered for just a few seconds and reciprocated my hug allowing me to examine his cheek. I attempted to apply an ice pack but Santino pulled away and returned his attention to some colorful manipulatives left on the table without further incident. School administrators were notified and an incident report was filled out. We ended the session washing with a hand-washing activity before Santino was brought into the classroom to work with the OT.

Santino arrived to program in good spirits following a dental exam which mom said was traumatic - for her! She suggested outdoor play as he deserved it following the appointment and as it was a nice day, weather-wise. Santino was happy to comply. He immediately sprinted to his favorite activities, the slide, rung ladder, tire play and bridge - and he engaged in a game of follow the leader and "do what I do." As he mimicked my actions, I identified, analyzed, and evaluated the movement concepts, mechanical principles, spatial concepts, safety considerations and strategies/tactics regarding movement performance in a variety of physical activities - saying them out loud as he engaged in them - (Florida State Standard PE.K.C.2.1). On occasion, Santino repeated a spoken word; however this as yet remains self-directed. He requested my help to lift him onto the tire by reaching for my hand; however he usually self-engages in the activities and knows just what he wants to do. We proceeded indoors to clean up and after hand-washing, we played a game of "Flip to win Hangman," a wooden hangman game with 37 flippable tiles. Santino enjoyed the bungee-hinge design and was encouraged to repeat the name of the letter he flipped over. However, when I attempted to flip over letters, he vocalized his disproval and snatched the game out of my hands, so we continued with him choosing the letters and hangman body parts, which I identified after they were flipped. Santino grew a bit tired at the conclusion of our session and enjoyed playing with legos for the remaining few minutes until it was time to switch classes/tutors. It was a good day. Santino remained in a pleasant mood throughout.

Santino entered school bright-eyed, refreshed, and responsive. He allowed me to show him how to open the door using the code, given hand-over-hand prompts. We began with puzzle assembly. Santino chose to assemble a wooden puzzle using the numbers 1 - 9. He picked the number two and I observed him look to and from the puzzle piece to the design to figure out which pieces went together. Santino appropriately selected the two pieces that formed the number 2, but grew frustrated when he was unable to join the pieces and his attention drifted to a bin containing animals. We worked on matching animals with the sounds they make; Santino correctly said "meow" when shown a cat. This was subsequently reinforced by reading him a book aloud about cats, "Cat Count," - and pointing out different numbers and illustrations of cats. When food snacks were taken out of his book bag , Santino showed interest in a banana but didn't eat it once peeled. However, he did hand this teacher a creamy yogurt snack which he ate well when afforded physical prompts. We went outdoors and performed some movement pattern repetition and exercises which Santino enjoyed as evidenced by the frequency of his vocalizations and lots of smiles. He grabbed my hand when he wanted assistance jumping onto and off the high tire, and repeated some verbalizations when performing movements corresponding to the activity and given verbal prompts. We went inside and proceeded to wash our hands in the sink. Santino tried to play with the water but was re-directed to the task at hand and afforded physical prompts when necessary - to obtain soap from the dispenser and towel dry his hands. He finished up the day playing with a blue truck, and repeated the word "truck" clearly when shown to him.

Santino arrived to school very tired, but once in the classroom, he perked up and we bagan working on reviewing academic skills. Santino initially sat in front of me as we sorted different objects into corresponding piles so that I could afford him hand-over-hand physical prompts and guided instruction. We identified the objects by naming each verbally as we placed them into their corresponding piles. We then moved onto a stack-and-sort activity, using a wooden educational toy, offering a variety of colors, shapes, and quantities with which to encourage and develop skill sets such as: matching, counting, stacking, fine-motor/eye-hand corrdination, manual dexterity, verbalization and problem-solving skills. Santino rose to the challenge of matching the shapes and colors, verbalizing a few following verbal prompts and encouragement. It was a productive day.

After putting away our book-bag and securing the communication book, Santino was tasked with looking at this teacher and finding her picture and/or name. While he remains uninterested in this activity, a balloon, which in the past has proven to be an effective reinforcer, was used to facilitate eye contact and bridge the connection between the picture and teacher, as well as expectations. Santino grew distracted and we moved to a more physically engaging activity involving the replication of movement concepts in a variety of physical activities - locomotor, non-locomotor, throwing and catching, for example.(Florida State Standard PE.K.C.2.6). We then moved to an art easel where Santino was afforded hand-over-hand assistance to write his name using a chalk holder to facilitate grasping of the chalk and better enable the mechanics of writing. Santino was cooperative during this activity. Next, he gravitated to the alphabet blocks where he arranged several in a vertical column until they toppled as he was closely examining them. We attempted a color discrimination activity and Santino did repeat the color red when shown three colors, but he did not identify the other 2 colors upon request, nor point to or give them to me upon request. Again, hand-over-hand prompts, paired with their verbal equivalents, remained necessary to elicit performance expectations. During our time together, Santino grabbed my hand and led me to his bookbag where I took out two snacks. Santino chose a creamy yogurt snack (via handing it to this teacher)and I afforded him physical prompts to spoon it into his mouth. We then proceeded to the sink where he washed and dried his hands and drank some water from the faucet. We are continuing to work on these skills, with prompts afforded as necessary, until skill acquisition allows for the fading of prompts.