Santino was in good spirits today - refreshed and responsive. He articulated a few words which, while not prompted but generated of his own volition, were clearly spoken and understood. We are continuing to work on encouraging Santino to respond appropriately when prompted and continue to seek effective reinforcers to stimulate and motivate him. Santino ate 2 and a half creamy yogurt smoothies, and he went outdoors for a bit to enjoy a few of his favorite activities. We reviewed words that paralleled his actions while he played on his favorite outdoor equipment. Santino did mimic some verbalizations while engaged in physical activity. Ingrid came to get him and he responded to her offer for a hug prior to taking her hand and leaving.

Santino was very tired upon arrival. We found our place in a classroom and Santino fell asleep as he was read a story. We worked on a few academic skills using a balloon as a motivator and reinforcement for compliance with directives, but Santino was clearly tired and unresponsive to efforts to engage him. His OT was to be arriving at 1:30 to work on feeding techniques with him, so he was woken at least 1/2 hour prior to her arrival so he would be responsive to working with her.

Santino was in good spirits and well-rested upon arrival to program. He was happy to accompany me to the classroom and we placed his book-bag in its usual spot over his cubby. Santino worked on hand-over-hand puzzles to facilitate his ability to attend to a task and follow directives. He works best when afforded hand-over-hand guided instruction, and we worked on the activity as he leaned back up against me, between my outstretched arms. Shapes were verbalized and Santino repeated 2 shapes after they were identified by this teacher. We then moved on to replicating patterns. Santino followed my movements, placing one leg before the other, as we walked alternating legs following a straight line. The words, 'left' and 'right' were uttered repeatedly as he coordinated his feet correctly replicating the pattern and demonstrating good balance and coordination skills. Santino enjoys movement exercises which are often accompanied by music or singing. When we went outside, Santino squealed with delight and went straight to his favorite playground equipment, the big slide, where he experimented going up and down in different angles and positions. He has become adept at climbing up the rung ladder and we count to 7 as he climbs up. Spatial concepts are also repeated and reviewed so that he becomes more familiar with words and concepts such as up, down, over and under. When we went back indoors, Santino immediately proceeded to the sink on his own and prepared to wash his hands. He is getting better at lathering, and we continue to work together pushing the lever to dispense soap from the wall mounted dispenser and to dry our hands after getting a paper towel. Before moving onto his next class and teacher, Santino was prompted to repeat the 'mom' or 'mommy,' which we have been working on, and he did so. Santino was afforded verbal praise and high fives by myself and another older student who was passing by and heard him. Today was a rewarding, fun, and productive day.

Santino had to be woken up after he arrived to program, and his mother (correctly) anticipated he would fall back asleep or have a slow start to the day. He immediately went to lie down on the couch and remained unresponsive to efforts to get him to re-locate to the classroom; however, he was responsive to receiving acknowledgments and greetings, in the form of hugs, from several students, and he reciprocated their high fives after a few repeated efforts as he was clearly very tired. As he reclined on the couch, Santino moved my hand to lightly stroke his back and leg and made soft cooing sounds. If I stopped, he replaced my hand so that I would continue to provide the tactile stimulation. I read him an early reader book, "Little Bear's Friend," by Else Minarik, as Santino looked at the illustrations by Maurice Sendak. As I identified several common words, I encouraged Santino to listen to, retrieve, and imitate my speech and spoken language (Florida State Standard SP.PK12.SA.7.1). He did not imitate the cued words; however he was relaxed and demonstrably very content to look at the illustrations as I read to him aloud. When we proceeded to the classroom, Santino promptly laid down, covered himself with pillows and cushions and readily fell asleep, despite peripheral noise and distractions. As it seemed indicated, I allowed Santino to rest undisturbed for the remainder of the session.

At the onset of our session, Santino enjoyed looking at pictures in a Spanish book as different objects and features were pointed out to him as he turned the pages. I then had him stand in front of me and afforded him hand-over-hand instruction as we worked on identifying and sorting shapes and colors using wooden puzzles. Recognizing that learning can come from careful observation (Florida State Standard SC.K.N.1.5), Santino was shown a few basic shapes and encouraged to examine them, using his preferred senses. He placed the shapes vertically at eye level, passed them from one hand to the other, rubbed them against his cheek,and smelled them - all ways by which to obtain information about their shape, size, weight and physical characteristics. He was afforded guided instruction as the shape was verbally identified by this teacher and placed on the board. It is hoped that after successive trials and experience, Santino will be able to apply tactile discrimination skills, such as identifying differences in characteristics of three-dimensional objects regarding size, shape, texture, and weight, with prompting methods gradually faded. (Florida State Standard SP.PK12.VI.1.1). Santino was able to find the corresponding shape of an octogon in a bin containing environmental signs by picking up a stop sign. This indicates an ability to assimilate and transfer knowledge and recognize/locate geometric shapes in varying formats and settings (Florida State Standard SP.PK12.VI.5.4).

Santino was responsive today and made efforts to communicate his wants and needs. He grabbed my hand to indicate where he wanted to go and made an accurate assessment and connection upon realizing that a rope had to be untied in order to access an activity to use it and gestured for help to untie it. In addition, we are working collaboratively towards facilitating Santino's ability to use his own communication system, including alternative/augmentative communication or assistive devices to communicate and acquire information. (Florida State Standard PK12.US.4.2). Balloons and bubbles were used as reinforcers and a means by which to facilitate supra-segmented speech. Santino finished the session washing and drying his hands, provided with prompts for the latter.

Santino was in good spirits today, having slept well and having woken up 6AM, later than usual, according to his mom. He entered the classroom and we put his bookbag above a cubby in its usual place before obtaining the communication board from its usual location. Santino looked at the picture of the teacher after he was afforded several physical prompts, and then looked at her; however, he did not attempt to verbalize her name as he had done once or twice in previous sessions. I then took out bubbles and used my mouth to blow air into the plastic ring to produce bubbles. While doing so, I repeated the word bubbles, emphasizing the 'b' sound and pairing it with a blue plastic sheet that Santino had grasped to facilitate the connection between the 'b'sound in bubbles and the 'b' sound in blue. We did this several times to emphasize the formation my mouth made to produce first the 'b'sound and then the 'bl' consonant blend followed by the vowel sound 'ue'. Santino required prompts to sustain attention to the task, but he did mimic the 'b' sound upon several prompts. The aim here is to help Santino produce suprasegmental elements of speech upon request (Florida State Standard SP.PK12.SA.1.1). Santino enjoyed the bubble activity. He giggled initially but lost interest rather quickly. We then used the 3 colored plastic sheets to identify colors and although Santino did not identify the color when asked, he did show interest in a motor activity involving a square flexible piece of tight fabric with which to flex and examine its bending properties. We used it to review spatial concepts such as over and under,and up and down. Santino brought over his bottle, but he did not drink the water when it was filled. He did, however, drink quite a bit from the sink faucet when we practiced hand-washing and showed improvement in his hand drying motions when handed a towel. This will remain an ongoing objective in future sessions.

Santino arrived to school refreshed and alert today, having slept well. He responded to prompts to follow me to the classroom, and we took out the communication book to help Santino make a connection between my face, name, and to understand that he had me first on the schedule today. After this, we removed assorted objects from a bin and Santino was asked to show me, by pointing and/or picking up, the colored object requested and place it in the bin. He required physical prompts for successful achievement of each component, but he was responsive to physical prompts during the activity and during clean up. Next, we played songs and Santino was asked to repeat the movements identified in the song and demonstrated by this teacher. He seemed to enjoy this activity and galloped around the room in circles, as patterns and shapes were repeated and identified physically and verbally. Another activity involved assembling a 6-piece puzzle of a dog in which numbers were written on the individual puzzle pieces and their corresponding place on the base of the set. Santino put two pieces back on the puzzle base, achieving 33% accuracy on the task; however, he quickly lost interest in this activity so we returned to playing songs. Santino enjoyed the 'Ants go Marching In' and repeated the words, 'march', and 'hoorah' after hearing them spoken. He also enjoyed 'Old McDonald had a Farm'. We identified the animals from visual cues and then imitated the sound each made. Although Santino's progress was inconsistent, he enjoyed the song and re-played it several times while I introduced the plastic animals that were named at the appropriate times. Throughout our time together, Santino was asked to point to a snack or beverage if he wanted to eat or drink. Towards the end of the session, Santino picked the bottle off the table and I poured his bottled water in it and he drank some. We finished the day washing our hands in the sink, with prompts necessary to assist him to turn on the faucets and dry his hands; he seems to enjoy this activity and is aware and more familiar with expectations. While most activities as yet remain student-led, Santino has been in good spirits and an upbeat mood. He remains most invested in activities as learning opportunities when he is allowed to choose them and learns a great deal from his experiences with hands-on activities.

Santino arrived at program accompanied by both his parents. He was very tired when he arrived. His mom explained that he would probably fall sleep, and that he needed to, as he had woken up at 4AM and had been awoken after falling asleep in the car. I took Santino to the classroom and read him a story. He seemed comfortable and very relaxed while listening and he did fall asleep. Santino spent the remainder of the session engaged in low-key, indoor, academic activities due to his low energy level and the inclement weather we experienced today.

Santino appeared a bit lethargic today. He vocalized quite a bit as he was brought to the classroom, and afforded prompts to place his book-bag in its customary spot. Next, he was shown the communication book but averted his eyes and turned his body away during efforts to use it. Instead, we found a long piece of halved accordion tubing that piqued Santino's interest. I allowed him to to examine it, which he did by flexing it into different positions and viewing it from different angles. I then found a small ball which, when placed inside the tubing would navigate its shape and curves and come out the other end. I showed this to Santino once and asked him to try it himself, placing the ball in his hand and motioning in a curved fashion to indicate this request. Santino followed my directives, given both verbally and via gestures), and he grew animated and clearly amused as he replicated the action and succeeded in having the ball exit the tubing. He appears fairly adept at using spatial awareness skills and cues by which to orient himself and manipulate objects, and this skill will be reinforced in future sessions. (Florida State Standard SP.PK12.US.16.1). Santino was given a cup filled with water, but he did not show any desire to drink from it. He did, however, perform his hand-washing activity demonstrating increased familiarity of expectations and competence in lathering.