Santino returned to program in good health and spirits. He was very amenable throughout the session, which was begun in the classroom, using the communication book. While Santino did not follow verbal directives pertaining to identifying his teacher by pointing to her picture, he followed physical prompts and sustained attention when shown pictures of his teachers and these were paired with their names. We went outdoors following this activity. It should be noted that Santino appears to have grown increasingly comfortable with the equipment he chose to use. We paired concepts of up and down, over and under, bottom and top with exercises and movement, and Santino was responsive and engaged. He grew very excited after mastering the art of climbing up the 7-rung ladder, using alternating feet and hands with which to lift himself onto the platform, exclaiming "WOW," when he reached the top. He also appropriately exclaimed "WOW" when he slid down various slides upon reaching the bottom. Again, spatial concepts as up and down, and top and bottom were paired with their correspondent movements and actions, following which we proceeded indoors to perform hand-washing. Santino washed his hands thoroughly, assisted with physical prompts, which were paired with their verbal equivalents, when turning the faucets off and on. He is able to lather up his hands independently, requiring only an initial prompt, and we are continuing to work on drying our hands after obtaining a paper towel. All in all, Santino was cooperative, compliant, more responsive to directives, and he seemed genuinely happy to be back at the program following winter break. It was gratifying to see the gains that had been noted prior to break sustained and consolidated following his return.

Santino was absent today. He was out sick with a fever.

Santino responded to several cues when asked to follow this teacher into a different learning environment (classroom), requiring only one verbal prompt to do so. By providing him with a consistent schedule and verbal and physical prompting techniques, followed by their commensurate counterpart actions, Santino has grown more familiar with routine and expectations. For example, when guided by his teacher and asked to wash his hands, Santino will walk to the sink and demonstrate, though his behaviors, that he correctly anticipates the required skillsets with which he will be tasked. We have been hand-washing one or two times per session, and Santino has grown to enjoy this activity and execute it better. Today was the first day he transferred the paper towel from one hand to the next during the drying activity, and he was afforded a great deal of verbal praise upon doing so. While as yet resistant to working with his communication book, Santino has become more responsive maintaining eye contact, sustaining it for longer periods and displaying more appropriate affect when engaged in play. He appeared interested and more engaged when two children tried to involve him in physical activity on the playground, and he looked amused and giggled when encouraged to imitate them. He mimicked them and jumped after them as they hopped across the playground bridge and looked over his shoulder in anticipation of their next action. Overall, Santino appears better able to demonstrate understanding of information presented orally using listening skills, including paying attention to cues (verbal and physical prompts), and linking to prior experiential knowledge gained from a structured daily schedule and the consistency of routine. We concluded the session with Santino guided as he selected (7) peel-off letters in his name and applied them onto a smooth surface.

Santino was back in the program today after a two day absence. He was still under the weather and acting lethargic and a bit irritable. He did not wish to remain in the lunchroom to participate in the holiday party according to the tutor he had prior to me, so we instead spent time reinforcing the concepts of up and down, and over and under, and the like, using objects in the classroom and equipment outdoors. Santino and I explored some sensory-motor activities in the classroom, played the guitar, and I read a book to him, 'Count to Christmas.' He was unresponsive when I attempted to work on the communication book with him, pushing the book away and increasing the frequency and volume of his vocalizations indicating his displeasure with the prescribed activity. He grew more lethargic by the end of the session and lay down on the floor.

Santino was very tired today, having woken up "mad early" as described by his mother; she indicated that she thought there might be a good possibility he would nap. He was lethargic in class and I observed his eyes closing on occasion, so I allowed him to lie down in the classroom, lowered the light and and provided him with some pillows; however Santino did not nap. He took out some different shaped plastic pieces, but he made no effort to play with them, but instead lay on top of them and wiggled around, enjoying the sound and tactile stimulation elicited by his actions. I read him a book and he seemed to enjoy this activity; however it only lasted a brief while before his attention turned to the alphabet blocks which he assembled methodically. Next, I blew up a balloon I had saved for Santino and prompted him to name its color (orange), but Santino did not verbalize it. I have been trying to help Santino appropriately acknowledge an interaction initiated by others by giving an appropriate response - either verbal or nonverbal, and this objective will be continued. We then played catch with the balloon, but Santino only wanted to pop it, even taking my hand to assist him in this goal. He started to become a bit frustrated when it failed to burst, but enjoyed when I deflated it and allowed him to feel the air escaping. After I blew it up again, however, Santino eventually succeeded in popping it and seemed very pleased he had attained his objective. He did not wish to engage in working with his communication book today, nor did he show any interest in eating any of the snack options with which he was provided.

Santino behaved a bit tired at the onset of the session, lying down on the mat in the classroom, but after having a nutritious drink and a brief 5 minute rest period, he became more energetic and responsive. We began with the communication book and Santino was asked to point to and identify his teacher by picture and/or name; however he was not engaged in this activity and did not maintain eye contact when afforded verbal and physical prompts. When we transitioned to an animal identification task, Santino immediately went to the bin containing plastic animals and removed the elephant and giraffe from the bunch after their names were stated. He was awarded praise and a high five for this correct identification and response. We then proceeded to a hand-washing activity and Santino was compliant and allowed this teacher to facilitate his performance. He enjoyed lathering his hands using correct circular motions but as yet remains dependent on prompts to obtain paper towels and use them to dry his hands. He is as yet a passive participant in this daily living skill objective. It will continue to be performed in our daily work in order to reinforce emergent gains noted and help Santino understand expectations and acquire skills. Santino grabbed this teacher's hand several times today to lead her to preferred activities. When outdoors, Santino repeatedly grabbed her hand and led her to the slide. He insisted, non-verbally, that she go down the slide. When she did as requested, Santino was reduced to fits of laughter. He brought her over to the ladder several times more to go down it, but eventually understood she was not going to go down again and went down himself. Santino was subsequently brought indoors and assisted in a hand-washing activity once again. He is more comfortable having become more familiar with the consistency of this routine and more understanding of expectations. Santino ended the session tracing alphabet letters, wearing a hat he had found, and giggling when invited to engage in a hat exchange with this teacher. Santino was amicable and responsive today, sustaining eye contact for longer intervals and reciprocating initiated actions.

Santino was shown the communication board at the start of today's session, and he was asked to identify his teacher by pointing to her picture and name. While he remained unengaged in this activity, it will be continued in efforts to establish a structure and consistency of routine and expectations. We then moved on to sort objects, placing them in piles and subsequently into bins. Santino was afforded hand-over-hand assistance to facilitate this objective. Next, we listened to different music, and Santino selected the songs he wanted to hear. He first choose 'Old McDonald', and we matched plastic animals that corresponded to the animals mentioned in the song. Santino next chose a song about colors and matching fruits. He listened to this several times and correctly repeated three colors: orange, yellow, and green, and three fruits: oranges, pineapple, and kiwi that were paired with these colors. Santino showed improved eye contact while participating in this activity. He then grew interested in a puzzle, and dissembled the 25 pieces; however he was not interested in re-assembling it when this teacher attempted to assist him. We finished the session playing with a variety of different plastic animals. Using the communication board, Santino was shown a picture of an elephant and a giraffe. While he did not hand the animal over to this teacher when it was verbalized, he was observed looking at the correct animal from the assortment, and he said its name when it was shown to him. Santino was asked if he wanted to eat and was shown 3 different options from which to choose. He handed this teacher the banana pudding and ate it with assistance. Today proved to be productive day, with gains in eye contact and verbalization noted.

The communication board was used to familiarize Santino with expectations and improve his ability to point to his teacher. This is the third time it has been used, however Santino has not yet shown much interest in it, to date. He is shown photographs of his teachers, along with their names, and he may manipulate the name to place it alongside the appropriate teacher's corresponding picture. Thus far, however, Santino remains unengaged and will push the book away to indicate he does not wish to participate in the activity. It will continue to be shown to him at the onset of each session so he becomes more familiar with expectations and stucture. Next, we went outside for a brief period and Santino very much enjoyed going up and down the slide. The activity was paired with the verbalizations 'up' and 'down' in efforts to foster his language acquisition skills and verbal reproduction repertoire. Once indoors, Santino was brought over to the sink to wash his hands. He enjoyed washing his hands in the water and rubbing his hands together with the proper motion with soap; he as yet required prompts to dry them with a paper towel. For the remainder of the session, Santino assembled some puzzles during which he demonstrated good visual-spatial and fine-motor coordination skills.

Santino was in good spirits, animated, and vocal during our afternoon session. We began our work together with a hand washing activity. Santino was receptive and performed to expectations, requiring prompts to turn on the faucet, but lathering his hands independently. He is as yet afforded hand-over hand assistance to obtain hand towels and dry his hands. Santino then observed as this teacher arranged different colors in a pattern, pointing to them as the color was verbalized. He was shown the same pattern several times, accompanied by the verbal equivalent of the color pattern. Santino was able to repeat the names of two colors, orange and yellow, out of the five shown him. He was also shown objects of the same color (purple grapes, green kiwi, yellow banana/pineapple), which were verbally identified when paired in efforts to reinforce and consolidate gains. Santino remained engaged in this activity for 8-10 minutes. He then turned his interest to touching and feeling some of the different textures of surfaces in his proximity and finished the session by following this teacher skipping and jumping on a circle map, accompanied by some of his favorite musical tunes.

Santino was engaged in a variety of sensory-motor activities in the classroom today. He enjoyed the variety of textures introduced and visually examined various objects from different angles and perspectives. He particularly enjoyed placing the corresponding number of pegs in holes in wooden baseboards and demonstrated excellent fine motor and visual-perceptual skills. Santino grew a bit frustrated and annoyed as the sleeve of his shirt was long and interfered with his ability to manipulate objects; however, he was satisfied and resumed his attention to the task at hand after this teacher cuffed the shirt and moved it above his elbow, freeing up his range of motion and dexterity. Santino did not wish to engage at all with his communication book today when it was introduced to him. He did, however, seem to be in a musical mood so songs were played for him. He immediately piped in the letters B-I-N-G-O upon hearing the first few chords of this song. When Santino produces sounds in a meaningful way, his efforts are rewarded with high five and verbal praise. (i.e., when he identifies a color correctly or repeats a word following a prompt). Santino appeared to grow a bit tired at the end of the session; therefore, this teacher read a book to him as he sat listening on a chair. Santino enjoyed looking at the pictures and following along with his eyes. He did not opt to eat anything today although he was shown a variety of food choices.