I had the opportunity to observe Lena during her geometry class today - virtual class. Lena did a great job for about 45 minutes of the class! At the onset of the class, it did appear that Lena was worried for frustrated with the fact that Mom and Mr Larry were talking and it was tough to understand. During the course of the class, Lena once said "I need your help" & did so before expressing any frustration! I'd call that a win! Throughout the class, Cari took the lead on teaching Lena. From my observation, Mr Larry seemed to teach Cari, and Cari would teach Lena. Mr Larry did provide praise statements and did state when things needed to be corrected throughout. It did not appear that Lena was listening to or prepared to respond to Mr. Larry and primarily waited for her mother to repeat any directive. It was extremely difficult as there were no visual supports, which would be very challenging for Lena during a math class - and so Cari provided these visuals. Cari also narrated what Lena was doing making it so Mr Larry could be aware of Lena's process in solving problems. This is likely specifically a difficult of virtual teaching and not necessarily an in-person teaching difficulty. Some recommendations that I would provide include (I've written a lot here and I would recommend us discussing or planning out how to implement many of these before jumping in):
Lena struggles with admitting that she doesn’t know something or asking for help – and may get frustrated if not supported quickly. From observing a class, it seems that Lena would benefit most from very clear directives with limited extraneous language. She would likely benefit from a combination of visual plus auditory supports (following observation of a math class with no visual supports –other than that provided by her mother- I don’t think Lena would be successful without those additional supports).



I would suggest for teachers to be clear about some of the implied requirements of a class such as “take out your __ book and turn to this page”, “write this down”, “get out your science notebook” - and then be sure to give her time to follow through with this request before you move on.



Embedding check-in questions as the teachers proceeds with the lecture would likely be very helpful. For example when the teacher provides Lena with a new definition – state it. Then ask her using a fill-in the blank sentence, or just have her repeat the word so you can check in for listening, etc. It would be best to vary these so she doesn’t get frustrated with the same questions each time.



Lena’s tools that she does use appropriately should be heavily and quickly reinforced (not necessarily with praise but with what she wants). For example, if Lena asks for help in an appropriate manner, this should be quickly provided. As she gets more comfortable with asking for help, then this can be stretched out (the support can be gradually provided, just a clue at a time) and variably reinforced when this is stronger in her repertoire.

Likewise, breaks that she requests appropriately should be reinforced to reduce the likelihood of a situation becoming more escalated. In a math class I observed, Lena had done great for 40 minutes – then she asked for a timer to tell her how much longer the class would be, started paying attention less and asked for a nail file and started filing her nails. I would suggest the teachers (and mom if she’s present) look out for these times and go ahead and offer her a short timed break – then get back to it. In the class I observed, Lena was pushed through this (likely because she was doing so well thus far) and it ended with her getting more frustrated stating that she “hates” specific things about what they were doing in the class, voice increased in volume, more moans/groans, repeatedly asking for the bathroom and squeezing/putting hand to forehead. While the break was not offered prior to the more "escalated" behavior (it was never concerning but definitely was not a productive lesson at some point) Cari did an amazing job at coming up with a requirement and then following through! Because Lena was told that a break was not available until the equation was complete, -it was perfect (and necessary!) that Lena be required to complete the expected task.. and then the break be granted. This helps ensure that Lena is not reinforced for escalated behavior, but rather for the contingency set in place.

Another solution to this might be non-contingent break cards available at the start of classes (there are various ways this could be done where she has some to start, possibly additional ways to earn more, or not, etc). When she chooses to use a break, as long as there’s a break card available it is immediately honored. But, when she’s out or cards, – she's out. Some consideration might also be made for a rule of a break card will be considered “used” if she engages in certain escape behavior and is not participating in class for a period of time... but this should be closely considered as we don’t want this to evoke further problem behavior. (clear rules should be set before hand and warnings should be provided in
the moment).

Today I had the opportunity to observe Lena during her Japanese class. This was her first academic class of the day. Her mom, myself (as a silent observer), her Japanese teacher and Lena were all present. Lena seemed very engaged throughout the duration of her class! When many questions were presented to Lena (I'm unsure what the expectation was for her to be able to answer these independently), her mom would often whisper her the answer and then Lena would share. This didn't seem to be a quiz of any sort and there were a few moments for Lena to respond independently. Lena did respond independently in a few of the opportunities. Her mom also frequently would prompt her or suggest to her where she could refer in the textbook for the answers. When provided with this support to refer to a specific page, Lena was very quick to refer, find the answer on her own and respond correctly. When Lena errored occasionally, she would usually apologize but was able to easily move on - she didn't error frequently. Later in the lesson when neither Lena or her mother knew the answer, Cari (her mother) would model saying "I don't know" which the teacher would quickly reinforce by providing help or the answer. Lena seemed to not want to admit that she didn't know the answer - even if it wasn't something she was expected to know yet. Because of all of the swift supports, there was little opportunity for Lena to become frustrated (resulting in an all around happy and effective teaching session), but also few opportunities for Lena to independently select a mode of support on her own (e.g.: deciding to check her Japanese dictionary, asking for help). It would be helpful for us to come up with a way that Lena feels comfortable with saying she doesn't know something or to ask for help - we can work on this during our 1:1 times. It would also be a good opportunity for possibly Lena's mother to review some resources that Lena can use during her lesson, and then giving her increasing amounts of time to utilize these skills on her own before providing her a prompt. I would encourage slowly increasing the time delay on providing support, as a sudden decrease in support from her mother could likely serve to be upsetting and leave Lena feeling unsuccessful in her lesson.

Richard requested to draw a dragon following a step-by-step visual demo. With assistance he located the activity online. He choose 2 different images to merge together. OT only provided verbal cues and a few visual demonstrations of how to draw certain shapes. A few times he stated "i can't do that" but with practice he was able to compete entire activity with good accuracy. Drawing triangles and diagonal lines in various positions/angles was challenging. Sessions will continue to work on these visual perceptual skills.

Observations of Christopher were made during social interactions with other students during lunch and recess (outdoor patio). Christopher was eager to communicate with two older students and made several attempts to interrupt their conversation with off topic comments and questions. The boys ignored or dismissed Christopher's comments. The boys were both engaged in a game on their phone and only wanted to talk to each other. Christopher eventually gave up and announced that he was going to find his friend. He found his friend and brought him back to the lunchroom. Christopher then engaged in conversation with 2 students who appeared to be more his contemporaries and have more in common with him. There were still some one-sided exchanges, with Christopher bragging about various things. His friends appeared quite comfortable with Christopher to tell him, "yeah, we know, Christopher." After lunch, the boys went outside (older 2 stayed inside to play on the phone). Christopher demonstrated good initiation of a fun game to play. He demonstrated good problem solving skills to play in the covered area since the rain was coming down hard. The two peers and two younger boys wanted to play. Christopher had the idea to play "Among Us" like the video game but had a hard time describing the rules to the other 4 boys. He simply said one of us will be the "imposter" but no one will know who. One kid agreed and said "I don't totally get it but ok, lets play." There was confusion and running around like the game Tag. The boys seemed happy to have the activity and fantasy play. When some confusion about the rules came up, some kids got frustrated and Christopher tried to persuade them to "Just play." It was recommended that he establish the rules so there aren't "uncomfortable" feelings about the game and it was discussed that players like to know what to expect. Recess ended and they all agreed to try it again next time. One boy said, "there is a better way, we don't have to just do it Christopher's way." The four boys and Christopher all seemed to feel satisfied from the play and easily transitioned back to class. Christopher stopped the SLP and said "I know you from Ms. Donna's office." It opened up the conversation to discuss the social thinking curriculum used by Ms. Donna. Christopher was very familiar with it. As we discussed the interactions at lunch and recess, we had a quick pow-wow reviewing how we can handle challenging social interactions. I shared with Christopher that, I work with other students at the school and if he would be open to help in the social situations. He said "yes" and I said that I look forward to seeing him again soon. Some preliminary social goals would include: how to be part of a group and work together as a group, problem solving during moments of conflict, using a filter and understanding what should stay in the "thought bubble" and what is something we can say to others, expected/unexpected behaviors during lunch/recess, initiate and begin a back and forth conversation exchange, identify signs of frustration or awkward moments and have strategies to address them, engage in cooperative play and be open to other's ideas, understand compromise and when it is necessary during play, and how to respond to/resolve conflict appropriately without hurtful language. All mentioned goals are based on informal observation, brief interaction, and casual conversation. With parent and teacher feedback, more specific and appropriate goals will be established.

I observed the feeding therapist, Amanda LaPlante, work with Santino for 1/2 hour this afternoon. I will attempt to apply her techniques when feeding Santino.

Observation/Meeting with Maya's speech therapist Ms. Lynne to discuss Maya's strengths and needs and exercises to implement in everyday class work.

Observation with Lynne, Maya’s speech and language therapist.