Richard was slow to get into our work and only wanted to return to Pokemon Go on the iPad. He was reminded that he needs to do his work before we get the reward of the iPad game at the end of the session. We focussed on a game with WH questions. It was explained that knowing all the answers and being able to explain them are two different skills. We needed to work on the "explaining" the answers. Using a "real life" example from recess, he understood why explaining things is important. During recess, the kids change the rules to the tag game that they play. It is difficult for him to follow the changes but then explaining/advocating for himself when he suggests a change or wants to stick up for himself is helpful. He agreed that sometimes the kids don't listen to him on the playground. It was explained that it's not that they don't listen but perhaps they don't understand your ideas because we need to make your "explaining muscle stronger." He likes to feel strong and agreed that he could make that muscle stronger. Richard had a good session working hard to strengthen his language, speech and social skill muscles. He was pleased with himself and enjoyed Pokemon GO at the end of the session.

Marcel was not thrilled to be back in school after a relaxing spring break. He was honest and said that he didn't really practice during the break. We jumped back on the ongoing list that we have established of his "most challenging R words." He has it on his phone for easy access to practice. He is very conscientious and is able to achieve target production at the word level with concentration of tongue position and subtle adjustments to positioning. He sounds great to the listener when he makes the effort but he still feels it sounds weird. More home practice is encouraged to generalize the sounds to production in sentences and informal exchanges.

Richard was seen in his room on time. He was in a great mood. Richard and I targeted many goals in an unstructured way. We targeted possessives in many different situations. He even self corrected later in the session. When talking about going to his "Grandma and grandpa house" (omitting the "S"), he eventually began to correct himself and add the "s" when using possessives. We worked on conversational turn taking and asking appropriate questions to reciprocate conversations with communicative partners. He even initiated, "Have a nice day, Ms Amanda" independently at the end of the session. Richard enjoyed the day of week/month task today as he verbalized he is feeling more comfortable with the concept. In addition, we targeted /s/ in conversation with minimizing the cues required, rate of speech/intelligibilty, word finding tasks, and vocabulary enrichment. Overall, Richard had a wonderful session with me.

Santino consistently responds to social greet, and initiates salutations with increased frequency. He continues to arrive smiling and with a happy demeanor. He once again initiated transition into the office rapidly, scanned the room and verbally requested an item out of reach but within his visual field. Joint /parallel chaining was facilitated once again this session, as Santino regulated action within the activity in addition to requesting continuation and/or repetition of the activity. Use of increased form to include Action+object + locative (form) following initial model and subsequent carrier phonemic cue was noted 6/8 opportunities this session. Santino was able to call attention and request assistance with increased form "Lynne, help me + action " 6/10 opportunities, x4 with maximum cueing. He continues to encode "where (is) single object" given contextual sabotage with increased frequency 4/6 opportunities noted this session. Frequency of social referencing continues to increase within shared enjoyment as well as within natural contextual play. Expanded engagement to include the concept of "trade" continues to be noted. 432 Hz continues to be utilized. Spoke with Ingrid at session close as per usual . Strong session once again.

Chris was seen on line this morning as Mom had messaged last evening that the kids had been exposed to someone who tested positive over the weekend and needed to quarantine. Some initial technological challenges presented themselves today, however, Jamie was subsequently successful at establishing connection. Chris was quick to share the news that he had been "exposed" and that he needed to stay home. He then appeared extremely somber, and proceeded to share info from the media that he often watches regarding superheroes. He subsequently shifted his affect and shouted "April fools!" Chris continued to initiate a multitude of topics in rapid sequence with decreased allowance for reciprocity. Familiar support strategies were provided to assist with cohesive ties and reference. Attentional shift was extremely high today, and many responses consisted of statements "I don't know" and "one sec." Periods of non response were also noted, followed by unexpected topic shifts. Familiar discussion of Chris' perception of attentional shifting was highlighted. He acknowledged that it was "hard today," and that he was really tired and was unable to engage in movement tasks that often support attention.

Richard was greeted in his room by SLP on time. We started the session talking about his plans for the weekend & how his morning went. This not only targets appropriate social and conversational skills, but recalling events in sequential order and word finding. Richard states that he does not recall what he does at home the evening before the session (i.e. what he has for dinner, what he does for activities, etc) - he states "I don't know, I can't remember". We worked on word finding and vocabulary enrichment activities for a while this session as he demonstrates frustration and decreased executive function when he cannot recall specific words. Today, he was trying to explain he eats a breakfast sandwich with sausage on it but did not recall the word sausage and he became frustrated and deviated away from that topic to avoid the task. With verbal assisance, Richard worked through the task and felt much better. While talking about topic of interests, Richard was recorded a few times on the iPad to provide auditory feedback of rate of speech. When given the choices of "too fast, too slow, or just right", Richard identified his rate of speech was too fast and not as intelligible with that rate of speech. This auditory feedback appeared to be helpful this session. /s/ in conversation was approximately 70%, and decreased with excitement/fast rate of Speech. We targeted past tense verbs in structured task (70% accuracy) and unstructured tasks (60%). He did well with the day of the week/orientation task. Overall, he did well today and we targeted many goals.

Richard was greeted in his room at 9:00am. He reportedly missed his alarm to wake up. Richard did appear tired in today's session. There was frequent yawning and moderate verbal assistance to remain on topic and attend to task. As of recently, Richard's more advanced language and executive function skills have been targeted more in combination with speech/articulation. Today, possessive ('s) was worked on in structured and unstructured task. As expected, Richard demonstrated increased difficulty with unstructured tasks. Past tense verbs is often difficult for Richard, especially when recalling personal events. Richard often attempts to retell events however uses present tense verbs. Today, we began targeting that goal as well. Vocabulary enrichment and executive functioning is always a goal in therapy. Richard did well with date/day of week/orientation tasks today. He is becoming more comfortable with this. Rate of speech and /s/ in conversation is continuously inconsistent depending on the topic at hand. Rate of speech increases and intelligibility decreases with a topic of high interest. When asked to slow down or correct the /s/ production, he does so for the immediate following word/sentence but then quickly returns to his baseline. He continues to require frequent prompting. I have been in contact with Andrea (his other SLP) and Willow (OT) to maintain a collaborative and multidisciplinary approach.

Santino once again happily entered the office, although reportedly a bit tired, as he had woken up just a short time ago. He initiated social greet, as well as stating "bye' to Ingrid. He hurriedly entered the office and requested the familiar activity from the previous session. Joint parallel chaining was again facilitated as Santino regulated action within the activity, as well as to repeat the entire action sequence. He was able to call attention "Lynne" as the task began 2/8 times when purposeful facilitation strategies were employed. Instances of social referencing were strong once again, paired with action regulation as well as during instances of shared enjoyment at the close of the action sequence. Expanded engagement to include the concepts of "trade" were successful once again. Strong session once again.

Chris was seen following the week hiatus due to spring break. He arrived happily, and was eager to share the "updates" of the anticipated new movie release dates that we had discussed previously. He shared details of each movie, and sustained comment /comment cycles of conversational exchange regarding characters to the best of his knowledge. Conversational expansion continues to be supported by familiar cue supports. Sustained engagement was stronger this session, and affect remained more consistent across most topics of discussion. Expanded aspects of perspective taking and presupposition were supported today within varied language activities.
Stronger use of cohesive ties was noted. At session close, mom shared that Chris will be starting to participate in "School of Rock" after school.

Richard was greeted in the lobby on time. He was in a great mood, excited to discuss his spring break vacation. Richard explained that his family went to Panama City for vacation and it took two days to get there. When asked about fun activities, Richard was able to report they went to the beach and pool. Richard continues to demonstrate difficulty with verbally sequencing events. He demonstrates difficulty and frustration if the listener doesn't understand the exact point of the story that he is trying to explain. Richard requires verbal cues to back track his train of thought and to sequence in order of events that happened. This difficulty may also be due to limited vocabulary, he tends to repeat himself using the same vocabulary when trying to express the same thought in a different way which sometimes becomes frustrating for him. Richard produced /s/ in conversation level with ~70% accuracy. Inconsistent reduced articulatory contact was noticed which affects speech intelligibility as well as increased rate of speech. Day of week task was covered today with moderate verbal cues. Possessive nouns were targeted in conversational speech. In addition, we targeted emotions/social situations in a structured task. Over all, Richard had a good session. He continues to require verbal cues to reduce rate of speech.