Marcel was prepared to share some other challenging /r/ words such as "sir" and "sure." He says he uses those words a lot and wants to get them right. We again used the video recording to get feedback on production and help with adjustment of tongue placement and creating tension in the tongue to strengthen the sound. As compared to a volley in tennis. If you don't have a firm wrist and grip on the racquet in the right position, you won't have control and hit a strong volley. So by strengthening the tongue and engaging it in the right position, the sounds will be stronger and closer to the target. To expand our practice list, we discussed some of our favorites. After discussing music, we discussed how practicing some of our favorite song lyrics is a fun way to get in sound practice. Marcel shared his playlist and that will be a fun way to practice our speech going forward.

Richard was excited to get to work on his sounds so we could resume "Pokemon Go." While practicing s blends with 70% accuracy at the word level, Richard also worked on vocabulary by describing each object in two ways. He got comfortable sticking with the same describing words of shape and size, while we branched out to discuss use of object, feel, emotions, and other ways of describing picture cards. Richard gets comfortable with keeping it simple and needs urging to step up to a challenge and work a little harder. He is fully capable of it and benefits from the positive reinforcement.

Marcel was eager and motivated to tackle a strong /r/. Using the phone to record himself practicing allowed Marcel to really see and hear the difference between his production of /R/ sounds vs the target production of a strong /R/. Using the visual feedback and visualization helped Marcel get his tongue in the correct position for a strong /R/. We made a list of the "tricky sounds" and also reviewed a list of most frequently used /r/ sounds to target those first. He liked the idea of getting results faster by targeting the most frequently used sounds. Marcel was encouraged to practice a little bit each day and the established list of practice words was sent to him via text for easy access on his phone. Just like in tennis, the more we practice a certain shot with correct positioning, the more consistent it will be.

Christopher was frustrated during lunch to see his sister sitting at the other table with someone Christopher does not get along with. The students were not even talking - everyone was doing their own thing on their phones. Christopher could not take his eyes off them, he would not eat, and was texting his sister nonstop asking her "how could you?" Efforts were made to distract him by inviting him to engage in conversation with other students and even move locations. He was struggling to regroup. Encouragement to eat his lunch with reminders that "your brain needs food to feel good and make good choices." He eventually ate about half of the burger. He agreed to go outside with some other peers. The kids invited Christopher to play an obstacle course game. He was laughing and enjoying it. Christopher was reminded to focus energy on the friends who make us feel good and want to be with us. To reinforce those positive interactions, Christopher was coached to tell the friends, "that was really fun. Thanks for asking me. Let's do it again." One perceptive friend told Christopher, "you can be really fun when you're not mad." During the recap in Christopher's office, it was discussed how we can control with whom we spend time. We can't control the actions of others but we can control who we choose to spend time with. We discussed how we can have positive interactions with people who make us feel good and relaxed. We reviewed "giving compliments" and "saying kind things" - just as we like to hear those things, those also make the friends have good thoughts about us and want to spend time with us. Christopher fell into negative thinking but was not resistant to some of the suggestions for reinforcing the friendships that feel good. He claimed to know "all the tricks" from Ms. Lynne and Ms. Donna and that they don't work. We discussed how we can be detectives and continue to find strategies that will work.

Richard had a lot of energy and had difficulty attending to articulation practice. We set the goal of going outside with a fun new game once we hit 100 words of practice. Richard achieved 65% accuracy on s blends at the word level. He is getting better at hearing himself, judging the production and self correcting. As promised, we went to the playground with the help of "Pokemon Go" to move and practice more sounds. With lots of questions about how it works, Richard demonstrated patience and problem solving skills while learning his way around a frustrating game. It presented with opportunity to ask his peers for help at lunch.

Richard was seen at 8:30-9:30am for ST/language therapy. He was greeted by the SLP in his room. He was happy and quite talkative today. He reported he had a "sugary drink" at the coffee shop near school which may have increased his communication output more than usual. Overall, Richard required moderate cues to reduce rate of speech. We worked on his awareness of "too fast" or "just right" when he was communicating with SLP. It was evident that when Richard is talking about things he is interested in (i.e pokemon, dragons, etc), his rate of speech increases rapidly. He accurately judged appropriate rate of speech 3/5 times. He required frequent visual cues (SLP using hand movement downward) to prompt a reduction in rate of speech - which was inconsistently effective. In addition, articulatory contact with his articulators is noticeably weak during conversational speech. This was the primary goal targeted in today's session throughout all activities in addition to sequencing thoughts into verbal output. There was a lingual lisp noted 4x throughout the session which was corrected with verbal cues. When targeting /s/ and /s/ blends in structured task today, RIchard produced them accurately at 100%. We read a book aloud to target auditory comprehension, answering wh questions, vocabulary enrichment, social/emotions, and overall articulation. Richard did well overall however required increased prompts today.

What a great session today was! Richard was extremely involved and interested in today's lesson. He arrived on time. He was extremely communicative with SLP, and applied feedback appropriately. We started the session discussing the art/graphic projects he has been working on. This targeted connected speech and speech intelligibility at the conversational level. It is evident Richard speaks at a faster rate when he is interested/excited in the topic. Today, pokemon/dragons/art was being discussed, therefore - more verbal cues were required to slow rate of speech, which he did apply accordingly. Richard chose a book to read, while we targeted word finding, vocabulary enrichment, feelings/emotions, auditory comprehension and /s/ and /z/ at conversation. He was excited about this activity and already chose his book to do tomorrow. We covered date/calendar as well. RIchard was very excited and enjoyed today's session! I will see him tomorrow to continue to target speech and language.

Santino continues to happily arrive each session. He naturally responds to social greet and Ingrid's salutation. He hurriedly entered the office and reached for the closet door while requesting "open closet door" once more as he clearly had an intention in mind. To his surprise, the door was locked, necessitating a verbal chain to sequence acquiring the key and subsequently unlocking and opening the door. Verbal requests remain consistent within the session. Vocal volume has been observed to be intermittently low these past few sessions, with variable social reference within communication attempts. Lights were turned off, allowing the fluorescent hum to cease, while allowing only the natural sunlight to enter the room. This modification appeared to assist with eye gaze establishment. Requests for assistance continue to be noted with use of
"help me" and "help me + action" 2/8 and 6/8 respectively following initial phonemic cue this session. Periods of strong verbal rehearsal observed once again. 432 hz continues to be utilized.
Strong session once again.

Anticipated Chris' arrival at the scheduled time this morning. Mom messaged within the time window to share that they were not going to attend this morning.

Richard arrived at school at 8:45, reporting he was late because of a car accident. He was out for the majority of the week last week however said he wasn't sick, rather his "yawn was caught in his throat". He was in good spirits today. We worked on recalling events from this weekend. He did well explaining some fun activities he did over the weekend, requiring minimal assistance with organizing and sequencing. During that task and other tasks throughout the session, we targeted speech intelligibility in connected speech. He sounded a little more "muffled" today. His mouth is crowded therefore he has to work on over articulation especially with words with /s/. We targeted orientation/date which he did very well with today! In addition, to finish the sentence we targeted /s/ in conversation during a structured task. Not only did this target articulation, it was a vocabulary enrichment task. Although speech intelligibility was decreased today, Richard was very involved and his participation/attention was fantastic. Richard has requested more reading during session and reported "I love Llama books", which is GREAT! There are many goals to be targeted with reading!