Richard was in a great mood and requested to play the memory game from last session. He was proud that he was ready to work and had already had a snack. In connected speech, when Richard is excited and speaking quickly, he often drops sounds in words. Addressing his pace of speech, with some recordings comparing fast "racer" speech vs "slow, strong" speech, Richard was able to see the difference. He worked hard at applying these strategies during the session. Richard is also producing a strong /s/ sound in spite of the recent missing tooth. He has worked hard at getting tongue placement just right. To get some fresh air, Richard joined the short recess with the other students outside. He enjoyed the social interaction. A peer was cheating during the outside play and Richard did not like it. During the last 15 minutes of speech therapy, during a game of "Sorry", Richard was being a little "tricky" and moving his pawn extra spaces. It lead to a productive conversation about being honest and how it's not fun to play with friends/classmates who don't play by the rules.

Richard was greeted by SLP in the hallway. He was happy upon greeting, wanting to show his pumpkins - requesting to paint one. We initially targeted day of the week/month - Richard continues to demonstrate increased understanding of this topic while filling in his calendar. We targeted /s/ and /z/ at conversation level, which continued to be approximately 70%. There were a few errors with his lingual tip going beyond his teeth resulting in a "lisp". However, his /s/ has improved significantly. There were some errors noted such as /th/ yet that is not appropriate to target at this time as it would be contradicting tongue placement for /s/ and /z/. When /s/ was targeted at sentence level (self generated sentences), Richard achieved 90% in all positions of the word. When /s/ blends were targeted at sentence level, he produced them accurately with 80% accuracy (improvement). We targeted social interactions today regarding how to respond appropriately to specific situations when he is feeling defensive. Richard responded well to that task. Overall, his speech is improving at a good pace.

Santino continues to happily respond "Good Morning" as he eagerly enters the office. Variation in natural comments to direct his attention to retrieving his backpack from Ingrid continue to be facilitative and as the session commenced he initiated the salutation "Bye Ingrid " spontaneously.
Spontaneous requests for desired items were noted 6/6 opportunities. Requests within each activity were once again strong, characterized by color/size + object 27/30 opportunities, 3 opportunities with use of phonemic cue. Spontaneous request for assistance was noted "Lynne, help me" once, with 3 additional requests "help me" given phonemic cue. Santino was able to successfully sort items within tasks into 2 groups with support 6/10 following 4 initial models. Response to personal choice yes/no questions were noted with single presentation of the question to elicit a head shake "no" x 8 opportunities. Social referencing was noted x6 instances in response to carrier phrases at session close. 432 Hz continues to be utilized. Sessions continue to be strong,

Chris was eager to share a very comprehensive Christmas list that he had generated. This afforded the opportunity to utilize his most motivational interests to be used as the components for expanded use of descriptive concepts, similarities and differences as well as categorical inclusion and exclusion. Allowance for conversational reciprocity continues to be supported strongly. Periods of attentional shifting were strong today as the activity transitioned to topics outside of his most motivating interests of Mario/gaming/and videos. Expanded discussion of the familiar terms of "thinking together' etc. were presented. His desire to remain focused on Mario was strong today as his requests to redirect the focus included "I need to finish what I'm telling you, What I'm trying to say is... ." As the session time was nearing a close he "needed" to go to the bathroom, upon his rapid return he hurriedly and worriedly asked if it was "ok to get off now" he forgot to do his homework. Brief discussion ensued and then he expressed appreciation and we closed the session.

Richard was in a great mood and gave an enthusiastic greeting. Richard was very talkative and shared some stories of a game he liked to play on an iPad. He was not ready to switch to lessons, so Richard was asked to identify /S/ words in the game to keep him focussed on speech goals. He liked that game and claims to be "really good at being a detective." Transitioning to a Minion memory game, focus was on speech and a good informal assesment of Richard's short term memory skills. He was determined to remember where the cards were and together we established some strategies for "remembering tough stuff." Richard entered the lunch room, unsure where to sit. With some cues for conversation starters, he was able to participate in conversation with some of the older students.

Richard was greeted in his room by SLP. He was eager to tell me he lost his front tooth. He expressed he wouldn't be able to "work on his /s/ sound anymore" however today was a GREAT day for Richard. His /s/ in conversation was in fact the best I have seen to date. He produced /s/ accurately in all positions with approximately 70% accuracy (even with a missing front tooth). We targeted /s/ at the sentence level in which Richard was directed to self generate sentences given a picture and he produced /s/ in all positions with 100% accuracy during this structured task. His progress is quite fast. /s/ blends continue to be more challenging as he omits the second phoneme in the blend (i.e. "sunk" for skunk"). We targeted /s/ blends at the phrase level given a verbal model with the following accuracy: /sk/ 5/8, /sn/ 6/6, /st/ 1/7, and /sp/ 3/6. Self awareness of correct and incorrect production has improved. With auditory comprehension tasks, a 4 sentence short story was read aloud, Richard answered simple "wh" questions about the stories with 62% accuracy, requiring moderate verbal cues/prompts. Richard was very pleasant and cooperative in today's session! Way to go, Richard.

Santino once again happily responded " Good Morning," and rapidly walked into the office. Provision of natural comment " Santino, you need your backpack, Ingrid still has it," prompted him to retrieve it and respond to her salutation. Santino once again pointed to the closet and requested "I want open closet door." Choices once more within his visual field allowed for numerous opportunities to indicate desired items. Request for desired items was noted with familiar carrier phrase use across 6 activities within the session. Spontaneous requests within each activity were strong this session, noted with 28/30 opportunities with use of expanded form which included 2 attributes +noun label. Request for assistance was noted via use of "help me + action" 5/6 opportunities given phonemic cue support. Choice making within presentation of binary choice with a focus on size concepts, as well as concepts of loud/quiet, on/off, over /under was noted with 5/8 opportunities. Use of delayed echolalia was noted with increased frequency this session, and social referencing was variable. 432 Hz continues to be utilized. Increased spontaneous verbalizations noted today.

Session commenced late today as Christopher arrived late for school. Christopher was eager to connect and share new items that he had with him today. He initiated "sharing his thoughts" with the request "Can I talk about it"? Strong focus on continued support of conversational expansion, highlighting cycles of reciprocity, as well as supporting use of descriptive concepts and cohesive ties. Allowance for expanded cycles of reciprocity was strongly supported today, as responses to questions/comments were facilitated with cues and prompts. Gentle redirection was provided throughout the session.

Richard was greeted by therapist on time. He appeared happy. We discussed day of week/month. We completed the auditory comprehension task in which Richard answered with 90% accuracy. He continues to improve with auditory comprehension tasks. I will continue to increase difficulty and length of the short stories being read aloud. In addition, we worked on /s/ at the phrase level achieving the following independent production - initial position, 90%, medial position 90%, and final position 100%. We will be targeting /s/ at the sentence level as he continues to improve /s/ and /z/ during structured activities. He continues to protrude his tongue past the dental and labial border resulting in a lisp at conversational level. We also did another day of a book activity targeting /s/ blends at a less structured setting given a delayed model, for example "the pumpkin was square", SLP states "the pumpkin was ____?" with Richard filling in the carrier phrase. He produced /s/ blends independently correct in 9/14 opportunities. We continue to target turn taking and social appropriateness during "games". Richard becomes upset and frustrated if he loses a game, however we have been working on responding socially appropriate when he loses. Have a great weekend.

Today was such a fun & productive session for Richard. He was greeted by SLP in his room. He reportedly forgot his backpack at home. We started the session targeting /s/ and /s/ blends doing a book/craft activity. We read a book called "The Legend of Spooky the Square Pumpkin" (a fall themed activity). SLP read the book aloud, asking simple "wh" questions along the way. Richard answered 4/5 questions correctly. He thoroughly enjoyed this book. The book had over 20 opportunities to produce /s/ blends, in which he independently produced ~50% correct at conversational level! The other 50% required verbal cues which was effective. /s/ and /z/ during this was also targeted with cues. We made a pumpkin craft that Richard named "Sparkles" which is great to target /sp/. He LOVED this. We used paper, scissors, markers, glue and glitter. Beyond our seasonal book activity/craft, we targeted /z/ in all positions at the phrase level with the following independent accuracy: initial position, 70%, medial position, 60% and final position, 100%. He continues to make excellent strides in the area of articulation therapy. As previously stated, when he gets excited/tells a story - the frontal /s/ lisp in more prevalent however improves with verbal cues. Great session, Richard!!