Given the choice to work inside or outside, Richard jumped up with excitement to go outside. He wanted to play the same ball/riddle game from last week. He said he was going to make it really hard and "tricky." We had lots of fun and got in some excellent practice. Working on phonological awareness skills, he was asked to identify where the target sound was in the word (beginning, middle, and end). It was hard for him at first and then he took more time to study the work before answering. Other kids joined us during their snack break and he was excited to introduce the game to them. Richard seems to thrive with the extra social interaction and the new point system for strong, clear speech. Richard learned some new vocabulary from an older participant.

We took the lesson outside to play a little catch while practicing our sounds. Sensory and movement activities help the brain focus and studies have shown it benefits speech therapy. Working on good language skills and vocabulary, we had to give a clue about a word with an S in it and the other person had to guess it. Richard loved the game and one we added in scoring - with no point if not said with strong clear speech, he really paid attention and demonstrated increased accuracy. Other students appeared on the playground and Richard invited them to play. They wanted to play but not our game. So Richard was disappointed. With some guidance and a script, Richard was able to negotiate and find a way to play with them on a game everyone agreed to. "If you don't want to play my game, what are your ideas?" "I can try something new." 2 of the 3 kids were older which can be a little intimidating. Richard felt more at ease once he was invited to play their game and he was very happy.

Richard was greeted by SLP in his room. He was happy upon arrival. He put away his belongings and was thrilled to see a new bean bag chair. We discussed the date/month/day of week. Some social greetings/conversational skills were targeted as well. Following unstructured tasks, we completed the articulation tasks including /s/ at the phrase level and /s/ blends at the word level. /s/ at phrase level, the following data was recorded with fading verbal and visual cues: /s/ initial position: 70% independent, medial position 75% independent, and final position 80% independent. The other opportunities required verbal cues, such as "oops, I saw your tongue", "try again with your tongue behind your teeth", etc. With /s/ blends, the challenge is increased however, Richard did exceptionally better today. /s/ blends were produced at the word level with the following accuracy: /sn/ 100%, /sk/ 100%, /sp/ 80%, /st/ 80%. Richard was very focused during articulation tasks. New activities during his breaks between drill were introduced which appeared to increase his motivation during session. With auditory comprehension tasks, Richard answered "wh" questions with 64% accuracy. Overall, today was a good session. A lisp is still noted during conversational speech however improved with verbal cues such as, "I love that story - can you tell me again with your new /s/ sound".

Richard was greeted at the desk by SLP. He appeared happy and focused today! Initially, /s/ at phrase level was targeted with the following accuracy: initial position 85%, medial position 70%, and final position 85%. All other productions that were not independently accurate required verbal cues (which were minimal). Richard's self correction appears to continue to improve. He independently uses the tactile cue of his thumb under his chin to assist with lingual placement. With /s/ blends at the phrase level, accuracy decreased due to level of difficulty. The following accuracy was achieved: /sp/ initial position 2/6 trials, /st/ 4/6 trials, /sk/ 1/8 trials (increased difficulty), and /sn/ 5/6 trials. It was evident Richard had more difficulty with /sk/ due to the placement of the tongue for this production. With /z/ at the word level, Richard achieved 80% in initial position and 95% in medial position. Great improvement. I am proud of his efforts in today's session and look forward to continuing to monitor his progress in speech therapy.

Richard was greeted by therapist at his room. He appeared tired however denied being tired. We took a walk to the kitchen to fill the water cup for his flowers to get his body moving prior to completing structured tasks. He mentioned he was hungry so he ate an apple sauce pouch from his backpack. /s/ at the phrase level was targeted during our first structured drill task. He achieved the following accuracy given a verbal model: initial position of the word 70% independent, medial position 80%, final position 85%. He continues to do well with producing /s/ during structured activities however during conversational tasks he required max cues to correct the position of his tongue which he is stimulable for. Prior to working on auditory comprehension tasks, we discussed simple understanding of day of week, month, and year. A recommendation of a calendar and schedule was made to assist in the orientation to dates/schedule/etc.
Auditory comprehension tasks were completed with 70% accuracy (7/10). Overall, it was a good session. Richard continues to benefit from verbal and visual cues for improvement of speech intelligibility.

Santino happily responded "Good Morning," and rapidly walked right in to the office and sat down. Natural comment of "Santino, Ingrid has your backpack we need to get it and say good bye to her" prompted him to walk back retrieve his back pack and respond to her salutation. He placed the backpack on the floor, pointed to the closet and spontaneously requested " I want open closet door."
Choices now within his visual field, he pointed, and responded to the carrier phrases "Ms. Lynne, I ........" "want attribute +object for 6 consecutive items. Additional requests within each task were noted with 15/25 following use of carrier phrases and 10/25 spontaneously. Single noun labels predominated. Requests for assistance via use of "help me + action " was noted with use of picture cues paired with carrier phrase today. Response to personal choice question forms continues to be noted with increased frequency. Strong carrier phrase response within natural comment tasks ( It's time to..... "clean up" / Let's go get ...... "Ingrid ." ) 432 HZ music continues to be utilized. Spoke in greater detail with Ingrid at session close to support carrier phrase use at home. Wonderful session

Christopher was eagerly wanting to share the multitude of apps that he recently downloaded onto his phone. This afforded the opportunity to once again focus on conversational expansion highlighting expanded cycles of reciprocity. His intention was to list the names, and as comments /questions were shared he utilized the familiar strategies to support topic shift, ( "Can I tell you more? I have something to tel you ") as a tool to resume sharing the list. Supports to increase cycles of reciprocity were provided throughout the dialogue. Movement sequences were encouraged as to support use of cohesive links and transitional topic ties as additional topics were shared. Chris was feeling the excitement of it being his actual birthday today, and supports for attention were provided throughout the session. Strategies that included " Come to my thinking place and think together so we can have he same picture in our heads" was successful today.
Gentle redirection was provided throughout the session today.

Richard was excited for the new selection of activities. However, still enjoys the lego box while "warming up" for speech therapy. Richard was eager to show off the new words he learned and how they practice speech sounds at the same time. He also brought his Pokemon cards and wanted to to find his speech sounds in the cards while we learned about the different characters and powers. While playing a card game that focused on /s/ and /s/ blend sounds, Richard also named the language attributes that went with each card focused on many new adjectives and colorful describing words, to describe the colorful photographs. Transitioning to lunch time, conversation was facilitated with some of the older students in the lunchroom. He appeared happy to have someone to talk with about Pokemon.

Richard was greeted by therapist, he appeared tired today. He yawned quite a few times in the session however denied being tired when asked by therapist. He reported playing golf and soccer over the weekend however could not recall any other activities. /s/ blends were targeted at the word level. He achieved 100% with a model with /st/, /sp/, /sn/ however difficulty with /sk/ as he continues to demonstrate lingual protrusion past his dentition. Verbal modeling and cues appear to be effective in increasing accuracy. He continues to incorrectly produce /s/ blends at the conversation level unless cued. With auditory processing tasks and verbal cues to maintain eye contact during the 3 sentence length short story - Richard answered the "wh" questions with 85% accuracy. Between structured tasks, we did convergent naming tasks which he demonstrated some difficulty with, stating "I don't remember things very good". Finally, /z/ was targeted at word level. In initial position, he achieved 65% accuracy, medial position 85%, and final position was 80% accuracy. A lot of material was covered in today's session!

Santino once again responded "Good morning" as he confidently and knowingly transitioned into the office. Natural comment of "Santino, Ingrid has your backpack" prompted him to retrieve it and place it on the chair in the office. Upon entrance, Santino once again scanned the room curiously for desired items. Santino pointed to an item out of reach, and responded to carrier phrase "Ms. Lynne, I....... "
" want the yellow ducks." This cycle of requesting desired items this session repeated across 5 activities. Additional request for a familiar task not within his visual field was noted with spontaneous verbal " I want farm" Requests for specific items within activities was noted with carrier phrases 12/24, spontaneously 12 /24. Regulation of action sequences increased this session noted following use of carrier phrases 10/20 ( "Ms. Lynne let's..." "Open the closet door.") and use of single action with phonemic cue support 10/20.
Requests for assistance with use of "help me" was noted x6 given phonemic cue. Response to personal choice Yes/no question forms continues to increase, with single presentation of the question form: " head shake no" and verbal "yes" given supports. 432 hz music continues to be utilized throughout the session. Attentional shift for periods of increased sustained engagement continue to increase. Strong session...