Christopher's excitement was overflowing as he was so eager to share the many new gifts he had received for his birthday. Cues to expand use of detail and increased length of reciprocal cycles were successful. Supports to facilitate topic or "idea" shifts were successful as Chris utilized varied strategies to interject a new topic. ( "I have a new idea to talk about," "Lets talk about...now"). Expansion into more complex conversation with a focus on response to "why" questions was supported with maximum cues and prompts. Movement sequences were embedded across all activities this session to support attention and modulation. Categorical inclusion was strong as Chris provided related items and rationale to support semantic relationships.

Richard was greeted at the door by therapist. He happily entered the room. Richard was in a great mood today and required less redirection. Auditory comprehension was significantly better today with short stories! He achieved 11/13 independently! Excellent job, Richard! I will increase length of short stories to increase difficulty. /s/ blends were inconsistent today. /sp/ 0% independent, 100% verbal cue. /sk/ 80% independent, 20% verbal cues, /st/ 30% independent and 70% verbal cues all at the word level given a verbal model by SLP. /z/ was introduced at the word level which is the same placement as /s/ however voiced. There were some intermittent lingual thrusting (lisps) however significantly improved since /s/ was initiated at the word level. /z/ initial position 85%, medial position 80%, final position 90%! /s/ at the phrase level in initial position only was targeted today achieving 85% accuracy. It is evident when Richard slows down and focuses, his accuracy improves. Less cues were required during structured tasks however continues to require support during conversational tasks. Connect 4 was used as a "break" activity and Richard is demonstrating improvement with independence, social skills, and executive planning/functioning. Well done, Richard! Have a great weekend and keep up the great work on your sounds!

Richard was greeted in his room by therapist. He was happy today, enjoyed telling the therapist things he was doing at home this week. Auditory processing was targeted with 82% accuracy. 5 stories were read that were 3-4 sentences long. Richard demonstrated improved attention to detail and increased confidence in his answers. Well done, Richard! /s/ phrase was introduced today given he mastered /s/ at word level. Initial position - 65%, medial position 55%, and final position 90%. He demonstrated self tactile cuing and required reduced prompting from therapist. He is beginning to determine correct production versus incorrect. Between structured activities, Richard requested connect four game. He has improved significantly with that game as well. Fine motor deficits still noted. /s/ blends were targeted with the following accuracy: /sk/ 100%, /sp/ 40% and /st/ 80%. A lingual lisp continues to be noticed at conversational level however /s/ production has significantly improved. Richard requested to make a book so we intend on making a book the next few sessions targeting the words we have been practicing in therapy. Another great, cooperative session by Richard.

Richard was excited to see therapist but disappointed that lego box was accidentally left in the car. All of our sessions have begun with 5 minutes of free building while we discuss session schedule and goals of the day. He politely asked if I could go get the box. "It helps me get my brain ready." Reinforcing to Richard, that it is "awesome" that he knows how his brain works best, the lego box was retrieved from the car. He demonstrated some flexibility by suggesting he could read a book instead but legos were really the "best for my brain." We expanded on the topic of "knowing how our brain works" and talked about being flexible and problem solving if something does not go our way (like if the legos are forgotten). Richard's eyes opened wide and he asked "what else do you have to play?" His growth mindset was praised. He was excited to look at silly pictures while targeting our s and s blend sounds. When he got stuck with some tough sounds and seemed frustrated, we took a break to talk about the Pokemon poster. After that great distraction and regroup, he came back to speech practice with improved accuracy of 70% at word level.
Richard is a pleasure to work with and proud of his effort.

Richard was in a great mood and excited to begin the session with our warm up while building legos. Using the plexiglass between therapist and Richard, he removed his mask for practice. He is very conscientious and already self correcting. He still benefits from a model, visual feedback, and visual cues. With some phonological awareness exercises, Richard is really tuned into the sounds and differences. He is constantly asking questions for feedback. That kind of awareness and self knowledge will help his mastery of the target s and /s/ blends. Switching gears, he picked out a book called "What Should Danny Do?" focussing on the power to choose and understand how his choices will shape what kind of day he has. Richard loved it! It also led to good discussions about making helpful choices at school and home, even if "we don't feel like it." We also explored the character's feelings and discussed what we do when we have the angry or sad feelings. Richard demonstrated good self awareness of coping skills when he has those feelings.

Santino responded "Good Morning" in response to social greet as he once again confidently and knowingly initiated the transition into the office. He responded "Bye Ingrid" in response to the carrier phrase +phonemic cue "Ingrid's leaving"..... + lip closure for B paired with slight inhalation. Picture cues continue to be presented as communicative starter support. Santino continues to actively scan the room for desired items. He consistently points to an object clearly out of reach that he desires. Provision of phonemic cue to initiate verbal request within increased sentence structure of "I want + object/attribute +object is successful with noted responses 18/20 opportunities. Regulation of action has increased these last visits with noted use of action form following carrier phrases which support specific action 12/14 opportunities. Response to yes/no question forms continue to be supported as "yes " responses typically follow a model.
Santino continues to respond to varied natural directives within the context of play and natural conversation with a single presentation of the directive with 85-90% accuracy.
Strong session once again. Validation of his intent supports verbal responses with cues when needed. 432 Hz music continues to be utilized throughout the session.

Thank you to Elise as she assisted Christopher with connecting on line this morning. Christopher excitedly initiated sharing a new Mario toy as well as the plush toys that he had brought with him today. Strong focus once again today on expansion into longer cycles of reciprocal contingent conversation. Supports to facilitate topic or "idea ' shifts were facultative as Christopher utilized question forms to indicate a topic shift ( "Can we talk about.... now? ") or a direct comment ( "Ms. Lynne? I want to talk about .....now"). Tasks focusing on use of increased use of detail, and cohesive ties were supported through scaffolding. Item identification through provision of attributes was supported through prompts as max repetition of stimulus was needed. Categorical inclusion was strong as Christopher provided related items and rationale to support semantic relationships.

Both SLP's that are working with Richard communicated prior to his session today to discuss the goals being targeted by each therapist. These calls will be continued to ensure continuity of care. Richard was tardy today however all goals were targeted in session. Less breaks were required. He was happy upon arrival. Auditory comprehension was initially targeted by SLP reading 3 sentence stories clearly and slowly aloud to Richard followed by 3 'wh' questions. Richard answered with 7/15 (47% ) accuracy. He required verbal cues for 4/15, and incorrect response in 4/15. He continues to require cues to assist with this task. Repetition of the story may be beneficial. /s/ at the word level was targeted with the following accuracy: Initial position: independent- 85%, medial position: independent - 80%, and final position: independent 95%. These accuracies demonstrate significant improvement at the word level and it is appropriate to initiate phrase level for /s/ phoneme. That will be targeted next session. /s/ blends were targeted at the word level. /sk/ 40% accuracy, /st/ 20% accuracy, /sp/ 20% accuracy. /s/ blends will be continued to be targeted at the word level. Between each structured activity, Richard and SLP play games that also target executive functional and social language. Breaks appear to be beneficial for Richard's attention during structured tasks.

Richard was happy upon arrival to school. Auditory comprehension was targeted first. Richard demonstrated moderate difficulty with this task. He answered 8/14 questions accurately (57%). He required verbal cues to listen carefully during the task as his accuracy improved when he was making eye contact with the therapist during the short story being read. /s/ at the word level was targeted with the following accuracy: /s/ initial position 80% independent, 20% verbal cues, medial position 85% independent, 15% verbal cues, final position 85% independent, 15% verbal cues. Richard has made tremendous gains with his sounds. /s/ blends were targeted with the following accuracy: /st/ 1/5 (20%), /sk/ 5/5 (100%), /sp/ 3/5 (60%) at the word level given a verbal model. Richard required moderate redirection to stay on task today. Have a nice weekend

Richard was greeted by SLP. He was in a good mood. We started the session by informally assessing Richard's auditory comprehension. Three sentence short stories were read aloud and slowly to Richard followed by simple 'wh' questions about the story. Richard answered these simple questions with 50% accuracy (6/12). I will continue to target this in therapy. In addition, /s/ sounds were targeted with the following data collected:
/s/ initial: independent=70%, verbal cues =30%
/s/ medial independent=65%, verbal cues =35%
/s/ final independent=80%, verbal cues =20%
Production of /s/ sounds continues to improve as Richard was able to produce /s/ in all positions of the word with decreased multimodal cueing. When asked where the air should be going when saying /s/, Richard correctly responded with "straight, not out the sides"
/s/ blends were introduced today. He was stimuable for /st/, /sp/, and /sk/ in isolation with increasing difficulty at the word level. He produced /st/ at the word level with 2/5 correct given a slight pause in the word. A visual was used to elicit /s/ blends. Overall, Richard had a great session!