Ben initiated an immediate request to finish the brief video he was watching as the session commenced, this allowed for subsequent discussion regarding video, movie, and tv preferences and dislikes. Conversational expansion was facilitated through use of carrier phrases and indirect questioning strategies. Subsequent presentation of casual games was once again utilized as a tool to engage interest while simultaneously encouraging further conversational expansion with emphasis placed on use of expanded contingent utterances, perspective taking and presupposition. Additional focus was placed on the dynamics of indirect and figurative language. Once more, supports were provided, as these areas reflect increased linguistic demand.

Christopher initiated the session rapidly by excitedly sharing his costume for the talent show.
He was eager to perform his routine. Sequential breakdown was supported, and he "performed many moves" with his sword props. He was rapid in his presentation, and was quick to start the activities planned for the session. Movement and varied cross pattern sequences were quickly embedded as task completion was needing support this session. He was focused heavily on his upcoming performance. Linguistic demand within tasks was modified to allow for increased success and opportunities for self reflection.

Christopher was excited to share his new nintendo 3d "switch " games. Details regarding specific characters, character traits, similarities and differences between them, and associated attributes were highlighted. Expansion into other games of interest, as well as tv shows that he is now interested in, allowed for increased focus on the familiar concept of "your communication
partner's perspective." Additional focus today was on expanded semantic categories, categorical inclusion and exclusion with emphasis on relational vocabulary. Continued use of cross pattern movement sequences to support attention continue to be facilitative.

Santino was greeted happily by therapist. He was laughing and smiling upon greeting. He walked to the fridge with SLP to make 2 choices of food he would like to work on today in therapy. He did not pick however he did assist with carrying them back to his room independently. The Noose blueberry yogurt (new with therapist) and the Stonyfield organic yogurt pouches were the two purees. When SLP opened the Noose blueberry yogurt and mixed it up, Santino began to self feed with visual cues and positive reinforcement. After approximately 8 bites, SLP visually introduced pouch yogurt (the same brand Santino had a difficult time with last session). He appeared to tolerate the new yogurt well. He watched as SLP placed pouch yogurt into the Noose yogurt - he did not push the yogurt away which is a positive change. He continued to take bites with both the Noose and pouch yogurt. Eventually, SLP placed pouch yogurt on spoon (only) and Santino continued to accept without aversion. When offered the pouch to express from the pouch itself, Santino opened his mouth hesitantly 3x w/ SLP expressing the yogurt. When placed in Santino's hands to self feed, he did so with hesitance. SLP assisted in expression 3x. It was a great visual transition for Santino. Strawberry pop-tart bites were introduced and Santino immediately pushed them away and refused to interact with solid food at that time. He did assist with clean up at the end. When cued to take them out of the bag, smell, or touch them - he refused and turned away. He took 3 sips from Nestle water bottle - he refused initially however with hand over hand and verbal cues, he independently took 3 small sips. He is continuously making progress every week! He remained calm and happy throughout session. I am proud of him.

Santino was seen for session 15 of 17 in Term 3 with this SLP and transitioned calmly between sessions. His "Pull-Up" was checked and judged to be wet. Santino transitioned calmly to and from the restroom (stopping to greet a younger sibling of a student, "Hello Baby", and a new staff member, "Hello,...Nice to Meet You", when prompted) and followed the visual schedule to complete all necessary tasks. Increased verbal rehearsal of unknown context was noted throughout the procedure and session. Upon return to the individual classroom, Santino appeared engaged and focused as the daily, visual schedule was referenced and reviewed. Santino verbalized "Miss Sharon", "Miss Christina", "Lunchbox", "Miss Ingrid", "Ride Car", and "Mom" to complete "First, Next, Then, Last" phrase sequences. Water and food choices were presented but rejected...Goals for the session remained consistent and included the following...1. to engage in forming a relationship with Santino that includes regulation, and shared attention and interest 2. to enter into two-way, purposeful interactions with gestures and intentional communication 3. to determine highly motivating/favorable, cause and effect activities, so that Santino may develop a feeling of control and predict/anticipate what will happen next 4. to imitate predictable action sequences and communication patterns through cause and effect activities. 5. to develop single-word requesting via eye gaze, picture exchange and/or verbalization...Consideration has been given to expand upon stated goals to include additional areas of focus such as: to respond to and participate in My Turn/Your Turn-Activities, to respond to Yes/No-Questions, to respond to WH-Questions, and to communicate Agent + Action and Action + Object constructs via verbalization and/or photo/picture exchange...Santino sat in the blue chair upon verbal direction and verbalized, "I want Farm Match-Up", immediately. The activity sequence was modeled. Santino appeared engaged as he participated in the "My Turn/Your Turn" sequence x 5. Subsequently, Santino selected "Who Lives in This House?" and participated in the modeled "My Turn/Your Turn sequence X 5 during the remaining 30-minutes of the session...Santino responded verbally to "Yes/No"-Questions for 57 of 57 opportunities in the following manner: Given Initial Phonemic Cue and/or Picture Exchange: "Yes", 4 of 4 and "No", 3 of 3 opportunities correctly...Spontaneous Response, Independent of Prompts or Cues: "Yes", 34 of 35 and "No", 9 of 15 opportunities correctly...It is important to note that increased reflux was observed during the session again today...Santino assisted with clean-up upon verbal direction. The session came to a close in the usual manner with the "Good-Bye" Song and reference/review of the daily, visual schedule in preparation for the next session. Santino verbalized, "Good-bye Miss Sharon". Continue as planned with focus on use of communication book/photos across sessions/instructors and settings to promote increased spontaneous verbalization...

Santino was seen for session 14 of 16 in Term 3 with this SLP and transitioned calmly between sessions. He greeted, "Hello Miss Sharon", verbally, when prompted. Santino appeared engaged and focused as the daily, visual schedule was referenced and reviewed. Santino verbalized "Miss Sharon", "Lunchbox", "Miss Ingrid", and "Mom" to complete "First, Next, Then, Last" phrase sequences. Water and food choices were presented but rejected...Goals for the session remained consistent and included the following...1. to engage in forming a relationship with Santino that includes regulation, and shared attention and interest 2. to enter into two-way, purposeful interactions with gestures and intentional communication 3. to determine highly motivating/favorable, cause and effect activities, so that Santino may develop a feeling of control and predict/anticipate what will happen next 4. to imitate predictable action sequences and communication patterns through cause and effect activities. 5. to develop single-word requesting via eye gaze, picture exchange and/or verbalization...Consideration has been given to expand upon stated goals to include additional areas of focus such as: to respond to and participate in My Turn/Your Turn-Activities, to respond to Yes/No-Questions, to respond to WH-Questions, and to communicate Agent + Action and Action + Object constructs via verbalization and/or photo/picture exchange...Santino sat in the blue chair upon verbal direction and was directed to 2 familiar activities. He verbalized, "I want Farm Match-Up", immediately. The activity sequence was modeled. Santino appeared engaged as he participated in the "My Turn/Your Turn" sequence x 10. Sunsequently, Santino selected "Who Lives in This House?" and participated in the modeled "My Turn/Your Turn sequence X 10. During the aforementioned activities, Santino responded verbally to "Yes/No"-Questions for 54 of 54 opportunities in the following manner: Given Initial Phonemic Cue and/or Picture Exchange: 7 of 7 opportunities correctly...Spontaneous Response, Indepentent of Prompts or Cues: 44 of 47 opportunities correctly...It is important to note that increased reflux was observed during the session...Santino assisted with clean-up upon verbal direction. The session came to a close in the usual manner with the "Good-Bye" Song and reference/review of the daily, visual schedule in preparation for dismissal. Santino verbalized, "Good-bye Miss Sharon" and "Ingrid", upon her arrival. Verbalization of "Ride Car" and "Mommy" was noted upon picture reference during the carrier phrase, "Ingrid will take you for a... then home to see...". Continue as planned with focus on use of communication book/photos across sessions/instructors and settings to promote increased spontaneous verbalization...

Santino was greeted by SLP, he appeared happy upon transition. SLP and Santino walked to fridge where the new food was. Given the choice of 3, Santino chose the vanilla pudding. SLP provided an additional choice of yogurt in a pouch. With the vanilla pudding, Santino immediately began to self feed with visual cues to initiate prior to participating in letter/spelling activity. Santino continues to take small bites from spoon. He consumed approximately 1/2 the container (approximately 2 ounces). When given a water bottle, he pushed it away. With hand over hand assist, he took 2 small sips of water without aversion. When transitioning to yogurt pouch, Santino assisted in opening the yogurt. SLP modeled smelling it, and he appeared to enjoy that as he laughed and smelled the yogurt 3/5. When told to "tap to lips", he leaned toward 1/5 opportunities. SLP squeezed small amount on lips - there was no attempt to lick off despite modeling to lick off lips. When SLP showed Santino it was yogurt by squeezing it on a spoon, he became more aversive. He started whining and hiding his face. He assisted in clean up with the yogurt task. When given the choice of apple jacks and chocolate chip cookie gripz, he batted both away and turned away. SLP chose apple jacks in efforts to interact with the food without aversion. SLP began taking them out of the bag as Santino assisted in counting. Visual attention increased with this task. SLP was tapping and labeling body parts and Santino appeared calm and enjoyed it - "knee, elbow, shoulder, nose, lips" 5x. Each time resulting in tapping the food to his lips without aversion. He did lick his lips 1x. He assisted in clean up calmly.

At this point in time, he appears more aversive to solid/crunchy food. We will continue to explore these foods in efforts to desensitize him. I'm glad he's carrying over other yogurts and puddings.

Santino smiled upon social greet and again followed line of regard to reach for his backpack. Just prior to transition, KIm and I had the wonderful opportunity to briefly share and discuss current successes and strategies that are supporting Santino. Use of pecs continues to be a valuable tool, with the emphasis on use of the pictures to facilitate increased sentence construction, variation and support verbalization, as well as enhance understanding of more complex abstract concepts. Simultaneous increase in use of phonemic cueing ( word and sentence starters) is paramount at this time. Santino labeled the numbers on the keypad as he pushed each button supported by phonemic cues as we proceeded onto the main area. Upon arrival to his room, he quickly reached for pictures of desired items for placement on the strip. He paused as the new book and picture strip were adjacent to the picture choices presented. This afforded the opportunity to explore the new book, and its contents. Models were provided and he imitated each model provided as pictures were labeled. Activities presented allowed for expanded sentence form within requests. Use of pictures as supports to support sentence structure and speech clarity as well as provision of simultaneous phonemic cues continues to be extremely facilitative. Balanced blending of yes/no personal choice questions and opportunities for spontaneous requests within a given task was a focus this session, supported with phonemic cues across 4 tasks of 8 cycles. Supports to increase use of expanded form to request assistance ( help me + action/action sequence) were facilitative as well across 12 opportunities.

Santino had a great session today. He was greeted by SLP after being seen with Marcus. He reported requesting the bottle/pediasure however didn't give it to him knowing the feeding therapy session was following. I genuinely believed this assisted in the success of this session as Santino was hungry and accepted the food presented. He transitioned well to the table with cues. He reached in SLP's bag for a new V-tech spelling/letter toy. He helped put the vanilla pudding and yogurt (strawberry Noosa) on the table. When given the choice, Santino requested yogurt. When we previously worked on this exact food, Santino was aversive and did not want to interact. Today - he independently began to self feed with verbal cues. When self feeding, he takes small bite sizes - increased with cues. He continued to eat the yogurt without aversion. It was a very calm session - we continued to make words with letters he requested. Side note, - he was noted to use increased verbal requests and answered "yes" questions. When pudding was introduced visually, he batted it away. Therefore, it was placed open in his visual field without demand being placed. A water bottle was offered and he refused however with minimal verbal and tactile cues, he drank 3 independent sips. While Santino was playing with the letter activity, SLP put small amount of pudding in the yogurt. Santino continued to consume without aversion. SLP added increased amount of pudding, Santino continued to eat it. It was then placed next to the yogurt. SLP was providing specific praise "great eating pudding". The spoon was then placed in the pudding container and Santino continued to eat. It is evident that Santino has significant visual aversion to new food however it appears as if hunger plays a large part in his feeding as well. I believe decreasing pediasure/supplemental drinks will increase the amount of food he will eat. Often, the drinks will serve as primary means of nutrition and children won't be as willing to accept new foods because the drink will fulfill the hunger. Overall, Santino had a fantastic session and was very calm and successful with food. I spoke with Ms. Ingrid about this. I will see him Monday. Please bring more puree food.

Christopher was eager to share his "ideas" regarding the anticipated release of new Nintendo games. Much of what he shared included specific characters that he is fond of and the roles that they may have in the new games. Strong supports to shape the ideas into linear, well connected language sequences were facilitative. Additional supports were provided as Chris was asked to clarify or provide the definition of vocabulary that he was using throughout this activity. This also allowed for expansion into the familiar concept of your communication partners perspective.
Additional activities focusing on expanded semantic categories, categorical inclusion and exclusion as well as similarities and differences were supported with embedded movement sequences and varied cue hierarchies.