Santino was greeted as he finished his session with Dorothy. She reported he was having a good day. He transitioned well to the table. He reportedly did not eat the yogurt that was offered. When SLP gave choice of yogurt and vanilla pudding, Santino verbally requested the pudding. He assisted with opening the pudding and placing the spoon in the cup without aversion. His visually attention has increased to the food. Santino requested to build train tracks. During that activity, he refused pudding from spoon, however tapped to his lips off SLP's finger 20x with minimal aversion, in fact - he leaned into therapist for additional "taps" to lips. He licked his lips to taste the pudding 15/20 opportunities. There was no grimace or gag with that. With cues and pause time, Santino successfully opened his mouth for pudding 3/10 times. There was less refusal and turning away with the pudding. When the spoon was re-introduced, Santino became upset indicating it was too challenging of a task for him. He assisted in clean-up with the pudding. With Chips Ahoy Grips (very small chocolate chip cookie pieces), he counted them sustaining visual attention and touched them with ease. He assisted in making them into crumbs. Without refusal, he "tapped to lips" 5x while licking off the crumbs. It was the end of the sessions and with prompting of "one more, then all done" - Santino opened his mouth for cookie crumbs. He grimaced while manipulating the crumbs but did not become upset. He laughed and had a great session. Throughout session, he was using increased verbal utterances to request his wants/needs. SLP provided verbal cues for "help" and "all done". He worked hard for tickles and train tracks. His relationship with food continues to be less guarded and more positive. I'm very proud of this session, he is doing great!

Ben was immersed in viewing items on his laptop upon my arrival today. He responded to my initiating a social greeting, and rather quickly shared that he was "very tired today," and didn't want to "do any thinking work today." Commenting strategies, as well as short anecdotes of the weekend's events were presented to allow for expanded conversational reciprocity. Supports were provided as Ben was a bit reluctant to expand into detailed exchanges today. Redirection strategies were provided when needed, so as to increase acknowledgement of perspective and presupposition. Ben's affect fluctuated a great deal this session, and allowance for expanded activities to include more abstract language was met with a great deal of resistance. Continued supports were provided throughout the session.

Christopher happily directed my attention to the new nintendo switch games he had with him today. This afforded an opportunity to focus on the formulation of short narratives to share information about each of the games. Strong scaffolding support facilitated increased use of cohesive ties and temporal markers. Modeling and cues provided support to increase vocabulary specificity. Cross pattern movement sequences were strongly embedded within activities today to best support attention. Increased success was noted within categorical inclusion /exclusion tasks this session. Conversational expansion was again a focus, supporting use of contingent responses to allow for increased cycles of speaker listener reciprocity.

Santino was happily greeted as he finished with Marcus, who reported Santino was in a good mood today. Santino followed directives to close computer and put away items to start session. He was smiling throughout session. He assisted in setting up for session. Placing paper plates on table for himself and SLP.Tortilla's were presented in a clear bag in which Santino took out of the bag with ease. There was minimal tactile aversion and no gaze aversion. He placed one of each on the plates. Cookie cutters that were letters were introduced. Cookie cutters are great because they promote sustained visual attention to food and allow the child to touch the food but for fun reasons! With cues, we built Santinos name with letter cookie cutters. Between each letter he assisted with opening the vanilla pudding on the side. When he initially saw it, he was very calm and happy and actually reached for it (this is why multiple exposures to food items is important). With SLP model, he placed a spoon in the pudding with ease. He stirred the pudding with SLP model with moderate gaze aversion. We targeted requesting "help" to push the letter cookie cutters into the tortilla's. We built his name on a separate plate. Santino really enjoyed this activity today! He was laughing and smiling throughout the interaction with food. It's important to keep feeding/food positive and fun yet continue to push through barriers to make progress. He then "painted" the letters SANTINO with pudding using a spoon. He was LOVING that. After that activity, he assisted in clean up. The Z-vibe was introduced and Santino immediately grabbed for that with excitement. He liked to visually stim, however with some prompting - he tapped it to his lips for an extended period. With visual model, Santino opened his mouth and stuck out his tongue. A yellow piece of what looked like food was on his tongue however I did not know what it was. When he later opened his mouth, it was gone. A chew tube was also introduced however he did not want that in his mouth. Veggie Straws and Cheetos were presented and he said "I want orange" - referring to the veggie straw. He assisted with making crumbs and rubbing on the zvibe then eventually tapping to his lips 6x. He did not lick the crumbs off his lips however his overall guard/aversion has reduced.

Christopher excitedly inquired about the activities today, and asked if we could "play" the "sequence and tell games" that were introduced in the previous session. Motivational target themes were again utilized. Scaffolding supports afforded Christopher the framework to expand the use of "connectors" between sentences and increase use of temporal cues. Expanded vocabulary use was noted today as the focus was also on similarities and differences as well as categorical inclusion and exclusion. Attention and motivation were supported with only minimal cues and strategies this session.

The session commenced as Ben was returning from the kitchen area with a snack. Discussion commenced rapidly as the topic of peers and outside play predominated. This afforded another excellent opportunity to focus on perspective taking, and the dynamics of "viewpoints." Expansion into "thinking game" activities afforded further opportunity to focus on the aspects of perspective taking, presupposition and understanding cohesive thinking patterns. Periods of frustration ensued this session, as thought sequences within a joint activity varied greatly. Allowance for broader based cohesive thought sequences to problem solve within "thinking language games" was variable today. Support and scaffolding strategies were provided to highlight understanding "the big picture" as well as linear, details within the big picture.

Santino was greeted by SLP as he completed his previous session. SLP gave him a choice of floor time or table, Santino requested table. The same pudding that was worked on Friday was visually presented and Santino showed interest (i.e. did not look away or whine like he did previous session). He watched as SLP opened the pudding with interest. He independently requested tickles and trains. As the trains were brought to the table, Santino reached for the Z-vibe with the spoon adaptive tip. SLP hand over hand assisted with bringing to his lips 10x w/o aversion. SLP provided sensory input to face as he would apply jaw pressure to the palm of hand. Santino does not present with oral aversions to touch (without food). With pudding, he assisted in scooping into the bowl with decreasing visual and tactile aversions. There was less aversion than Friday to the pudding. When directed to "tap to lips", Santino refused. While playing with train tracks, SLP tapped pudding on lips, he immediately licked off the first trial. With additional trials, he would wait a few seconds and then lick his lips while playing or lick his lips with therapist model. This is significantly improvement. He has not yet independently brought food to his mouth however he is continuing to improve with allowing food/oral motor tools to come to his mouth with less guard. Feeding therapy is continuing to remain positive as we continue to work on shifting his vision of food. While assisting with clean up, Santino threw away the pudding and participated in the process with ease. I will continue to target multiple puree type consistencies. Overall, it was a good session. I will see him Friday

Santino was greeted by clinician and was brought to a new classroom as his room was being cleaned. A floor time session was conducted and Santino responded quite well. He did appear tired and had a bit of a congested nose throughout session. Santino was mildy agitated as we began. The preferred train tracks were presented and Santino immediately requested "tracks". SLP presented the (new) vanilla pudding.Pudding was chosen as Santino previously had a preference with yogurt (white, creamy, puree) - therefore, this food was chosen based on sensory components. SLP modeled partially opening the pudding, while offering him to assist in the process. He immediately turned away from the food and refused. SLP provided positive praise for visual attention ("good looking Santino"). While SLP began to scoop the pudding into the bowl, Santino would grimace and immediately turn away, requiring redirection 5x. The Z-vibe with spoon attachment was introduced and Santino demonstrated interest, verbalizing "tap tap tap" (recalling last sessions cues). Santino refused to place the z-vibe in the pudding requiring tactile assist to take it from my hand into the bowl 3x. With reinforcement, Santino eventually placed the spoon from one pudding cup to another 10x. This demonstrated Santino's improvement with desensitization quite rapidly. During these trials, Santino brought the spoon tip close to his mouth, and also smelled the pudding - showing interest. While playing with the train track, SLP wiped a small amount of pudding on his lips and he immediately licked off without aversion. This occurred 4 more times, with some guard however decreasing aversion. He licked off his lips without a grimace or gag, and started to look over at the spoon. When it was time to clean up, he was asked to "kiss" the pudding which he did 4x. ON the last trial, he opened his mouth for the pudding which was then placed intraorally without aversion! :)

Although Santino appeared tired and a bit irritable, he did very well! I'm looking forward to expanding his food repertoire in addition to decreasing sensory aversion to food. He did well interacting with this food today .

Santino was greeted by clinician and was brought to a new classroom as his room was being cleaned. A floor time session was conducted and Santino responded quite well. He did appear tired and had a bit of a congested nose throughout session. Santino was mildy agitated as we began. The preferred train tracks were presented and Santino immediately requested "tracks". SLP presented the (new) vanilla pudding.Pudding was chosen as Santino previously had a preference with yogurt (white, creamy, puree) - therefore, this food was chosen based on sensory components. SLP modeled partially opening the pudding, while offering him to assist in the process. He immediately turned away from the food and refused. SLP provided positive praise for visual attention ("good looking Santino"). While SLP began to scoop the pudding into the bowl, Santino would grimace and immediately turn away, requiring redirection 5x. The Z-vibe with spoon attachment was introduced and Santino demonstrated interest, verbalizing "tap tap tap" (recalling last sessions cues). Santino refused to place the z-vibe in the pudding requiring tactile assist to take it from my hand into the bowl 3x. With reinforcement, Santino eventually placed the spoon from one pudding cup to another 10x. This demonstrated Santino's improvement with desensitization quite rapidly. During these trials, Santino brought the spoon tip close to his mouth, and also smelled the pudding - showing interest. While playing with the train track, SLP wiped a small amount of pudding on his lips and he immediately licked off without aversion. This occurred 4 more times, with some guard however decreasing aversion. He licked off his lips without a grimace or gag, and started to look over at the spoon. When it was time to clean up, he was asked to "kiss" the pudding which he did 4x. ON the last trial, he opened his mouth for the pudding which was then placed intraorally without aversion! :)

Although Santino appeared tired and a bit irritable, he did very well! I'm looking forward to expanding his food repertoire in addition to decreasing sensory aversion to food. He did well interacting with this food today .

Christopher expressed interest in the new "sequence and tell" activities that were introduced this session. Focus on supporting linear organization of ideas and thoughts to allow for increased communicative success was targeted. Strong scaffolding supports allowed for task completion, as Christopher maintained interest and attention with minimal supports today. Stronger linear play /story sequences with use of supporting cohesive ties was noted across 4 themes. Expanded vocabulary use within language tasks was supported, once more focusing on self- generated sentences vs. "previously heard phrases." Natural conversation was supported to allow for increased reciprocal cycles of exchange and awareness of the listener's perspective within the exchange.