Ben initiated social greeting and rapidly engaged in conversational exchange across a multitude of topics. As conversation shifted into more of a narrative generation, cues and supports were provided to once again support the dynamics of reciprocity, perspective taking and the importance of tending to the body language, intonation patterns and eye gaze of your communication partner. Additional supports were provided to enhance self awareness of social referencing, personal space boundaries, loudness levels, and use of intonation to best support intended message. Subsequent topic expansion was supported across a multitude of topics as familiar "thinking game" play activities were provided.

Christopher happily initiated sharing the plush toys he had with him once again today, however, he appeared extremely tired and fatigued. He subsequently shared that he was indeed extremely tired. Scaffolding and cues allowed for increased contingent comments, as conversational reciprocity was less expansive today. Subsequent focus was on use of self generated dialogue vs. recall and "use " of previously heard scripted dialogue from the videos that he may have seen. Task transitions were supported today and linguistic expectation was modified as Christopher was clearly tired. Activities which focused on vocabulary specificity, with decreased use of non specific terms and use of specific cohesive ties was highlighted this session.

The session commenced with supporting Christopher regarding the schedule for the day, and establishing familiar patterns of conversational reciprocity. Gentle encouragement to support topic maintenance and cohesive sentence links while sharing information regarding a specific topic was provided. Chris excitedly shared the plush toys that he had with him today. Opportunity for expansion of discussion into character traits, categorical inclusion and exclusion, as well as similarities and differences was provided. Supports for "connecting thoughts, shifting thoughts and closing thoughts" were provided consistently this session. Opportunity for cross pattern movement sequences was expanded into independent movement activities, with a focus on repetition of sequences with fluidity and were scaffolded in small increments into more complex sequences. This activity allowed for increased sustained attention, and increased cohesive sentence links in the conversational language activities that followed.

Santino was greeted by the therapist as he finished his session with Marcus. He transitioned well from the floor to the table. He immediately requested Pop the Pig. Dorothy observed session for carryover purposes. A choice of cheetos and captain crunch cereal were offered ("do you want sticks or balls?"). Santino requested cereal after initial refusal/turn away. He appeared visually aversive as he looked away toward the wall. He was directed to place 10 pieces on the napkin which he did do with SLP model. Initially he refused to interact however he completed task with verbal reinforcement. He placed them in the all done bowl with ease. He refused to kiss the piece with SLP model - SLP tapped to hand, forearm, shoulder, and cheek 5x. Santino intermittently refused. With SLP model, Santino crushed the cereal into crumbs. He did elicit facial grimace however he continued to play with the cereal with ease. He was given a napkin to wipe hands as he was demonstrating a finger play. Between interaction trials of cereal, he was given hamburger pieces to put into the pig's mouth as a "pause time" to take a small break between food trials. Throughout session, when Santino would appear agitated/guarded and turn away from the task, he would be directed to complete one more trial and have a break in efforts to keep feeding therapy and food positive. With muffins (second exposure), he smashed onto the table with the palm of his hand. Santino refused to interact further with the muffin. When white cheddar Cheetos were presented, he immediately began to crush into crumbs without direction. SLP tapped crumbs to hand, arm, shoulder and lips. Santino demonstrated minimal aversion and began to play with the "fishing game". He intermittently licked the crumbs off of his lips. At that time, he assisted in clean up. The plan for feeding therapy was discussed at length. I look forward to continuing to work with Santino as his visual and tactile aversions decrease. I will see him next Friday.

Santino was seen for session 3 of 3 in Term 3 with this SLP. He transitioned calmly from the dining room to the individual classroom. The daily, visual schedule was referenced and reviewed twice in an attempt to eliminate confusion with the daily sequence....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 Goal 5 to include modifier + object/action in the phrase "I want..." via picture exchange and/or verbalization...Santino was directed to an array of 4 planned activities. He referenced the photos, selected one, then requested a familiar activity via verbalization paired with photo exchange, "I want police car!". The "Build and Play Police Car" was presented. Santino requested via photo exchange paired with verbalization throughout the activity, which involved using a screwdriver to assemble the police car. The following verbalizations were noted over the 30-minute segment: "I want screwdriver" x 8, "I want bumper", "I want lights", "I want siren", "I want spoiler", "I want wheel x 2", "I want little wheel" x 2. As the back bumper and front bumber with lights closely resembled one another, Santino was observed to examine the photos and parts carefully prior to verbalizing his request successfully!. Once assembled, Santino was encouraged x 5 to push the police car under and through the legs of the chair, which he did with success x 1...It is important to note that Santino noticed loose screws on the car (from "collision" with chair legs) and requested the screwdriver to tighten them via spontaneous verbalization, "I want screwdriver" x 3...Santino requested "Find the Dino 50-Piece Giant Floor Puzzle" from and array of 3 remaining planned activities via photo exchange paired with verbalization, "I want dino floor puzzle". White "frame" and colored "inside" pieces were labeled by this SLP. As each piece was labeled (with dino name) and presented, Santino built the entire 3' x 2' "frame". Reference to the illustrations on the box was noted, frequently. Verbalization associated with the activity was not noted. Verbal rehearsal of unknown context was prevalent throughout the 20-minute segment...As Santino assisted with clean-up, he verbalized, "inside pieces", upon verbal direction to place them in the box...The session came to a close in the typical manner with the "Good-Bye Song" and reference to the daily, visual schedule in preparation for the next session. Santino verbalized the following: "Miss Christina, Lunch Box, and Miss Ingrid and Mommy" to complete the phrase, First..."Miss Ingrid", Then..."Mommy"...Continue as planned with focus on use of communication book/photos across sessions/instructors and settings...

Santino was greeted in the kitchen area when he finished with his previous lesson. He transitioned well into the room, carrying the "all done bowl". Per Ms. Dorothy, Santino refused yogurt today. Santino appeared intermittently tired throughout session as he would rub his eyes and require additional verbal cues to attend to the task. When given a choice, Santino requested Mr. Potato Head. Pretzel sticks were introduced visually and Santino immediately placed in the all done bowl. He refused to "blow" into the bowl however he did bring the stick to his cheek. While interacting with Mr. Potato head (targeting increased verbal output), Santino followed SLP's model by tapping the pretzel rod to his lips 10. He would intermittently push away or begin to become upset however was easily redirected with embracing squeezes on his arm (7 seconds counted out loud). He appeared to enjoy that tactile input when he became upset. With SLP model, Santino tapped the pretzel to his teeth 2/5 trials and immediately licked his lips. There was decreased aversion during that task. This is a great step because he allowed the food inside his mouth without using the guard of his lips! Santino independently requested Pop the Pig in the therapist's bag of materials. Santino assisted with clean up of previous activity as well as pretzels. When yogurt was offered (preferred), he refused. When given the choice of peanut butter crackers or yogurt, he verbally requested crackers. With model, Santino crushed the cracker into crumbs using his finger tips - smiling while doing so. This appeared to be an enjoyable sensory task for him. After crushing the crackers, he wiped the crumbs on SLP's pants to remove any crumbs from his fingers. SLP provided a napkin to wipe his hands for additional trials. Using whole crackers, Santino tapped to his lips 5x with intermittent refusal. With the crumbs, SLP tapped to his lips. There was no aversion. In fact, after approximately 20 seconds of pursed lips, he licked the crumbs off with ease. There was no facial grimace or sign of distress. Santino remained calm throughout session. He did turn away from the food when it was presented initially however eventually interacted with it. He continues to make gains with new foods being presented to him. The more exposure, the BETTER! I will see him Friday!

Santino was seen for session 2 of 2 in Term 3 with this SLP. He appeared distressed and teary-eyed upon transition, perhaps related to anticipation of dismissal. The daily, visual schedule was referenced and reviewed twice in an attempt to eliminate apparent confusion with the daily sequence. Santino seemed to recover quickly, but appeared fatigued throughout the session...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 Goal 5 to include modifier + object/action in the phrase "I want..." via picture exchange and/or verbalization...Santino was directed to an array of 3 planned activities. He immediately referenced the photos, selected one, then requested a familiar activity via verbalization paired with photo exchange, "I want police car!". The "Build and Play Police Car" was presented. Santino requested via photo exchange paired with verbalization throughout the activity, which involved using a screwdriver to take apart then reassemble the police car. The following verbalizations were noted over the 40-minute segment: "I want screwdriver" x 14, "I want bumper" x 2, "I want lights" x 2, "I want spoiler" x 2, "I want wheel" x 8. As the back bumper and front bumber with lights closely resembled one another, Santino was observed to examine the photos and parts carefully prior to verbalizing his request successfully!. Once reassembled, Santino was encouraged x 2 to push the police car under and through the legs of the chair which he did with success x 1...It is important to note that Santino requires minimal, if any, assistance to use the screwdriver and to assemble/disassemble the vehicle. The session came to a close in the typical manner with the "Good-Bye Song" and reference to the daily, visual schedule in preparation for dismissal. Santino verbalized "Mommy" to complete the phrase, First...Miss Ingrid, Then..."Mommy". In response to, "Who is here?", Santino verbalized, "Miss Ingrid!"...Continue as planned with focus on use of communication book/photos across sessions/instructors and settings...

Santino was seen for session 1 of 1 in Term 3 with this SLP. He appeared calm upon transition between sessions as he finished eating his yogurt with Miss Dorothy in the individual classroom. The daily, visual schedule was referenced and reviewed. His Pull-Up was checked and judged to be very wet. Santino transitioned calmly to the East restroom and participated in the procedure to change into a dry Pull-Up. During the walk back, Santino referenced a small plastic container of magnetic letters and shapes located on the top of the bookshelf in the hallway. He requested via spontaneous verbalization, "I want shapes". The container was retrieved by this SLP then carried to the individual classroom by Santino. He immediately sat on the floor and attempted to remove the lid. Santino referenced this SLP and requested help via spontaneous verbalization, "I want help!". Assistance was offered and the contents were examined by Santino for approximately 1 minute.
He appeared to lose interest quickly and assisted with clean-up upon verbal direction...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 Goal 5 to include modifier + object/action in the phrase "I want..." via picture exchange and/or verbalization...Santino was directed to an array of 3 planned activities. He immediately referenced the photos, selected one, then requested the novel activity via verbalization paired with photo exchange, "I want dino puzzle!". During the remaining 30-minutes of the session, Santino helped organize the 50-piece dino floor puzzle into white "frame" and colored "inside" pieces as each was removed from the box and labeled. He referenced the illustration on the box as a guide to create 3/4 of the frame with moderate assistance...As the session came to a close, Santino assisted with clean-up. The "Good-Bye Song" and reference to the daily, visual schedule were completed in preparation for the next session. Santino seemed distressed, perhaps in anticipation of dismissal, but appeared to recover quickly...Continue a plan with focus on use of communication book/photos across sessions/instructors and settings...

Santino was greeted by clinician at 2:00pm. With verbal direction, Santino closed his computer from previous lesson. A choice of Cheerios and Cheezits were provided ("Santino, would you like to play with circle or squares?). Santino chose Cheez-its. He initially presented with visual aversion by gazing away from the food when opened and placed into his visual field. With a model from clinician and verbal cue, Santino made a "square tower" of Cheez-its with fading visual aversion. When SLP tapped cracker to her lips to model kissing, Santino demonstrated aversion and visually refused. With each success interaction with the cracker, Santino independently requested to play a "fishing game" in the SLP's therapy bag. When the rice and beans were presented (preferred at home, however not at school), Santino demonstrated maximal aversion by immediately pushing it away from him. He independently requested "Pop Pig". With SLP model and reinforcement, Santino would interact with the spoon on the plate with SLP utilizing hand over hand with minimal resistance. While playing Pop the Pig, Santino interacted with the rice and beans as he was comfortable with "tap tap tap" from his fingers, his arm, and cheek. When modeled to kiss/tap to lips the rice and beans (in efforts to bring closer to his mouth ) - Santino verbally refused and turned away. He did indeed allow SLP to tap the spoon with rice and beans to his lips 3x, immediately followed by wiping off with ease. When mini muffins were presented, Santino independently took them out of the bag and began to mash them on a paper with his palm. He appeared to enjoy the tactile sensory input from that as he was calm and smiling. When SLP modeled bringing the muffin closer to her face, Santino refused and turned away. In efforts to continue to keep feeding therapy/meal time positive, activity was discontinued. With verbal and visual cues, Santino cleaned up the area by kissing 15 Cheez its and placing them in an "all done" bowl. At that time, the session was complete. Overall, Santino did well participating in therapy however increased aversion in comparison to last session. I will see him Monday! Continue to visually present new foods without expectation of eating them, it will keep feeding positive!

Thank you,
Ms. Amanda

Santino established brief reference in response to initial social greet. Assistance was provided to guide the transition this morning, as his focus was inconsistent. He rapidly engaged as he was again encouraged to assist with pushing the keypad to successfully enter the main area. Provision of choices, both familiar and novel were immediately available upon entrance into his room. He rapidly scanned the picture choices, as well as the bag of activities, and subsequently reached for the pile of additional picture choices not yet displayed. He rapidly searched for a preferred item. Upon locating it, he quickly placed it on the picture strip and verbalized as he simultaneously pointed to the picture sequence on the strip ( "I want color shapes"). Continued paired/simultaneous verbalization of intent with the finger point along the sentence strip is evident, with increased use of more frequent spontaneous verbalizations once engaged within an activity. Santino appeared to be a bit tired today, as he would actively engage for brief periods followed by periods of postural changes, eye rubbing and decreased engagement. He responded well to sensory inout, HANDLE activities and RMT as his arousal, engagement, referencing and vocalizations increased following these tasks. Task engagement, use of picture exchange, and verbalization subsequently increased.