Christopher excitedly shared details abut his new Nintendo game as our session commenced. This afforded an excellent opportunity to structure and organize details to best support sequential ordering of ideas. Scaffolding strategies and cues to increase use of cohesive ties were successful. Additional supports to enhance "noticing " the non verbal cues ( eye gaze, facial expression , body language) of your communication to assist with ensuring a more successful communication exchange were provided. Additional focus on the awareness of self generated dialogue vs. recall of "previously heard" dialogue was again discussed.
Cross pattern movement sequences continue to be embedded across language activities with great success.

Santino - What a fantastic first therapy session! Santino was greeted by therapist and Dorothy. Therapist was informed he finished the yogurt with some assist to feed. He was transitioned to the table with verbal direction. He verbally requested Pop the Pig game that was in therapist's bag. To establish rapport and begin the session, we opened the game and placed all pieces on the table. With phonemic cues, he requested the hamburger colors with "I want purple hamburger". A clear bag of pretzel sticks were introduced in Santino's visual field. He immediately presented with visual/gaze aversion by looking away. With reinforcement, he rolled the palm of his hand over the pretzels in the bag as therapists auditorily described "bumpy", "hard". A bowl was provided to place pretzels in after interacting with them. With therapist model, Santino blew on the pretzel 3x and placed into the bowl. He then brought pretzel sticks to his lips 5x with verbal reinforcement and intermittent breaks of playing Pop the Pig. Santino was noted to wipe his hands on his lap after each trial, indicating tactile aversion however remained calm throughout tasks. Shortbread letter cookies were presented. He initially looked away from the cookies. A fishing game was introduced to play between trials of interactions with new cookies. He would verbalize each letter that was on the cookies, placing on the table - he would then wipe his hands on his lap. He tapped to his lips 5x with praise and soft tickles as praise. With therapist model, Santino crushed the cookies into crumbs on a napkin. An additional napkin was provided to allow him to wipe his hands whenever he demonstrated the need to do so. With a model, Santino tapped the crumbs to his lips as SLP gently wiped off with napkin. (EXCELLENT!) At that point, the session was complete. Santino was happy throughout the entire session and appeared to enjoy the interaction with the therapist and food. Dorothy then walked him out to leave for the day. It is recommended that Santino continue to be exposed to food visually to decrease his visual aversion. Great work Santino!

Santino was seen for session 48 of 49 with this SLP in the individual classroom and appreared calm upon transition between sessions. Santino verbalized "Miss Sharon" and "Christina" upon review of the daily, visual schedule...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 requested "Gingerbread Man" via spontaneous verbalization. The familiar activity was presented and Santino participated in the predictable sequence to create a "Gingerbread Man" from Play-Doh. Spontaneous verbalization to request was noted throughout this 40-minute segment and included the following X 2 : "I want Gingerbread Man, I want Yellow Play-Doh, I want Orange Play-Doh, I want Rolling Pin, I want Help, I want Eyes, I want Mouth, I want Buttons". Afterward, Santino assisted with clean-up upon verbal direction and remained at the table as three new books were introduced and read aloud by this SLP. He turned pages and seemed to look at the illustrations. Related verbalizations were not noted, however. The session came to a close in the typical manner with the "Good-Bye" Song and successful photo exchange on his daily, visual schedule in preparation for the next session...Continue as planned with focus on use of communication book/photos across sessions/instructors and settings.

Santino was seen for session 47 of 48 with this SLP. He was met upon transition to the restroom with OT as a change of pull-up was required. Both this SLP and OT assisted with the procedure. Santino appeared fatigued throughout. He seemed calm upon transition back to the individual classroom where the visual schedule was referenced and reviewed...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 searched for and requested Pop! The Pig" via verbalization. He appeared upset when the preferred item was not available. His feelings were validated, followed by an introduction to 2 novel and 2 familiar activities. All were rejected. Subsequently, book choices were presented in an array of 2 novel and 2 familiar options. All were rejected. Santino continued to show signs of distress. A familiar book was presented by this SLP and read aloud. Santino lay on the pillows and fell asleep for 20-minutes. He awoke and appeared pleasant as the "Clean-Up" and "Good-Bye" songs were presented. Successful photo exchange on his daily, visual schedule followed in preparation for dismissal. Santino verbalized "Miss Sharon" and "Lunch Box" upon photo removal.
Additionally, he verbalized "Mom" to complete the "First/Then phrase initiated by this SLP (i.e. First..."Miss Ingrid", Then... "Mom")...Upon Miss Ingrid's arrival, Santino verbalized "Miss Ingrid is here!" in response to the question, "Who is here?"...Continue as planned with focus on use of communication book/photos across sessions/instructors and settings.

Christopher was excited to show me his new poster, The End Game. We researched it on the Internet and learned that it is an exclusive poster by illustrator Chris Skinner and the first one in a series of ten commissioned by Marvel Studios. Chris explained it is a rare poster that he purchased in NY over the Thanksgiving break. After identifying all the superheroes and the one villain in the poster, Christopher identified their emotions based on their facial expressions and postures. He identified most with Captain America because of his strength and because he fights for good. Christopher finished up the session creating a scenario involving the Plushie characters and puppets he brought to the program, and we put the End Game poster up in his classroom.

Santino was seen for session 46 of 47 with this SLP in the individual classroom and appeared pleasant and calm upon transition between sessions...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...As noted previously, Santino requested "Pop! The Pig" via verbal request ("Pop Pig") from the activities in this SLP's bag. The photo of his request was added to the sentence strip on the communication book and referenced by Santino. Independent of direction, Santino removed the strip, handed it to this SLP and verbalized "I - Want - Pop! The Pig" paired with point to each element of the sentence. His request was immediately validated. Santino requested "Hamburger", added it to the strip, then removed and presented it to this SLP followed by point to all elements of the sentence paired with the verbalization: "I - Want - Hamburger". When asked, "What Color?", Santino opened his communication book, located the "Colors" page, selected "Yellow", added it to the sentence strip, then removed and presented it to this SLP paired with point and the verbalization: "I - Want - (Color) - Hamburger". His request was immediately validated...This exchange of two-way, purposeful interaction with intentional communication continued INDEPENDENT OF PROMPTS/CUES for 2 of 2 opportunities. Over the following 14 of 14 opportunities, Santino REQUESTED SPONTANEOUSLY, INDEPENDENT of the sentence strip:
"I - Want -(Color) - Hamburger!!!...Additional verbalization paired with communication intent was noted from time to time and included the following: "Pink Nose", "Hat", "Eyes", "Belly", "Spatula", in reference to the "Pig". Santino verbalized number words correctly for 16 out of 16 opportunities to complete the phrase initiated by this SLP, "Hamburger Number...???". In addition, "Did Pig/He Pop?" was posed after each turn as Santino was directed to the "Yes"/"No" pictures on the communication strip. This SLP modeled the responses...Santino stood and handed this SLP his blue container into which water was poured and presented to Santino. He lay on the pillows with the bottle in his mouth but did not drink. He stood, reached for a shake then handed it to this SLP. The photo of the vanilla shake was referenced by this SLP and added to the sentence strip. Santino verbalized, "I - Want - Vanilla - Shake". His request was validated and he lay on the pillows with the bottle in his mouth, but did not drink. When asked, "All Done Vanilla Shake?", Santino removed the bottle from his mouth and stated, "I want Pop the Pig!". His request was validated. He held the bottle with one hand and drank all but a few sips of the shake while he manipulated and played with the "pig". "All Done" or "More" "Pop! The Pig?" was referenced and verbalized by this SLP. Santino verbalized, "All Done Pop the Pig", independent of prompts/cues via sentence strip then participated in clean-up of the activity...Santino took a break for approximately one-minute then followed the one-step verbal direction to sit in the brown chair. Attempts to entice Santino to participate in an activity to create a Thanksgiving Turkey using "feathers" cut from his "Do-A-Dot" art made previously were successful...Via sentence strip x 2, Santino verbalized, "I- Want - Turkey - Feather." then glued each to the turkey's body. The remaining "feathers" were glued by Santino absent verbalization as he began to rub his eyes and yawn frequently...The session came to a close in the usual manner with clean-up, the "Good-Bye" Song, and successfull photo exchange on his daily, visual schedule in preparation for dismissal. Santino verbalized "Miss Ingrid" and "Momma" x 2 to complete the "First/Then phrase initiated by this SLP (i.e. First..."Miss Ingrid", Then... "Momma")... Continue as planned with focus on use of communication book/photos across sessions/instructors and settings.

Santino was seen for session 45 of 46 with this SLP in the individual classroom and appeared pleasant and calm upon transition between sessions. The daily, visual schedule was referenced and reviewed...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...Santino requested "Pop! The Pig" via verbal request ("Pop Pig") from the activities in this SLP's bag. The photo of his request was added to the sentence strip on the communication book and referenced by Santino. Independent of direction, Santino removed the strip, handed it to this SLP and verbalized "I - Want - Pop! The Pig" paired with point to each element of the sentence. His request was immediately validated. Santino removed the "Pig" from the box and all of the "Hamburgers" from the storage compartment independently. As in the previous session, Santino requested "Hamburger", added it to the strip, then removed and presented it to this SLP followed by pointing to all elements of the sentence paired with the verbalization: "I - Want - Hamburger". When asked, "What Color?", Santino opened his communication book, located the "Colors" page, selected "Yellow", added it to the sentence strip, then removed and presented it to this SLP paired with point and the verbalization: "I - Want - Yellow - Hamburger". His request was immediately validated...This exchange of two-way, purposeful interaction with intentional communication continued INDEPENDENT OF PROMPTS/CUES for 15 of 15 opportunities over 35 minutes. Additional verbalization paired with communication intent was noted from time to time and included the following: "Pink Nose", "Hat", "Puffy Belly", "Spatula" - in reference to the pig -. Santino verbalized number words correctly for 16 out of 16 opportunities to complete the phrase initiated by this SLP, "Hamburger Number...???". In addition, "Did Pig/He Pop?" was posed after each turn as Santino was directed to the "Yes"/"No" pictures on the communication strip. This SLP modeled the responses..."All Done" or "More" "Pop! The Pig?" was referenced and verbalized by this SLP. Santino requested and verbalized, "All Done Pop the Pig", independent of prompts/cues as he followed the sequence noted previously then participated in clean-up of the activity...Santino took a break for approximately one-minute then followed the one-step verbal direction to sit in the brown chair. Attempts to entice Santino to participate in an activity to request "Do-A-Dot" markers were successful as he requested via sentence exchange paired with verbalization and point, "I - Want - (Color)" for 10 out of 10 opportunities. He proceeded to create his own color pattern on white paper and verbalized "Splash" and "Puddle" as he dabbed color throughout the paper. (This creation is part 1 of 2 to be completed during the next session.) It is important to note that he removed and replaced the caps on each bottle independently...The session came to a close in the usual manner with clean-up, the "Good-Bye" Song, and successfull photo exchange on his daily, visual schedule in preparation for dismissal. Continue as planned...

Santino was seen for session 44 of 45 with this SLP in the individual classroom and appeared pleasant and calm upon transition between sessions. The daily, visual schedule was referenced and reviewed...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...Santino requested "Pop! The Pig" via verbal request ("Pop Pig") from the activities in this SLP's bag. The photo of his request was added to the sentence strip on the communication book and referenced by Santino. Independent of direction, Santino removed the strip, handed it to this SLP and verbalized "I - Want - Pop! The Pig" paired with pointing to each element of the sentence. His request was immediately validated. Santino removed the "Pig" from box independently, but appeared to have some difficulty removing all of the "Hamburgers" from the storage compartment inside the "Pig". The "Help" picture was referenced by this SLP and placed on the sentence strip by Santino who pointed to each component of the sentence paired with the verbalization: "I - Want - Help". His request was immediately validated and the remaining "Hamburgers" were removed from the compartment by SLP. As in the previous session, Santino requested "Hamburger", added it to the strip, then removed and presented it to this SLP followed by pointing to all elements of the sentence paired with the verbalization: "I - Want - Hamburger". When asked, "What Color?", Santino opened his communication book, located the "Colors" page, selected "Yellow", added it to the sentence strip, then removed and presented it to this SLP paired with point and the verbalization: "I - Want - Yellow - Hamburger". His request was immediately validated...This exchange of two-way, purposeful interaction with intentional communication continued INDEPENDENT OF PROMPTS/CUES for 15 of 15 opportunities over 35 minutes. Additional verbalization paired with communication intent was noted from time to time and included the following: "Pink Nose", "Hat", "Puffy Belly", "Spatula" - in reference to the pig -. Santino verbalized number words correctly for 9 out of 16 opportunities to completed the phrase initiated by this SLP, "Hamburger Number...???". In addition, "Did Pig/He Pop?" was posed after each turn as Santino was directed to the "Yes"/"No" pictures on the communication strip. This SLP modeled the responses..."All Done" or "More" "Pop! The Pig?" was referenced and verbalized by this SLP. Santino requested and verbalized, "All Done Pop the Pig", independent of prompts/cues as he followed the sequence noted previously then participated in clean-up of the activity...Santino took a break for approximately one-minute then referenced and requested the book, "Brown Bear, Brown Bear, What Do You See?" via the sentence strip paired with the verbalization: "I want Brown Bear, Brown Bear, What Do You See." Santino followed the predictable sequence, tracking all words and reading all text for the entire book...The session came to a close in the usual manner with clean-up, the "Good-Bye" Song, and successfull photo exchange on his daily, visual schedule in preparation for dismissal. Continue as planned...

Santino happily transitioned to his room following strong social referencing upon greet. Upon arrival to his room he once again rapidly scanned picture choices presented on the table. He quickly placed the picture of the desired item on the strip, reached to place the strip in my hand, isolated distal point to each word/picture paired with simultaneous verbalization "I want shapes."
This sequence repeated itself as he requested color choices after opening his book and removing the color pictures. This wonderful, spontaneous independent manipulation of pictures on the sentence strip paired with picture point and simultaneous verbalization was demonstrated consistently throughout the entire session across all activities. Expansion of picture use across all environments to allow for increased spontaneous requesting is encouraged . Additional concepts of size +object continues to be presented. Independent use of the visual schedule continues as Santino seeks out the arrival of the next teacher following familiar closure, allowing for subtle changes in the closure sequence. Such a fantastic session !!

Christopher was extremely curious about the activities planned for the session. He wanted to share his ideas and asked about the materials I had brought today. Chris was excited to create a poster board sequence utilizing Mario stickers consisting of pictures and familiar "sayings" and vocabulary. Additional poster board task consisting of character identification following provision of brief description was incorporated into the plan. Support to identify the "key" details to allow for accurate identification was successful. Conversational expansion with a focus on "connecting thoughts, closing thoughts and shifting thoughts," was also a strong focus.