Chris was eager to utilize the Mario plush toys he had with him once again as part of the activities planned for the session. Scaffolding strategies to organize ideas and generate a story sequence provided the springboard for the "plush" activity. A strong focus was placed on self generated dialogue vs. recall of "previously heard" dialogue. Additional focus emphasized use of cohesive ties in order to better link thoughts and story grammar components. Continued use of cross pattern movement sequences embedded within language activities facilitates overall attention and modulation.

The session commenced following a brief outdoor activity with peers. Social greeting was conveyed with a pleasant affect. Conversation expanded quickly, as a multitude of topics were discussed. Ben initiated discussion regarding his haircut, allowing for expanded reciprocity and strong use of contingent responses to comments, and an excellent segue into perspective taking.
The "thinking game " challenge was once again utilized, allowing for opportunities to support awareness of gestural and facial cues as well as expanded use of varied intonation to indicate intent.

Santino was seen for session 43 of 44 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...Santino referenced this SLP through the glass in the door, grabbed both my hand and bag, then pulled me into his room. He immediately requested "Pop! The Pig" from an array of 3 activities via photo exchange paired with the verbalization, "Pop The Pig"! The photo was added to the sentence strip on the communication book and referenced by this SLP. 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 difficulty removing 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 compartment was opened by this SLP and emptied by Santino. He, then, 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: "Watch Belly", "I'm Hungry" x 2 - prior to "feeding" the "pig" -, "Yum", "Two Eyes", "Pointy Ears", "Pink Nose", "White Hat" - in reference to the pig -. Santino responded to the question, "What Number?" x 2. 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...Santino took a break for approximately one-minute then referenced and requested "A is for Apple" via the sentence strip paired with the verbalization: "I Want A is for Apple". Santino followed the predictable sequence and tracing pattern, either independently or with minimal assistance. He lifted flaps and verbalized the following: Apple, Ant, Ball, Bee, Cat, Car, Duck, Elephant, Egg, Frog, Fish, Gate, Goat, House, Igloo, Jam, Strawberry Jam, Kite, Lamp, Moon, Mouse, Nest, Nut, Octopus, Pig, Pear, Queen, Quilt, Rabbit, Ring, Shoes, Truck, Umbrella, Vase, Whale, Xylophone, X-Ray, Yacht, Zipper"...The session came to a close in the usual manner with clean-up and the "Good-Bye" Song. Santino verbalized "Miss Sharon" and successfully exchanged photos on his daily, visual schedule in preparation for dismissal. Continue as planned...

Team meeting allowing for the collaboration and sharing of current academic profile.

Santino arrived for this morning's session expressing distress. Mom had shared that last night he went to bed very late due to sibling staying up late, and a different route to school was taken. The transition went smoothly, and he quickly was observed to seek out activities of interest. Periods of hyperemotional reactivity were evident. Provision of RMT and T touch provided support to assist with modulation.
Santino initiated requests for desired items with reach to exchange single pictures for the initial 4 trials. Guidance for placement of picture on the strip and subsequent exchange was facilitative following 3 trials. Paired /simultaneous verbalization within the exchange was noted on 6/8 trials. This is a significant increase as the shift to more spontaneous initiation of requests via verbalization emerges. Social referencing and periods of overall engagement were inconsistent however, as influence of the morning's happenings continue to impact his arousal state.
Periods of strong visual distraction and delayed echolalia were noted throughout the session as well. Joint verbalization and/or singing continues to allow for increased periods of referencing during these instances.

Santino was seen for session 42 of 43 with this SLP in the individual classroom and appeared pleasant and calm upon transition between sessions. The daily, visual schedule was referenced and reviewed. Santino verbalized "Christina" and "Mom"! As noted in the previous session, the skin on Santino's lips was noticeably dry and peeling. Water from his bottle was applied with a tissue by this SLP to provide hydration...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 was presented with 1 novel and 1 familiar activity. He requested, "Pop! The Pig", as in the previous session, via photo exchange then entered into two-way, purposeful interaction with gestures and intentional communication to participate in an adapted, predictable version of the game for 15 out of 15 opportunities. As noted previously, Santino located color choice independent of direction in his communication book then added it to the "Sentence" Strip. Minimal verbal and physical cues/prompts were required for removal of the strip. Santino handed the strip to this SLP independent of direction and pointed with minimal physical assistance to each element on the strip (i.e. I - Want - Yellow - Hamburger) for 4 out of 4 opportunities then requested a change in game procedure via gesture as he handed the die to this SLP. His request was validated and play continued in a "My Turn/Your Turn" sequence paired with a roll of the die to determine the color of the "hamburger" to "feed" the "pig". Santino participated in this manner with moderate to minimal physical assistance to roll the die. He selected the associated hamburger color from the "pile" independently for 7 of 7 opportunities. (He gestured to "feed" the "hamburger" on each turn of this SLP.) Verbalization paired with communication intent was noted from time to time (i.e. "Red Hamburger, Purple Hamburger, Roll Die x 3, Feed Pig, Pick Green"). Santino responded to the question, "What Number?" x 2. 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 referenced and modeled the response, "NO" x 14. Santino verbalized, "Yes!" and removed the corresponding picture from the strip in response to the final question!.."All Done" was referenced by this SLP and Santino assisted with clean-up upon verbal direction. He joined in singing all of the words of "The Clean-Up" song...Santino was directed to 3 novel and 1 familiar book choice. He requested
"A is for Apple", an interactive alphabet presentation with tracks to trace letters and flaps to flip. Hand-over-hand assistance was provided, initially, to trace the letters with his "Pointer" finger. Santino followed the predictable sequence and tracing pattern. Approximately half-way through the alphabet, he did so independent of assistance. Santino lifted flaps and verbalized the following: "Ant, Bee, Car, Dog, Duck, Elephant, Egg, Frog, Fish, Gate, Kite, Lamp, Pear, Queen, Ring, Shoes, Vase"...The session came to a close in the usual manner with the "Good-Bye" Song. The daily visual schedule was reviewed in preparation for the next session. Santino seemed to show some distress via teary eyes and verbal rehearsal of the ABCs. (He may have thought it was time for dismissal). His feelings were validated and the schedule was reviewed again...Continue as planned...

Student was absent today due to illness.

Santino was seen for session 41 of 42 with this SLP in the individual classroom and appeared pleasant and calm upon transition between sessions. The daily, visual schedule was referenced and reviewed. The skin on Santino's lips was noticeably dry and peeling. Water from his bottle was applied with a tissue by this SLP to provide hydration...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 was presented with 1 novel and 1 familiar activity. He requested, "Pop! The Pig" via photo exchange then entered into two-way, purposeful interaction with gestures and intentional communication to participate in an adapted, predictable version of the game for 14 out of 14 opportunities. As noted in the previous session, Santino requested Color + Object via photo exchange and located color choice independent of direction in his communication book then added it to the "Sentence" Strip. Minimal verbal and physical cues/prompts were required for removal of the strip. Santino handed the strip to this SLP independent of direction and pointed independently (3x) or with minimal physical assistance to each element on the strip (i.e. I - Want - Red - Hamburger). Verbalization paired with communication intent was noted from time to time (i.e. "Red Hamburger, Purple Hamburger")...A number from 1 to 4 is embossed on the bottom of each "hamburger bun" and indicates how many times the "chef's hat" is pushed. This action causes the "pig's belly" to grow. Santino is cued each time to..."watch the belly"...as he pushes in anticipation of the buckle to "pop" and the "pig's arms" to raise...A second round of the game was requested by Santino via photo exchange and a new version was introduced in a
"My Turn/Your Turn" sequence paired with a roll of the die to determine the color of the "hamburger" to "feed" the "pig". Santino participated in this manner with moderate to minimal physical assistance to roll the die. He selected the associated hamburger color from the "pile" independently for 12 of 12 opportunities..."All Done" was referenced by this SLP and Santino assisted with clean-up upon verbal direction...During the remaining 10-minutes of the session, the book, "Brown Bear, Brown Bear, What do You See?", was presented to Santino for the first time by this SLP. He appeared to show great interest as HE READ the predictable story sequence aloud with minimal assistance by this SLP. He tracked the words visually and with his "pointer" finger as he read, then referenced the simple illustrations and slid the panel to reveal the new animal on each page. Santino verbalized the following in response to "What is that?" for 3 of 3 opportunities:
"Green Frog, Purple Cat, White Dog"...The session came to a close in the usual manner with the "Good-Bye" Song and successful photo exchange on his daily visual schedule given verbal and minimal physical cues...Continue as planned with focus on intentional communication to request and initiate via social referencing paired with photo exchange and verbalization.

The session commenced with Christopher eager to share the Mario plush toys he had brought with him today. He shared that he wanted to use them today with our "thinking work." We utilized the toys as a springboard for conversation and story generation tasks. Christopher, however was not feeling well this morning, and attention was fleeting. We revisited the topics of "connecting thoughts , closing thoughts and shifting thoughts," and Christopher subsequently shared that he wanted to talk about the voices in his head. Gentle encouragement to expand in this area was successful for a very brief period as he rapidly shifted into another topic. Session goal expectations were modified this morning as Christopher truly was not feeling well.

Santino was seen for session 40 of 41 with this SLP in the individual classroom and appeared pleasant and calm upon transition between sessions. The daily, visual schedule was referenced and reviewed and Santino verbalized, "Goody-bye, Mr. Marcus."...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...This SLP joined Santino on the floor as he was already engaged in a Disney ABC Puzzle. Attempts to extend his chosen activity were met with some resistance, although permitted within a few minutes. The pictures associated with the letters chosen by Santino were referenced by this SLP then by Santino who verbalized as he added to the puzzle (i.e. "N" for.....Nest). Immediate echolalia was noted after comments by this SLP (i.e. "Blue Polka Dot Eggs in the Nest")...Santino was presented with 1 novel and 1 familiar activity.
He requested, "Pop! The Pig" via photo exchange then entered into two-way, purposeful interaction with gestures and intentional communication to participate in an adapted, predictable version of the game for 16 out of 16 opportunities over 2 consecutive trials. Santino requested Color + Object via photo exchange. He located color choice independent of direction in his communication book then added it to the "Sentence" Strip. Minimal verbal and physical cues/prompts were required for removal of the strip. Santino handed the strip to this SLP independent of direction and pointed with minimal physical assistance to each element on the strip (i.e. I - Want - Red - Hamburger.). Verbalization paired with communication intent was noted from time to time...Santino assisted with clean-up upon verbal direction. The session came to a close in the usual manner with the "Good-Bye" Song and successful photo exchange on his daily visual schedule given verbal and minimal physical cues. Santino verbalized, "Sharon"...Continue as planned with focus on intentional communication to request and initiate via social referencing paired with photo exchange and verbalization.