Santino was seen for session 37 of 37 with this SLP in the individual classroom and appeared pleasant and calm upon transition between sessions. The daily, visual schedule was referenced and reviewed by Miss Dorothy and Santino verbalized, "Sharon" paired with social reference upon photo exchange...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 2 novel and 2 familiar activities, and 4 familiar book options. Santino chose "Boo! A Book of Spooky Surprises then seemed to change his mind as he picked-up "The Little Old Woman Who Was Not Afraid of Antyhing". Santino was redirected to the communication book and requested the aforementioned storybook via exchange. As in the two previous sessions, Santino appeared to take immediate interest in the text and illustrations. During a 40-minute period, Santino requested the book twice via exchange and engaged in two-way, purposeful interaction with gestures, shared interest, and intentional communication. He pointed to text as if decoding whole words (paired with reference to illustrations) and verbalized the following, expanding his utterances throughout, as an adapted version of the story with props was presented by this SLP: "Once Upon a Time, Old, Old Lady, Little Old Lady, Cottage, Walk, Seeds, Basket, Walked, Dark, Moon, Moon Shining, Stopped,
She Stopped, Shoes, Shoes Went CLOMP! CLOMP!, Two Big Shoes, Two Shoes CLOMP! CLOMP!, Get, Get Out, Pants, Pants WIGGLE! WIGGLE!, Bumped, Shirt, Shirt SHAKE! SHAKE!, White Gloves, Two White Gloves, White Gloves Go CLAP! CLAP!, Hat, Tall Black Hat, NOD! NOD!, Faster, Quite, Quite Fast, Orange, Scary, Scary Pumpkin Head, Boo! Boo!, Ran, Ran Fast, Stop, Didn't Stop, Door, Locked Door, Rocked, Quiet, Knock, Knock-Knock-Knock, Open, Open Door, Brave, Bravely, Happy, Good Night, Up, Garden...Santino was encouraged to use props to imitate the action sequences of the Shoes, Pants, etc. and did so with moderate to minimal verbal and/or physical assistance by this SLP. He tried on the white gloves and tall black hat twice..."All Done" was referenced by this SLP then selected and verbalized by Santino who assisted with clean-up afterward upon verbal direction...Santino reached for his green bottle from the table (filled during the previous session with Miss Dorothy) and lay on the pillows. The beverage leaked from the bottle and may have disrupted Santino's intention to drink as clean-up of the spill was necessary...Continue as planned with focus on intentional communication to request and initiate via social referencing paired with photo exchange and verbalization.

Santino was seen for session 36 of 36 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...The visual schedule was referenced and reviewed. Santino was presented with 2 novel and 2 familiar activities, and 3 familiar book options. Santino chose "Boo! A Book of Spooky Surprises then positioned himself on the pillows. He rejected the item upon receipt. Choices were presented a second time. Santino requested "The Little Old Woman Who Was Not Afraid of Antyhing". He appeared to take immediate interest in the text and illustrations once again. During a 35-minute period, Santino engaged in two-way, purposeful interaction with gestures, shared interest, and intentional communication. He pointed to text as if decoding whole words (paired with reference to illustrations) and verbalized the following, expanding his utterances throughout, as an adapted version of the story with props was presented by this SLP: "Time, Once Upon a Time, Old, Old Lady, Little Old Lady, Cottage, Walk, Forest, Path, Seeds, Basket, Moon, Moon Shining, Stopped, Shoes, Shoes Went CLOMP! CLOMP!, Two Big Shoes, Two Shoes Go CLOMP! CLOMP!, Pants, Pants WIGGLE! WIGGLE!, One Pants Go WIGGLE! WIGGLE!, Shirt, Shirt SHAKE! SHAKE!, Shirt Go SHAKE! SHAKE!, White Gloves, Two White Gloves, White Gloves Go CLAP! CLAP!, Hat, Tall Black Hat, NOD! NOD!, Quite, Quite Fast, Orange, Orange Pumpkin, Scary, Scary Pumpkin Head, Boo! Boo!, Ran, Ran Fast, Door, Locked Door, Rocked, Quiet, Knock, Knock-Knock-Knock, Open, Open Door, Good Night, Scarecrow...Santino was encouraged to use props to imitate the action sequences of the Shoes, Pants, etc. and did so with moderate to minimal verbal and/or physical assistance by this SLP..."All Done" was referenced by this SLP then selected and verbalized by Santino...Santino removed his green bottle from his backpack and handed it to this SLP. His request was validated as he was directed to the communication book and a field of 3 beverage photos to indicate his request. Santino handed the bottle to this SLP twice more who in turn redirected him to the photo choices. Santino requested via photo exchange paired with verbalization, "Pediasure", upon removal of the photo from the strip. He assisted in the familiar sequence to transfer the beverage into the bottle then lay on the carpet to drink. Santino was positioned in a slight recline, but did not drink. He positioned himself back onto the pillows and drank 3/4 of the beverage. Upon verbal direction, Santino assisted with clean-up....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 both verbal and minimal physical prompts from this SLP...Continue as planned with focus on intentional communication to request and initiate via social referencing paired with photo exchange and verbalization.

Ben was engaged in viewing a mine craft activity on his lap top, and indicated that he was quickly turning it off. Strategies utilized to engage conversation included inquiries regarding wildlife and nature as it related to recent events that I was sharing. Ben was happy to engage in varied topics and utilized strong links and devices to signal a topic shift when needed. His affect was more variable, and commensurate with the intentions he was sharing during conversation. He happily expanded across related topics to include recall of more personal events ( visiting Aunt Laurie , trips to the Palm Beach zoo, and snorkeling). Social referencing was more consistent today, and opportunities to better understand and relate to perspective taking were increased within the nature of the conversation today.

Christopher continues to show strong gains across all target goal areas. Conversational reciprocity with a focus on recognizing your communication partner's perspective as well as expanding use of contingent, cohesive ties to connect ideas and transitions continues to improve. Support for sentence organization and linear frameworks for topic maintenance and topic shifting continues to be a strong focus. Use of visual supports, motivational props as well as the continued use of cross pattern movement continues to facilitate success and sustained attention. Chris' overall awareness regarding self modulation, and distractibility continues to improve as his ability to recognize his role within the communication dynamic increases.

Santino was seen for session 35 of 35 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...The visual schedule was referenced and reviewed. Santino was presented with 2 novel and 2 familiar activities, and 3 familiar book options. Santino chose "Boo! A Book of Spooky Surprises", sat on the pillows then turned the pages independently as he looked through the book. Sensory input via the "Purple Elephant" was provided from 1-5 seconds on cheeks, chin and lips. Santino tolerated all while looking through the book. Santino chose the book a second time and followed the predictable text pattern of questions and answers with his pointer given minimal verbal and physical assistance as the story was read aloud by this SLP. Santino supplied the following verbalizations at the appropriate pause time during the familiar sequence: "Boo x 3, Me x 1, You x 3, Witch x 1, Pointy Hat x 1"...Santino was introduced to a new book option, "The Little Old Lady Who Was Not Afraid Of Anything". He appeared to take immediate interest in the text and illustrations. During the remaining 40-minutes of the session, Santino engaged in two-way, purposeful interaction with gestures, shared interest, and intentional communication. He pointed to text and verbalized the following, expanding his utterances throughout, as an adapted version of the story with props was presented by this SLP: "Old, Old Lady, Little Old Lady, Cottage, Path, Seeds, Basket, Moon, Moon Shining, Stopped, Shoes, Shoes Went CLOMP! CLOMP!, Two Big Shoes, Two Shoes Go CLOMP! CLOMP!, Pants, Pants WIGGLE! WIGGLE!, One Pants Go WIGGLE! WIGGLE!, Shirt, Shirt SHAKE! SHAKE!, Shirt Go SHAKE! SHAKE!, White Gloves, Two White Gloves, White Gloves Go CLAP! CLAP!, Hat, Tall Black Hat, NOD! NOD!, Quite, Quite Fast, Orange, Orange Pumpkin, Boo! Boo!, Ran, Ran Fast, Door, Locked Door, Rocked, Quiet, Knock, Knock-Knock-Knock, Open, Open Door, Good Night, Bed...Santino was encouraged to use props to imitate the action sequences of the Shoes, Pants, etc. and did so with moderate to minimal verbal and/or physical assistance by this SLP..."All Done" was referenced by this SLP then selected by Santino. He 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 both verbal and minimal physical prompts from this SLP...Continue as planned with focus on intentional communication to request and initiate via social referencing paired with photo exchange and verbalization.

Santino was seen for session 34 of 34 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...The visual schedule was referenced and reviewed. Santino was presented with 2 novel and 2 familiar activities, and 3 familiar book options. Santino referenced each, but, as in the session prior, appeared to be in search of another preferred activity. Independent of direction, Santino searched this SLP's bag of activities, pulled-out "Mr. Potato Head", sat on the pillows then attempted to open the container. Upon redirection and reference to the options presented, Santino requested, "Pop-Up Pirate" via photo exchange, but immediately rejected the activity once provided...In an attempt to engage Santino, another novel activity was presented. Santino stood and sat in the chair at the table upon verbal direction then began to assist with removal and set-up of the activity to create a Jack-O-Lantern...Santino requested via photo exchange all materials required to complete the task: Foam Pumpkin, Eyes, Nose, Mouth, 3 "Vines", and the letters, H-A-P-P-Y x 2. Moderate to minimal physical assistance was provided as he placed each item in it's location correctly...Verbal rehearsal of unknown context was noted intermittently. Santino verbalized letter names upon receipt..."All Done" was referenced by this SLP then selected by Santino. He 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 both verbal and minimal physical prompts from this SLP...Continue as planned with focus on intentional communication to request and initiate via social referencing paired with photo exchange and verbalization.

Santino was seen for session 33 of 33 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 the session commenced, Santino was presented with 2 novel and 2 familiar activities, and 3 familiar book options. Santino referenced each, but appeared to be in search of another preferred activity. He referenced the photo library of this SLP and looked through each photo until he came to "Play-Doh" then handed it to this SLP. As Play-Doh was not an available option, Santino became quite teary-eyed and cried. His feelings were validated and alternate options were presented, once again, but rejected. In an attempt to redirect, entice and engage Santino, the 2 new activities were introduced consecutively by this SLP. Each seemed to hold his attention for only 5-minutes, however. Maximum verbal and physical prompts were given to engage Santino in photo exchange. "All Done" was referenced by this SLP upon signs of disinterest. Santino selected and verbalized "All-Done". He assisted with clean-up upon verbal direction then stood independent of direction and sat on the pillows...Food and beverage options were offered, but rejected...Santino chose an "ABC" book that he may have referenced with another instructor...Attempts to engage Santino in his chosen activity were permitted, but limited. He appeared to vocalize a repetitive verbal rehearsal of unknown context. At times, his vocalizations appeared to be connected to a visual list of ABCs written on the whiteboard in his room...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 both verbal and minimal physical prompts from this SLP...Continue as planned with focus on intentional communication to request and initiate via social referencing paired with photo exchange and verbalization.

Christopher initiated conversation rapidly as he often does, affording the ongoing opportunity to allow for expanded speaker -listener reciprocity, and recognizing your communication partner's perspective. Expanded discussion into conversation "starters" and the idea of questions vs statements to lead into conversation was addressed. Strong success this session with use of cohesive ties, as topics were organized and connected with use of props to support sentence organization , topic maintenance and appropriate topic shifts. Cross pattern movements were embedded once again as attention was variable today. Christopher is now showing such growth during periods of distraction as we often talk about "thinking." He shared today that he was aware that he was distracted, as mom and sister were outside the door chatting. Christopher continues to do so well each session.

Santino happily entered the front desk area, established sustained reference, and shared a "hug." The "walking song" continues to be a familiar facilitative tool to transition to his room. He quickly scanned all picture choices that were set out on the table, and reached to place the desired item of choice in my hand. Gentle redirection to remove his backpack and then move forward with activities was encouraged. Subsequent redirection to place the picture of choice on the "picture strip" and exchange the "strip" for the desired item paired with verbal stating of his intention was facilitated through hand over hand assistance. 3 Cycles of 5 trials to remove and replace the picture of choice and exchange the entire strip, and allow for verbal stating of the intention was performed with full hand over hand assistance. Additional cycles of 5 trials across 3 different tasks were offered to allow for the transition of more independent removal and placement of selected pictures, subsequent exchange, and verbal imitation following the exchange with an average of 4/5 and verbal imitation with an average of 2/5 for the duration of the session.
Strong focus to be in the area of independent manipulation of the pictures, to segue into more independent use of the picture book, which includes scanning across pages, removal and replacement of pictures within the book, carrying the book (his lexicon) across environments to allow for successful initiation of communication across social contexts. Strong focus remains on the supporting of verbal stating intent within the exchange to anchor the intention of requesting vs verbalizing the labels upon receipt of the desired item. Use of the visual schedule continues to be a strong facilitative tool as Santino now "looks" to the schedule as session closure is indicated, to anticipate the arrival of the next teacher or transition.

Santino was seen for session 32 of 32 with this SLP and appeared pleasant and calm as he was met in the "East" classroom and transitioned to the individual classroom. Students and teachers were decorating the lobby for Halloween. Santino referenced and verbalized "Ghost" from several decorations displayed on the table...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...The daily, visual schedule was referenced and reviewed...Upon entering the room, Santino immediately sat on the pillows. Upon direction, he stood and sat in a chair at the table and referenced the communication book. He selected "Where's the Witch?" from a field of 4 planned options. The predictable pattern was read aloud by this SLP as Santino lifted the felt flaps at appropriate points. Verbalization was not noted..."All Done" was referenced by this SLP then selected by Santino. In an attempt to engage Santino further, this SLP presented 2 novel and 3 familiar activities. He requested Play-Doh via photo exchange then immediately requested the Gingerbread Man and all items in the appropriate sequence via photo exchange to complete the activity once. Santino appeared focused and engaged with shared attention and interest during this two-way, purposeful interaction with gestures and intentional communication. Santino requested the following: red, Play-Doh, Gingerbread Man cookie cutter, rolling pin, eyes, mouth, and buttons via photo exchange and requested "More" + Color + "Play-Doh", "More" + Eyes, and
"More" + Buttons when necessary...Santino verbalized the following: "Cookie, Cookie Cutter, Gingerbread Man, Gingerbread Man Cookie Cutter, I Want, More, Want More, Eyes, Buttons"..."All Done" was referenced by this SLP and selected by Santino who requested "Build-and-Play Police Car" as his next activity...The vehicle had been disassembled previously and the chassis, only, was presented to Santino. All other components were presented via photo exchange. Santino requested the following to complete the vehicle assembly: car frame, siren, spoiler, front bumper, back bumper, 4 tires, 8 screws, and the screw driver. He maintained focus throughout the 30-minute activity and verbalized the following: tire, screw, screw driver..."All Done" was referenced by this SLP and selected by Santino. He assisted with clean-up upon verbal direction. The session came to a close in the usual manner with the "Good-Bye" Song during which he verbalized "Good-Bye" once during pause-time... Successful photo exchange was completed on his daily, visual schedule given both verbal and minimal physical prompts from this SLP..Continue as planned with focus on intentional communication to request and initiate via social referencing paired with photo exchange and verbalization.