Session commenced once again with strong social reference upon greet, and successful reference to the visual schedule in order to initiate the transition. Santino reached for my extended hand, and the "walking song" facilitated additional reference as we approached his room. He placed his backpack on the pillow following a single presentation of the directive. He quickly scanned the pictured choices of activities on the strip containing 8 options. He consistently removed the picture of the desired activity and reached to place it in my hand 15 times this session, across 2 familiar tasks and 2 novel tasks . An item randomly fell onto the floor adjacent to the bag of materials. Upon retrieving it, he spotted an item of interest in the bag, began to reach for it, refrained, and quickly glanced at the picture strip of choices. Unable to "find " it, he reached for the zip loc bag on the table containing many additional pictures. Together we located the picture, he quickly handed it to me in order to indicate his request, paired with brief social reference. Opportunity to request specific color choices within activities was again presented. He successfully requested specific color 6/6 x in a series of 3 paired with verbalization 15/18 opportunities. He subsequently initiated color choice specificity within the novel task as well. New reciprocal exchange activity allowed for collaborative tower building, allowance for wait time, and increased social referencing across a 10 cycle exchange for 3 cycles. Use of absurdity continues to be a valuable tool, allowing for increased social reference, and indication of intent within personal choice yes/no question forms, and to "repair" "silly" instances of mishap in play. Session closure was again facilitated through use of the familiar "clean up" song, joint reference to the visual schedule, removal of my picture, placement in the pocket, and acknowledgment of the next teacher's arrival. Consistent verbal imitation of the model "Marcus, where are you? " as we awaited his arrival was noted 4 times. Continued use of classical music during session is noted as well.

Christopher and I "bumped " right into each other as he came searching for me as I was on my way to his room. He excitedly shared that he "had so much to tell me today." He rapidly began to share that he was flying on the airplane today, as Comic-con was this weekend in NY. He has been sharing his excitement about the event for weeks, and was excited to discuss the trip today. A wonderful topic to allow for expansion, reciprocity, and recognizing your "talking partner's" perspective. Supports to allow for increased conversational turns, and the use of cohesive ties and temporal links were facilitative. Cross pattern movement sequences were embedded within the session to allow for increased sustained attention within cycles of conversation. Additional topics included the menagerie of plush Mario characters he had brought with him today, allowing for expansion into the concepts of character traits which have been a recent focus during sessions.
Shaping and supporting cohesive responses to more open-ended question forms was an additional focus today as well.

Christopher excitedly inquired about the "Superman character story book" that was discussed at the close of last session, and he shared that he "was ready to get busy."
The premise of the book that was generated together was to identify the characters and "special powers" based on descriptors provided. Expansion once again into character qualities and associated attributes, as well as similarities and differences was highlighted. Christopher continues to expand his awareness and understanding of these concepts. Expansion into short narrative generation utilizing the characters from the previous activity was a subsequent focus. Emphasis once again was in the areas of perspective taking, and use of cohesive links and temporal cues to enhance overall linguist organization. Highlighting word choices was focused upon as vital to help your listener better understand, as we discussed how "words match our thinking to help your talking partner. Strong session once again.

Santino was transitioned by Miss Christina to meet this Speech-Language Pathologist (SLP) in the corridor. Santino appeared pleasant and calm as he proceeded back into the individual classroom for session 20 of 20 with this SLP...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 directed to Mickey Mouse "Deck the Halls!" Big Fun Coloring Book which he referenced during the prior session with Miss Christina. Santino and this SLP sat facing one another on the floor with the book situated between us. Santino was prompted to tell this SLP about the pictures as he turned the pages independently. Santino engaged and entered into a two-way, purposeful interaction with gestures and intentional communication via spontaneous verbalization and reading of both single and multi-syllabic words, and two-word phrases printed or pictured on the pages. Continuous back and forth engagement via eye contact, smiles, laughter, gestures and facial expressions of what appeared to be excitement and pride in his verbalizations were noted throughout the entire session. Santino verbalized and/or read the following during the aforementioned interaction: Holidays, Mickey Mouse, Lollipop, Party Time!, Mistletoe, Presents, Present, Hat, Love, Candy Cane, Minnie Mouse, Fun, Eating Cookie, Delicious,
Ho-Ho-Ho-!, Pluto, Donald Duck, Oh, boy!, Goofy, Snow, Snowman, Day, Play, Surprise!, Jingle Bells, Merry Christmas!, Write, "Oooooooo!", Happy Holidays!, Accordian, Bone, Tuxedo, Daisy Duck,
Gingerbread Man, Horray!...The session came to a close in the routine manner with the "Good-Bye" Song. Santino appeared to transition easily from the Mickey Mouse book and successfully completed the photo exchange within the classroom and the lobby given verbal and minimal physical prompts from this SLP...Continued as planned with a focus on activities to build and expand upon functional communication via photo exchange, verbalization and written words. Santino appeared to have a pivotal session today!!! A joyous interaction, indeed!!!...

Session commenced once more with strong social reference upon greet and successful reference to the visual schedule to initiate the transition. Familiar "walking song" facilitated brief reference as we transitioned to his room. He placed his back pack on the pillow following a single presentation of the directive. Picture choices were readily available to assist with initial use of picture exchange in order to avoid the need for redirection to the pictures following reach for the desired items themselves. Picture strip contained 7 possible choices this session. He consistently removed picture and reached to place it in my hand 16 times during the session with the intent to choose the same task and/or choose a new task. Social reference was highly variable this session however.
Opportunity to make specific "color" choice requests within a sequence within a task was introduced. He successfully scanned the color options and requested specific colored items belonging to the task on 6/6 trials for 8 consecutive repetitions of the activity. Verbal imitation of the color label was noted on 4/6, X2, 3/6, X2, 2/6, X1, and 1/6 X3. Strong use of carrier phrases during the exchange cycle facilitated verbal label of the color twice prior to the exchange rather than after. The focus continuing to be on the shaping of the reactive verbalization into proactive initiation of verbalization in order to increase spontaneous requesting. Santino appeared to be a bit tired today overall, as he was observed to "stare " off for brief periods. Overall another strong session as his use of picture exchange to indicate his requests continues to increase. Session closure was again indicated by the familiar clean up song, Attention was directed to the visual schedule in order to remove my picture. He independently removed my picture, and placed it in the pocket following verbal supports. Focus was then placed on Dorothy's arrival, and he again immediately turned to the window anticipating her arrival. He verbalized " Bye" as I exited following Dorothy's model.

Santino was seen for session 19 of 19 with this Speech-Language Pathologist (SLP) in the individual classsroom. He appeared pleasant in demeanor and seemed to transition easily between sessions with successful photo exchange via Miss Dorothy. The daily, visual schedule was arranged to include photos of Miss Christina and his backpack then reviewed with Santino by this SLP...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...Classical Music for Attention and Focus was played in the background...Santino appeared warm and "flushed" as the session commenced. Food and beverage choices were offered but refused by Santino. (His temperature was monitored via touch and seemed normal at approximately 15-minutes into the session.)...Santino sat in the chair upon a single verbal direction and selected, via photo exchange, the wooden "snake" alphabet puzzle...Each puzzle piece was presented individually upon request via gesture and/or eye gaze for 26 of 26 opportunities. Attempts to elicit the letter names by pausing and waiting throughout the familiar "Alphabet" Song as each piece was connected to form the "snake" were unsuccessful (with the exception of letter "D"). This SLP requested "help" from Santino. Hand-over-hand assistance was provided over a single opportunity to guide Santino to point to each letter (with his "pointer" finger) as the song was repeated with each new letter added to the "snake's" body. He appeared interested, focused and engaged as he kept in time with the song (except for the prolongation of "G" and "P") while tracking each letter visually as he pointed for 13 of 13 opportunities. Santino chose to run his finger along the letters as the remaining 13 were added given both verbal and physical prompts to "point" to each letter. Upon completion of the puzzle, Santino stood and peeked out of the glass in the door. He was redirected and chose Bob Books First!, Level A, Set 1, Book 1, "Mat", from an array of 3 planned activities via photo exchange...Santino referenced the cover then tracked the text both visually and physically with his "pointer" finger with minimal hand-over-hand assistance as it was read aloud by this SLP. Illustrations depicting characters' actions and feelings were referenced. Questions pertaining to basic story elements (WHO did WHAT?) where presented...Santino referenced the laptop on the table and exchanged the photo presented...Santino was provided maximum hand-over-hand assistance to type single-word and two-word responses to questions pertaining to basic story elements (i.e. Mat., Mat sat., Sam., Sam sat.). The written responses on the screen were read aloud by this SLP as Santino tracked the words visually...The session came to a close in the routine manner with the "Good-Bye" Song and successful photo exchange with both verbal and minimal, physical prompts by this SLP. Continue as planned. Santino showed continued engagement, focus, and interaction today.

Santino was seen for session 18 of 18 with this Speech-Language Pathologist (SLP) in the individual classsroom. He appeared pleasant in demeanor and seemed to transition easily between sessions with successful photo exchange via Miss Janis. The daily, visual schedule was reviewed with Santino by this SLP...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...Classical Music for Attention and Focus was played in the background...Given a choice of 2 planned activities, Santino chose, "Mat", from the Bob Books series and sat on his pillows. He visually inspected and turned the pages of the book independently. Santino was guided via minimal hand-over-hand assistance to physically track the brief sentences with his "pointer" finger as the short story was read aloud by this SLP. Visual tracking of the text was noted throughout. Connections were highlighted and referenced between the story and the simple illustrations of the characters, their actions and feelings. Santino seemed engaged, interested, and focused as the book was read aloud 3 times consecutively in the aforementioned manner...Santino stood independent of direction, sat at the table and selected the 'Farm Match Up" activity from a field of 2 planned activities displayed on the table. The game proceeded in the predictable sequence with success at each level for 5 out of 5 opportunities each. Santino appeared to lose interest in the activity (given attempts to redirect) and was directed to assist with clean-up. He selected then placed the animal requested into the box successfully for 10 out of 10 opportunities. Santino closed the flaps independently. Attempts to elicit the animal names upon selection were unsuccessful. Delayed echolalia was noted at times throughout the activity...Santino was presented with a foam, "train" number puzzle. He selected colored pegs from a field of 2 via gesture and eye gaze for 15 out of 15 opportunities. Attempts to elicit verbal requests for each colored peg were unsuccessful. Delayed echolalia of color names was noted, however. Santino was successful with one to one correspondence as he inserted the pegs into numbered cars for 5 out of 5 opportunities. Santino assisted with clean-up by removing and placing all pegs into the container...The session came to a close in the routine manner with the "Good-Bye" Song and successful photo removal on his daily, visual schedule given verbal prompts and minimal physical cues and assistance from this SLP. Santino verbalized, "Here we go!" spontaneously as we exited the classroom....He seemed happy to greet Ingrid!..Continue as planned.

Ben initiated social greet this session with expanded social referencing. He quickly inquired if he could share two "things" on his laptop. This afforded an opportunity to expand into various topics for increased conversational turns. A new "thinking strategy" task was presented, and Ben expressed great interest. Subsequently, his affect changed, and there was uncertainly regarding his confidence level, and/or enjoyment of the activity. As this was explored with him, he shared that he was using his "poker face." This afforded a wonderful opportunity to discuss once more the dynamics of perspective taking, the perception of your communication partner, body language and gesture, and inferencing. Additional activities continue to focus on use of expanded descriptive concepts, associations and semantic relationships within various language tasks. Cross pattern movement was encouraged this session, although he preferred to remain seated.
Supports to sustain focus were successful.

Christopher excitedly inquired if I had something new in my bag today. He was happily surprised as a new lego activity was presented. As in previous sessions, the focus on collaborative teamwork, and sequential organization was highlighted. He subsequently shared a new sticker book that he had with him. Conversational topic expansion strongly focused on the dynamics of reciprocity and the comment/comment exchange with a decreased need for question within the exchange.
As conversation expanded, Christopher had "a really great idea" to give a DC sticker picture to Mrs. Judie. "She will like Batman because her name is Batt," he excitedly shared. The activity was expanded to include a written letter, and embellish on character traits as an opportunity to generalize the concepts that have been targeted in recent sessions. Prompts and supports were extremely facilitative, to include descriptive concepts, and to increase linear organization of sentence structure within the task. Strong session today .

Santino was seen for session 17 of 17 with this Speech-Language Pathologist (SLP). He transitioned from the "East" classroom into the lobby via Mr. Marcus where he was met by this SLP...Santino lay on the black sofa and appeared fatigued. The daily, visual schedule was reviewed as it was received with the sequence intact. Attempts to redirect Santino were successful after a few minutes and he proceeded into the individual classroom without protest...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...Upon entry to the classroom, Classical Music for Attention and Focus was played in the background...Santino referenced the "Snake" alphabet puzzle arranged in a field of 2 planned activities displayed on the table. He followed the one-step verbal direction successfully to sit in the chair. Each puzzle piece was presented individually upon request via gesture and/or eye gaze for 26 of 26 opportunities. Attempts to elicit the letter names by pausing and waiting throughout the familiar "Alphabet" Song as each piece was connected to form the "snake" were unsuccessful. This SLP requested "help" from Santino. Hand-over-hand assistance was provided over 3 opportunities to guide Santino to point to each letter (with his "pointer" finger) as the song was repeated with each new letter added to the "snake's" body. Santino repeated the pointing sequence independently from letters "G" to "Z" (20 of 20 opportunities). He appeared interested, focused and engaged as he kept in time with the song (except for the prolongation of "P") while tracking each letter visually as he pointed...The second 20-minute planned activity,
Bob Books First! Level A: Book 1, "Mat", was introduced to Santino. (As the books progress, this series uses all the letters of the alphabet, except "Q", with consistent sounds and patterns of three-letter words and short sentences throughout.) Santino looked at the cover briefly then turned to retrieve "Farm Memory Match Up" from the bag of materials (kept in reserve by this SLP) situated near the door behind the desk...In an attempt to "join" in his chosen activity, the segment continued as Santino engaged in a purposeful, two-way interaction with gestures and intentional communication to play a modified version of the "Match Up" game...Santino was presented with each of 10 small, plastic farm animals individually. He followed one-step verbal directions (i.e. "Pull the...apart.", "Put the top of the...down.", "Put the bottom of the...down.") to set-up the game for 10 out of 10 opportunities each. This SLP would then hide 4 pieces under "haystacks". Santino participated in the game for 25 out of 25 opportunities as he was instructed to "Pick one!" from a field of 4 "haystacks" until he found a matching pair. He reassembled each correctly and required assistance to turn and line up the nose and tail details, only. Santino placed each animal back on the floor upon each one-step, verbal direction with the positional modifier, "next to" (i.e. "Put the sheep next to the horse.") for 10 out of 10 opportunities. He seemed to show interest, intense focus, task persistence and engagement for approximately 25-minutes. Santino appeared to look to this SLP for reassurance that he was proceeding correctly. He was reinforced and praised for his efforts throughout the activity...Santino assisted with clean-up by placing the animal requested (from a declining field of 10) into the box for 10 out of 10 opportunities. He closed the flaps independently upon request...Santino rubbed his eyes and lay on the floor. This SLP lay beside him and presented the book "Mat" referenced earlier. Santino tracked the short sentences with his "pointer" finger and turned each page with moderate "hand-over-hand" assistance from this SLP...The session came to a close in the routine manner with the "Good-Bye" Song and successful photo exchange on his daily, visual schedule given verbal and moderate physical prompts from this SLP...Continue as planned with focus on functional, single-word requesting via eye-gaze, photo exchange, and/or verbalization. Santino continues to be a joy to work with!