Santino was seen for session 16 of 16 with this Speech-Language Pathologist (SLP). He transitioned from the "East" classroom into the individual classroom via Miss Christina. Santino appeared teary-eyed and fatigued. He was greeted with the "Hello" Song in an attempt to help soothe and calm him. The photo exchange on his daily, visual schedule was completed successfully with both verbal and physical assistance, then arranged to display the remainder of his schedule sequence (i.e. Backpack, Mom, and Ingrid) by this SLP. The schedule was reviewed with Santino...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 offered food and beverage choices which were both met with rejection. He stood independent of direction and selected the bag of 26 colored balls and requested via gesture for assistance to open the bag which was closed tightly with a clasp. Hand-over-hand assistance was provided and Santino showed what appeared to be intense concentration and task persistence to remove the clasp and the balls from the mesh bag. He looked up and engaged with eye-contact from time to time, especially when little fingers were "stuck" in the mesh. Assistance and encouragement were offered with intense affect by this SLP throughout the task to provide reinforcement for his focus and efforts...Santino was observed to verbalize color words and
"Hey! You come back here!" as some balls rolled out of his reach. Additionally, it should be noted that he added what sounded like, "I'm gonna tell Mamma!"...Santino seemed to show signs of fatigue once again and completed only 2 opportunities to toss the balls into the large basket. Attempts to engage were rejected as he lay on the pillows and rubbed his eyes...A short predictable storybook was presented and read aloud as Santino fell asleep quickly...After
15-minutes, the "Good-Bye" Song was presented. Santino woke slowly then completed the photo removal successfully both in the classroom and lobby with verbal and physical prompts from this SLP. Santino opened the door with assistance and greeted Mom happily!..Continue as planned.

Santino was seen for session 15 of 15 with this Speech-Language Pathologist (SLP). The photo exchange was completed on his daily, visual schedule via Miss Dorothy and arranged to display the remainder of his schedule sequence (i.e. Miss Christina, his backpack, Mom, and Ingrid) by this SLP. The schedule was reviewed with Santino. A brief visit by Miss Christina to reinforce the schedule followed...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 greeted with the "Hello" Song. Eye contact was fleeting. He seemed to need a sensory break outside of the classroom. His "pull-up" was checked and found to be very wet. Santino easily transitioned to the restroom, but attempts to enter were met with rejection. Santino began to cry and lay on the floor in the "East" classroom. Attempts to redirect were eventually successful and the sequence began (i.e "Pants Down",
"Pull-up off", "Sit on Toilet", "Count to 5", "Wipe",
"Flush Toilet", "Shoes Off", etc.) until complete. Santino assisted throughout, but remained teary-eyed. Subsequently, he seemed to want to remain in the "East" classroom. He followed the one-step verbal direction, "Get your backpack.", given repetition and appropriate "wait-time". Santino fussed as we passed the lobby door, possibly in anticipation of dismissal, but was redirected quickly back to the individual classroom...Once inside, Santino immediately selected the bag containing the 26 colored balls and requested via gesture to open it. During the remaining 25-minutes of the session, Santino appeared regulated and showed shared attention and interest as he engaged in the purposeful, predictable, two-way interaction with this SLP. He selected the color requested from a field of 2 (and sometimes 3) for 26 out of 26 opportunities, then tossed each into the large container. Santino verbalized "orange", "red", "green, and "yellow" appropriately when asked, "What color?", throughout the activity from time to time...Santino remained engaged and scanned the items prior to selection. Eye contact was noted consistently upon presentation of the balls...The session came to a close in the routine sequence with the "Good-Bye" song and successful photo exchange on his daily, visual schedule with both verbal and physical prompts from this SLP...Santino transitioned calmly into his next session...Continue as planned with continued focus on single-word requesting via eye-gaze, photo/picture exchange and/or verbalization. Santino is delightful!

The session commenced with a strong social reference upon social greet. Visual schedule was shared, he subsequently reached out, touched my picture with his finger and reached for my hand as it was extended to initiate the transition. Familiar "walking " transition song was sung. Santino placed his backpack on the cow pillow following a single presentation of the directive. He rapidly reached for the closed bag of materials once more, and he was quickly redirected to the picture strip placed across his small white binder containing 5 pictured choices. He quickly scanned and removed the picture of the desired item and reached to place it in my hand. Continued use of affirmation and validation of his request was presented and pictures were re-ordered at the close of each repetition of the task and /or new task presentation . Verbal imitation was noted on 12/16 opportunities presented during the picture exchange for the desired activity to include the noun label (bear train/shape game). Social refereeing was noted on 8 of the 12 instances of verbal imitation.
New tasks presented this session resulted in brief periods of increased use of delayed echolalia
( singing the ABC song, scripts from something he'd seen). Joining him in his song and providing T-Touch allowed for increased social referencing during moments of modeling and demonstration of the newer materials, eliciting strong interest. Communicative temptations within tasks were again presented in cycles 6 and 8 with immediate echolalia noted to encode color +object word combinations on 4//6, 3/6,3/6 and 4/6 opportunities. The verbal imitations continue to be heard predominantly upon receipt of the desired item, however, 2/14 were noted in anticipation of the item. This success is significant as it supports the need to shape the focus from reactive based verbalization to proactive initiation of verbalization to request. Classical music, (baroque) was played in the background for the duration of the session.
Session closure was indicated by a familiar clean up song. Santino refrained from reaching for pictured items in order to exchange. Attention was directed to the schedule, with verbal support that "we " were done. He was directed to remove my picture and independently placed it in the pocket. Focus was then placed on "Time for Dorothy," and he immediately turned to the window anticipating her arrival, as "Dorothy, where are you?" was modeled. He subsequently imitated that model 3 times. Strong session.

Christopher excitedly initiated conversation this session. Overall attention to tasks was consistent and participation was strong. He happily shared his DC characters, and took the initiative to expand on the character traits. He saw my excitement in response to his doing so, and his pride was evident. Expansion into similarities and differences across characteristics and traits was supported with the use of only minimal cues today.
Focus was also on use of broader semantic concepts across activities. Additional cues and scaffolding were provided as expansion into more complex tasks was challenging.
Christopher shared, "I'm feeling confused with this,"as the new tasks were presented. This afforded a wonderful opportunity to share positive feedback and praise, as he expressed his confusion, where as previously he would typically abandon, act silly, or quickly excuse himself to get a drink or use the restroom as an avoidance. Strategies to include familiar cross midline patterning, verbal rehearsal and visual cues facilitated increased success. Strong session today.

Santino was seen for session 14 of 14 with this Speech-Language Pathologist (SLP). The photo exchange was completed on his daily, visual schedule via Miss Janis...Santino sat on his pillows in the individual classroom on the "North" side of the campus. He seemed tired, though pleasent and calm as he rubbed his eyes and transitioned between teachers...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 greeted with the "Hello" Song. Eye contact was fleeting. Food choices were presented while asking, "Do you want to eat?". Santino seemed uninterested. Beverage choices were presented while asking, "Do you want a drink?". Santino tapped the Organic Vanilla Shake...A two-way, purposeful interaction ensued as Santino engaged in eye contact, turned the caps and poured the beverage into the green container successfully given both verbal cues and physical assistance from this SLP. He giggled at the "glug-glug-glug" of the shake as it was poured into the container. Santino lay on the pillows and drank 3/4 of the beverage while this SLP sang a variety of melodies regarding his chosen activity...Subsequently, Santino followed a one-step verbal direction successfully to sit in the chair at the table where he focused and engaged for 20-minutes on a planned, sequenced, predictable activity. Santino was successful for 8 out of 10 opportunities to "pick one" in a field of 2 "haystacks" to find the matching top and bottom pieces of 10 farm animals. (The top and bottom "snap" together to form a whole farm animal.) He verbalized "chick" twice throughout the activity. Santino helped to clean-up by selecting the animal requested successfully from a field of 2 for 10 out of 10 opportunities. He followed through to place each one into the box. Subsequently, Santino participated successfully in a "My turn/Your turn" exchange to place each of 20 haystacks back into a box. He showed patience and restraint as he selected one haystack, only, from a field of 2, thus leaving another for "My turn". Santino followed a one-step verbal direction independently to help close the flaps on the box...During the final 20-minute segment, Santino stood from the chair independent of direction and selected the mesh bag of 26 plastic, colored balls. The clasp came loose and all fell to the floor leading to another two-way purposeful interaction with intentional communication to select then toss the balls into a large basket...Santino positioned himself on the pillows. Two balls of different colors were presented. Santino followed the one-step verbal direction to "pick one" from a field of 2 successfully for 25 of 26 trials and tossed/threw each into the basket for 26 of 28 opportunities. Santino verbalized "orange" and "red" when asked, "What color did you pick?", for 3 out of 3 and 2 out of 3 opportunities, respectively. Eye contact and concentration were noted throughout as he appeared to participate happily in the activity...The session came to a close in the routine manner with the "Good-Bye" Song. Santino was directed to the daily, visual schedule for review. Santino removed the backpack photo independently upon request and immediately secured his backpack given direction to do so. Once at the door to the front lobby, Santino was asked, "Who is that?" He replied, "Ingrid!" then removed her photo from the daily, visual schedule and proceeded to help open the door and greet her...Excellent interaction, focus, concentration, and verbalization today...Continue as planned...

Upon arrival to Ben's room, he was once again actively engaged in viewing items of interest on his laptop. As we exchanged a social greeting, I commented briefly on the dynamics of body language relating to the discussion last session. He happily referenced me, and inquired if would be alright to finish what he was watching, as it had only about 1-2 minutes remaining. As he closed his laptop he initiated conversation about what he was watching, allowing for expanded discussion into the concepts of perspective taking, and inferencing. Focus shifted into the concepts of use of expanded descriptive concepts, associations, and semantic relationships within varied language activities. Ben is quite motivated and is enjoying the tasks presented, he happily shared during the session today that he would like to be able to work together on Mondays and on Fridays as well, as he liked our lesson time.

Christopher came searching for me this morning as I was searching for him as well, having arrived at his room to discover that he had moved. He returned to his original room unbeknownst to me.
He was eager to discuss his new Lego picture frame and the Lego Marvel characters that adorned it. Gentle encouragement to discuss the room change, and a variety of other topics was supported with carrier phrases, lead in cues, and scaffolding this session as Chris' attention was fleeting a bit today . He shared that he was tired, as the session progressed. Rapid topic shifting was subsequently noted, with intermittent periods where he was rather pensive. Gentle encouragement to allow for expanded reciprocity was facilitative, however, overall cycles of exchange were inconsistent today as well.

Santino arrived 15 minutes late for the session as mom had phoned to share that they were running late as Santino was eating breakfast. Upon arrivaL, he initiated brief eye gaze in response to social greeting, and glanced at the visual schedule as it was presented. He happily transitioned to the familiar room and placed his backpack on the "cow pillow' with gestural and hand over hand support. As he rapidly reached for the closed bag of materials adjacent to the table, a strip of 4 pictured choices was immediately presented, he quickly scanned and removed the picture of the toy of choice and reached to place it in my hand. Continued use of affirmation and validation of the request using declarative statements was provided. The 4 choices were continually presented, each time reordering the pictures on the velcro strip, as the task came to a close. He subsequently initiated requests via picture exchange 12 times throughout the session. Overall social referencing within the exchange was highly inconsistent, as periods of delayed echolalia were strong this session. Strong focus lies in the area of increasing Santino's overall awareness of verbal regulation, supporting the shift from verbal reactivity, to verbal initiation. Increased use of immediate echolalia was noted this session. Use of sabotage and absurdity continue to be a facilitative tool to increase responses to personal choice yes/no questions within a repeated play framework. Session closure was again indicated by a familiar "clean up song," removal of my picture from the schedule, hand over hand placement of the picture in the pocket and referencing the next teacher. Santino subsequently looked to the window anticipating Dorothy's arrival.

Christopher excitedly opened his door as I approached his room, waiting to share his new "theories" regarding upcoming Marvel movies. The session then subsequently commenced as it typically does with the initial focus targeting conversational expansion, allowance for conversational reciprocity, acknowledgment of your communicative partner's gestures, facial expression and non verbal cues. Today's discussion evolved into new awareness regarding "thinking about thinking,'" and "thinking together." Chris was attentive and motivated for the duration of the session and as the conversation expanded, Chris shared that this "stuff is hard since (he)/I didn't talk until( he) / I was 5." We expanded on the aspects of how smart he is and that he has so many wonderful things to share and talk about and that "back then" the words just weren't quite ready to come out yet. The duration of the session was spent discussing the aspects of conversation as we "talked about talking." Truly wonderful session today.

Santino was seen for session 13 of 13 with this Speech-Language Pathologist (SLP). He transitioned with Mr. Marcus and met this SLP to escort Santino to the individual classroom on the "North" side of the campus. The daily, visual schedule was reviewed with Santino by this SLP...Santino investigated the room which had been arranged by Miss Denise to include two tables, small chairs, pillows and a pterodactyl hanging from the ceiling. Santino investigated the 3 planned activities displayed on one of the tables. Photos were presented in a field of 2 over 3 separate opportunities. Verbal and physical cues were given to select just one. Santino chose both photographs in each trial...Santino gestured upward with his hands for preferred activities displayed out of reach. Photo choices were presented. Santino protested then reached for his lunchbox...When ask, "Are you hungry?", Santino tapped the yogurt. He chose not to eat the yogurt. When ask, "Do you want a shake?", he selected vanilla. Santino was engaged in a two-way purposeful interaction to open the containers and pour the beverage. He gestured and pulled this SLP to the door (as if requesting to exit the small room). Attempts to redirect him to the pillows in the room were met with rejection. His repeated gestures were acknowledged and a transition was made back to the "East" classroom where he lay on the floor next to the "cow" pillow. Santino seemed disregulated, but was eventually calm and finished the entire shake...Attempts to engage afterward were met with rejection. He did, however, seem to respond to attempts to soothe/calm as he lay on the carpet, snuggling with his pillow. Santino seemed to be almost asleep 10-minutes prior to dismissal...The "Good-Bye" song was tolerated. With each attempt to "wake" him for dismissal, Santino apeared agitated. Mr. Marcus assisted by retrieving his backpack and lunchbox from the individual room...Santino transitioned with this SLP in a more relaxed, pleasant demeanor to greet Ingrid. He removed her photo successfully from the daily, visual schedule with both verbal and physical prompts from this SLP...Follow-up with the recommendation to display photographs of all teachers, Mom and Ingrid on his daily, visual schedule for repeated review and reference throughout the day. Continue to review and revise best options for the session location to accommodate Santino's needs at any given time.