The session commenced with Christopher excitedly wanting to share the Marvel characters that he had brought with him once again . This afforded the opportunity to once again expand on the concepts of perspective taking, as well as expansion of increased abstract semantic concepts. Conversation expanded into the ideas of character description beyond the visual observances, and "the doing" descriptors. Expansion into the concepts of personality traits that are greater in depth and scope to include the concepts of character qualities was addressed. Strong support was provided and additional characters from other motivational tv shows was explored, as well as utilizing Christopher and myself as the focus provided a stronger platform for Chris to identify with the concepts. Further elaboration into story grammar generation and narrative development followed.
The use of cohesive ties and temporal links was again supported. Additionally, cues to support the acknowledgment of your conversational partners gestures, facial expressions and non verbal feedback is important to the success of their understanding of the topic. These are familiar concepts that have been introduced as they relate to conversational exchange. Christopher was motivated and focused throughout the session. Focus once again on the concept of "thinking about thinking" as topic shift was again high. Chris once again identified with the notion of "lots of ideas jumping around in his head", and responded well to cues and prompts to support more linear progression of utterances with use of ties. Strong session.

The session commenced once again with social greet in the lobby area and use of the visual schedule to assist with transition and teacher sequence for the day. The session today subsequently followed a slightly different sequence as Sharon joined in the session today for the purposes of enhancing collaboration and carryover of specific reference and verbal facilitation strategies, activity prompts and cues, specific execution of strategies to include task chaining, sabotage elements, and use of picture. exchange. Specific long-term and short-term goals were also discussed as Santino participated in tasks presented. Santino happily engaged and periods of referencing were frequent, both within a "speaker" initiation role in order to indicate intent to repeat an event, as well as in response to clinician verbalizations. Single picture exchange was consistent and independent as he would scan for the picture needed in order to exchange for the items desired, paired with brief social reference. Models and supports to increase verbal accompaniment remains a strong focus. Extremely positive session today .

Santino was seen for session 5 of 5 with this Speech-Language Pathologist (SLP) in the "East" Classroom. He appeared pleasant in demeanor and seemed to transition well between sessions as he exchanged photos successfully on his daily, visual schedule with both verbal and physical prompts by this SLP...
Goals for the session 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 introduced to the therapy ball and the "Hello Song". He appeared regulated afterward and was directed to the large, middle table to choose from a field of 2 cause and effect activities. A one-step verbal direction to sit in the chair was not executed. Santino appeared to be "in search of" something and walked about the classroom. Attempts to engage him in his chosen pattern of movement and to enter into shared attention and interest were met with protest via a hand gesture. This was interpreted as "Give me space/step aside, Miss Sharon!". He then lay on the rug in the "circle-time" area where he rolled onto his back and rubbed his eyes. Attempts to engage Santino, as in previous sessions, were met with rejection. At one point, he rolled toward this SLP and seemed to be teary-eyed. His emotion was met with validation (i.e. "Oh my, Santino! I can see your teary eyes. You seem sad! Maybe you want Miss Sharon to move away/give you space."). This SLP obliged and he seemed to recover within seconds. Attempts to redirect Santino to the table were met with rejection, once again....
A cause and effect activity was brought to the "circle-time" carpet area to entice Santino. He appeared intrigued and engaged for approximately 15-minutes with eye-contact and intentional, two-way, purposeful interactions to complete three cycles of the patterned action sequence. Imitation of the communication pattern was not noted, however...
Santino stood, spontaneously, then traveled to his backpack, reached in, retrieved a container of strawberry-banana yogurt, and presented it to this SLP. His request was validated and another two-way, purposeful interaction with intentional communication was engineered to locate a spoon. He giggled and engaged in continuous eye contact between this SLP and the items from his backpack as each was removed one by one (i.e. shorts, shirts, socks, etc.) followed by, "Is this a spoon?...Nooooooo!". A trip to the kitchen was required to locate a spoon. Utensils were removed from the container on the counter in the same fashion as from his backpack. Some frustration was noted as the process continued, at which point a spoon suddenly appeared. The final question and affirmative response, "Is this a spoon?... Yeeeeeee...s!!!" were presented. Santino and this SLP returned to the East classroom. He followed a one-step verbal direction to sit and chose to do so on the carpet in the "circle-time" area. This SLP feigned ignorance and "needed" help to open the container of yogurt. With both visual and verbal cues, Santino obliged by reaching and grabbing the tab. Together the yogurt container was opened and a spoonful was presented along with the single-word, "Yogurt!" as he engaged in eye contact. Santino cleared the spoon with his lips. An expression of what appeared to be, "Oh! This is sour!", followed. Each spoonful was presented upon eye contact (interpreted as his request) and paired with the single-word, "Yogurt!". Part-word, verbal cues with vowel elongation (i.e.Yooooo....gurt) were introduced in an attempt to elicit a single-word request. Santino verbalized, "Yogurt!", paired with eye contact, once, after the third presentation. This two-way, purposeful interaction with intentional communication (requesting via eye contact) continued for approximately 20-minutes. Santino ate 2 containers of yogurt!...
Continue as planned for the next session and introduce a smaller classroom on the North side of the campus. Interacting with Santino is just wonderful!

The session commenced with strong conversational flow across a variety of topics. Allowance for narrative generation was supported as Ben expanded on topics of choice. Further conversation focused once again on areas of strength for Ben as well as areas that he highlighted as being challenging. He embellished, and shared that he "has trouble saying what's on the top of my (his) mind", and that "its hard to express what I (he) really feel(s)" Conversation expanded into the area of strategies that support those areas of focus within our sessions. Strategies from Brain Gym and the concepts of cross patterning were discussed and subsequently modeled. He expressed strong interest in the ideas of "left and right brain" and collaboration of the two hemispheres. He actively participated in a multitude of tasks which embedded cross pattern movement sequences within reciprocal language tasks. He subsequently went on to share thoughts about how his brain and body work together, and that sometimes he "can't control his body, and that he can get "too excited". He shared examples of when this has occurred and we further discussed his participation with OT. Strong session today.

Santino was seen for session 4 of 4 with this Speech Language Pathologist (SLP) in the "East" Classroom. He appeared pleasant in demeanor and seemed to transition well between sessions as he exchanged photos successfully on his daily, visual schedule with both verbal and physical prompts by this SLP...
Goals for the session 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 behavior via eye gaze, picture exchange and/or verbalization...
As the session commenced, Santino was introduced to the therapy ball and "Hello Song". A sudden shift in demeanor, to what seemed to be "over-arousal", was met with side to side, linear rocking and continued singing for a few minutes. Subsequently, Santino appeared to be regulated and followed a one-step, verbal direction to sit on the stool located at the small table. Assistance was provided for comfort and support. Attempts to engage Santino in each of 2, 20- minute, cause and effect activities were met with visual and tactile inspection of each component. Santino requested via eye gaze and reaching. Attempts to elicit a "yes" gestural response for desired items (i.e."Do you want...?") were unsuccessful. Santino engaged in the patterned action sequences successfully, but did not imitate the communication patterns. For approximately 15-20 minutes between the "sitting" tasks, Santino retired to the rug in the "circle-time" area where he lay on the floor and rubbed his eyes. Attempts to enter into two-way interaction/engagement did not appear as successful as noted in the previous sessions...
The session ended in the typical manner with side to side rocking, in-time with the "Good-Bye" song, followed by removal of the photo successfully from his daily, visual schedule with both verbal and physical prompts from this SLP...
Continue as planned for the next session with a focus on single-word requesting. Santino is a joy to work with!

Santino was seen for session 3 of 3 with this Speech-Language Pathologist (SLP). He was greeted in the "East" classroom and appeared to transition easily and calmly from Mr. Marcus as he exchanged photographs successfully on his daily schedule with both verbal and physical prompts from this SLP.

Goals for the session remained consistent and were evaluative in nature with an additional focus on building rapport and developing a relationship with Santino.


Santino presented with a pleasant demeanor as he transitioned to the "middle" classroom where the therapy ball and "Hello" song were introduced in order to maintain regulation and to develop a routine. Santino obliged, then followed a one-step verbal direction successfully to sit in the chair at the table. Assistance for proper position and comfort was provided.

Santino was introduced to the activity, "Who is in the House?". He was able to maintain focus, organization and continuous attention to the task for 20-minutes. Santino participated in a predictable sequence of verbal and action patterns within the activity. He requested objects via gestural reach and eye gaze. Attempts to elicit yes/no verbal or gestural responses were unsuccessful. Santino executed the action sequence successfully, labeled objects (name and color), and action words within the sequence.

Santino sought the sensory ball for 1-2 minutes with support from this SLP at his hips.

Attempts to engage Santino in a gross-motor, back and forth, turn-taking activity involving pushing/driving cars and trucks through a tunnel proved unsuccessful. Santino did crawl through the tunnel once when enticed by a vehicle on the opposite side.

Santino was directed back to the table and followed a one-step verbal direction successfully to sit in the chair. Assistance was provided for proper position and comfort.

Santino participated in a fine-motor magnetic puzzle activity at the table for approximately 10-minutes. Attempts to elicit yes/no verbal or gestural responses to indicate the desired puzzle pieces were unsuccessful. He did request via reaching gestures and eye gaze.

For the last 15-20 minutes of the session, this SLP followed Santino's lead in an attempt to form a stronger relationship and to enter into a two-way, purposeful interaction with gestures and intentional communication with him. He transitioned to the "East" classroom and lay on the carpet in the "circle-time" area while rubbing his eyes. This SLP sat beside him and commented that he looked tired. Santino grabbed my hands and placed them on his head. This SLP began to sing "Head, Shoulders, Knees, and Toes" repeatedly along with the actions. Santino grabbed my hands, placed them over his eyes and held them in place. "Santino! Where are you?", I asked. He responded by removing my hands to reveal, not only, extended eye-contact, but also, a "gleam in his eyes", accompanied by smiles, and deep giggles! This exchange occurred repeatedly over a 15-minute period!



The session came to a close with side to side rocking, in-time with the "Good-Bye" song, followed by removal of the photo successfully from his daily schedule with both verbal and physical prompts.

Continue as planned for the next session and incorporate "cause and effect" play to assist Santino to develop a feeling of control and to predict and anticipate what will happen next.

It was heartwarming to make a stronger connection with Santino today! I look forward to working with him next week!

Santino was seen for his second session with this Speech-Language Pathologist (SLP). He was greeted in the "middle" classroom and presented with a pleasant, calm demeanor as he exchanged photos successfully on his schedule with both verbal and physical prompts.

Santino transitioned with this SLP and the Occupational Therapist into the restroom as it was necessary to change his "Pull-UP". Subsequently, Santino's Speech-Language session commenced in the "East" classroom.

Goal(s) for the session continued to be evaluative in nature with an additional focus on building rapport and developing a relationship with Santino.

In keeping with routine, Santino was directed to the therapy ball in order to assist with regulation. Attempts to engage him in this activity were met with rejection. Temptations with other activities, chosen to entice multiple sensory modalities, were also met with rejection. Subsequently, Santino paced in the classroom and stopped for a few seconds at several "centers" to examine toys. This SLP joined Santino and attempted to entice him with ideas to extend his play selections (i.e. As Santino removed cooking utensils, then replaced each immediately, a "Wok" was presented along with an invitation to help cook.). Santino accepted and examined the "Wok" then placed it on the "burner". Immediately afterward, he walked to the "circle-time" area and lay down on the rug. (Information reported by his teachers indicated that Santino sought rest and slept at times throughout the day.) In an attempt to develop a connection with Santino, this SLP mirrored his actions and affect as he progressed to the "story-time" area and lay on the black pillows in the corner. He turned his head toward this SLP who reciprocated in his direction. Santino then engaged with eye contact and asked, "Are you sleeping?"!!!...Santino "woke" this SLP with his rendition of "The Itsy-Bitsy Spider". He was joined repeatedly in song and associated movements. "Kisses" from the "spider" to his cheeks followed. Santino responded with smiles and intermittent eye contact. The session came to a close at that point.

Santino was guided to the schedule and removed the photo successfully with both verbal and physical prompts.

Continue as planned for the next session.

Once again, it was a pleasure to work with Santino!

Santino was seen for an initial session with this Speech-Language Pathologist (SLP). He presented with a pleasant, calm demeanor and seemed to transition well between sessions.

Santino exchanged photos successfully on his schedule by using both verbal and physical prompts to complete the task. Gesturing and verbal prompts by this SLP resulted in a good-bye hug for
Ms. Dorothy.

The goal(s) for the session were evaluative in nature with an additional focus on building rapport and developing a relationship with Santino.

Santino was directed to the therapy ball in order to assist with regulation and develop a routine. The "Hello" Song was introduced at this time. Santino hummed along. Once complete, Santino and I engaged in three, separate, 20-minute activities to develop shared attention and interest, to engage in forming a relationship and to enter into two-way, purposeful interactions with gestures, and intentional communication.

Santino was able to remain calm and organized throughout the session by taking no more than 1-2 minutes for a walking or sensory ball break between each 20-minute segment. He was warm and engaged and chose between 2 implements (one functional-one absurd) in order to gain access to the desired objects during child-directed, adult-guided play. He followed a one-step verbal direction to sit in the chair and engaged and persisted in a purposeful interaction to gain access to a second 20-minute activity. Attempts to enter into his child-directed play during another 20-minute period were met with rejection and mild distress, initially, but with persistent, increased affect and playful obstruction by this SLP, Santino allowed interaction briefly in his play.
Delayed echolalia was noted throughout the session.

The session ended with joint clean-up of all materials followed by more sensory input on the therapy ball while I engaged in singing The "Goodbye" Song. Santino removed my photo successfully, using both physical and verbal prompts, in preparation for the next session.

Continue as planned for the next session.

It was a pleasure to work with Santino!

Santino was encouraged to wait in the lobby area, and await my arrival. This afforded the opportunity to present the visual schedule to indicate that I was the "first" teacher in the sequence for the day.
He immediately initiated eye gaze in response to my social greet and then once again as he followed my line of regard to reference my picture on the schedule. He easily placed the back pack on his shoulders and was guided to place it on the designated "cow" pillow upon entrance into the room. He rapidly reached for a desired toy immediately, and once again indicated the desire to repeat the familiar sequence that had been presented previously. Familiar communicative temptations were again provided in cycles of 6. Expanded use of immediate echolalia was again facilitated to encode color +object in a series of 2/6, 3/6, 4/6 . Indication to repeat the cycle via use of verbal "again" following a model was noted x4. Subsequent cycles were paired with single picture of the item to facilitate picture exchange as a means to establish increased intentional requesting . Single picture exchange was facilitated ( x2 with hand over hand, x4 with a visual cues, and x4 independent ) via placement of the picture in my hand in exchange for the desired item. Referencing was indicated 6/10 trials. All verbal prompts were declarative and as per protocol, and completion of the exchange cycle was noted with validation and comment "you asked for .....".
Awareness of the exchange and implementation of the exchange cycle were extremely successful. Use of pecs is encouraged across tasks to expand intentionality paired with social referencing during instances of requesting desired items/actions.
Yes/no to indicate personal choice was again a focus, and was successfully implemented via use of the element of sabotage and absurdity following repeated sequenced cycles within tasks.
Santino once again smiled and laughed as the incorrect item was presented as the next choice, and imitated "no, silly silly " x4/6. Additional steps within the sequence to include movement and sensory input( Techniques from Handle and Brain Gym ) were once again followed by strong periods of increased social referencing to include 3-4 seconds across 6 cycles of exchange.
Session closure was 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 then looked to the window clearly anticipating Dorothy's arrival.
Strong session, as Santino remained engaged and seated for the full hour once again.

Christopher approached the main lobby area and peeked through the window in the door as I was engaged in conversation with Elise at the front desk. He smiled and "let me know that he was waiting" via his body language and eye gaze. It was not yet quite 8:50 and it was evident that he was eagerly anticipating the start of our session. Moments later as I approached his room he quickly opened the door and awaited my response to the line up of marvel characters that I had never before seen arranged on top of the cabinet in his room. This instantly afforded a wonderful opportunity to expand on the concepts of understanding your talking partner's perspective, and increasing sustained cycles of reciprocal exchange. Familiar supports to increase use of cohesive ties, and temporal links were provided, and were again highly facilitative. Topic shifting was rapid once more, and once again a strong focus of the session was in the area of "thinking about thinking," and recognizing your communication partners non verbal cues. Following the provision of supportive cues and discussion regarding "topic jumping" Christopher sweetly responded with animated gesture "Miss Lynne, I do have so many ideas going on in my mind." Strong scaffolding was provided as each topic was explored and subsequently supported to allow for stronger conveying of ideas within the topic and use of cohesion to allow for reciprocal exchange within the topic. Brain Gym cross pattering methodologies were embedded as well, and continue to be extremely facilitative.