Christopher was excitedly peering through his window as I approached his room. He was excited to share some new videos that he created on the tick tock app. Session focus was on establishing an understanding about the balance within the session in order to sequence and transition between different activities and topics, as strong preoccupation with the videos was evident today. Discussion expanded to include the familiar concepts of "thinking together ," and "thinking about thinking." Topic shifting was rapid, and gentle guidance and support was provided so as to allow for transitional topic shifts. Perspective taking and focus on "your talking partners perspective" and non verbal cues from them that are important as they signal either their understanding or their uncertainty when engaged in a conversational exchange was greatly expanded upon today. Expansion into repairing communication breakdown was subsequently a focus today as well.

student was absent today.

The session commenced with Christopher eagerly wanting share costume ideas for his anticipated participation in the upcoming comicon event. This allowed for rapid expansion into conversational reciprocity. Increased support was provided as allowance for reciprocity was minimal. Topic shifting was rapid as well. Supports for inclusion of temporal links, expanded descriptive concepts and cohesive ties were provided throughout the session. As additional activities were provided, the discussion expanded into the scope of 2nd grade vs. 3rd grade. Strong avoidance was observed today and was supported with cues and supports. Cross pattern movement sequences and varied Brain Gym techniques were re-introduced and embedded into the language activities. In addition, provision of strong patterned verbal cue supports was woven throughout all tasks in which processing appeared more challenging.

Santino initiated eye gaze in response to social greet. He was present in the designated classroom area upon greet, and was guided to place his back pack to a designated place in the room, a small black and white pillow that resembles a "cow" face. He rapidly reached for a familiar and highly preferred shape sorter that provides both visual and auditory feedback from the bag of materials. He was eager to engage with the toy and quickly extended the item for assistance paired with very audible vocalizations. He reached for the items in the same familiar sequence that had been presented in the previous session. Familiar communicative temptations were provided in cycles of 6 this session. Expanded use of immediate echolalia was again noted to encode color +oblect /shape in the 6 step sequence with a frequency of 3/6 X , 4/6 X2. Indication of intent to repeat the cycle via use of "again" following a model X5. Request for additional repetitions of the same task was indicated following the 6 cycles, and additional chaining was expanded upon to include the response to personal choice yes/no question forms. The use of sabotage within the sequence paired with absurdity allowed for this successful transition. Santino smiled and laughed as the incorrect item was presented paired from the pre established sequence. The stimulus was presented with strong rising question intonation ( "do we need the purple bear ?") followed by immediate "no, silly" paired with supporting intonation. A new chain was rapidly established and presented in a series of 6 cycles. Additionally, new steps were added following completion of the 6 cycles to include movement patterns ( strategies from Brain gym, RMT, Handle) and provision of sensory input ( 1. alternating foot stomp, rowing and compressions). Strong periods of social referencing steadily increased from fleeting moments 1-2 x per cycle to sustained moments of 2-4 seconds with 3-4 x per cycle at session close. Continued use of strong cue hierarchies, patterned predictable verbal chains, and techniques adapted for RDI and floor time are embedded within each session. Very strong session today.

Team meeting: establish team communication, room assignment, strategies for language facilitation across team members,
( response time to name and/or directive as a single presentation and subsequent assist when no response is observed.
decrease use of "more" and signing expectation but rather signing only used as a multimodalic tool in presentation of tasks.
Increase overall vocabulary specific noun and verb labels across tasks).
Academic curriculum parameters, S/L goals, SI strategy application across team members, visual schedule development, exploration of pecs,
team to provide pictures of themselves for visual schedule use.

Chris was seen for an initial session following the summer hiatus. He happily and excitedly initiated sharing a variety of topics of interest. He eagerly shared new information regarding upcoming marvel movie sequels. This afforded an opportunity to shape a timeline in which to help organize and sequence the many movie titles being shared. Additionally, Chris shared the new apps on his new phone, primarily the tick tock app. Christopher maintained a high level of intent to share his thoughts rapidly, however, engagement was variable, and a multitude of supports were provided to enhance social referencing and wait time for expanded conversational reciprocity, as allowance for conversational exchange was diminished. Chris indicated that he was happy to be back at school and very much liked his new room with the window.

Ben was seen for an initial speech and language therapy session. A wonderful rapport was established, and a focus was placed on identifying initial baseline parameters for specific goal development. Conversation blossomed rapidly as Ben felt comfortable sharing information about his interests, plans for possible future endeavors regarding herpetology, his "reptile room," and his 2019 Christmas list. He utilized the presentations that he had generated on his lap top, which allowed for expanded reciprocal conversation as opposed to direct narrative.
Further conversation expanded into Ben sharing thoughts about his perceived strengths as well as areas that may feel "tricky." He was open and honest as he shared his thoughts about math, "explaining ideas to people, and talking to people in general, as well as being able to talk about how he feels." Discussion included strategies for success which included embedding movement (techniques adapted from Brain Gym, RMT, Handle) into the plans for the work that we will be doing together. Ben happily agreed and expressed interest in the sessions that will follow.
Ben was an absolute pleasure.

Santino initiated eye gaze twice in response to social greet. He once again easily transitioned to the familiar room, and was once again guided to carry his backpack and place it in the designated area in the room. The session commenced once again with familiar highly motivating activities and task sequences in order to continue to provide routine within the session. Communicative temptations were once again presented in cycles of 8 with increased chaining sequences within each task (3-4). Santino once again responded well to the tasks presented and demonstrated increased indication of intent once again via imitation of "again" to repeat the action sequence with a frequency of 4,5,4, and 6, times across 4 tasks.
Expanded use of immediate echolalia was again noted specific to "color+ object" forms to indicate request within a patterned sequence following additional carrier cues 2-3x per event.
Provision of increased sensory input and patterns of rhythmic movement continue to be highly facilitative, with increased social reference noted. Continued use of strong cue hierarchies, patterned predictable verbal chains paired with each task and techniques adapted from RDI and floor time are recommended. Exploration of specific pecs use is recommended, as tool vs. task perception appears uncertain for Santino at this time..

Jack was seen for a final session as he prepares to transition to Marsh Pointe for the upcoming school year. He once again happily transitioned to his room and was eager to participate in the tasks presented. Periods of gentle support and redirection were again provided to assist with task closure and transition. Emphasis on use of materials in novel and expanded ways was once again a primary focus this session as a means to encourage dynamic thinking, flexibility of thought and creative collaboration. Activities focusing on following line of regard and expanded use of spatial concepts was also a focus. Gentle support was once again needed at session close, as Jack benefitted from strategies to assist with modulation during transition. Continued recommendations to follow up with developmental vision assessment were shared.

Jack excitedly and happily initiated transition to his room. Brief exchange with mom as the session commenced allowed for her to share plans of enrollment in Marsh Pointe for the upcoming school year. Support for her decision was shared and encouragement to contact myself and Batt staff should she need assistance throughout the school year. She expressed appreciation and also confirmed the appointment for developmental vision assessment with Debra Shim.
Jack happily participated in all activities presented this session. Supportive redirection was provided to assist with task closure and transition. Provision of opportunities to engage with materials in novel ways was once again embedded into the session as a platform to encourage dynamic thinking, flexibility of thought and creative collaboration. Strong focus was placed on directing action events within a reciprocal play scheme utilizing expanded spatial concepts this session. Additionally, varied movement patterns were again embedded within activities as well as placing emphasis on postural support while participating in table top tasks.