S: Noah was seen at the Batt School for treatment. He was eager to work with the SLP and compliant for the duration of his treatment session. Play-based, child led therapy, along with structured language tasks utilized. O: Noah completed an alphabet identification task where the letter was provided verbally, and he had to select the correct letter from a field of 3 letters. He completed this activity with 10% accuracy. Noah was then trialed with an alphabet identification activity in which he had to match the letter provided to the correct letter in a field of 3. He completed the activity with 40% accuracy. Noah then completed a spatial concepts activity where he reviewed spatial concepts (e.g. in, on, under, behind) and was asked to follow directions using the spatial concepts. He completed the activity with 60% accuracy. Noah completed a sight word matching activity in which he was asked to match the sight word provided to the correct sight word in a field of 3 answer choices. He completed the activity with 40% accuracy. Lastly, Noah’s play skills were observed with data collected during a variety of play activities. He displayed the ability to turn-take/share in 60% of trials. A: Noah displays some decreases across POC goals, which may be attributed to a lapse in services over the summer. Goals will continue to be monitored. Additional language testing to be considered. P: Continue with current plan of care. Discuss options for additional language testing to establish new skills baseline.

The session commenced with Chris enthusiastically asking, "Are you ready for some big news Ms. Lynne?" He allowed for a response, and happily proceeded to share his new comic book publication. Response to questions regarding the publication were at times vague, however, he was attentive and motivated to share details about the storyline. This afforded an opportunity to highlight the importance of vocabulary specificity and use of cohesive ties within narratives, as well as within conversational exchanges. Speaker- listener reciprocity was strong this session as responses to comments with use of contingent responses was noted 70% of the time. The need for direct question use in order to facilitate ongoing exchange was greatly reduced this session. Review of target /s/ phoneme production was completed. The need to re-establish /s/ production with lingual retraction as a goal is noted. Strong session today.

Today Richard completed the CELF-5 evaluation. Specifically the understanding spoken paragraphs section. Richard did an excellent job during this section. He listened, sat in his chair, and asked for breaks when he needed them. Richard's evaluation report will be completed and provided to BATT and his family by next week.
Goals that will be targeted:
-TH sound
-Comprehension questions from age appropriate paragraphs/stories
-Sentence assembly (putting chunks of words together to formulate complete sentences)
-Formulating sentences with different kinds of words (adjectives, adverbs, articles,nouns)
-Semantic relationships
-Sequencing

Chris excitedly initiated conversation this morning once again. Attention was strong and motivation was high. Chris utilized familiar topic initiation "phrases" with increased frequency this morning. Scaffolding supports were provided as Chris itemized, and subsequently shared details of different characters across 6 "storylines" that he has in mind for his next projects. The multiple lists were lengthy, and the use of varied question stimuli and cue supports allowed for increased specificity of detail and vocabulary variation. Supports to manage the pace of his verbalization were provided, as his rate was rapid today. In addition, "notes" were taken as he itemized characters and provided details as well as production titles. The "notes" were shared with Chris as the discussion came to a close. Chris shared a sweet facial expression of astonishment as he looked at the notes and responded, "Oh wow Ms. Lynne, I'm so sorry. That's a lot!" We reviewed the strong use of "connectors" that he used to link details. Speaker -listener reciprocity was strong this session with a noted decrease in speaker-speaker overlap. Responses to direct questions were consistent, with a noted decrease in stimulus repetition. Response to comments was characterized by familiar affirmation, and a noted increase in use of expanded contingent comment 8 times within the session. Time did not allow for full review of /s/ phoneme targets. Review will commence next session.

Today was our first session of the school year. It is a pleasure to be back with Richard! We caught up on his summer (while listening to TH and his rate of speech). We also worked on the science vocabulary words on his board in his classroom. After reviewing the words and their definitions.
Accelerate, distance, friction, speed, energy, motion, direction and force.

Will begin CELF testing tomorrow.

Chris enthusiastically initiated conversation with a strong focus this morning. He was eager to discuss details regarding his new ideas for both comic book projects as well as "You Tube" productions. He rapidly inquired about morning break as he was concerned that "our time might be cut short" as it was on Wednesday. He was reassured knowing that break time will now be rotational. Topic initiation and transition was supported with familiar "starters and phrases" 6/9 opportunities. Topic maintenance was sustained with notable increases in vocabulary specificity and increased use of cohesive ties. Response to requests for clarification when details within topic reference were not "shared knowledge" were supportive and strong. These opportunities allowed for increased expansion into the aspects of presupposition, perspective taking, and acknowledgement of body language, intonational shifting, facial expression, and gesture. Conversational reciprocity was variable this session as speaker -speaker overlap was frequent. His excitement and motivation to share the many ideas he had was a strong factor in overlap this session. Attention was strong this session. Notable shifts in target /s/ production characterized by increased lateralization is now observed. Full review of target production across syllable structures, and phrases will commence next session.

CASL Language Evaluation, 5 sections. 1 left. Discussed what testing was done so far with parent's mother. Will finish testing and write up and present parents with results.

Chris was eager for the virtual session to commence this morning as he logged on prior to the start of the session. Today's session was the first visit of the school year following the summer hiatus.
Chris rapidly initiated conversation with a strong focus. He was very much wanting to "discuss" his completed summer "You Tube" projects as well as his upcoming collaborations and productions. This afforded a wonderful opportunity to review and expand upon the familiar strategies that best support increased speaker-listener reciprocity, decreased speaker-speaker overlap, topic transition and use of cohesive cues and temporal links. Familiar supports and scaffolding cues were provided, allowing for increased conversational reciprocity, and use of expanded comments within the exchange. Chris was observed to utilize the familiar strategy of "question repetition" four times during instances of attentional shifting to assist in self redirection to topic. Topic transitions were characterized by rapid shifts, prompting a review of "topic starters" and "transition phrases." Subsequent topic revisions were noted with use of increased phrases supporting the shift. Additional review of current goals will continue through next session so as to establish a baseline of goals for the coming year. Strong session today.

S: Noah was seen at the Batt School for treatment. He was eager to work with the SLP and compliant for the duration of his treatment session. Play-based, child led therapy, along with structured language and informal speech sound tasks utilized. It is noted that within the session, there was a tornado warning issued. This impacted some of the session data (i.e. more limited data collection), as the session was moved to a different location on the school’s campus. This is also noted to be Noah's last session prior to summer break. Goal maintenance activities were sent home with Noah at the end of his session for continued practice during session lapse. O: Noah completed a spatial concepts activity where he reviewed spatial concepts (e.g. in, on, under, behind) and was asked to follow directions using the spatial concepts. He completed the activity with 65% accuracy. Noah also completed a sight word identification activity (e.g. I, a, to, is, it, you, go) when provided initial modeling of the words. He identified the sight words in a field of 3 with 67% accuracy. Noah then completed a letter identification activity for mixed letters from A-Z. He was asked to identify letters in a field of 3 and completed the activity with 63% accuracy. Noah’s play skills were observed with data collected during a variety of play activities. He displayed the ability to turn-take/share in 78% of trials. Lastly, Noah’s speech sounds were informally assessed. He continues to maintain intelligibility between 70-80% in connected speech dependent on context. A: Noah continues to display stability/progress across POC goals. P: Continue with current plan of care.

Today during our last session Richard was surprised we still had activities to complete. We practiced /th/ in conversation while discussing one of his favorite recipes to makes. Again, due to him choosing a topic of interest, his rate of speech increased and a few of his articulation targets slurred together. He did well with cues to reduce his rate. We also completed a book of summer plans together. We took turns reading the prompts and then he drew pictures and I wrote the caption he dictated to me. He seems excited for a break from the school routine. He is doing such a great job and is a very
polite and kind student.