During our first session, Richard was eager to begin. We worked on separating /th/ into initial, medial and final positions of words. Richard’s accuracy is best in initial words. In medial positions of words, he tends to delete or replace with /f/. When I brought this to his attention he agreed but says he “doesn’t think about all of that when he is just talking” We continued by practicing medial /th/ in sentences and highlighting the /th/ in the middle of the word to increase attention and awareness.
Chris was in a great mood today. Our topic of discussion was “Apologies”. We discussed many components of apologies such as how to create a sincere apology, how to graciously accept an apology etc. Chris noted that he doesn’t always feel apologies are necessary and he doesn’t see the point of accepting them if he doesn’t like the person/apology. We discussed social norms that he may not agree with but has to decide the best way to respond on a case by case basis.
Chris rapidly initiated conversation this morning as he was eager to receive feedback regarding his recent "You tube" video productions. Review of "content" choices was highlighted. Additional discussion in the area of perspective taking, and presupposition was also highlighted. Reflection on recent peer interactions was discussed today as well, and review of strategies adapted from the Social Thinking literature was provided. Allowance for speaker listener reciprocity was strong this session, characterized by 4-6 cycles of exchange, and significantly decreased instances of speaker-speaker overlap. Strong session today.
S: Noah was seen at the Batt School for treatment. He was noted to be waking up from a nap immediately prior to entering session. Some initial crying and task refusal noted, though Noah was quickly redirected and compliant for the duration of the session. Play-based, child led therapy, along with structured language tasks utilized. Play skills (e.g. turn-taking; sharing, waiting) informally assessed throughout the session. O: Noah’s play skills continue to be informally assessed with progress noted. Noah completed a MLU expansion activity within session. He completed the activity with 68% accuracy. Noah also participated in two letter identification activities (“A” and “B”). He identified the letter “A” (both uppercase and lowercase) in an increased field when provided a model with 70% accuracy. He identified the letter “B” (both uppercase and lowercase) in an increased field when provided a model with 40% accuracy. A: Noah displays stability/progress across additional POC goals. P: Continue with current POC.
S: Noah was seen at the Batt School for treatment. He was eager to work with the SLP and compliant throughout the session. Play-based, child led therapy, along with structured language tasks utilized. Speech sounds and play skills (e.g. turn-taking; sharing, waiting) informally assessed throughout the session. O: Noah’s speech intelligibility continues to remain consistent at 75% across a variety of context. Play skills informally assessed with continued progress from previous sessions noted. Noah participated in a color identification task where he was asked to identify a color in a field of 3. He completed the task with 70% accuracy. Noah also completed a MLU expansion activity. He completed the activity with 65% accuracy. Lastly, Noah participated in two letter identification activities (“A” and “B”). He identified the letter “A” (both uppercase and lowercase) in an increased field when provided a model with 69% accuracy. He identified the letter “B” (both uppercase and lowercase) in an increased field when provided a model with 40% accuracy. A: Intelligibility shows stability with use of intelligibility strategies (e.g. say it slow; overexaggerated speech, etc.). Noah also displays stability/progress across additional POC goals. P: Continue with current POC.
We continued our discussion on Empathy. Chris was given many different situations and was asked to use empathy to decide how that person might be feeling and give one way he could respond to them in that moment. Christopher demonstrates difficulty extending empathy to people he wouldn’t consider to be friends. During multiple scenarios, Chris was quick to tell me what he would do but then explain he knew what answer I was looking for. Chris loves to joke and receive a reaction from his jokes especially when he feels uncomfortable.
We began our session with medial /th/ words. Richard was demonstrating difficulty focusing. He produced medial /th/ with 70% accuracy in 10 opportunities. If the sentence included a /th/ word that wasn’t the target word his accuracy of production decreased of the non target word. We continued with irregular plurals in sentences. Richard is beginning to demonstrate understanding of the use of regular and irregular plurals. He was able to correctly chose the irregular plural with 60% accuracy but requires more exposure to the variations. I read a grade level story aloud and Richard completed a vocabulary task from the story. Richard feels confident completing vocabulary tasks and often pulls from prior knowledge especially when reading non-fiction text. We continued with a story grammar and text feature task that Richard did well on.
Maddie was eager to transition to speech today. We held our session outside. We began with a bag of initial /s/ objects. We worked on the “snake sound”. Maddie’s /s/ in isolation sounds great. Her initial /s/ is usually omitted but with prompting and a mirror can be elicited with 40% accuracy. She does better when we split the word up and slide from one sound to another.
Chris was observably tired, and was engulfed in thought this morning. He responded to direct question stimuli, however, repetition of the question was needed 60% of the time. He began to initiate conversation 4-5 times, as it was evident that he was wanting to "share and discuss" something that was preoccupying him. Expansion was minimal however, as he would abruptly topic shift following each initiation. Redirection strategies were supportive, however, Chris refrained from
providing additional information. Attention to target activities, was highly variable, and familiar strategies adapted from the Brain Gym and Reflex integration literature were provided to best support Chris today.
After a break for lunch and recess, Richard returned with a clear head and better focus. We continued with a /th/ word search to increase exposure to common /th/ words and work on visual scanning. Richard becomes easily overwhelmed during scanning tasks, as expected. He does better when given prompts and a reduced visual field to search for targets. We continued with a reading comprehension task. I gave Richard a few minutes to read a passage about the swamp. He took a few minutes but informed me it was too difficult. We switched to a recorded auditory version of the text which was much easier for him to follow along with. We paused the recording multiple times to check for understanding and review age appropriate vocabulary words. Richard completed the task with comprehension questions and received a 90%.
