Richard was a little mentally tired from morning testing when I met with him. He kept asking me to repeat myself and was having a hard time focusing. We moved our session down to the floor so he could move around and attempt to use alternative seating. Our first task was to use /th/ words in initial and final positions in sentences. At first, he was creating long run on sentences and losing his train of thought throughout. We used a visual to create simple sentences including a subject and a verb. This allowed him to decrease his rate of speech, increase his accuracy of production and create grammatically correct sentences. We continued with an auditory identification task. I provided Richard with a list of words and he was to tell me if /th/ was in that word. He did this with 60% accuracy. Sometimes he seemed to be guessing and sometimes he was overgeneralizing /th/.
Chris was in a great mood today. He told me about his great weekend and plans for this week. Our topic of discussion was Empathy. He looked up the definition of empathy and tried to explain what it meant to me in his own words. He was able to grasp the concept but didn’t understand the importance. We went through many scenarios in which we could use skills of empathy in real life. Chris demonstrated difficulty relating to the scenarios unless that included adults or peers that he cares for. This topic will be continued on Wednesday.
Maddie did a great job today. We reviewed initial /f/ sound articulation placement and practiced accurate final /f/ coarticulation in the mirror. We continued by testing stimulability for /s/ in isolation and then /s/ in initial position of words. We also practiced slowing down by using breathing techniques. Maddie is quick to move from one activity to another and often times uses a quick rate of speech that decreases intelligibility.
Today Christopher and I discussed the topic of asking for help. Chris was hesitant to discuss this with me as he noted he would rather not doing something than ask for help. We discussed various scenarios in which he may have to ask for help even if it is difficult. While he agreed he was sold on the idea of actual doing so. We continued by discussing how he could introduce himself to a new student. He said he would prefer not to make any new friends so we discussed the event hypothetically and worked through different ways we could continue the conversations.
Richard and I began our session with an auditory comprehension task. I read the riddle aloud and he would answer with an appropriate /th/ word in various target positions. We continued by practicing /th/ words in conversation. Richard demonstrated the most difficulty with final /th/ words as he continues to habitually substitute them for /f/. This however, doesn’t really affect his intelligibility in conversation. Additionally we worked on a problem solving task using a word ladder that required Richard to manipulate phonemes/sounds to create new words that fit the picture description. We concluded our session with a compare and contrast task using a venn diagram and dragging the descriptors into the correct location.
Maddie demonstrated some difficulty transitioning into the speech room after returning back the routine following absence. We began with auditory bombardment of initial /f/ words. We continued with a game of finding objects that began with our speech sound. She was able to articulate initial /f/ with 30% accuracy. We continued by increasing accurate productions in the mirror by working on /f/ in the final position with 80% accuracy. This brings her attention to lip posture for accurate /f/ production.
The session commenced with Chris unexpectedly initiating the session from home in a timely manner. He was observably tired, however, he was motivated and participatory. Use of familiar conversation starters was strong, and rapid topic revisions and transitions were also frequently noted this session. Varied question stimuli provided the foundation for increased topic expansion, and verbal description of familiar events. Recall of detailed sequential events was supported with prompts and cues. Validation of "lack of interest," in recall of past events, whether deemed exciting and memorable or mundane was discussed. This afforded an additional opportunity to highlight the aspects of perspective taking and presupposition, as well as self awareness within a conversational exchange. Conversational expansion was variable this session, as fairly rapid topic shifting remained throughout the duration of the session. Aspects of indirect language, double meaning words and phrases, as well as idioms were also a focus of today's session.
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. It is noted that there was an increase in structured language tasks that were completed throughout the session. Speech sounds and play skills (e.g. turn-taking; sharing, waiting) informally assessed throughout the session. O: Noah’s speech intelligibility throughout session is noted to be at 70% to 75% intelligibility based on 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 following directions with spatial concepts (e.g. put the socks on the dresser). He completed the activity with 58% accuracy. Lastly, Noah participated in a sight word activity. He was able to read the sight word “to” with an initial model and fading cues with 65% accuracy. He also identified the sight word “to” in a field of 4 with a model with 50% 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. Difficulties with spatial concepts (e.g. in vs. on, above/below) noted. P: Continue with current POC. Introduce directions with spatial and temporal concepts.
During our second session together Richard requested we complete a shared reading of another non fiction book. During this we focused on simple decoding, non fiction text features and answering comprehension questions of grade level text. Richard did a great job with this and I am happy to see him interested and engaging with text he enjoys.
