S: Noah was seen at the Batt School for treatment. It is noted that he was sleeping upon entry to session. Babysitter, Michael, noted that Noah did not nap on Tuesday, Wednesday, or Thursday. When woken up, Noah began to cry and cling to Michael. Michael assisted with transition to speech room. Noah was noted to cry and attempt to hit at self and SLP at initial portion of session. Calm down strategies such as taking a walk, deep breaths, and rocking were utilized throughout treatment. Once in a calm state, Noah was eager to work with the SLP and worked until the end of the session via play-based, child led therapy. Noah was able to successfully transition out of session with verbal reminders and advanced warning. O: Modeling of calm down strategies as well as increased utterance length utilized throughout session. Color identification briefly worked on. Task completed with 20% accuracy. A: Minimal formal targeting of goals noted due to heightened state throughout session. Color identification appears to be at baseline, though minimal data noted. P: Continue updated 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 assessed informally. Use of timers for transition out of treatment utilized but noted to be unsuccessful. Some crying/throwing of objects noted when transitioning out of treatment. O: Noah’s speech intelligibility throughout session is noted to be at 65% to 75% intelligibility based on context. Noah participated in a color identification game. He identified the colors blue, red, yellow, and purple with 30% accuracy. Noah was probed with a letter identification activity in which he circled or colored the letter “a” (both uppercase and lowercase) with a model in a field of other letters. He completed the activity with 30% accuracy. Noah also completed a structured following directions activity with 40% accuracy. A: Color identification and following directions continue to be at baseline. Intelligibility displays slight increase across contexts. Letter identification probed with baseline to be established. P: Continue updated POC. Add letter identification goal.
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 assessed informally. Use of timers for transition out of treatment utilized and continue to be successful. O: Noah continues to increase his MLU with SLP. His overall intelligibility displays some increase, repeating slowly, then from model PRN when not understood. Noah was again probed with color identification activity to establish a baseline. He completed the activity with 20% accuracy. He was also probed again with following 1-step directions with 2 key words (e.g. give the pencil to the bear (when provided with 2 objects and 2 animals)) to establish a baseline. He completed the activity with 40% accuracy. Noah was also probed with a sight word activity. He completed the activity with 30% accuracy given moderate to maximal support. A: Noah’s MLU continued to display great progress. Baselines have been established for color identification and following directions with multiple key words. Noah’s intelligibility and stimulability are noted to be at a stable level. Pre-primer sight words utilized in sight word activity. Noah is noted to be emergent with sight word recognition. P: Update plan of care to reflect color identification goal, sight word goal, following directions goal. Probe letter identification and add to POC.
Chris arrived a few minutes early to today's session, eager to share a multitude of items that were at the forefront of his mind. He initiated conversation with a familiar starter phrase and provided an array of topic details. Gentle reminders regarding the "knowledge of his talking partner" supported revision and clarification of key details related to his topic. Attentional shifting was strong this session and familiar cues were provided to facilitate successful topic transitions. Speaker -listener reciprocity was characterized by the need for increased use of direct questioning, as Chris was observed to acknowledge comments with single markers ( yeah, uh huh, etc.) followed by a single contingent comment and a subsequent topic change. Familiar supports were provided throughout the session in order to enhance self awareness, expanded reciprocity and communicative success.
Richard was in a great mood today. First, we reviewed common sight words. Richard did a great job with this and only needed minimal prompting to attend to the task. We continued by working on /th/ in conversation in initial, medial and final positions of words. Instead of stopping his stream of thought we have decided to use a /th/ card on the desk that I can gesture to and he can attempt self correction. Together we read “The Ultimate Jungle Rumble”. He enjoyed this book and it kept his attention. We worked on story prediction, age appropriate vocabulary and text features of non fiction texts.
Today Christopher chose to use alternative seating to make himself comfortable. He seemed to find it easier to sit still in this seating however, he did tell me it was hard to pay attention. Our social topic for today was Group Participation and Collaboration. Chris was able to admit this is hard for him because he has difficulty feigning interest in what others have to say. He was able to make the connection to group participation in school and how that may look as an adult with a job. This perspective helped him to understand the importance even if he does not prefer the approach. He related it to YouTube and described how collaborations between channels work and why it would be mutually beneficial to each creator. When we spent time brainstorming the pros and cons of group work, Chris wasn’t able to come up with any pros on his own but he was able to understand the pros I suggested. Overall, Chris knows the social topics we are discussing are difficult for him but his ability to see another person's perspective is increasing.
Today Maddie and I continued articulation of /f/ in isolation and /f/ + a vowel to continue coarticulation practice. She continues to accurately produce /f/ in isolation given many cues to bite her lip or look at herself in the mirror. Initial /f/ plus any additional sound still creates difficulty for Maddie as she attempts to insert the /g/ sound in between. I also probed for stimulability of /s/ in isolation. Maddie is able to produce /s/ at this level and should continue to strengthen this awareness before continuing to /s/ at the word level or /s/ blends.
Madison did a great job today. She demonstrates a little difficulty transitioning to speech because she doesn’t want to miss out on what her classmates may be doing. Once in the room Maddie is ready to play and practice. Given visual and verbal cues, Maddie was able to produce /f/ in isolation with 75% accuracy. We continued with the /fi/ /fa/ /fo/ syllables. Maddie does better with /fa/ and /fo/ because the transition to the open mouth syllable in the coarticulation is more drastic than the lips redacting for /fi/. This continues to only be successful when Maddie has the visual feedback of the mirror. We also worked on using he and she pronouns correctly in conversation/structured play.
Chris stated multiple times how tired he was today and that is was difficult to focus. This was evident because he usually spends our session sitting in his chair but today he was laying on the floor and hiding behind his chair. I do not usually see this behavior during our short time together. Our topic today was extending and accepting apologies. Christopher explained that he finds this difficult to talk about. We were able to determine the only person he feels really comfortable apologizing to is his mom. After multiple exchanges he was able to determine that apologizing makes him feel vulnerable and he can only extend that feeling to someone he greatly trusts. Chris demonstrated really great awareness here. When we concluded he still felt that apologizing is very hard for him but could implement the techniques to accepting apologies when warranted.
During our second session today, Richard and I worked on comprehension. Richard was a given a passage below age appropriate reading level to read aloud. He demonstrated difficulty sustaining attention and became easily frustrated during the task. Richard would benefit from daily flash card practice of common sight words for repetition and memorization of commonly seen words during reading. Even though he demonstrated difficulty with word attack skills he was still able to answer the comprehension questions with great accuracy. We continued by locating the /th/ words in the passage and attempting to accurately produce them in sentences recalled from auditory memory. Since Richard demonstrated difficulty with reading fluency, articulating the words in sentences from auditory memory produces greater accuracy because he doesn’t have to exert maximum effort while trying to decode.
