The session commenced once more with an unanticipated change. Chris initiated the session "connection" from home 10 minutes prior to the scheduled time. He shared that he wanted to "be sure to meet this morning." He was commended for showing such initiative, and for taking responsibility to be sure to honor his scheduled commitment. He appeared to be extremely tired, and a bit "out of sorts" as responses to questions were characterized by latent responses, and responses that were unclear. Brief discussion regarding attention, self reflection, awareness and perspective allowed for increased engagement. His fatigue was strong this morning and although he had been seated at his desk as the session commenced he transitioned to his bean bag chair mid way through the session. We discussed closing the session at the 20 minute mark. A moment later, mom entered his room, reminding him that he needed to get to school.
The session was closed abruptly. Conversation with Elise followed in order to clarify that it is strongly encouraged that speech and language sessions continue to be provided from school on the designated Monday and Wednesday 8:30 time slot. Should an alternative plan that includes home sessions be decided upon for an interim period, it is recommended that a new "Theraplatform" home link be established, ensuring that Chris is able to log on independently. Elise shared that she had spoken with the family regarding Chris' arrival on Mondays and Wednesdays and that she will be sure to re visit this recommendation with them today to ensure optimal success each session.
Christopher's outlook and attitude started great at the beginning of today's session. We took a break from testing today. First, we made list of positive characteristics of a friend. What being a good friend means to him and how someone can be a good friend to him. We again discussed using our internal filter to make jokes or comments to the appropriate audience. We separated comments that are appropriate for friends, family, and adults/teachers. We also briefly discussed if some jokes are funny or just used for shock/reaction. Christopher demonstrates difficulty taking another person's perspective. Next week we will discuss scenarios and try to change our perspective by putting ourselves in someone else's shoes. Chris seems to have a difficult time recovering if something is bothering him. We discussed ways we can improve our mood after a negative reaction or situation but we need to continue to practice them in real time.
Richard was ready to participate when I arrived today but had a difficult time focusing. We broke the session up into multiple parts to keep from having to maintain attention on one task for too long. First, we worked on auditory discrimination of sounds. Richard's accuracy of /th/ at the word level in commonly used words such as "something, bathroom, birthday, etc" is around 50% so we spent some time listening to determine if a word I was saying had a /th/, /sh/ or /ch/ phoneme. He was able to tell me which group the word belonged in 80% of the time. However, when I used these words in a sentence he was only able to tell me if I produced /th/ accurately 50% of the time. This lets me know that his awareness to the sound needs to increase. Additionally, working on these digraphs assist in reading and spelling. Richard demonstrates difficulty using irregular plurals, especially those that end in f ( leaf- leaves, knife-knives etc.) He completed this identification task with 50% accuracy. We will continue to explicitly teach and learn these until he can generalize the rule. We read a short CVC story together. When Richard reads aloud it is very helpful for him to maintain his place using his finger or a pointer. We will continue with foundational reading/phonemic awareness to increase his confidence and decoding skills.
This morning's session commenced with an unexpected change. As the meeting time arrived, Chris phoned using "face time" sharing that he was at home and wanted to be sure to attend our meeting today. He asked how to meet with our "on line" connection. Following guidance, he attempted to "log in" with both his school email and then with his home email. Chris happily participated from home. He was attentive and enthusiastic for the duration of the session.
Overall linguistic organization was strong, and conversational reciprocity was characterized by more lengthy cycles of exchange, and use strong contingent responses to questions and comments. Response to complex questions was characterized by repetition of the question, pausing, and subsequent formulation of a lengthy cohesive response 6 times during the session.
As the session came to a close, Chris shared that "we might need to meet like this again" due to the fact that upon his early arrival to school, he needs to stay in the "supervised area." Brief discussion to expand his understanding regarding our early Monday/Wednesday meeting time, and the "free" time that he has on the alternate days was provided. A subsequent conversation with front desk staff at school allowed for detailed discussion of today's session and to clarify session plans moving forward.
During our second session after lunch Richard reported having a stomachache but was still willing to continue with speech. During this session we focused on coarticulation of words containing the /th/ phoneme in the medial position of words. Richard demonstrated difficulty with this and required max cues to slow down his speech and accurately produce medial /th/ in words such as bathroom, something, toothpaste, birthday etc. He is capable of this but gets ahead of himself and lacks attention to detail. We continued by working on very short story comprehension. Richard answered these age appropriate story questions with only 50% accuracy. We will continue to work on this to build up his stamina in listening comprehension and joint attention.
Richard was ready to work today. We began the session focusing on attention to detail, joint attention and recognizing patterns. We continued by working on a beginner reader, titled "The fin" Richard would benefit from using a reading pointer or his index finger consistently while decoding words as he often loses his place or only sounds out the beginning of the words. He was able to answer comprehension questions regarding main character, beginning middle and end, and summary questions verbally. We also worked on parts of a sentence and determining a complete sentence from a run on sentence.
Christopher was in a good mood at the start of today's session. He reported he had a good weekend and couldn't believe it was Monday again already. He informed me that last week on the playground the unstructured game of tag didn't go as well because he is having trouble avoiding certain peers during the game. We continued CELF5 testing. Chris demonstrated difficulty with retaining short paragraphs of information being read to him and then answering questions pertaining to it. He explained he has a hard time keeping his attention focused while someone is reading to him. During recess a new rule was introduced that kept certain student's from tagging the same student's repeatedly. At some point during recess Christopher's mood changed. He said he didn't want to talk about it and I informed him I was available if he changed his mind.
Today we attempted to continue CELF5 testing in the area of listening comprehension. After the first presented paragraph, it was clear Christopher wasn't in the head space for testing today. Even after only working with him a few weeks it was also obvious to me that his performance on this subtest was not to the best of his ability. He told me he had a lot on his mind today and would prefer a different activity. Instead, we decided to discuss the reasons listening comprehension is important in real life. He was able to brainstorm 3 real life scenarios (future employment, parents, friends) in which it would benefit him to take in information, dissect it and respond appropriately. Chris demonstrates strengths in knowing the right thing to do, he just has to execute it. I was proud of his ability to advocate for himself during testing today.
Today Richard requested multiple breaks throughout the session. He reported he was tired and hungry, making it hard to think. We continued testing with the CELF5. We completed the following directions subtest and attempted the reading comprehension subtest. The reading comprehension subtest required Richard to read a paragraph presented that is on an age equivalent level. He was hesitant and after looking at it for a few minutes told me that it was too hard to read and he couldn't figure it out. I will eliminate this subtest and find a non standardized passage on his level in order to analyze his relative strengths and weaknesses in the area of reading comprehension.
Additionally, we worked on parts of a story and creative story telling skills using story dice. Richard has a great imagination.
As this morning's session commenced, Chris was observably upset. His body language, affect, and overall arousal were clearly impacted on a large scale. He began to share that he "lost subscribers" on his "You Tube" channel. He expanded briefly, however, the majority of his verbalization centered primarily on reiteration. This afforded an opportunity to review "emotional states" that had been discussed in previous sessions. He agreed that he was "out of sorts" and "stuck on a thinking trail that didn't feel good." A multitude of strategies were utilized to support Chris throughout the duration of the session. He remained quite passive, although affect shifted somewhat as he was responsive to new topic introductions near the close of the session.
