Tristan was excited to play monopoly. The ground rules for the game included using our strong, kind, and respectful communication skills. We reviewed how we use our articulators to produce strong /S/ sounds and how volume and pace also play an important role in how clear our speech sounds to others. We also reviewed how even when a game is competitive or there is negotiating for properties, it is even more important to communicate effectively. Monopoly provided a great platform to practice speech, reading/phonological awareness practice, new vocabulary, and target some key executive functioning skills.

Santino was greeted in the pre-k classroom as he finished with Ms. Janice. He was happy during transition. He did well with all activities in therapy today. We started the session with a preferred book, he chose which book out of a choice of 3. We targeted "where" questions "where + animal" with model 10x, using carrier phrases for answers "in the ___" etc. Santino required a verbal model 9/10. Increased echolalia and scripting during today's session. Joint attention was improved. Santino did answer yes/no questions appropriately 1/10, requiring cues for all other opportunities however cues were reduced to phonemic cues only. Simple "what" questions were targeted with combining object function (i.e. "what do we eat") with a visual field of two of pictures of cookies and a lion. Santino identified the correct answer 4/10 opportunities. Play Doh was utilized for increasing utterance length. Santino thoroughly enjoyed this interactive activity. He requested many times for additional items, help and extinguishing the task. He requested colors, shapes, and tools for the play doh with assistance. Cues are still heavily provided however continuing to improve. Session was discussed with the following teacher seeing him after me in attempts to carry over the speech and language skills.

Santino was greeted and transitioned to the back room where we often do therapy. We initiated the session with a book activity to target naming verbs. Santino's attention to the book was fleeting, requiring moderate cues to attend. It was recess for the other students so we went outside to achieve some peer to peer opportunities & target social/pragmatic goals. Santino became upset being outside, pulling to go in. However, with strategies - Santino self regulated with singing, tactile chest taps, and walking. Eventually, the other students went inside and Santino happily walked around the playground with the therapist. Santino requested the car on the playground, with many verbal auditory bombardments, Santino enjoyed that task. To go inside, he answered a yes/no question of "do you want to go inside", his immediate response being "go inside" (echolalia) - with cues, Santino answered with "yes". Increasing MLU's using verb+object, attribute+object, and object+location was targeted with maximal verbal bombardment during play. Commenting was targeted with "it's a ____" and "I see____". Verbal prompts/models are used in a majority of opportunities. Santino's eye contact was fleeting. Joint attention was reduced. Echolalia was increased in today's session. Feeding therapy followed this speech session.

Richard was greeted in his classroom after he finished OT. He reportedly had a good session with Ms. Willow! So happy to hear that. Richard was very excited to show me his new spider man toy with silly string/water. We worked primarily on problem solving and executive function since he could not figure out how to take the contraption off of the top in order to reach the silly string. We targeted peer interaction/initiation to request for help as well as asking adults/teachers. He initially grabbed the toy from my hand and we discussed more effective way to get things back from people (i.e. asking if finished rather than grabbing from people). This was targeted a few times with therapist and peers. First, Richard was attempting to get it off himself but we discussed using our resources (i.e. asking adults or the internet to look for directions). We did both of those things and eventually we asked a peer for help for which he was successful removing the top. Richard required verbal support to interact/initiate with his peers during this situation. The situation aroused again when we needed help getting it to work with the silly string. Richard and I worked through additional problem solving strategies that may help - He LOVED this. He was proud and felt very successful. He is blooming socially, it has been great. He was very happy and compliant while doing /s/ and rate of speech in conversational setting. He required moderate cues to slow rate of speech and produce /s/ accurately while excited during specific topics. We did a recap of the session and discussed the social/pragmatic/problem solving. Overall, it was a great session from Richard. Keep up the good work! We will continue to target speech, language and pragmatic social goals in the context of therapy.

Upon commencement of the new school year, it was shared with Chris' mom that the possibility of decreasing the quantity of service provision may be considered as goals would be reviewed, and reformulated as needed to reflect Chris' current profile following the summer hiatus. Following the recent discussion with Dad, prompting the time change to the 8:30 start time, a complete review of current progress over the last 6 weeks was provided. Clinical recommendation at this time is to continue twice weekly sessions with a duration of 30 minutes, allowing for frequency and consistency of target goal provision. Focus of today's session was once again supporting the allowance of speaker listener reciprocity. Chris was very much wanting to share some "concerns" that he was having related to recess time. Strategies were provided to assist in navigating the social peer dynamics. Use of familiar supports to assist with clarification of intended message, as well as topic transition were provided.

Chris excitedly initiated communication as he so often does. He shared some of the new items that he had with him, and this afforded the familiar opportunity to expand conversational reciprocity. Chris utilized familiar starter strategies. The majority of reciprocal exchanges were supported by use of direct question followed by a contingent response. Topic shifting was rapid this session, and was acknowledged and subsequently supported to encourage use of familiar "topic transition phrases."
Vocabulary expansion continues to be noted consistently. Strong focus on the aspects of communicative success were highlighted once again this session. Familiar supports to assist with clarification of intended message were provided. Instances of communication uncertainty continue to result in abandonment of topic and abrupt topic shift. Supports to persevere through the instances of mis- communication, enabling successful revision and or repair to ensure increased success within an exchange continues to be a strong focus. Aspects of perspective taking, and presupposition, interpretation of body language, facial expression, and gesture as means to assist with identification of communication message success continue to be embedded within "conversational" activities. Chris was highly motivated this session, and although topic shift was rapid, Chris continued to remain vested within the activities presented.

Richard was greeted in his classroom as he finished his reading assignment with Ms. Debbie. He was in a good mood today - very compliant. We did a fun "cooking" activity to break up the session a bit and encourage increased motivation. We started the session with working on date/day of week task. He enjoys this (especially on Fridays :)). Richard is continuing to demonstrate understanding of this skill. We targeted multisyllabic words, rate of speech, and /s/ in conversation making frozen strawberry lemonade. Words with the /s/ sound included were: ice, strawberry, scoop, start, stop, etc. The multisyllabic words were: lemonade, ingredients, strawberry, recipe, etc. He loved doing this!! Richard was very compliant and receptive to prompts and cues in today's session. Social and pragmatic goals were also targeted with peers and teachers/therapists. Overall, Richard did very well today and I'm pleased with his continued progress.

Speech therapy was broken up into two sessions today. We did feeding therapy in the middle. I like breaking it up, it gives him a small break from structured tasks. Santino was a few minutes late today so we had a delayed start to the session but the transition was good. We started with a book activity, which Santino enjoyed. He does need cues to maintain visual attention to the book. Santino benefits from carrier phrases such as "It's a ___", "the frog is ___". Echolalia typically isn't as prevalent when given carrier phrases rather than asking questions without cues. yes/no questions were targeted and Santino did show improvement today. He answered simple yes/no questions in 4/10 opportunities. Following simple directions was targeted using preferred objects. Santino followed 3/8 directives independently, 5/8 with visual and verbal cues. An iPad app called "My Play Home" was utilized for many language purposes in today's session. Santino enjoys the iPad/digital activities. This was used for verbs, auditory bombardment of language, increased MLU, and following directions. Sabotage activities were used for requesting. Overall, it was a good session with Santino.

Richard was greeted in his classroom after his OT session with Ms. Willow. Richard was laying on his beanbag chair eating skittles. He was asked to put them away until after lunch, which he did comply with the request. I had a brief conversation with Willow regarding Richard's demeanor this school year. It has been clear that Richard has been more defensive and combative during sessions. I recall when he gets hungry, he becomes irritable so I avoid that by always offering a snack prior to the session. Social stories and pragmatic language is being targeted in therapy as well to work on situational goals with peers and teachers/therapists. Richard was less defensive in today's session overall and was happy to comply with most tasks. Ms. Willow said he had an orange as a snack in her session prior to mine which may have helped. Richard required prompting and moderate cues while targeting social and pragmatic goals. He became slightly frustrated when not knowing an appropriate way to respond to situations however when we talked through them, he felt better about the answers. Following that, we targeted multisyllabic and /s/ sounds in a semi structured task. We talked about pictures presented and how they may apply to our lives.He enjoyed this. He required moderate cues to "keep his tongue back", and "teeth together" for /s/ production at conversational level. Richard requested a book we did last year so we did that (auditory comp), answering questions about the book. Rate of speech was increased with topics of interest and excitement. Cues were offered to decrease rate of speech for intelligibility purposes, which was effective for short term however quickly returned to rapid rate with a new topic. Frequent cues required. Overall, it was a better session today.

Chris excitedly initiated conversation as he regularly does. He had a wide variety of topics to share this session. Strong support was provided to facilitate topic shifting, as Chris was hurriedly offering snippets of "information" across the varied topics that he had on his mind. His range of affect shifted rapidly reflecting the diverse thoughts that he was sharing. Allowance for reciprocity was decreased this session, as responses to requests/comments to assist with clarification and cohesion were inconsistent. Discussion of the familiar concept of "attention jumping" was visited in response to session progression. Chris shared that he "couldn't help it today," that he "was tired, upset and angry at a lot of things." Supports were provided, familiar strategies were shared to assist Chris. The session closed early as he subsequently asked if " he could go early today." This request was honored today.