Santino was greeted in the classroom, he was happy upon arrival. In order to prepare for the two sessions, we went to the cubby with his feeding materials where Santino saw Froot Loops (we were successful with yesterday). Santino verbalized "Froot Loops....I want Froot Loops" independently. this was a great spontaneous request (especially for food). As we started the session, Apple Jacks were put in a cup for Santino and he immediately smelled and ate the entire cup of Apple Jacks while we targeted language skills. Joint attention/play task was targeted using paint dots making a rainbow. We not only took turns, requested "my turn, your turn", "top off, top on", "turn turn", requesting help, etc. Santino required moderate to max cues to expand utterance length. Santino continued to independently request "iPad", however this was used at the end of the session when a break was warranted. A book activity was shared to target "where" questions, yes/no questions, and following simple commands. Santino benefits from phonemic cues throughout sessions. Eye contact was fleeting. Naming verbs was targeted, with 10% accuracy. He named 1/10 verbs independently. Auditory bombardment was utilized during this task as Santino would name the object rather than the verb in the picture (i.e. a picture of a girl eating pizza, when asked "what doing", Santino would respond with echolalia or "pizza".) I provided correct production of "eating pizza". Santino was very happy in today's session and it was considered successful and productive.

Santino was greeted in the lobby when he was dropped off for school. He reportedly ate lunch 40 minutes prior to drop off. With that information, we started with speech therapy in efforts to work on feeding when Santino is more hungry. We targeted identification of verbs in a field of 4 with 60% accuracy. We targeted following one step simple commands with the use of prepositions/location. Santino independently achieved 4/10 and increased accuracy with visual support. With answering simple yes/no questions - Santino required multimodal cues to answer with yes/no versus echolalia of the question being asked. With repetition, Santino did improve with this skill. When asked questions that applied to him (i.e. "Do you want to go outside" or "Do you want to eat lunch") - Santino did require cues to answer yes/no however did eventually express yes or no to the questions. He chose to play "subway surf" on my iPad with requesting "subway surf" after minimal cues to request his desire to play an iPad game. We did an interactive book activity to target yes/no, auditory bombardment of vocabulary as well as prepositional skills. At the end of the speech session, we went on the playground. This was a wonderful opportunity for Santino to request his wants/needs. To describe "go up stairs, go down slide", at the end of the slide he was given a choice to jump off slide or swing/turn with SLP. He enjoyed this interactive activity on the playground to target his overall speech and language skills. Eye contact was fleeting. Overall, it was a good session and Santino was happy.

Richard was greeted in his classroom after his OT session with Ms. Willow. She reported he had a good session! She and I discussed our request for a more optimal seating option for Richard as he demonstrates decrease core support, taking less focus away from focus on the task at hand. We started the session with the rolling chair however Richard was moving quite a bit and very distracted away from the task presented to him. We got a stationary chair and his focus significantly shifted for the better. He did not move/wiggle in his chair. It was a fantastic change of focus for him. He was advised if he needed a break to move his body - he was more than welcome to ask for one and we can accommodate that. We targeted the date/day of week/holiday orientation. Richard is already improving with this, picking up where he left off last year with his knowledge with this concept. Following that task, we completed an articulation task targeting /th/ in all positions with the following improved accuracy: Initial position, 90%, medial position 40%, and final position 70%. He continues to demonstrate self awareness of errors with attempt to correct them. /s/ in all positions was targeted at conversational level requiring moderate cues. With cues, Richard does produce /s/ with more adequate articulatory contact resulting in increased intelligibility. Rate of speech was targeted during topics of interest (today we discussed outer space and career aspirations). Overall, it was a much better session in terms of attention and focus. Richard did well with structured and unstructured tasks. As stated before, additional language and pragmatic goals will be targeted.

Chris arrived to school 25 minutes late. Fortunately, Elise had logged in for Chris anticipating his arrival and we were already connected virtually, sharing the screen as he entered the room. He was a bit unsettled as he was late, and shared his feelings regarding missing so much of "our time."
Supports to redirect attention and initiate conversation were successful, however, distractions were high this session as he also expressed that he didn't have breakfast and was very hungry, as well as sharing his thoughts regarding the upcoming weekend plans. Chris was successful at providing contingent responses to alternative topics that were provided, and engaged in cycles of reciprocity following use of varied cues this session.

Richard was greeted in his classroom as he was finishing his session with a previous teacher. Richard required multiple verbal redirections this session to remain in his seat during structured tasks. He was given frequent breaks as he demonstrates the need for them. I believe a stationary chair would be beneficial for him. We targeted orientation of date/days of the week/month of year. Richard required maximal support for this task since it was the first time doing it this school year. He does demonstrate interest in knowing holidays/months etc. The /s/ sound was targeted as well as rate of speech and increasing speech intelligibility for a while this session while discussing topics of interest. Richard did require more frequent prompts and cues to produce /s/ with articulate speech. There was an increase in saliva production that pools in the anterior portion of his oral cavity while talking fast/increased rate. He was provided multimodal cues to slow down rate of speech which did correlate with /s/ accuracy increasing. There are many less lingual protrusion ("lisp") with /s/, however he continues to demonstrate weak articulatory contact. /th/ in all positions at the word level was targeted given a visual and verbal cue with the following accuracy: initial position 50%, medial position 40%, and final position 20% accuracy. Richard did demonstrate SOME self correction following incorrect productions. Final consonsnats were dropped at times (typically /s/) in conversational speech however there is not a clear pattern with this. I will continue to monitor language and pragmatic skills and communicate with Ms. Andrea (Richard's other SLP). Thank you

Tristan was in a great mood and eager to play Guess Who. Guess Who is a great language game working on many language and communication skills. It is also a good assessment of social-language skills with using turn taking, negotiations, and sportsmanship. Tristan is competitive and eager to win. When he lost the game, I told him good detective skills and good game and put out my hand for a handshake or high five. I explained that my rule is win or lose that we always use good sportsmanship. Tristan expressed interest in learning UNO next time and asked if we could play Monopoly.

Spencer was sad at our initial meeting. He said he hit his head and hurt his ankle so he was icing it. We started with "would you rather" icebreaker to have some laughs and get to know each other. With some of the silly questions like "would you rather eat pizza everyday for every meal or ice cream every day for every meal?" and some gross ones, we were able to giggle. Spencer forgot all about the head and ankle injury and we were able to move through other fun activities getting to know each other. We discussed our favorites including sports, foods, travel, and what makes us happy. Errors were heard in connected speech with /L/, /R/, and various blends. Until formal goals are established, I explained to Spencer that I was a communication specialist to help him communicate his ideas and thoughts with clear and confident speech while also building our vocabulary and how we understand and express ourselves. He said he was on board as long as we had fun. He put in some requests of his favorite games including building, Uno, Monopoly and other "cool games." Looking forward to working with Spencer and supporting his speech and language development.

Initial session with Tristan focussed on establishing rapport and getting to know each other. Using a fun handout with fill in the boxes about "favorites," we exchanged information about our favorite food, sport, activity, place to travel, movie, etc. Tristan was resistant to read and write so we did the activity verbally. He was attentive and curious about many topics mentioned. He asked a lot of questions about travel locations which led to conversation about weather patterns such as tsunamis, hurricanes and earthquakes. Using maps and videos we had interesting conversation. Tristan was full of questions so instead of just answering them with google or asking Siri, we tried to use problem solving skills and use language skills (inferencing, asking questions, prediction, new vocabulary). This provided a nice baseline for informally assessing Tristan's speech, language and communication skills. I explained my role as a speech-language pathologist was to help him communicate his ideas and thoughts in a clear, effective, and meaningful way. He was a pleasure to work with and I assured him that he will have fun while we work on our communication goals.

Chris was eager to begin the session today as once again he was "waiting" in the virtual waiting room prior to the session commencement time. He was excited to share information as he often does, as well as share new "items" that he had with him. Chris initiated the session rapidly, with use of the familiar "sentence starters" that he often utilizes. Pacing and reciprocity were strongly supported this session with familiar as well as more novel cue supports. Speaker overlap was noted to be strong this session. Chris demonstrated awareness of the instances of speaker overlap, and responded well to supports to expand reciprocity. Strong emphasis was once again placed on aspects of perspective taking, presupposition, and interpretation of body language, gesture, facial expression and intonation. Discussion of attention and aspects of "attention jumping " were highlighted once again this session as his phone was chirping with " alert" notifications of new videos that were uploaded from his subscriptions. Strategies to support joint attentional shifting, collaborative topic discussion were utilized, however, distractions became strong as the session progressed. The session subsequently closed 15 minutes early.

Santino was greeted in the pre-k classroom, he was sleeping upon my arrival. It took approximately 15 minutes for Santino to fully wake up. His mother did state he was up very early the last two days. When Santino did wake up, we did a book activity to assist with transition and regulation. He did transition to the table to do more speech therapy tasks. We started with targeting requesting, increasing utterance length, naming descriptors/attributes, joint attention, and requesting for help/more/all done (communicative needs/wants). We did a train activity which Santino appeared to enjoy building the tracks and adding to the trains while using their characteristics. Santino required maximal cues for this task. Feeding therapy was from 2-2:30 to break up the speech therapy session. Following the feeding therapy - identifying verbs in a field of 2 and 3 was targeted, with 50% accuracy. Following simple one step commands was targeted for receptive language skills - 3/10. Answering simple yes/no questions was targeted in a structured setting (is this a____). Phonemic cues were very beneficial for this tasks. Prompting continues to be required in efforts in the future to reduce the amount needed. Overall, a lot was accomplished today and it was a good session.