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.

Santino was greeted at the door while being dropped off by his mother. His mom reported waking up early and being upset/tired upon transition. Santino went to the pre-k classroom and immediately laid down on the floor with a blanket while crying. Sensory input was provided to his arms and chest with a tapping motion. Santino did calm down and appeared regulated until an attempt to transition to his classroom area. He cried again, therefore we did three sing along songs which did help as well. After transition, Santino was putting his fingers in his ear, saying "ear", and opening/shifting his jaw as if he was trying to relieve pressure. Play-doh was presented and played with targeting many goals including requesting, following directions, answering simple yes/no questions, increasing utterance length (2-3 word utterances), commenting, using descriptive words, requesting help following a sabotage activity (opening the play doh when given to him with the top on), all while providing proprioceptive input. Santino was calm during this activity and very receptive to the fading multimodal cues given to him. A vocabulary task was completed following the language task. Santino named + carrier phrase of "it's a __" 15/20 objects. A book activity was implemented to target use of verbs and attributes. He requested a book given a choice of three. This is the point of the session when Santino became very tired and heavy eyed. We went to the playground to "wake up our bodies". Santino independently requested to go inside after a few minutes. Santino did respond well to therapy although he appeared very tired and may not be feeling well.

Richard was greeted following lunch/recess outside. He just came in from playing tag with his classmates outside. I believed it was beneficial for him to come in from moving his body and relieving some energy he may have built up throughout the day. It has been an observation of mine the last two days that Richard has appeared somewhat disorganized with his thoughts and requires more redirection to not only conversation but to each task during therapy. This was reported by another teacher as well. Richard may benefit from a stationary chair, rather than a chair with wheels to avoid distraction. The first portion of therapy session focused on event recall, and discussing what our objectives and goals of speech therapy are for the year. We discussed new hobbies and interests for rapport establishment all while targeting rate of speech and /s/ in conversation. When cued, Richard does slow his speech and over articulate his /s/ however very frequent cues are required at this time. In addition, Richard demonstrates partial word deletion with multisyllabic words (i.e. with the word "teleport", he said "te-port") he was asked to repeat himself two times until it became clear. A new sound was introduced today, /th/ (both voiced and voiceless) in all positions of the word He achieved the following accuracy: initial position with a model 40%, medial position with a model 30%, and final position with a model 20%. He did discriminate between correct and incorrect productions auditory. He intermittently self corrected. Overall, it was a relatively productive session. I will continue monitoring his attention, pragmatics and language skills.

Chris continues to exhibit strong enthusiasm as the sessions commence. He is eager to share information and initiate conversation with familiar "sentence starters" as noted in previous summaries. Focus on strategies to expand topic initiation "starters" and topic shifting was supported with familiar cues and was noted with strong success this session. Periods of comment/comment exchange were demonstrated with increased frequency and within cycles of increased length this session as well. Chris was noted to request clarification of comment/s/ shared when allowance of reciprocity was diminished, affording the strong opportunity to further expand topic expansion. Strong emphasis on the aspects of perspective taking and presupposition continues to be highlighted each session with provision of support to increase the use of detail, referencing, as well as the acknowledgement and interpretation of body language, gesture, facial expression and intonation. As conversation shifted to the comic project that he was working on with another student, his eagerness to seek out that student became strong and attentional shifting heightened. Continued discussion of "attention" was subsequently re-visited, encouraging Chris to once again alert his communication partner of instances when his " attention jumps away."
He agreed, and shared that he "couldn't focus anymore" appropriate topic closure was supported and he subsequently asked if he could please go meet the "student" and speak with him about their project. He expressed strong appreciation and the session closed 15 minutes early. Strong session today.

Richard was greeted in his classroom as he was finishing science. Today was his first day back to school. He was clearly still adjusting and may be a little tired from the day back to school after summer break. Today, was a day to evaluate where Richard is in terms of speech and language in addition to re-establishing rapport with SLP for the school year. The GFTA-3 assessment was given for articulation. Richard received a standard score of 94, percentile rank of 34%. This is improved from last year's evaluation. He demonstrates the same area of difficulty which tends to be at conversational level, there is a lingual lisp of s, and rapid rate of speech which affects overall speech intelligibility. He substitutes s/th, d/th, and f/th. This will be targeted in therapy as well. He omits "S" with some concepts i.e. "that look(-s) like", ""everybody know (-s) that", and "that(-s) what I did this summer". I will continue to monitor areas of concern for language and pragmatic skills. I look forward to working with Richard this school year.

Chris was eager for the session to commence and had logged on prior to the start of the session once again. He continues to initiate conversation with use of the familiar starter strategies noted previously. Topics and "information" of choice that he focuses upon continue to afford the opportunity to facilitate expansion and reciprocity. The majority of reciprocal exchanges are supported by use of direct question followed by contingent response. Comment/comment exchanges are characterized by use of an affirmation/agreement and often followed by a shift to a semantically related topic. Familiar cue supports and strategies to enhance use of "topic transition phrases" are becoming increasingly successful. Phrases such as "do you wanna know another thing? "are now utilized more frequently to assist in providing a successful change of focus. Strong focus on perspective taking and presupposition was highlighted today, with strategies to support the use of detail, and interpretation of body language, facial expression and gesture as means to identity successful communication exchanges. Aspects of overall attention shifting was re-visited as well, encouraging Chris to alert his communication partner, specifically teachers when his "attention jumps away" in order to support shifts as needed and use of facilitative redirection tools. Familiar cross pattern movement strategies were encouraged this session, with the premise of being a "drummer' were facultative at supporting redirection to topic and task.

Santino was seen following feeding therapy. To take a movement break after eating, we initiated speech therapy outside on the playground. Auditory bombardment was provided using 2-word utterances. Santino did in fact repeat many of the desired utterances. We targeted requesting "I want____" using carrier phrases. Santino requested slide 4x. Santino answered a yes/no question independently 2/10 opportunities. This will continue to be targeted in therapy. Combinations of words was heavily targeted today. verb+noun, attribute+noun, etc. Santino relies and benefits heavily on carrier phrases and phonemic cues. Social skills were targeted with greetings. Santino independently requested "Brown Bear" book, this is a great activity for commenting "I see __" and carrying it over into novel situations. Santino requested 'tickles' as a reinforcer during therapy. Verbs were targeted (naming) -ing (i.e. running, swimming, crying, etc.) Santino required moderate cuing for this task. Great session overall.

Chris was eager for the virtual session to commence and was logged on prior to the start time.
He happily initiated conversation with use of the familiar "starter" strategy of asking "Can I tell you something?" The topics of his choice have frequently afforded the opportunity to lead into conversational expansion. Focus on expanded reciprocal exchange was supported this session predominantly by return questioning to facilitate a response. Comment /comment exchange was inconsistent this session. Familiar cue supports and strategies to support use of cohesive ties and topic shifting were successful this session. Mid session, Chris shared that he was extremely hungry, and subsequently this rapidly become a strong internal distraction. He shared that he needed to phone his mom and ask if she would bering him some donuts. He phoned, she wasn't able to comply with the request. The solution was to make some popcorn, one of his favorites, as he had microwave popcorn in his backpack. Goal focus and attention subsequent to this diminished. The opportunity to re-visit familiar techniques and supports during periods of strong attentional shifting and distraction were facilitative, however, it was appropriate to close the session at the 50 minute mark. Consideration to modify the session duration to 45 minutes while maintaining 2 sessions per week is noted, as goal review and planning for the term continue.

Chris was seen virtually this session, following the summer hiatus. He was excited to share many details about his recent interests, and the "video" projects that he has completed. He shared his two new "You Tube" channel sites and requested that I "subscribe" and watch all of the videos that he has "posted." Attention and motivation to share information was strong. Review of current goals and performance was successful this session as Chris was happy and engaged for the duration of the session. Goal parameters for the coming term reflect the continued focus on conversational reciprocity, perspective taking, use of cohesive ties, and strategies for topic shifting, and expansion. Additional focus continues in the area of vocabulary expansion, as well as comprehension and use of higher level language concepts, indirect language, expansion of higher level social reasoning and theory of mind.
Support for articulation clarity (/s/) remains as well.
Consideration for reduction to 1 session per week is noted at this time.

We completed our feeding session (see note) - Santinos pull up was changed. We began the session with asking hands, following directions and verbalizing the steps while doing this with a model. Santino independently requested Pop the Pig he saw in my bag. "Pop the Pig"... Verbal cues to use requests "I want Pop the Pig" with model. We played pop the pig targeting social interactions, turn taking, answering simple what and where questions, following simple directives, and combining 2 word utterances. Utterances modeled were: My turn, your turn, put in, pop pig, push down, take out. Phonemic cues were most beneficial with answering simple "what" questions. "What is on his head?". .. "it's a /h..." "hat". Santino also responds well to carrier phrases and pauses. "I see a _____". We read an interactive flap book to work on labeling nouns with descriptor and answering simple questions. Lastly, identifying verbs in a field of two was targeted with 70% accuracy. Overall, Santino did well this session and I'm happy with how today went.