At the beginning of the session Tony was very playful and moved from toy to toy. I had to use a lot of hand-over-hand and redirection to get Tony to do an activity. There were some activities that he just didn’t want to do. But Tony still had a pleasant disposition and after swinging and jumping Tony settled in to the ABA. During swinging I said “swing” and “ready, set, go” then pushed him. I counted to ten and Tony pulled up my fingers, making a counting sound. I also for fun grab Tony’s legs and say “feet up” and Tony holds his legs up on his own while swinging. After a while Tony whined to go inside and I said “all done’. Tony suddenly got quiet and smiled so I waited with him in the swing. He stared then signed “all done” so I stopped the swing and brought him inside. Tony also wanted to jump and grabbed my hand and said “ump” and jumped. We jumped quite a few times throughout the session (some for sensory and some for redirection).
During matching I said “put with same” as I modeled putting lizard one with lizard two in the box. I did this once then did this with Tony using physical prompt (hand-over-hand). After doing this twice, Tony then did this with just a verbal prompt a few times. He also did this with plasic dinosaurs and a lot with his squishy balls. I took Tony’s hand and we squished the balls and Tony played with these for a while before we did the matching with them. The squishy balls were the most effective with matching today.
Tony later played appropriately with his peek-a-boo blocks, stacking (and making counting sounds) and also putting them in the noise making contraption (a plastic elephant) that the blocks were designed for. He played well with this for a while. I was able to use verbal prompt to get Tony to place two blocks back into their storage box but he was really into the elephant and then a Dora Explorer book.
Tony didn’t want to play with his bouncy balls during the rolling activity but did better when I pulled out the bowling ball again and lined up the pins. Tony rolled the ball into the pins with mostly physical prompt but did it after a while with just verbal prompts. At one point Tony’s mom said “walk” and Tony took her hand and we walked in the grass outside. At one point Tony sat down and rolled in the grass. We came back inside and worked some more.
During sticker activity Tony only needed verbal prompting. He peeled the stickers by himself and placed them on the page after I said “peel sticker”. He kept peeling on his own. I did used verbal and gestural (saying “put sticker here” and pointing to the designated square). Tony did this activity well and 3/4 the time the sticker was completely in the box. Since Tony really enjoys the peeling we did this for a long time.
Tony signed “all done” to the therapist 3Xs today and once said it clearly while doing it. He did this at swingtime, snacktime, and lunchtime. When the therapist said “bye, bye” to Tony he turned around and waved at me. A rocky start but it was a productive day.

So today was kind of uneventful. Tony woke up from his nap because the cat was in his room so he spent a good 20 minutes crying before he calmed down. He watched a little TV which calmed him down and then Marlaina and I took him outside to swing. While Tony was swinging I would make sounds to keep his attention. Everytime he would swing up towards me I would make a noise like “Ahhh” and then Tony would imitate me and do “Ahhh.” Other noises included “Arrrrr” and “Booo”. Tony really interacted well with this…I got a lot of eye contact and smiling too! Well, this was probably the highlight of the day because after this Tony’s mood was very inconsistent. Tired and screaming one minute and then the next he would be watching TV. He really didn’t want to focus today. I tried redirecting him with various things like the red ball, the drum (‘do this’ and bang on the drum), and stickers…but Tony seemed pretty tired and kept reaching for Marlaina to take him upstairs. We went for a walk before he went to bed and did “jump” a few times and Tony would jump. He started requesting it, reaching up for me saying “yump” rpeatedly. So of course, we did jump all the way back to the house. After this, Tony went to bed. So not a whole lot happened today but I did learn something with the swinging thing.

The day started with Tony having a sandwhich that he ate well while watching Sesame Street. Then he put his hands up and made different sounds until knocking his crust onto the ground. The therapist put it back on the tray then said and signed “all done”. Then I took Tony’s hand and did the sign for “all done” with him while saying the phrase. After this I tried to get Tony to roll a ball (we used a large, then a medium ball) but Tony was distrated with running around and looking at the tv/magazine pictures. Then he wanted to swing so he grabbed his mom’s hand and took her to the door. Mom and therapist said and signed “swing” to him before placing him in the swing. While he went back and forth the therapist counted to ten aloud and using fingers. This kept Tony’s attention and he grabbed the therapist’s hands while she did this. Then the therapist grabbed Tony’s legs (holding them up) and said “legs up!”. I did this as Tony swinged up/down. After doing this Tony would hold up his legs on his own and would receive lots of verbal praise. He then did this a couple of times on his own. When it was time to come inside I said and signed “all done” then took Tony inside.
Once inside we were able to line up the bowling pins together (while counting them to ten) in a triangle then the therapist rolled the ball into the pins a couple of times while saying “roll it” or “roll the ball”. Then I used hand-over-hand while saying it to get Tony to roll the small bowling ball into the pins. Then I used verbal praise. I said “do this” and rolled the ball into the pins. Then I gave Tony the ball and he rolled it into the pins. More verbal praise was used and Tony picked up the ball a couple of times on his own and rolled it.
Later Tony wanted to pull out his “Go fish”, “Old Maid”, and “Match” cards so we did some matching. We used them and I first matched the objects while saying “put with same”. Then I said this while grabbing Tony’s hand to do the activity. Verbal praise and then I did this again. Then I gave Tony the objects and said “put with same”. Tony put the card in the box w/only verbal prompt twice afterwards before wanting to quit. I had to use redirection quite a bit today and was able to get him to do this for a short while later in the session (w/just verbal prompt).
Throughout the session Tony jumped, once on the trampoline while holding onto the therapist’s hands and saying the sound for “jump”. Most of the time he just jumped on the floor, though. We Tony seemed a little unfocused or upset we jumped and then went back to work. At one point Tony really wanted his mom’s hand a lot so we took a walk (the three of us) in the park and on the sidewalk. Tony swinged on the hammock and walked some more until coming inside. Tony was a little calmer and we peeled some stickers and counted blocks. Tony wasn’t too interested in the blocks today but he did peel the stickers on his own (I only partially peeled one for him) and place them on the page. The therapist put stickers in the squares and then said “do this”. The therapist pointed to a square and said “put sticker here”. Tony did this or atleast got in the general area most of the time. Later he just wanted to put a sticker in every square just to have them filled.
After this I got out the squish ball and squeezed it. Tony pushed back in the bubbles on it. I also grabbed Tony’s hands and had him squeeze the ball too. Tony like this so much that when the therapist said/signed “all done” Tony got upset and his mom did it for a while and then took him upstairs for his nap. He fell fast asleep. Today was not bad considering that I haven’t seen Tony since Friday. He had short attention but we still got a little work done in the different activities.

As most of you are aware, that Tony had a really rough week last
week… a giant boil caused by diminished immune system due to a
break from our normal GFCF diet (he accidentally ate the wrong
bread). This week started off as yet another nightmare. Sunday
evening, he didn’t go to bed until around 3am (Monday morning). He
was completely hyperactive and uncontrollable. Monday found him
screaming for most of the day (as Megan and Lauren can attest to).

After much thought and searching, we finally found the gluten filled
item that had led to this behavior. In fact, we had purchased a new
vitamin supplement for Tony last week. I thought that I had reviewed
the ingredients, but, I somehow missed the all important last one…
WHEAT GERM! Who would have thought that a children’s liquid vitamin
would contain wheat? Not me, obviously. Live and learn.

Today Tony did pretty well considering that he had a 3am bedtime the other night and still seemed a little out of sorts. We started out swinging first which I think kind of calmed him down…he still gets fussy when Marlaina leaves his sight. After swinging we worked on the matching drill “put with same” using the blocks. He did it a few times unprompted but he didn’t really want spend that much time on it….so we went for a walk…Marlaina, Tony and I. After the walk, I worked with Tony with stickers. I peeled a few off and prompted him to put them on the page in his new sticker book. After a few trials Tony started to peel off the stickers himself and put them on the paper. I started to prompt him to put each sticker in a specific location (where my finger was) and I would say “Sticker here.” He did this twice and then I decided he’d had enough so we moved on to rolling the ball..sitting on the floor with the ball facing Tony we rolled it back and forth a few times. I would say “roll ball” as I rolled it to Tony. He would push it back to me..I can really tell that everyone has been working with the ball thing with Tony..so great job guys! After that he (well, we) watched Booh Bah for a little. He picked up his small multi-colored notepads and played with them by setting them on their spine. Since he was so into the organization of the notepads, I took a crayon and started coloring on one of them. Tony watched and then I handed him the crayon. He was very reluctant to take the crayon at first but when I started pounding the crayon on the paper saying “Do this” he did it once. We stopped the activity after this..he’d had enough with me messing up his notepads. Tony had dinner after this activity (walked to his chair). After eating he did a few really cool things. While we were eating he walked over to me and looked at me right in the eyes. Marlaina also caught him playing appropriately (and unprovoked I might add) with the wire and bead toy! Yeh for Tony! So today definitely ended with a happy note…and a happy Tony too!

Okay, so today did not provide the best working conditions. Poor Tony woke up with the ugly green monster of a boil still on his inner thigh. He’s been running a fever and felt awful today. He could also barely walk. Needless to say, we did the best we could. Tony started off the day by grabbing his mom’s hand and go to the back door to swing. While swinging the therapist counted aloud to ten with her hands. Tony grabbed the therapist’s fingers while counting. Then Tony whined to go inside so the therapist stopped the swing, said/signed “all done” then brought him inside. We did this 2xs today (Tony wanted to swing again later).
Then Tony had a small snack and watched his favorite shows. The therapist showed him the “food” card. Also, his mom used the “eat” sign with him. The pic for “cup” was also used later with his drink. Then Tony finished (by throwing his food onto the floor). The therapist and mom said “all done” and let him out of the highchair. Tony immediately started lining up his bowling pins. The therapist helped him by moving the pins into a triangular shape rather than letting him just line them up in a straight line. Then the therapist rolled the ball saying “roll it” into the pins and knocking them down. Tony said, “yea” and clapped. The therapist did this again before using hand-over-hand and having Tony do this. Then Tony grabbed his larger soft ball and rolled and bounced it before putting it into his basketball hoop.
Later Tony matched clothespins (he didn’t want to see the lizards today–screamed if they came near him [he did this with leaves too]). The therapist put one in a box and said “put with same”, then placed the 2nd clothespin into the box. Then the therapist repeated the activity with Tony using physical prompt. After that, the therapist did the activity by just saying “put with same” and Tony put the clothespin in the box with its match a couple of times before wanting to quit.
Lastly, Tony was really upset at this point (tired, rubbing his eyes, limping) and took his mom’s hand to the front door. We all walked to the park then Tony just wanted to sit on the ground. He walked a little more before going inside. Then he wanted to sleep so he went to bed. We completed a few activities and could only do them a couple of times each but it was as good as can be expected considering the unwelcome in-law living on Tony’s leg.

Today we introduced matching 3-D objects to Tony. The therapist used a box with a rubber lizard in it. Then the therapist gave Tony the 2nd lizard and said, “put with same”. Then, with hand-over-hand, Tony placed the lizard into the box with the other lizard. We did this a couple of times before the therapist said “put with same”, handed Tony the lizard, then he put the lizard into the box by himself. He did this a couple of times by himself. We then switched to plastic dinosaurs and Tony did it again (first with hand-over-hand and then just w/verbal prompts).
Tony also played with his bowling ball and pins. The therapist lined up the pins then rolled the ball many times to the pins while saying, “roll it”. Then Tony attempted to roll the ball. If he missed the pins then he just knocked them over with his hand and said “yea” while clapping. The therapist used hand-over-hand, repeated “roll it” and got him to roll the ball to the pins and knock them over. Then he did it later on his own. Despite his crayon fixation (he was lining and re-lining them while we were doing this) Tony still paid attention to the activity.
With the crayons the therapist took Tony’s index finger and touched them firmly while counting to ten. The therapist also lined the crayons up with Tony in different directions and not according to color while counting to keep him from fixating. We transitioned into counting and stacking blocks of various colors, shapes, sizes. Tony of course loves the counting so we used this to complete the stacking and lining.
Later Tony played with foam alphabet letters. His mom and the therapist noticed that he was making sounds that sounded like the alphabet while he was playing with them so the therapist started singing the alphabet song. Then Tony actually picked up where the therapist left off with the alphabet. The letters weren’t pronounced clearly but you could definitely tell that he was saying them. So the therapist kept singing the song and pointing to the letters simultaneously.
Tony started looking at his Cookie Monster book so the therapist took his finger and had him touch the objects on the pages while saying them aloud to Tony (and doing this very quickly as OT suggested).
When Tony had lunch/drink the therapist showed him the chips pic and gave him chips while saying the word. This was done with his food and his cup too.
Tony jumped some with therapist on the floor while mouthing “jump” and holding the therapist’s hand. But unfortunately Tony (poor guy) has an injury on his thigh so he was uncomfortable and limping around like an old man. He was also really tired so the combination finally got to him and he just cried and cried until his mom put him down for a nap. Tony re-arranged his toys so that he could prop his swollen leg up on them! Then he went to sleep. Today was an okay day considering Tony’s condition/mood.

Ok…so I took a break from post last week, but am back on track. I think the biggest thing I have noticed over the past few sessions has been Tony’s interest in various play activities. He has attempted to take part and imitate actions and sounds related to play. It’s been really great to see the joint attention to these tasks! We have done things like pushing a little truck back and forth, loading crayons into the back of the truck, pointing to pictures in books, and pushing buttons on a musical toy. Today, while looking and pointing to pictures of foods, I showed Tony the sign for “eat” and made sort of a lip smacking sound. He immediately looked at me, put his hand to his mouth and clicked his tongue. He continued to imitate this 4x. He was making great eye contact and actually tried to put his hand in my mouth a couple of times. I thought this was really cool! Tony made multiple attempts at vocal/verbal imitation today. He tried an /s/ sound, two, bye, beep beep, and the tongue clicking. I’m proud of him! Hooray for everyone’s hard work!

Today was all about counting 1-10–from blocks, to number of jumps, to bowling pins, etc…Tony loves to count objects so this was used to direct him to a task. In order to get Tony to pour objects we counted the number of pours (even though he only did this a couple of times at different attempts). To get Tony to roll a ball towards his mini bowling pins (rather than lining up the pins in a straight line) the therapist counted the pins with him (hand-over-hand and saying the numbers aloud). Once the bowling pins were knocked over, strong verbal praise and clapping was used. Eventually, Tony wasn’t trying to line up the pins and he was rolling the ball to knock down the pins. We also pulled out blocks of different colors, shapes, and sizes and lined them up and counted them with Tony’s finger firmly pressing each block as the number was said. Tony later pointed on his own and made the sounds, “un, du, ee….” (sounding like he’s counting–mimicking the inflection of the voice).
Therapist later took Tony outside and swinged him, counting the number of swings. He was okay today with his mom staying indoors. As he swinged the therapist grabbed his feet and said “feet up”. When Tony held up his legs on his own he received lots of verbal praise. He held his legs up a lot on his own. Therapist kept his attention so he didn’t “zone out” while he swinged.
Tony completed the sticker activity (peeling partially-peeled stickers and placing them in the squares) very well. He attempted to peel the stickers without assistance until the therapist peeled a corner for him. Then he peeled them and put them in a square that the therapist was pointing to at that time. If he went for the wrong square sometimes then the therapist used hand-over-hand. He received the verbal praise/clapping for this. Tony responds very well to the praise so this is used often. Tony continued to peel stickers for a while. Towards the end of the session Tony showed signs of being tired so if he went to his mom then the therapist redirected him with jumping on the floor or tickling (both times he said “jump” (ump) and “tickle” (including the sign). Then it was back to his objectives.
Tony put different shapes in the shape sifter. Sometimes he would want the therapist to use hand-over-hand with him even though he could do the activity. So the therapist sat on her hand and used the other to point. Tony then put the right shape into the right space. Later Tony wanted a snack and led his mom to the high chair. Once he got his sandwhich (and pork rinds) the therapist took his finger and pointed to his sandwhich and said “food”, then to his pic and said “food”. This was done whenever Tony had his sippy cup, too. After snacktime there was more work/play until Tony took his mom’s hand and waved/said “bye, bye” to the therapist. Then he went to bed at a quater ’til 1pm so he worked a little bit longer today! Tony is really warming up to the therapy and he’s really trying/progressing. Best day yet!

Today was Tony’s first day of his swimming class at the YMCA. It was initially difficult leaving because Tony threw a complete fit when Marlaina took a business call and went outside. I tried blocks, his “big ball” and other toys to try and distract him but he didn’t stop until she came back. After we actually got out the door to get in the car Tony had calmed down and played in the backseat with Morgan and his toys. He must really like the car because he didn’t make a sound the whole 30 minutes we were driving. After we got the the Y, there were two OTs that took Tony into the water. He was the only one in the class for today so he got lots of added attention. One would hold Tony and the other would sing or stimulate him with water toys while they floated him around. One thing Tony really liked was a big red bouncing ball they passed back and forth to him. He did so well in the water (I actually was thinking he was going to freak out at first) but he was laughing, smiling, babbling and was doing quite a lot of splashing too. Water has so many theraputic qualities but also its great because Tony can’t exactly “run off” so he has to try and stay focued on the people in the water holding him. I think he really enjoyed the class. Hopefully no one else will sign up for that slot so Tony can continue getting private lessons!