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Sensory diet

Bathing routine

Bathrooming routine

Toothbrushing

Mealtime routine

Leisure exploration

Putting on socks

Prewriting strokes with comfortable grasp

Drinking from a cup

Cutting and spearing with fork a knife

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When LiVa demonstrates signs of dysregulation, he benefits from opportunities for physical space, limited auditory input (a quiet space and limiting words spoken to/around him), and ample time to regulate (roughly 10 minutes in the past).

The vibration plate and the infinity swing have been tools that have helped with self-regulation

Once regulated, it may be helpful to position a low pressure activity nearby so that LiVa can join in or watch from afar once ready.

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Turning learning tasks into a game

Starting with something easier first to build momentum and confidence

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LiVa can count independently up to 10 and is progressing to 20, he is familiar with the names of the teen numbers but mixes them up when rote counting

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Utilizes his right hand when writing and cutting

When writing he is progressing towards utilizing a tripod grip

Can cut along a dotted line and utilizes his left hand for stabilizing the paper

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LiVa is independent with his toileting routine. He will typically ask for the bathroom when needed. He does sometimes benefit from a reminder to go to the bathroom. If you ask him if he needs to go to the bathroom and he says no, honoring his no and autonomy is very important.

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LiVa has shown consistent interest in pretend play that involves monsters, spying, sneaking, and playing pranks. It is helpful to use these play themes to increase engagement with activities that may be perceived as difficult, ie: fine motor activities or uncomfortable, ie: messy play. When we pretended to make a banana peel out of yellow play dough with the plan to plant it somewhere sneaky, he was much more interested in engaging with the medium in ways that pushed his comfort zone.

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Always give LiVa control over engagement in tactile play activities.

One way to instantly increase comfort is to provide a dry towel or apron to LiVa prior to initiating the play. It is helpful for the adult to engage in the play alongside LiVa. The adult can model using their own dry towel/apron to wipe hands when they want a break.

Having access to a mirror or a live, velfie view of himself while engaging in tactile play provides additional visual feedback to make sense of this sometimes dysregulating form of input.

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Sometimes LiVa comes with lunch items that are precut. In these instances, it is still helpful to offer him a fork to use to pierce the food. Attention does not need to be drawn to the fork and no cues need to be provided to use the fork. Access to the fork simply provides another option for self-feeding.

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primary mode of communication:

spoken language

augments communication with:

gestures (reaching, leaning, turning away, standing up, pushing, pulling)

vocalizations (cry, laugh, groan)

facial expressions (smile, frown/grimace, furrowed brows)

eye gaze (looking at / away from objects or people)

proxemics (moving towards or away from objects or people)

Bilingual Spanish/English

some Spanish is spoken in the house and says some Spanish words such as "sopa"

Communication Style

GLP in early stage 4 where he is learning to use grammar and generate his own flexible phrases

Considerations

has Childhood Apraxia of Speech: a motor planning difference that makes it hard to coordinate speech movements

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Expressive

communicates a variety of communication intents

preferences, protests, comments, questions, transitions, self-advocacy

exploring self-generated grammar

Receptive

follows multistep directions during activity of interest usually involving gross motor, building, sensory-seeking activities

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Spontaneously produces single words, 2-word combinations, and phrase elaborations

Single Words

Noun

Verb

Adjective

Quantifier

Wh-Question

Two-Word Combinations

Quantifier + Noun

Adjective+Noun

Pronoun + Verb

Interrogative Modification

Constructions

Subject-Location Elaboration

WH-Question Elaboration

Conjunction Modification

Verb Elaboration

LiVa indep stated “I’m tired” while working on the motor planning production for the word “binoculars", when SLP offered transitions, and when SLP offered an idea of play he did not want to participate

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1. self-generate sentences with third person pronouns (he, him, his, she, her, hers)

2. self-generate sentences with auxiliary verbs (is, am, are)

3. produce 25 two-word combinations [noun-noun, attribute-noun, noun-location] to refer to referents around him

4. produce utterances using ‘Verb and Verbal Elaborations’

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benefits from adults highlighting targeted grammatical structures when modeling grammar (e.g. using a louder volume when producing ‘HE’ in a sentence).

benefits from being given extra time to produce language. Stage 4+ utterances require more cognitive effort to assemble and express. He benefits from need additional time to mentally organize his thoughts before speaking, especially after being given a model

Avoid direct correction of his grammar. Instead, repeat back his utterance using the desired grammar once he has finished speaking to him the model without the demand to repeat it.

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LiVa enjoys competition/ racing or “winning” helps him feel in control and connected.

He enjoys being first, the fastest, or the best, this meets a need for autonomy and success.

When dysregulated, he may show clenched fists, jaw clenching, kicking, or throwing as signs of overwhelm.

He may use phrases like “shut up” or “stupid” when frustrated, this is his way of expressing distress or a need for space.

Too many choices or adult-led suggestions can increase pressure; he responds better to limited options and a strong sense of control.

He is not yet labeling his emotions, would benefit from gently narrating what he might be feeling (ex: “That looked frustrating”) to help build awareness.

A busy or loud environment can elevate his stress; calm, organized spaces support his regulation.

Consistent access to sensory items, including movement breaks, deep pressure, or access to tactile objects, may help prevent escalation.

During early signs of dysregulation, playful co-regulation like a race or pretend play is more effective than direct redirection.

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Direct Observation & Deescalation Strategy 

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Direct Observation & Deescalation Strategy 

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Upon entering the room, LiVa was observed to be dysregulated. He was clenching his fists, flexing his muscles, and punching his own hands.

When I entered I began with nonverbal mirroring to connect with LiVa’s physical presentation. I mirrored his clenched fists and muscle flexing, then introduced stepping stones as a safe outlet for physical input. I prompted with clear, engaging language:

“Punch hard” → LiVa punched the stepping stones multiple times

“Kick fast” → LiVa performed repeated kicks

“Try elbow” and “Try knee” → LiVa followed these prompts successfully

Throughout the routine, I incorporated LiVa’s preferred gestalts (e.g., “I’m stronger,” “Faster,” “I’m the best”) to maintain engagement and affirm his experience as a gestalt language processor (GLP).

A movement-based obstacle course was introduced, and LiVa continued engaging in safe gross motor activities with embedded imaginative play (e.g., “Don’t fall in the lava,” “Step on this fast”). I offered co-regulation by holding hands and balancing together on the wobble steps. I modeled emotional regulation language (“I’m mad, I need safe karate”) to pair movement with emotional awareness.

After approximately 6–7 minutes of physical and imaginative co-regulation, LiVa independently stated, “So tired,” and took a sip of water. I echoed, “Yes, water helps,” reinforcing his self-awareness.

Following this, LiVa returned to playing near peers and demonstrated the ability to select a new activity to transition to.