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Lesson ID

Name of play coach*

Your Child or Clients name

Session Date*

How long was your session?*

How did you feel in your session?*

Pick from the options below

Client Name and Session Summary*

A quick summary of your session including anything of significance. For example, a new word or new motivating game. Anything you may have observed or learned about working with your child.

Level of engagement

On a scale of one to ten, ten being the highest quality. Rate you and your child’s joint attention and shared enjoyment overall for your session. When estimating this, consider the time spent attending to the same activity, did your child appear joyful? were they spontaneously communicative? Did they consistently reference your face and make meaningful eye contact? Were you enjoying yourself in relation to them?

Please enter a number from 1 to 10.

Balance of Initiating and Responding

Describe the balance between Initiating and Responding within the social loop for you and your child across those same interactions. Initiating includes any communication that indicates continuing the game or adds to it in some way without being requested or promoted in some overt way.

You are 90-100% of the initiating to begin and continue the game
You are doing 80-90% of the initiating and re-initiating of the games
You are doing 70-80% of the initiating and re-initiating of the games.
You are doing 60-70% of the initiating and re-initiating of the games.
You have a fairly balanced interactions with your child initiating 40-60% of your social interactions and games in a playroom setting at any given time. There will always be variation.

Social Referencing and Eye Contact

Rate your child's overall use of social referencing and eye contact during your interactions. Don't consider times when your child was being exclusive.

My child frequently and consistently references their social partner during interactions.
My child referenced me at times of high motivation, but will often talk without looking at me.
Eye contact looked strained, forced or difficult.
Eye contact only happens upon request.

Gestures used

Check all that apply to your session. Gesture types are displayed in the order that they typically develop. Check all that you observe your child doing on their own or through spontaneously imitating you.

Motor-Skill Gesture (ex. Taking you by the hand)
Contact Gesture (ex. Making contact with an object to draw your attention to it)
Distal Gesture (ex. Pointing, waving, nodding etc)
Symbolic Gesture (ex. Using your hand as telephone or arms as airplane wings)

Physical Imitation

Did your child use any physical imitation of another person in their session?

Yes
No

Describe what your child imitated.

Symbolic and Imaginative Play

Did your child engage in symbolic or imaginative play?

Yes
No

Symbolic and Imaginative Play

Choose one of the following to describe your child's level of Symbolic and imagination play in your session.

Performs simple single symbolic actions, like pretending to eat toy food
Performs a sequence of simple symbolic actions, like pretending to feed a baby and put them to sleep.
Performs sequences of 3 or more simple symbolic actions consistently.actions.
Acts out more sophisticated imagination themes like pretending to be a pirate or going to space. But may be controlling about how or what they play.
Fluently and flexibly plays all most imagination games that are presented.

Describe Symbolic/Imaginative play from your session

Describe briefly your game or activity, and what your child's role was, what symbolic play they used or imagination theme they engaged in.

Rate Social Flexibility from 1-10

Rate your child's flexibility during interactive games and activities. A "1" being highly rigid, not open to other's ideas, will only play certain games of their choosing or talk about only their topics, and a 10 being open and curious to their social partners ideas and interests. This doesn't mean that they are interested in doing everything all of the time, but at least they are open to trying it out. No child, autisitic or not will be one way all of the time, use this tool to see an overall trend.

Please enter a number from 1 to 10.

Games and Activities

Please use the 3 spaces below to describe your three most interactive and motivating games or activities that you played with your child

Game/Activity #1

Give your game or activity a brief descriptive title and a short description of how to play it. Be detailed enough that someone else could follow your instructions and play the game as well.

Game/Activity #2

Give your game or activity a brief descriptive title and a short description of how to play it. Be detailed enough that someone else could follow your instructions and play the game as well.

Game/Activity #3

Give your game or activity a brief descriptive title and a short description of how to play it. Be detailed enough that someone else could follow your instructions and play the game as well.

Advanced Conversation Skills

This section is for kids and young adults who are highly communicative either verbally or through a device and are working on conversation skills such as storytelling, sequencing, having affect and expressing emotion, understanding social cues or being flexible within a conversation.

Are you working on advanced conversation skills?

Your child should be able to sustain reciprocal conversations on basic topics of interest for at least a few conversation loops.

During your session was your child able to share a story with a beginning, middle, and end?

To tell a clear story we need a beginning, middle, and end and we need to put things in the correct order. This is called sequencing and is a component of effective storytelling. This can be a simple three-sentence story, doesn't have to be War and Peace!

During your session what best describes your child's affect during conversation?

We're defining affect as facial expression, voice modulation, and body language during a conversation.

Emotional Regulation

This is a place to document any crying, whining, tantrums or meltdowns, what steps you took and whether or not they were useful. Use this to document the outcome of any strategies you're implementing to help evaluate any changes to be made.

Did your child have any sigificant meltdowns or tantrums during your session?

Tantrum defined as simply crying and screaming to get something of value, generally a toy, screen time or food. It can be intense, but relatively short-lived. A meltdown is more intense, can last longer and onclude physical aggression.

Describe your child's meltdown or tantrum

What preceded it? How did you respond to it? How did it finally end or get resolved?

Verbal Communication

Pick the verbal level that currently describes your child

Note this is just a marker to be used to compare down the road.

Not yet verbal
Makes one or two different sounds for communication
Makes word like sounds
uses 1-10 clear sinlge words consistently
uses 10+ clear single words and som two to three words phrases
Uses a larg vocabulary of single words and short phrases to make needs known
Uses longer sentences to express more complex thoughts, but still has a hard time being fluent often getting stuck or frustrated.
Can speak fluently, but may have trouble combining with eye contact.
Fluently speaks and incorporates eye contact, intonation and gestures.

Verbal Language Notes

Use this space to make a list of any new words or sounds used in your session, include words that you've hear but that are still emerging.

Self Evaluation

Answer the questions below to help keep you focused and improving on your play skills session to session.

Social Magnetism

Rate yourself on how effective you were as a Social Magnet for your child. A "1" being "I was tentative and flat" and a "5" being "I deserve an Oscar! I was entertaining, dynamic and user-friendly!"

Please enter a number from 1 to 5.

Rate of Request

Your rate of request is how often you are asking your child questions, making a request or placing a demand on them. During your play sessions, you want to be around 0-1 questions per minute. To accurately figure this out you'll need to watch a 15 minute video clip, count the number of requests/questions and then divide that by 15. You don't have to do this for every session, but it's nice to do every now and then. Otherwise feel free to estimate using the choices below. Understand that while 2 questions per minute don't sound like a lot, in an hour session that's 120 questions! Yikes!

Notes for Next Time

What is at least one thing you want to do differently in your session? This could be working on being more dynamic and magnetic to your child or being more creative, making a game or a theme. Anything, you want to do is fine, review this before your next session as a reminder.

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