Obesity is very common in the past few years in children. Parents can use some of the following behavioral techniques to assist their children to maintain or loose weight when it is recommended by their doctor. 
1.  Environmental structuring of the home is a basic behavioral technique that can be used. One example is to have only healthy snacks in the refrigerator and kitchen so that when the child is hungry he will eat something healthy.
2.  A second environmental technique is to reduce access to the refrigerator. Some newer refrigerators have locks that can be activated or deactivated.  This is particularly useful with extreme obesity or Kids with problems such as "Prader Willi" syndrome. 
3.  A third technique is scheduling which leads to less snacking between meals.  Children can be informed that eating is to occur only at meals and during two snacks during the day.
4. Another behavioral technique is to reduce the size of the plate at meals so that it looks like more food. 
5.  Encouraging children to chew each bite at least 10 times so that they digest the food.
6.  Eating only when hungry and not for social reasons can help children to loose weight. 
7. Parents can take time to explaining long term and short term consequences of weight gain and over eating or eating unhealthy.
8. Children can be encouraged to participate in shopping and purchasing healthy items rather then items that are high calorie. 
9.  Parents can purchase books to read that talk about healthy eating and eating food from each food group. 
10.  Parents might try regularly scheduled weight and height measurements to increase awareness of health and eating habits and the effect on weight. 
11. Another concern is making sure to schedule specific limited amount of time for sedentary activities like computer or television. Exercise time should also be included in the schedule each day. 

It is never to early to start encouraging healthy eating habits, reinforcing these habits and discussing consequences for you children to encourage healthy eating habits in your children as they become adults! 

Training can be done for child in a variety of schedules. Before starting treatment one should consider the schedule of the child and how to fit into your life and work schedule realistically.  Parents may select to do most of the training in specific time slots during the week or on the week-end.  The advantage of this schedule is that you can do many trials and this can speed up learning. However, this may be inconvenient and sometimes the child will wonder why you are repeatedly asking him to do the same thing (ex. taking on and on his shirt). A second option is to do the training during the normal daily activities. This is sometimes easier since time does not have to be set aside specifically for training. The other advantage is that the child can generalize his behavior to different environments or with different people. For example, during meals at home or at restaurants the same training techniques are used.  There are many other advantages and disadvantages that should be discussed.  Family should review these alternatives and sometimes combine the two methods of scheduling training and decide which is best for them and their child! 

In choosing which exercises to work on first more frequently in a child with poor motor skills and aspirer or autism one should think about the functional skill deficits of the child. If a child is having difficulty using a fork or spoon then sports or leisure activities that emphasize the hands may be beneficial since you will be strengthening these muscles and movements.  Exercises that stress the lower body are also beneficial but if the priority is to develop self-care skills that require more dexterity then he as the fine motor movements should be emphasized. Some leisure activities such as using an iPad may also improve fine motor skills. 

Finally, one should also consider forks or spoons for example that are easier for the child with motor problems to use. Considering the selection of equipment and leisure or sports activities can be important in promotion of more rapid learning of self-care and daily living skills in children with both motor and Autism or  Attention problems. 

Behavior Therapist often use music as part of their treatment plan. In past years music therapy was funded by organizations more often.  Soon they started fading out funding for this type of therapy. Many clinicians and parents were disappointed by this fading of the service. Often facilities or caregivers would incorporate music therapy in the recreational therapy which was covered.  Currently, music is used predominantly in Behavior therapy and recreational therapy. Parents and caregivers should let the recreation or behavior therapist know if their child enjoys music as a reinforcer. 

Behavior therapist do a functional assessment which includes a reinforcer survey. If music is determined to be a reinforcer it is very helpful as a part of the behavior plan informally or formally. Often the behavior therapist will use music as a replacement behavior or just as a learned or acquisition skill with the program.  If the child enjoys the sensory reinforcement of the sounds or use of their arms to manipulate items a musical instrument or device can be very effective.  The  child can also receive an extrinsic reinforcer for playing the instrument. Finally, the behavior therapist may teach the child to play instrument using other reinforcers such as tokens, edible reinforcers or social praise.  

Some examples of using music to replace behavior include drums for sensory reinforcement including the sound and the vibration. Another example is using radio stations that are preferred on a headset to provide sensory reinforcement if the child likes that type of music. Music might be also scheduled during the day as relaxation for children that are aggitated or aggressive.  In addition learning a new instrument may result in social praise and attention when the child plays the instrument.  

Music can be utilize by the behavior therapist in a variety of methods. One method is to have the child play the instrument. A second method is to have the child play music on a radio, stereo or on earphones. Headphones are especially practical and easy to use with contingencies of the program.  The headphones are practical because you can use them in any location such as when going to a doctor appointment, in the car, at work, and on the bus.  Some instruments can be played outside or in a private room if they disturb others or headsets can be used with some instruments. The therapist or caregiver can put the headphones on easily when the child is displaying good behavior based on the targeted goals for behavior.  Music can help the therapist to create a positive environment for the child even during non-preferred activites.The result is an increase in compliance and decrease in inappropriate behavior.  As people often say music can make the world go round. 

Children with special needs such ADHD or autism spectrum disorder often are not in touch with long term contingencies.  Focusing the childs attention on long term contingencies can lead to big improvements in behavior and academic performance.  Some tips in focusing on the future are discussed below. When meeting with teachers it is helpful to focus on the potential of your child such as intelligence or social skills. Secondly, the parents can focus on the future by discussing the future with the child. For example, the parent might discuss what car, job, spouse, kids, money or job title they might want when they grow up. This should be done on a regular basis hopefull daily or weekly.  Thirdly, the parent might go onto the computer and look at people in jobs or careers the child might like, look at cars they might purchase or computer equipment.  Focussing on long term goals will focus their attention on the future. 

Mealtime is an excellent time to do some social skills training. Caregivers should set up a reinforcer such as computer games after meals, preferred food items, deserts, social praise with smiles or clapping. Reinforcers can be anything that increase the occurrence of the  appropriate social skills. The teaching begins before the meal as well as during and after the meal.  The meal should be very structured with different chores such as setting the table, passing items to each other cleaning the childs plate off the table or taking others dishes and washing the dishes or putting them in the dishwasher. 

During the meal verbal skills can be increased with instructions from the parents regarding a game or family tradition that is done during the meal. For example, the parent might say we are going to each tell a story and go around the table with each person sharing a story about his/her day. The adults should also participate since this will provide a model of what the child should do.  The other children in the family should be encouraged with praise to ask relevant questions, praise or actively listen by repeating parts of  the story that is told.  Finally, mealtime should have a definite end criteria for the child and this should be set up verbally prior to the mealtime. For example if the parent wants the children to stay for a certain amount of time or until they finish desert this should be expressed prior to the meal. 

Also, prior to the meal the parent should explain the criteria for reinforcement. For example, the parent might say if you sit nicely at the table, tell a story and eat your food then you can have desert or computer time.  With very small children that eat quickly a small toy or objects to entertain them might be helpful in helping them to control there behavior and stay seated at the table.  Mealtime is becoming less common in this country but it is important to try to do this at least during one meal a day if possible in order to develop and maintain your children's social skills. In the long term the time parents devote to social skills training during will pay off with wonderful conversations with their children throughout their lives! 

Parents often have behavior problems that seem unsolvable. A brainstorming session about the environment often leads to completely eliminating the behavior problem.  Some examples of this type of solution are listed below.  The childs home situation can be altered to solve the behavior problems. For example, if two children are fighting regularly in the bedroom the family might make arrangements to have them sleep in different areas. If a second bedroom is not available the living room can be used simply by adding a sleeper couch, futon or even a folding cot for camping.  Another area is the school program. At times the bus or classroom can be an arena for arguments. In this case moving the childs' seat, changing bus or bus seating. Finally, if clothing becomes a stimulus for a behavior problem. For example, a child that has tantrums if his clothes are torn or wet might be better off with waterproof or stronger material pants.  Brainstorming is very important in design of programs and working together with your therapist is very effective in solving your childs' problems completely! 

Parents often struggle with thinking of what to do with their child with special needs (ex. autism spectrum) after he receives his diploma from high school. The following is a review of some of the options they might consider. The caregiver should way the short term and long term benefits of each option for their individual child and themselves.   

One option is to place them in a day program with activities. A second option is a workshop setting. Some workshops are "stand alone workshops" and some you can pay or get funding to attend even though they are part of 24 hour living facility. A third option is to try to attain employment in the community either on their own or with the assistance of supportive employment.  Supportive employment can be arranged and often the child is sent for evaluation in order to determine the best type of job for him. Another alternative is to have some job arrangement which can be performed in the home such as data entry, phone calls or other jobs in the home. 

A sixth alternative is to continue the childs education at  Community college or technical school where he can attain credentials or certificates for a job.  A seventh alternative is to enroll him in a job for special needs persons such as programs with plants or animals. Some job programs are geared toward hiring only special needs persons.   There are a large number of other alternatives. Parents will benefit by dreaming with the child about an ideal job that utilizes skills the child has as well as having reinforcing activities or items the child will enjoy.  This "brainstorm" session might include other professionals or friends and will result most likely in a more peaceful and fulfilling life for your child. 

Parents and therapist often are not sure which behaviors to prioritize in training new skills or choosing replacement behaviors.The following identifies some important factors to consider in the selection.  One factor to consider is to try to select a skill that will lead to the long term goals of the client.  This often requires alot of imagination, observation and research to come up with some alternative goals with the client and his caregivers that will lead satisfying to a more satisfying lifestyle for the client.  Once these goals are established all other training should be in agreement with these long term objectives. A second factor to  consider is  the inappropriate behaviors and the caregiver or trainer should attempt to design acquisition skills that will most likely reduce those behaviors. This may be done by teaching skills that are difficult to do at the same time as the inappropriate behavior or skills that result in the same types of reinforcement.  Parents and trainers should always keep in mind that teaching skills that are not connected to the overall treatment plan goals to achieve will not lead the client as rapidly to acheiving the satisfying lifestyle the client and family want to achieve.

Caregivers often do not realize the importance of a schedule for their child with problems such as autism, behavior problems or even attention deficit and non-compliance problems. The following includes some of the advantages and how to implement scheduling effectively  

The advantage of a schedule are the following. The parent is able to let the child know what is to be done next in a positive manner. Also, children know that the previous activity will end at a specified time so they do not get upset. Thirdly the child can look forward to certain prefered or reinforcing activities during the day. Finally, the child is more productive with his time learning since there is not as much time that does not include an activity for learning. 

To effectively implement the scheduling of a childs day it must be first individualized to the particular client. Secondly, it should include some preferred activities or reinforcers or time for choosing a reinforcer during the schedule. Thirdly, it is helpful to make the child aware of the schedule or review the schedule in the beginning of the day and throughout the reminders of the next activities scheduled. This serves as a stimulus for good behavior.  If paired with the reinforcer to be expected this will improve the childs' behavior even more during the activities. 

Posting the schedule is usually in practice not that helpful, The child frequently ignores the posted written schedule and in many cases has vision, reading skill problems or simply does not bother to look.  Although some therapist and researcg reports it is helpful to post it is suspected by this author and others that posting is more of a help to the parent or caregiver in most cases. However, It is very helpful for the caregiver to have a copy for themselves either posted or in a binder or other location. 

The schedule of course should be updated regularly and include the childs choices and preferences in the schedule. Consistancy, throughout the day is also very important. If changes have to be made in the schedule it is helpful to discuss the changes prior to the day or hour in which the change will occur with the child. The prior discussion of a change, may avoid any strong reactions such as tantrums that could result from changing the routine. Parents and caregivers will find that the schedule is a very useful tool in improving the childs' Behavior.