When your child reaches the age of 16- 18 parents start to hear from others that it is important to proceed to attain adjudication if this was not done yet.  Parents can attain the paperwork to do this or information from a social worker or online generally.  When the child is a minor the parent is automatically the guardian but once they become an adult this must be established in the courts.  There are many things to consider when you are thinking about whether to purse guardianship and competency for your child. The following are some of the important things to consider in making this decision.
1.  The first issue is that if your child remains competent as an adult he may be subject to any punishment that adults receive for his behavior in the community. Usually the consequences legally for adults are more severe then for a child that has not  been adjudicated incompetent and has a parent as a guardian. 
2.  The issue of guardianship has become very visible in the newspaper recently in the past 10 years and there are alot of support systems in place at this time to help parents accomplish this legal procedure.  For example, there are some pro bono, legal aide  or lower rates that may be available if you consult with a lawyer specializing in this area or with a social worker.  In the past people often can attain assistance from lawyers as "pro- bono" or from other sources based on their salary.
3.  There are different types of adjudication and guardianship. For example, there is one type of guardianship which is only over medical decisions and this may be attained at a lesser cost.  Parents may want to start out with guardianship over medical concerns and later attain full guardianship over other areas for their adult child. 
4. If any medical issues come up the parent as a medical guardianship can make these decisions.  For example, if your child is told by the doctor he needs a feeding tube the parent will have the right to decide when this might be done or whether the risks outway the benefits to your child and discuss this with the doctor. Without the guardianship procedures may be done without input from the guardian of the medical issues.
5.  Guardianship and adjudication may affect certain benefits your child can receive and parents should consult with the support co-ordinator or social worker for information regarding the financial implications.
6.  Funding and budgets in the future may include the legal status in decisions about eligibility for benefits.
7.  Parents should consult with doctors, social workers, lawyers and legal aide professionals and research in books or google to make a definite decision about guardianship and adjudication. 
In general, guardianship and adjudication should be pursued to protect your child's health, welfare, financial benefits and avoid legal problems for the future of your child. 

Caregivers and parents have in certain cases become frustrated training their child a simple skills such as toothbrushing or tying shoes.  Below are some tips for creative use of other equipment or equipment in general to make your training much more rapid and fun for your child!

1.  Toothbrushing- to make tooth brushing easier parents may try and electric toothbrush. Some of them are quite inexpensive. One can purchase a battery operated toothbrush for under 10 dollars at a drugstore or department store.  Also, parents can purchase a preferred brush for your child. For example if he likes superman  one might purchase the superman electric tooth brush. 
2.  Shoe lace tying- to make teaching shoe tying parent or caregiver might try using other types of shoes such as velcro shoes or slip on tennis shoes.
3.  Eating skills- there are a large variety of adaptive equipment available for eating. For example, a built up spoon for someone who has an unsteady or weak grasp.
4.  Walking- teaching someone to walk one can start with a more restrictive device such as a walker then fade to a three legged cane and then to a cane. Always, make sure to consult with and follow any physical therapy or medical recommendations when working with adaptive equipment. 
5.  Drinking- there are special cups such as cups with a straw, cups similar to a child's "sippy cup" and large or smaller sized cups.  Start out with one and then slowly fade to a more normal cup. 
6. Hair brushing- is your child upset when you comb her hair? Try using a wide tooth comb or brush and then gradually fading to smaller teeth. In some cases a wide tooth comb might be continued indefinitely to prevent pulling the hair as you comb. 
Always remember to use reinforcement, shaping in combination with the adaptive equipment and you will have more rapid results from your training with your client and child! 

Autistic children frequently have accompanying sensory medically involved issues that should be addressed by parents either before or during the treatment to assure more success with training. The following is a list of areas to look at and refer the child to specialist if it appears there are problems. 
1.  Hearing referral should be suggested to the parent or caretaker if any deficit is noted or suspected during the behavioral assessment.  This might be referral to an audiologist or to an ENT or someone with specialization in the area of hearing. 
2.  A full physical should be done to evaluate if there is any pain that could interfere with perceptions of senses. For example, allergy or tonsils may interfere with the ability to swallow or  learn speech if the client senses pain when they speak.
3. The evaluation of the vision of a child is important in determining if they are able to see. Recently, it was determined that autistic children often focus on the mouth more than the eyes.  It makes sense that increase his ability to see a face through glasses or other corrective treatment for vision might be helpful. If one eye is "lazy" this might interfere with perceptions and sensory awareness of the environment. 
4.  Some children may not have good strength in there fingers which may limit there ability to grasp and feel certain items. Exercises or occupational therapy might strengthen there ability to grasp objects  and more sensory awareness during the manipulation of the objects. 
5.  Parents might want to evaluate dental health too. The pain of a tooth may distract the child and reduce his awareness of other activities around him. 
6. Preventative measures should be taken to maintain peak sensory awareness. For example, brushing the hair away from his/her ears to prevent infection or water from getting into the ear canal. Drying the ears may also prevent any infection or problems with water in the ears. 
7. Pain in any part of the body may distract from the child's ability to focus on what is going on in his environment. This includes stomach aches, pain in tonsils and any injuries. Even a stomach ache may lead to the child focusing on that pain instead of the task requested. 
In general, referrals should be made when any problem is suspected during the functional assessment. The healthier and happier the child is the faster he will learn. Pain and medical conditions can distract the child awareness through his senses and lead to slower learning and development during early childhood. 
 

Preparing to toilet train your child? Don't forget to pick up some pull-ups for during the training.  Firstly, The reason these are more effective then diapers  is that they are easier for the child to pull down and up. Secondly, they are a good cue to the parent to encourage them to attempt toilet trips rather than changing the diaper.  Thirdly, it is a good idea to buy pull ups that are attractive to your child such as with "hello Kitty" on them. 

Also, it is a good idea to buy underwear next after the toileting accidents are only once or twice a week. The underwear might also have designs or characters you child likes so that he will be proud to wear "big boy underwear"!  Finally if you have already a big supply of diapers you might use them at night until they are used up in order to save money. Night time toilet training is usually accomplished after the daytime toile training. 

If an intensive toilet training session is not possible it is still effective to do in when possible but being prepared with the prepared with pull-ups will increase the spead of toilet training. If you need some asssitance the best-seller "Toilet Training in less than a day!" by Nathan Azrin is available in paperback on websites such as Amazon and others. Also, an AP will come out next year most likely with the book on it. The book is written by my Father Nathan Azrin! It breaks down toileting training into easily accomlished steps and details. REmember the advantages of toilet training are many including a required prerequisite in most schools at a certain age and the conveince for you  of not having to change diapers sometimes 3 or more times a day!! The small amount of time toilet training will lead to amny more hours of freetime for the parents from changing diapers!!:)

People often start to get agitated and then it escalates into a tantrum. Parents and caregivers often have to   deescalate the situation or calm it down after it occurs. The following is a list of possible steps to take beginning with deescalation and then to calming a situation. Each person is different so an observation and analysis of the tantrum behavior will help and is essential to identify which methods to use.
1.  If the caregiver or parent observes any facial expressions, movements or behavior that show agitation it is best to intervene at this point. The intervention can include relaxation techniques, redirection or a cue word to calm the person down.
2.  Once the behavior starts to begin or even when the precursor facial expressions begin the parent/caregiver can redirect the person to another activity or distract them by discussing another topic.
3.  Another method of deescalation is to provide some relaxation methods for the person. Perhaps the person is tired and the caregiver can ask if they want to lay down or take a drink of water to relax. 
4.  Finally, if the behavior has started to occur then usually removing the person from the environment, moving the audience away or ignoring the person and engaging in another activity will deescalate the behavior. 
5. Finally any major reinforcers such as affection or activities preferred should not occur if the behavior has escalated at all into verbal or physical aggression. 
6. Also, in some cases training or physical management might be necessary if tissue dammage is imminent. 7. 7. However, on of the  best way to avoid aggression or tantrusm from occuring is to fill the time during the day with activities and reinforcers for those activities.Finally one should seek advice of a trained Behavior Analyst for aggression or tantrums. 

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! 

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. 

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. 

Clinicians are often presented with physical symptoms that suggest medical involvement during assessment or intake.  The first thing that therapist should consider doing is to recommend that the parent or caretaker immediately or as soon as possible follow-up on a medical issue. The medical issue should be ruled out and addressed by the parents in order to treat the client effectively with behavioral treatment.  Some examples of medical issues might be something as simple has hearing loss or ear infections. There is a large body of research and talks at conferences about the relationship between hearing or ear problems and diagnosis such as autism or other developmental delays or diagnosis. There is a large body of research regarding other medical problems such as blood pressure, diabetes or low blood sugar, constipation and the resulting behavior problems that may occur.  A thorough physical or a specialist such as an otologist may be a good recommendation. If there is a strong reason to believe that a general physical may not be sufficient then an expert in the problem such as an otologist or cardiologist might be something for the caregiver to consider in order to completely rule out the medical origin of the behavior.  However, even if there are medical causes of a behavior one can still treat the problem with non-restrictive behavioral procedures. Often the behavior problem has both medical and behavioral causes that are revealed in the functional assessment. Therefore both behavioral and medical treatment can work together to resolve the issues and the child can look forward to the possibility of achieving a normal life without behavior problems!