Parents should consider many of the issues below when a diagnosis for your child. 
1.  A diagnosis can assist in getting the correct treatment for your childs' specific problems.
2.  A daignosis can lead to attainment of financial assistance necessary to attain treatment.
3.  Some parents weigh the advantages of treatment verses the disadvantages of a child having a label of a diagnosis at a young age.
4.  Parents often consider the benefit of treatment verses the stigma the child might have as a result of the diagnosis. 
5. Parents might consider the fact that labels at a young age can be overlooked in the future once the behavior problems are resolved and the child is behaving appropriately in school and at home. 
6.  The long term costs of not treating a child with problems should be considered. It may cost thousands of dollars a year to care for a child with a disability or other diagnosis. The dollar costs should be considered.
7.  In addition to monetary costs parents might consider the social costs to the family as well as society. The family unit can easily be disrupted with a child with behavior problems. It can affect the marriage of the parents as well as people in society they are exposed to at stores, school, church, banks or even the grocery store. 
8. Finally, the child himself may have a lifetime of problems if his problems at an early age are not addressed with treatment.
The above are just a few of the things to consider in deciding whether to see a doctor or specialist and possibly receive a diagnosis as a young child. 

Rienforcers are difficult to choose that are effective. Some ideas to make them more effective are listed below. 

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. 

The latest trend is to buy and iPad, Ipod or other computer gadget and expect learning to magically occur. In most cases more is needed. I a few cases the child may learn on their own but in most cases parents should consider the following in order to have success. One point is that often a child with autism is not visually motivated to use the equipment. In this case the parent can motivate the child with extrinsic reinforcers for use of the equipment. For example, if the child plays one educational game or looks around on the web for 30  minutes then the child receives a preferred food snack such as chips or an activity.  Another point is that the computer must have reinforcers within the aps that reward the child automatically. For example there are programs such as "head sprout" that include reinforcers within the educational game at the end of a correct response by the child. Parents should be careful to set-up reinforcers within the device programs and extrinsic reinforcers in order to achieve optimal chances of success when purchasing an electronic gadget so that the money is put to good use and learning occurs in the child!!

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! 

Therapist can more easily generalize behavior with the session by introducing different antecedents, situations and consequences within the training session. This reduces the cost, time and inconvenience of going to different location and situation in the community. The formal program may contain the basic skills and informal reinforcement can be used during the day to program for generalization outside the session.

For example, the therapist may work on saying "hello" during the session and then have the client practice saying hello by answering the telephone throughout the day or greeting people that come to the door.  The informal parts of the program that are modeled and discussed with the family can lead to a more dramatic and  improvement in the client overall behavior observed by others in the community. 

Pshychotropic medication and behavior therapy work together and separately.  There are advantages to using behavior therapy in conjunction with medication.  The parent or client can gradually reduce the medication as the problem behavior becomes manageable or disappears. This is usually done with through the use of graphic displays of the progress/outcomes, data collection sheets, observation in different environments and analysis of the trends of the problem behavior compared to the medication changes. 

It should be noted that some problems do respond well to medication based on the research and some problems are merely improved by a sedation of all behavior. One might consider researching the medication to affirm that there is some validated benefit before using it for yourself or  a child. It is helpful to note exactly when the changes are made in the clients medication so that it can be determined whether any benefit is  derived from the medication. Discussion about reduction or changes should be brought up at each meeting with the doctor prescribing the medication. It is useful to bring a graph of the behavior and general procedures used so that the doctor understands all variable affecting the progress of the clients behavior. For example, if a new program procedure started last month and the behavior decreased dramatically then a reduction in the medication might be discussed and considered. Generally, the doctor usually reduces the medication slowly so that there are no side-effects.  Generally, taking medication for long periods of time or even short time periods can cause serious and mild side effects and this should be considered in deciding whether to use medications.  It should be noted that each individual case is  deferent and other factors in the environment or health factors also effect the behavior of the client. Individual differences and specific graphs or data should be used as tools in making decisions about whether to take medication, reduce medication or change medications. 

Parents often spend endless days and nights wondering what the next step is to send the child to school or wait and do further ABA. In many cases the question is also whether to hold off on sending him to the next grade level and do both ABA and the previous grade again.  There are many factors to consider in this decision. 

One factor is the reaction of others in society to their decision. Many times parents fear of the negative reactions of their friends, relative, peers or school administration effects their decision to hold the child back one year.  Most people would agree that the most important factor should be that the child progress normally and live a normal life. The temporary reactions of others will not be remembered in most cases once the child is making wonderful grades and living a normal childhood with no behavior problems. 

A second factor is the actual work that the child does based on the decision that is made.  In some cases people will say that he will not be challenged as much if he stays in the same grade.  When in fact usually reviewing the same material with basic academics can build a strong foundation for future academics. 

A third factor to consider is the social relationships of the child. If the child is very young usually the social factors that are disrupted by keeping the child back are only temporary and are forgotten in the next year or so. The friends he would have had in kindergarten are just replaced by different friends when he takes the class again. 

Finally, maturity, height and biological issues sometimes discourage parents from holding a child back. When in fact a child that is taller or smarter than the others will usually receive more accolades and awards and positive feedback then the child that is the shortest and not as knowledgeable in the classroom. The positive feedback can lead to an improved self-concept and higher expectation for success that usually lead to a  what is referred to as "positive momentum" and further success for the child.  

In general, each of these factors should be weighted and if there is more doubt then it is the current authors opinion that keeping the child in the current classroom with ABA assistance will lead to a more productive life.  The past problems will be forgotten once the child is receiving positive feedback and success. The child will more probability that he will be mainstreamed and graduate in the regular classroom, go to college possibly and live a much more fulfilled life in the future.

Trainers in the field often find themselves limiting there reinforcer list to a short number of standard reinforcers. There are several things to remember to make your reinforcers extremely powerful. 

One thing is to use some sort of reinforcer survey to assure you capture as many possible reinforcers as possible. There are many surveys already available to you that others have done or you can create your own! 

Second is to remember that anything that increases the probability the behavior will occur is a reinforcer. Therefore even relatively unusual items such as a nap, a favorite chair, a unusual toy, helping you with a chore, running out side in the yard, even a rock that the child likes the color of can be used as reinforcers.  Therapist should keep their eyes and ears open for novel and unusual reinforcers especially in the case of clients that are difficult to teach things. 

 Thirdly, reinforcer sampling is a good practice. This technique of reinforcer sampling involves testing the reinforcer with the client by giving them a sample to see if they enjoy the item and even giving it contingent on a behavior to see if it increases the behavior. 

REmember Reinforcement is extremely powerful in training the child or client but only if it is truly a reinforcer in that it increases the frequency of the desired behavior! :)

Parents and others often ask about the differences between Speech therapy and Behavior Therapy with a Communication goal.  There are several possible differences one might observe in the Applied setting. Although in theory they are not usually specified in books or training programs (See guidelines speech and Behavior therapist follow for more accurate discussions).

One difference is the focus of Behavior therapy is usually first on breaking down the speech into functional components rather then structure of the words or sentences. Behaviorist usually set goals such as training of words to attain items, express a need or other functional use of the words.  Speech therapist traditionally stress the formulation of the words and the exact pronunciation as well as use of the word. Note that the above is a generalization over many years of experience and observation and may not be the case with all speech therapy. 

A second major difference is the focus of the behaviorist is on generalization, maintenance of speech and using the words in the environment on a daily basis consistently. In order to achieve this behaviorist typically set up different environments to practice the functional use of the words at home or on outings for example. The may also have the client use the words throughly the day in different situations in one environment in order to achieve consistency. Behaviorist almost always set-up contingencies and reinforcers specific to the individual in order to motivate the client to actually Speak. The outcome research and applied application usually shows a tremendous increase in verbalizations by the client  in a very short time using Behavioral Approaches.