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Home , Autism, Autism spectrum

Au t i s m Mental Issues&

A guidebook on issues affecting individuals with

Introduction to Autism& Mental Health

utism is a neuro-developmen- performance and sustainability. For example, tal disorder that is typically studies have looked at students diagnosed diagnosed by age three and is with ADHD, pediatric , a lifelong . It has an and anxiety, and have found simi- impact on three main areas in lar outcomes. Van Ameringen, Mancinia, Aa person’s life: social development, commu- and Farvoldenb (2003)1 found that anxiety nication skills and restricted interests. As a disorders are associated with a higher rate of spectrum disorder, autism can affect some- early school withdrawal. Pavuluri, O’Connor, one in mild to severe ways in these areas. Harral, Moss and Sweeney (2006)2 studied In addition, we see sensory and behavioral pediatric bipolar disorder and ADHD and differences that can become barriers to fully noted that no difference between these two participating in one’s education. groups of students existed when looking at academic performance. Both groups expe- Students on the often rienced difficulties with , memory, have a co-existing mental health disorder and problem solving. All of these issues that may be undiagnosed. Professionals served to contribute to poor academic per- have little information on this topic and formance. Similarly, students diagnosed with frequently miss the of a depressive mood disorders have been related co-existing mental health disorder. Teachers to lower academic achievement3. There is a are left unequipped in their classrooms to high percentage of students diagnosed with determine what is motivating their stu- Pervasive Not Oth- dents with autism to behave in ways that erwise Specified who have been determined challenge their education. The assump- to have a co-existing mental health issue. tion of most people is that all behaviors are related to a student’s autism diagnosis. The information contained in this docu- This assumption will leave mental health ment is to provide the reader with signs issues that exist untreated and may, in fact, and symptoms of autism and mental health exacerbate symptoms. concerns, what educators need to know, managing a crisis, and resources that are The research indicates that mental health available to support students, their families issues have a negative impact on academic and educators.

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Ab o u t Me n t a l He a l t h Sc r e e n i n g addition, the Autism Spectrum Disorder- for Comorbid for Children (ASD-CC) is a 49-item informant based rating scale Mental health screening tools designed to identify emotional difficulties Comorbid that commonly occur with ASD. A mental health screening tool is a brief, Psychiatric culturally sensitive questionnaire for identify- Important steps to remember when ing individuals who may have mental health implementing and interpreting the challenges that merit further attention, Conditions in intervention, or evaluation4,5 screen 1. Obtain parental consent and student • Screening tools can serve three pri- assent before administering screening. Students with mary purposes: 2. Administer screening in a confidential 1. Assess an individual’s symptoms. area, and prioritize privacy of results. Autism Spectrum 2. Measure progress after intervention has begun. 3. Remember clinical judgment can over- ride results from a screening assessment. Disorders 3. Provide a framework for discussing an A student who does not meet a particular individual’s challenges. cut-off score on a screening tool may still • A screening tool is not a diagnostic tool need further evaluation. but rather a “triage” process. A positive 4. Notify and offer assistance in connect- screen does not necessarily mean a stu- ing parents of any student found to be in dent meets criteria for a diagnosis. Only a need of further evaluation with a local trained clinician is qualified to interpret mental health professional. screening results. 5. Immediately refer to a trained profes- First steps in implementing the sional any student who screens positive screening process6 for suicidal or homicidal ideation. • Develop a planning committee comprised of parents, educators, mental e x t t e p s health experts, primary care providers, N S and other representatives from the com- munity. The planning team will: 1. Formulate a “Planning Team” com- prised of relevant individuals from school »» Develop policy ensuring confidential- ity safeguards are in place. and community to develop confidential- ity policy, formalize community liaisons, »» Draft agreements between schools and make critical decisions about the and collaborating community providers screening process (e.g., when to screen clarifying responsibilities in order to facilitate the collaborative process and and what tools to use). address liability issues. 2. Ensure adequate staff training on »» Ensure policies are approved by screening tool implementation, scoring, appropriate education and mental and interpretation. health boards. 3. Designate contact person within the »» Determine when to administer the school to oversee the screening process. screen (e.g., transitional grades: 6th–7th, 4. Obtain parent consent and student and 9th–10th) and what tools to use. assent before administering screen. »» Ensure adequate staff training and 5. Make appropriate referrals based on supervision on how to administer, screening results, including immediate score, interpret the data, and refer to referral for positive screen for suicidal or community providers, etc. homicidal ideation. »» Identify a “Screening Coordinator” (e.g., guidance counselor, nurse) who assumes responsibility for the screening process. • A list of recommended screening tools can be found at http://www2.massgen- eral.org/schoolpsychiatry. The majority of these screening tools have not been stud- ied in individuals with ASD, and results should be interpreted cautiously. In

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While the core deficits of autism have been • This policy warrants reconsideration due to Signs of Possible well-studied, a less investigated cause of the large number of individuals with clini- impairment in individuals with ASD is the cal symptoms in these areas and the impli- occurrence of comorbid psychiatric disorders. cations for treatment that this presents. Mental Health Recent epidemiological studies have suggested that nearly three out of every four individuals ADHD with ASD meet criteria for another (comor- Conditions in ADHD may be the most common co- bid) mental health disorder7. Unfortunately, occurring psychiatric disorder among chil- are often overlooked in the ASD Persons with dren with ASD, occurring in approximately population, with serious negative consequences 50% of one sample8. on , school and family function- Autism Spectrum ing, and access to appropriate treatment. • Other studies have estimated rates as fall- ing between 28.2% and 31%7,13. Disorders • The rate increased to nearly 55% when 13 Pr e v a l e n c e o f Me n t a l He a l t h sub-threshold cases were included . Iss u e s i n ASD • ADHD in combination with ASD may confer significantly increased risk for a more complicated symptom presentation; Research has consistently indicated that nearly 85% of individuals with comorbid persons with ASD exhibit an increased risk ASD/ADHD met criteria for an addi- of developing psychiatric disorders, when tional disorder13. compared to the general population. • Studies within the last decade reveal rates Anxiety 7,8 between 67% and 70.8% of individu- Anxiety symptoms seem to be “part and als with ASD who would meet criteria parcel” of the everyday experience of many for an additional mental health disorder individuals with ASD, with a large number described within the Diagnostic and (over 40%) meeting DSM-IV criteria for Statistical Manual of Mental Disorders- specific anxiety conditions7. The most com- 9,10 Fourth Edition (DSM-IV) . mon anxiety diagnoses appear to be: • Having a comorbid psychiatric condition significantly increases the risk of multiple • Specific or fears (44%)—fear of diagnoses. specific objects, activities, or situations (e.g., heights, insects, the dark, storms, etc.). »» 41% of the entire sample had 2 or more co-occurring disorders in addition to • (29.2%)—fear of being ASD, with 17% having 2 disorders and negatively evaluated in social situations. 24% having 3 or more7. • Generalized Anxiety (13.4%)—persistent, • Evidence also suggests that individu- excessive, uncontrollable anxiety/worrying. als with ASD may be twice as likely to • (10.1%)—recurrent exhibit comorbid disorders when com- panic attacks that are not associated with pared to those with non-ASD intellectual any specific stimuli. or developmental disabilities11,12. • Obsessive Compulsive Disorder (OCD) is also very common, although rates in Prevalence rates for the most common individuals with ASD have varied across co-occurring psychiatric disorders: studies from approximately 8% to more One of the challenges to diagnosing comor- than 33%7,13. bid psychiatric conditions in ASD is the »» However, some level of compulsive result of specific exclusionary criteria within behavior may be observed in the major- the DSM-IV diagnostic system9,10. ity (>85%) of individuals with ASD14 indicated that the vast majority (86%) • In the DSM-IV, a diagnosis of autism of their sample exhibited some level of precludes making a formal diagnosis of . a number of other psychiatric disorders, • Disorders which commonly co-occur including Attention Deficit Hyperactivity with anxiety disorders in the general Disorder (ADHD), Obsessive Compul- population, including sive Disorder (OCD) and Social Anxiety and other disorders, have also been Disorder, thus making it impossible to observed in ASD. receive a comorbid clinical diagnosis of these mental health conditions.

4 Depression and Mood Disorders ated with psychiatric . to the ASD condition itself (e.g., all Depression and Mood Disorders have pro- challenging behaviors are attributed to • Examples include the known disorder), effectively ruling duced the most variable comorbidity rates (associated with hyperactivity and social of all the mental health conditions, ranging out the possibility of the presence of anxiety), Prader-Willi syndrome (asso- another disorder. from very rare (less than 1%) to upwards of ciated with compulsive behavior) and 30%. More is known about prevalence rates seizure disorders (which can be associated • Baseline exaggeration is a related of depression in ASD than is known about with aggression and/or anxiety). concept in which behaviors signaling the comorbidity with bipolar disorder. development of a psychiatric condition Familial genetic factors simply reflect an increase, or exacerbation • Depression of, long-standing behavioral difficulties. »» In one study, 10% of the children with There is increasing evidence that the inci- This increase in severity of challenging autism had at least 1 episode of major dence of autism and mood disorders seem to behaviors may be a of depression meeting DSM-IV criteria13. cluster in families. internal distress (agitation, depression, hypomania, anxiety) and is especially »» Rates for sub-threshold symptoms • Bipolar disorder might be more com- (a period of depression or irritability likely to occur for symptoms that com- mon in first- and second-degree relatives which did not meet DSM-IV depres- monly occur in autism, such as hyperac- families with . sion/dysthymic disorder criteria) range tivity or obsessiveness. 7,13 • An association between symptoms of from 11% to nearly 25% . • Applicability of current diagnostic OCD in parents of children with autism »» As in the general population, rates of criteria to individuals with ASD is and repetitive and restricted behaviors in mood/depressive disorders seem to questionable, particularly for those with their children has also been observed17. increase in adolescence and adulthood, intellectual and/or significant occurring in 25% and 30-37% of indi- communication challenges. Symptoms viduals, respectively8,15. Psychosocial factors may “look” different in individuals with • Bipolar Disorder These may also contribute to the development ASD than they do in typically-developing »» One study indicated that the prevalence of comorbid psychiatric conditions, both in individuals, while others cannot be of bipolar disorder was 3 times that of the general population and in individuals evaluated as accurately in non-verbal or major depressive disorder, accounting for with ASD (e.g., peer rejection, low levels of minimally-verbal persons with ASD. 75% of their sample of individuals with , academic difficulties, etc.). »» Since many diagnoses, such as depression ASD and comorbid mood disorders15. • Individuals may be at increased risk and anxiety, rely in part on subjective »» Family history of mood disorders in complaints (feelings of sadness, restless- for encountering these psychosocial fac- first- and second-degree relatives may ness, loss of pleasure, worries or intru- exacerbate risk for developing bipolar tors due to their social and communica- sive thoughts), less-verbal individuals disorder. Only 10.7% of individuals tion deficits and behavioral patterns. will often not meet diagnostic criteria. with ASD without a comorbid mood • Cognitive and processing limitations disorder had a family history of mood These roadblocks to making comorbid diag- (such as problem-solving/coping skills) noses are especially dangerous because they disorder, compared with 37.5% of those are often less well-developed in persons with comorbid ASD/mood disorder15. limit access to psychiatric condition-specific with ASD, which further increases their treatment and may prevent the diagnosis Identification and treatment of mood risk of adverse psychosocial experiences. and treatment of other serious psychological disorders in ASD is critical, as research • Many individuals with ASD are aware impairments. Identification and treatment indicates that the presence of clinically sig- of their difficulties and this awareness of comorbid disorders is associated with nificant depressive symptoms is linked to less often increases during puberty. Awareness better long term outcomes than treating optimal long term outcomes16. of one’s “differentness” may underlie the core symptoms of autism alone13. development of anxiety and depression.

Fa c t o r s w h i c h ma y i n c r e as e Po t e n t i a l In d i c a t o r s o f a n r i s k f o r c o m o r b i d i t y Fa c t o r s Wh i c h ma y Hi n d e r Un d e r l y i n g Me n t a l He a l t h Id e n t i f i c a t i o n a n d Di a g n o s i s ss u e i n n d i v i d u a l s w i t h Certain factors may play a role in increas- I I ASD ing the likelihood of developing a comorbid Individuals with ASD often are under-diag- disorder and may underlie the high preva- nosed and therefore go untreated. Commu- This section describes common symptoms of lence rates of psychiatric conditions among nity professionals may face specific challenges specific psychiatric disorders in the general individuals with ASD: in making an accurate diagnosis of psychiat- population, along with behaviors that may ric conditions among individuals with ASD. be noticed in an individual with ASD. It is important to note that symptoms of anxiety Associated medical conditions & Some of the more common roadblocks to accurate diagnosis include: and mood disorders (depression/bipolar) syndromes often can only be recognized as deviations Individuals with ASD have additional • Diagnostic Overshadowing: this term from previously exhibited behavior, especially comorbid medical conditions that are associ- refers to the tendency to attribute the when the individual’s level of cognitive and/ development of new problems/behaviors or language ability is limited and/or there is

5 no well-developed augmentative communica- which is difficult to control and which »» Another frequent compulsive behavior tion strategies. occurs in a wide range of situations, for children with ASD was the ‘‘need to activities and subjective feelings of tell/ask’’, which typically involves hav- restlessness or being “keyed-up” or “on ing to ask the same question in exten- ADHD edge” and/or irritability. sive question-asking rituals or having to Symptoms of ADHD in the general popula- »» Behavioral symptoms include agita- say the same statement over and over. tion include the following main symptom tion (fidgeting, playing with objects, “clusters”: hyperactivity, impulsivity, and difficulty sitting still, pacing), difficulty Depression inattention. Individuals can be diagnosed with separating from caregivers, avoidance of • The most essential features of major certain objects and/or activities or dis- 3 different “subtypes” of ADHD, based on depression in DSM-IV are change of which symptom cluster their behavior reflects. tress (freezing, crying, trembling) when these objects/activities are encountered. mood and loss of interest. Depressed 1. The predominantly hyperactive/ mood is typically indicated by either Behaviors which may indicate an anxiety subjective report (e.g., feels sadness or impulsive subtype, consists of symptoms disorder in individuals with ASD: such as interrupting others, blurting out emptiness) or observation made by others answers, being “on the go,” difficulty sit- • Avoidance of new people, tasks, environ- (e.g., appears tearful or irritable). ting still and talking excessively. ments and/or materials. • Additional symptoms include: feelings of 2. The predominantly inattentive sub- • Increases in performance of rituals and/ lethargy, , or loss of energy, changes type is characterized by distractibility, or rigid and inflexible behavior. in sleep and/or eating habits (either too much or too little), reported feelings of forgetfulness, difficulty with sustaining • Increases in reliance to or scripts. worthlessness or excessive or inappropriate focus on tasks or activities, organizational • Increases in resistance to transitions or problems, and making careless errors. guilt, difficulty concentrating or indeci- changes to routine. siveness, and recurrent thoughts of death, 3. The combined subtype includes symp- • Narrowing of focus of attention on suicidal thoughts, attempts or toms from both hyperactivity/impulsivity special interest. plans for committing suicide. and inattention. • Withdraws from social situations or • In individuals with autism, the most com- Behaviors which may be observed in indi- begins to avoid social situations. mon presenting symptoms of depression viduals with ASD: • Low frustration tolerance and/or tan- may be significantly increased agitation, • All of the symptoms of ADHD may be trums when things don’t go “as expected.” self-injury, and/or temper outbursts18. observed in a similar manner in individu- • Perfectionistic behavior (may be related Behaviors which may indicate depression als with ASD. to anxiety over performance). in individuals with ASD: • However, children with ASD are sig- • Seeks constant reassurance through • Increase in tearfulness or irritability nificantly more likely to exhibit the repetitive questioning and/or checking and/or absence of “happiness” or smiling inattentive subtype (rates of 65% in a behaviors. in individuals who frequently did so in recent ASD sample) and children without In addition, the following may also differen- the past. developmental disorder typically exhibit tiate the symptoms seen in individuals with the combined subtype13. • Loss of interest in activities or friends. ASD from those in the general population. • Resistance to participating in activities Anxiety • Specific phobias13: that were once engaged in willingly. • Our current diagnostic system contains »» Common phobias in typically devel- • Agitation or restlessness, pacing, hyper- a variety of specific anxiety disorders, oping children (such as fear of flying, activity, or . which differ primarily in the object or stores, standing in lines, bridges, and • Development of, or an increase in tan- source of the anxiety, as opposed to the tunnels) seem to occur at much lower trums, meltdowns, or aggression. rates in children with autism. specific symptoms displayed. • Development of, or an increase in stereo- »» The most common phobias in children • All anxiety disorders result in avoidance typed behaviors. with ASD (found in 32% of one of the source of anxiety, or experiences sample) were fear of needles and/or • Decreased or increased sleep, resists bed- of extreme distress when the source is shots and crowds. time and/or wakes up frequently at night. encountered. »» Over 10% of the children with autism • Difficulty staying awake during the day. • Symptoms can be physiological, behav- also had a of loud noises, which • Decrease in attention to tasks. ioral and/or cognitive: is not common in typically developing • Decrease in productivity and/or . »» Physical reactions include sleep diffi- children. culties (e.g., problems falling or staying • Obsessive-compulsive disorder (OCD)13: • Self-deprecating comments. asleep), muscle tension, being easily »» The most common type of compul- • Deliberate, potentially lethal acts. fatigued, headaches, stomachaches, sion in children with ASD was a ritual shortness of breath, rapid heartbeat, and involving other individuals; nearly half Bipolar Disorder sweaty palms. of the children diagnosed with OCD »» Cognitive symptoms include dif- • In the general population, bipolar disor- had compulsions that involved others der is defined by distinct periods where ficulty concentrating (inattention) or having to do things a certain way. having one’s mind go “blank,” worry

6 mood is persistently and abnormally flags” for the consideration of a comor- »» Change in behavioral patterns that elevated, expansive, or irritable. bid psychiatric disorder. persist longer than expected after an • Individuals with bipolar disorder may have • Identify professionals with expertise in environmental change. a decreased need for sleep (often going psychiatric/psychological disorders who »» Sudden development of new behaviors. for days without sleeping) and an inflated can participate in the assessment and treat- »» Any time a functional behavior assess- sense of self-esteem or importance (feels ment/educational decision-making teams ment is being conducted or a change of one is “special” and/or “invincible”). when a comorbid disorder is suspected. placement (due to challenging behav- iors) is being considered for a student. • Additional symptoms include distract- • Consider the possibility of a comorbid ibility, racing thoughts, a pressure to mental health condition for individuals • Refer student for screening/evaluation keep talking, and/or excessive risk-taking with ASD exhibiting any of the following: of mental health concerns. behaviors or involvement in pleasurable »» Changes in behavioral patterns that • Provide teachers and family members activities with high potential for harmful cannot be explained by medical condi- with information and strategies to consequences (such as sexual activity, drug tions or recent environmental changes. assist student while they await screening use, compulsive gambling, shopping, etc.). and diagnosis Behaviors which may indicate bipolar disorder in individuals with ASD: Add i t i o n a l Re ad i n g s • Mood is inflated, elated, irritable, angry or fluctuates between happy and • Centers for Control and Prevention (2007). Prevalence of Autism Spectrum irritable throughout the day regardless of Disorders — Autism and Developmental Disabilities Monitoring Network, 14 circumstances. Sites, United States, 2002. Surveillance Summaries, MMWR,56 SS-1, 12-28. • Decreased frustration tolerance, • Dekker, M. C., & Koot, H. M. (2003). DSM-IV disorders in children with borderline overactivity/hyperactivity. to moderate . I: Prevalence and impact. Journal of American • Aware at night and active about the Academy of Child Adolescent , 42, 915–922. house or awakens early and appears ener- • Dekker, M. C., Koot, H. M., van der Ende, J., & Verhulst, F. C.(2002). Emotional and getic despite their lack of sleep. behavioral problems in children and adolescents with and without intellectual • In relationship to developmental level, an disability. Journal of Child & Psychiatry & Allied Disciplines, 43, 1087–1098. individual feels they can do or achieve more than is typical for them. • Dykens, E. M. (2000). in children with intellectual disability. Journal of Child Psychology & Psychiatry & Allied Disciplines, 41, 407–417. • May create new tasks or take on new jobs or work that are not realistic. • Ghaziuddin, M. (2002). Asperger syndrome: Associated psychiatric and medical conditions. Focus on Autism and Other Developmental Disabilities, 17, 138-144. • Increase in the frequency and/or inten- sity of vocal stereotypes, perseverative • Ghaziuddin, M. (2005). Mental health aspects of autism and Asperger syndrome. London questioning and/or repetitive speech. England: Jessica Kingsley Publishers. • Increase in preoccupation with hobbies • Sinzig, J., Bruning, N., Morsch, D. & Lehmkuhl G. (2008). Attention profiles or recreational activities. in autistic children with and without comorbid hyperactivity and attention • Increase in the frequency or intensity problems. Acta Neuropsychiatrica, 20, 207-215. of ritualistic or compulsive activities, • Tsiouris, J. A. (2001). Diagnosis of depression in people with severe/profound rituals may become rapid or disorganized. intellectual disability. Journal of Intellectual Disability Research, 45, 115–120. • Increase in the intrusiveness of interactions with others; less inhibited (disinhibition). Jo u r n a l s a n d We b s i t e s • Increase in obvious sexual interests. • Inability to follow previously under- • National Association for the Dually Diagnosed (NADD)— www.thenadd.org stood rules and limits. • Journal of Autism and Developmental Disorders • Hallucinations, , and paranoid • Mental Health Aspects of Developmental Disabilities thoughts. • Diagnostic Manual—Intellectual Disability (DM-ID): A Textbook of Diagnosis of Mental Disorders »» An adaptation of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Ne x t St e p s Edition—Text Revision (DSM-IV-TR). »» The goal of this text is to facilitate a more accurate psychiatric diagnosis of people with • Provide training to families and ID. Chapters cover individual DSM-IV categories and special issues (i.e., assessment school/community personnel working and diagnostic procedures and presentations of behavioral of genetic disor- with students with ASD with informa- ders). For each disorder, descriptive text and details of how to apply diagnostic criteria, tion about mental health disorders and as well as tables of adapted diagnostic criteria are included. behaviors which should serve as “red

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Pr o a c t i v e Me as u r e s t o Su p p o r t »» Encourage the student with praise for Awaiting Diagnosis: success as well as attempts. Me n t a l He a l t h Iss u e s »» Make it meaningful to the student. Supporting • Keep it simple and short. Take A Public Health Approach19 »» Practice often for short periods of time. Individuals with • Know the students. • Teach by example. Autism Spectrum »» Take data on the mental health of students »» Demonstrate relaxation skills; model »» Are mental health needs being met? what the student should do to relax. »» Are there gaps in mental health • Focus on the goal. Disorders & services? »» Focus on a student using these skills »» Use data to identify risk factors and when situations arise. Mental Health protective factors for students. 21 • Identify risk and protective factors. Be Prepared Concerns »» Risk factors: conditions that increase • Know community resources and con- the likelihood of problem behavior. tact information. »» Protective factors: conditions that • Establish relationships with related interact with risk factors to reduce the community professionals. likelihood of problem behavior. »» , psychiatrists, physicians, »» Balance a deficit approach to reduce law enforcement officials, crisis teams, etc. risk factors with a strengths-based • Educate law enforcement officials about approach to promote protective factors. potential crises. Promote Physical Health • Teach student with ASD how to com- municate with law enforcement officers, • Provide information regarding healthy firefighters, emergency medical techni- eating, exercise, sleep, etc. cians, and other community helpers. • Provide information regarding • Teach the student with ASD whom to management. call in different situations.

Teach Coping Skills Establish a Crisis Plan with the • Support the development of self-aware- Student and their Family ness, particularly of one’s emotional experi- • Provide the student with ASD a lami- ences (i.e. Anger Scale or Anger-mometer). nated information card including: • Teach self-regulation techniques (i.e. name, diagnosis, symptoms/behaviors, deep breathing, progressive muscle relax- , allergies, and guardian’s ation, sensory breaks, etc.). name and contact information. • Establish primary contact (physician et Teach a Student to Relax20 al) as well as back-up contact in • Remember that relaxation is a skill. the event of an emergency. »» Teach explicitly, practice regularly, and • Enter the student in a community iden- monitor progress (data collection). tification system, if possible. • Pick the right time. • Consider a MedicAlert bracelet. »» Without distractions to promote concentration. • Make the time. Me t h o ds t o Ca l m a n »» Set aside a regular time to teach and Es c a l a t i n g Si t u a t i o n practice relaxation skills. • Create a habit. »» Practice consistently until relaxation Responding Constructively to 21 skills become a ritual or habit. Emotional Outbursts • Create a relaxing environment. • Recognize that “meltdowns” do not »» Provide a quiet, comfortable area for “come out of nowhere.” the student to learn and practice. • Recognize that you can make a differ- • Use praise and make it fun! ence; avoid the assumption that there is “nothing” you can do.

8 • Recognize that you may experience • Wait patiently; don’t rush. • Teaching self-awareness, self-regulation, emotions during the process as well. • Provide appropriate distance for the and relaxation skills. »» Remain calm; avoid a power struggle individual student (be close or allow space). • Providing opportunities to practice with the student. • Reverse some yes/no, short list or either/ skills prior to distress. • Recognize the warning signs or triggers or questions for clarity. • Learning community resources and con- for a “meltdown.” • Keep your facial expressions to a mini- tact information (including school security). • Reduce the stressors in the environment. mum. Facial expressions are often • Establishing relationships with com- »» Remove distractions from the environ- difficult to interpret for many individuals munity resources and shared necessary ment or remove the student from the with ASD and may be distracting. information. stressful environment. • Teaching student with ASD appropri- • Respond to the student RATHER than Interventions to Manage a Crisis ate contacts for different situations. the behavior. Situation • Teaching student with ASD how to • Focus on the present moment and issue 1. Remain Calm, to the extent possible. communicate with community contacts. at hand. 2. Assess the severity of the situation. • Establishing Crisis Plan with student, • Be concise; less is more with verbal 3. Follow the Crisis Plan. family of student, and related professionals. directions. 4. Determine whom to contact. »» Avoid teaching, preaching, or explaining Calming an Escalating Situation until the student recovers from distress. »» Visit http://www.211atyourfingertips. org to locate appropriate services. • Carefully review and learn the methods »» Focus directions on what you want the to calm an escalating situation. person to do rather than what you don’t »» Dial 211: Free, Confidential Crisis want them to do. Counseling. • Discuss methods to calm an escalating situation with related staff/team. • Use simple, direct language. »» Dial 911: Emergency mental health and basic life support ambulance services. • Create materials to support the student » » Avoid rhetorical questions, ultimatums, during escalating situations or distress. generalizations, sarcasm, or gentle teasing. 5. Dial 9-1-1 only for an emergency (www. tampagov.net). »» Speak to the student one-on-one, if • Practice self-regulation techniques as a possible. • An Emergency is: responsible adult during times of distress. • Try to encourage the student to re- »» Any serious medical problem (chest • Minimize stressors in environment. phrase, in his/her own words, important pain, seizure, bleeding, serious wounds). • Create materials or developed area for points you want them to retain to make »» Any type of fire. downtime following recovery from distress. sure they’ve understood. »» Any life threatening situation (fights, • Implement methods to calm an escalat- • Mean what you say and say what you person w/ weapons, gas leaks, etc.). ing situation, as needed. mean; follow-up words with actions. »» Any crime in progress (whether or not a • Debrief escalated situation with • Maintain realistic expectations for the life is threatened). student as well as related staff/team student. 6. Dial 813-231-6130 (Hillsborough AFTER situation occurs. »» Recognize that the student may County) for non-emergencies. struggle to understand you, particularly • Non-emergencies include: Manage a Crisis via non-verbal communication (i.e. »» Delayed or "not in progress" offenses. • Remain calm by using self-regulation facial expression, , etc.). »» Intoxicated persons who are not techniques. • Focus on emotional equilibrium then disorderly. • Assess the severity of the situation. provide support for recovery after equilib- »» Cars blocking the street or driveway. rium is regained. • Determine the appropriate contact. »» Non-injury auto accidents. »» Allow quiet downtime with a relaxing • Contact the appropriate resources. activity. »» Minor complaints. »» Praise student for positive aspects of situation, explicitly and generously. Re l a t e d We b s i t e s »» After recovery, teach the student how Ne x t St e p s to respond appropriately in future • The National Association for the similar situations. Dually Diagnosed Proactive Measures http://www.thenadd.org Tips on Communicating During an • Taking data on mental health of all • The City of Tampa Escalating Situation22 students. www.tampagov.net • Be gentle; Use a soft but firm tone. • Identifying risk factors and protective • Be tactful. factors from data. • Start with an open and positive attitude. • Promoting protective factors and reduc- ing risk factors. • Keep it short.

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School administrators, school psychologists, Local Chapters Helpful Resources guidance counselors, school resource officers, »» Collier County CHADD educators, parents, students, and community [email protected] & Links members can access additional information 239-352-7223 to understand and support individuals with »» Lee County CHADD a co-existing mental health disorder. This (239) 466-1167 mental health resource list is not all-inclusive, »» North Pinellas and West Pasco but it provides a starting point for school teams Chapter CHADD and parents when additional information and/ (727) 786-2981 or intervention are needed to support a student. http://www.chadd.net/template. cfm?affid=282&p=about »» Sarasota CHADD (941) 685-6098 e n t a l e a l t h e s o u r c e s M H R http://www.chadd.net/template. cfm?affid=102&p=about »» South Pinellas CHADD Emergency (727) 409-4696 • Dial 911 for Emergencies http://www.chadd.net/template. cfm?affid=298&p=about • Crisis Line National Suicide Prevention Help Line is a • Depression and Bipolar Support national 24 hour, 7 day a week crisis line. Alliance (DBSA) 1-800-273-8255 DBSA is a patient-directed organization focusing on the most prevalent mental illnesses – depression and bipolar disorder. National Organizations Provides current on-line training and • The American Academy of Child and educational materials written in language Adolescent Psychiatry (AACAP) the general public can understand. The AACAP is a professional medical http://dbsalliance.org organization comprised of child and Local Chapters adolescent psychiatrists trained to »» DBPSA - Lakeland promote healthy development and to Contact 1 (863) 510-0941 evaluate, diagnose, and treat children and Contact 2 (863) 413-2788 adolescents and their families who are »» DBSA - Suncoast Center affected by disorders of feeling, thinking, St. Petersburg learning, and behavior. Provides Facts Contact 1 (727) 327-7656 x 4209 for Families available online in English, Contact 2 (727) 327-7656 x 4280 Español, Deutsch, Malaysian, Polish, »» DBPSA - Tampa Bay Icelandic, Arabic, Urdu and Hebrew. (Includes Zephyrhills area) http://www.aacap.org PO Box 340572 • Child and Adolescent Bipolar Tampa, FL 33694 Foundation (CABF) (813) 878-2906 CABF improves the lives of families http://www.dbsatampabay.org raising children and teens living with »» DBSA - West Pasco bipolar disorder and related conditions. New Port Richey Fact sheet and printed materials are Contact 1 (727) 819-9427 available to download. Contact 2 (727) 364-5528 www.bpkids.org • Mental Health America (MHA) • Children and Adults with Attention- Mental Health America (formerly Deficit/Hyperactivity Disorder (CHADD) known as the National Mental Health CHADD is a national non-profit Association) is dedicated to helping ALL organization providing education, people live mentally healthier lives. With advocacy and support for individuals with our more than 320 affiliates nationwide, AD/HD. In addition to an informative they represent a growing movement of web site, CHADD also publishes a variety Americans who promote mental wellness of printed materials to keep members for the health and well-being of the and professionals current on research nation – everyday and in times of crisis. advances, medications and treatments Obtain information about mental health affecting individuals with AD/HD. topics using the online search engine. http://www.chadd.org http://www.nmha.org

10 Local Chapters »» NAMI of Manatee County • Devereux Florida Intensive Residential »» Mental Health America of Greater 628 Emerald Lane Treatment (IRTC) and Dual Diagnosis Tampa Bay Holmes Beach, FL 34217 Centers 12901 Bruce B Downs Blvd MDC102 (941) 778-2095 8000 Devereux Drive Tampa, FL 33612 Linda Davis Viera, FL 32940 (813) 972-2618 [email protected] Referrals: 1(800) 338-3738 ext. 77130 http://www.NAMIManateecounty.org http://www.mhagreatertampabay.org http://www.devereux.org »» NAMI of Pasco County • NAMI Child and Adolescent Action »» IRTC provides services for children Center (CAAC) PO Box 412 Elfers, FL 34680 and adolescents between the ages of 5 The CAAC works to improve the lives Gloria Strother and 17, with various diagnoses such as of children and adolescents living with (727) 992-9653 affective disorders, , history mental illnesses and their families [email protected] of and neglect, emotional and through advocacy, support and education. http://www.nami.org/sites/NAMIPascoCounty psychiatric difficulties. CAAC provides resources and technical »» NAMI of Pinellas County »» Dual Diagnosis Center serves assistance to NAMI affiliates at the state 466 94th Ave N individuals with a wide range of and local levels. Follow link to Child and St. Petersburg, FL 33702 symptoms and behaviors associated Adolescent Mental Illness Fact Sheets. (727) 791-3434 with intellectual delays, who may also http://nami.org/caac [email protected] suffer from psychiatric disorders. • National Alliance on Mental Illness http://www.nami-pinellas.org »» Statewide Intensive Psychiatric Program (NAMI) »» NAMI of Polk County (SIPP) provides intensive services to NAMI is the nation’s largest grassroots NAMI Polk County, Inc. children and adolescents (6 through 17 organization for people with mental 1090 US Highway 17 S years of age) within a four to six month illnesses and their families. Founded in Bartow, FL 33830 treatment period. 1979, NAMI has affiliates in every state (863) 533-4411 • Florida Department of Children and and in more than 1,100 local communities [email protected] Families (DCF) http://www.namipolk.com across the country. Chapters provide (See DCF listings under each county.) training, support groups and information DCF administers public mental health, and referral services. Follow link to Statewide and Regional Providers , and self-directed care “Inform Yourself” for information about • AdvoServ Carlton Palms programs throughout the state. Obtain mental health conditions and medications. 28308 Churchill-Smith Ln services through ACCESS Florida. http://nami.org Mount Dora, FL 32757 http://www.myflorida.com/accessflorida Local Chapters (866) 310-2681 or (352) 383-3685 »» Abuse hotline: 800-962-2873 »» NAMI of Charlotte County http://www.advoserv.com/florida.html »» Find lists of providers and directories of Chapter provides information and Serves children, adolescents and adults local DCF and ACCESS offices on the referral, training, support groups, and with autism, developmental disabilities, agency’s web site. Crisis Intervention Training (CIT) for severe emotional disturbances, dual http://www.dcf.state.fl.us/mentalhealth Charlotte County law enforcement. diagnoses, conduct disorders, medical Call (941) 268-8033 for more information. concerns and related diagnoses. Local Providers http://namicharlottecountyfl.org »» specialized treatment for significant »» NAMI of Collier County behavioral problems such as aggression, Desoto (12th Circuit) Chapter provides information and property destruction, oppositional referral, training, support groups, behavior, self-injury, and inappropriate • DCF Circuit 12 (Manatee, Sarasota direct services, and Crisis Intervention sexual behavior. and DeSoto Counties) Training (CIT) for Collier County law »» intensive training in which 9393 North Florida Ave enforcement. NAMI of Collier County have not been addressed through years of Tampa, FL 33612 publishes a Mental Health Resource limited opportunities to learn and develop (813) 558-5500 Guide for Southwest Florida. Call (239) 434-6726 for more information. • Central Florida Behavioral Hospital • Coastal Behavioral Healthcare, Inc. http://www.namicollierco.org 6601 Central Florida Pkwy 1901 Baker St »» NAMI of Hillsborough Orlando, FL 32821 Arcadia, FL 34266 PO Box 4352 (407) 370-0111 (863) 993-2911 Brandon, FL 33509-4352 http://www.centralfloridabehavioral.com http://www.coastalbh.org [email protected] Specialized programs: Mental health outpatient services (adults) http://www.namihillsborough.org »» Eating disorders • Florida Assertive Community »» NAMI of Lee County »» Pervasive development Disorders/autism Treatment (FACT): Sarasota/DeSoto Chapter provides information and spectrum disorders (Sea Harbor Center) County FACT Team referral, training, support groups, and »» Co-occurring psychiatric and substance 1750 17th St abuse disorders Crisis Intervention Training (CIT) for Sarasota, FL 34234 »» Adult inpatient hospitalization Lee County law enforcement. (941) 308-2936 Call (239) 377-9024 for more information. »» Adolescent inpatient hospitalization http://namilee.nami.org »» Adolescent partial hospitalization http://www.coastalbh.org (Continued...)

11 FACT Teams provide comprehensive for the emergency mental health and • Lee Mental Health community-based treatment to persons substance abuse needs of children, (Formerly known as Ruth Cooper Center) who experience severe and persistent adolescents, adults and the elderly. 2789 Ortiz Avenue mental illness. The Children’s Crisis Stabilization Fort Myers, FL 33905-7806 Unit is a 6-bed, non-hospital, inpatient http://leementalhealth.org • Gulf Coast Jewish Family Services mental health unit that provides brief »» Children’s Emergency Services (DeSoto, Manatee, Sarasota) voluntary and involuntary evaluation 8051 N Tamiami Trail, Suite D-6 Provides intake and assessment of and treatment. David Lawrence Center individuals presented voluntarily for Sarasota, FL 34243 is the Baker Act Receiving Facility (941) 358-4242 help with mental health and substance for Collier County. David Lawrence abuse service needs and provides http://www.gcjfs.org Center Crisis Stabilization Services are linkage to both Lee Mental Health Mental health services available 24 hours/7days a week. services and those outside the system. Call (239) 455-8500 for more information. »» Emergency Services Department Southwest Florida »» Walk-in Urgent Care Services The Emergency Services (ES) • Charlotte Behavioral Health Care Walk-in Urgent Care Services are Department provides assessment and designed for individuals in need of 1700 Education Avenue referral services for children between crisis intervention or support as well as Punta Gorda, FL 33950 the ages of four (4) and seventeen (17) symptom relief. Services are available 24 who are experiencing a mental health or (941) 639-8300 hours/7 days a week in Naples and during http://cbhcfl.org substance abuse emergency. Lee Mental regular business hours in Immokalee. Health ES Department operates 24 Charlotte Behavioral Health Care Call (239) 455-8500 for more information. hours/7 days per week including holidays. is a voluntary and involuntary brief »» Outpatient Therapy Call (239) 275-4242 for more information. residential treatment program offering Outpatient therapy is available for »» Child/Adolescent Crisis Stabilization screening, assessment, psychotherapy, and children ages 2-17 and their families Unit/Addiction Receiving Facility to individuals who are who may present with negative The Children’s Crisis Stabilization experiencing an acute mental health crisis behaviors, difficulty at school and/ Unit (CCSU) provides inpatient crisis and pose a danger to themselves or others. or family problems as a result of a stabilization and support for individuals »» Crisis Stabilization Unit (CSU) psychiatric disorder or life stressors. ages four (4) to seventeen (17) that are The Crisis Stabilization Unit provides Call (239) 455-8500 for more information. at risk of harming themselves or others voluntary and involuntary brief • Florida Self Directed Care (FLSDC) due to a mental health or substance residential treatment program offering Florida Self Directed Care is abuse crisis. The CCSU also serves as screening, assessment, psychotherapy, administered by NAMI of Collier the Addiction Receiving Facility for Lee and psychoeducation to individuals County and Baker Act receiving facility County and funded by Department of for Adults and Children for Lee County. who are experiencing an acute mental Children and Families Circuit 20 and health crisis and pose a danger to Lee Mental Health CCSU operates 24 serves Charlotte, Collier, Glades, Hendry themselves or others. hours/7 days per week including holidays. Call (941) 575-0222 for more information. and Lee counties. The website offers a Call (239) 275-4242 for more information. comprehensive list of mental health and • Mental Health Association of »» Therapeutic Behavioral On-Site (TBOS) community resources sorted by county. TBOS provides intensive at-home Southwest Florida http://flsdc.org therapeutic counseling for children, 2335 Ninth Street N. Suite 404 adolescents, and their families who are • Florida Department of Children and Naples, Florida 34103 unable to attend regular outpatient Families (DCF), Circuit 20 (239) 261-5405 therapy and for whom other services have Children’s Mental Health http://www.mhaswfl.org been exhausted. Services are provided at 2295 Victoria Avenue In addition to a range of public and home and at satellite locations. Fort Myers, FL 33906 consumer education programs, the Mental Call (941) 639-8300 for more information. Call (239) 338-1324 for information Health Association publishes the Directory • David Lawrence Center • Hendry/Glades Behavioral Health of Southwest Florida Licensed Professionals 6075 Bathey Lane P.O. Box 87 in Private Practice, on their website. Naples, Florida 34116 Labelle, FL 33975 Call (239) 261-5405 for more information. (239) 455-8500 (24 hour/7 days) Call (863) 674-4050 for information. • SEDNET www.davidlawrencecenter.org • Hendry/Glades Behavioral Health http://www.fldoe.org/ese/sedhome.asp David Lawrence Center is a community 601 W. Alvarado Avenue SEDNET is the Multi-agency Network mental health center that provides Clewiston, FL 33440 for Students with Severe Emotional affordable mental health and substance Call (863) 983-1423 for information. and Behavioral Disturbance. SEDNET abuse services in Southwest Florida. The Region 8B provides services in Charlotte, Center provides 50 different programs • JBH Behavioral Healthcare System Collier, Glades, Hendry, and Lee counties and services including 24 hours/7 days 12550 New Brittany Blvd., Suite 200 and facilitates improvement in the lives of per week crisis intervention. Fort Myers, FL. 33907 community children through technical Call 239-936-1114 for information. assistance, training and advocacy. Children’s Mental Health Services http://jbhllc.com/fservices.php Contact SEDNET at the Collier County »» Crisis Stabilization Services School Board (239) 377-0116 for more Crisis Stabilization Services are available information regarding supports for students.

12 • Youth Haven Services Hillsborough (13th Circuit) clinical case management and linkages to and Prevention Programs • DCF Circuit 13 (Hillsborough County) community supports / resources. 273 Airport Road South 9393 North Florida Ave • Gulf Coast Jewish Family Services Naples, FL 34104 Tampa, FL 33612 13542 N Florida Ave http://www.youthhaven.net (813) 558-5500 Tampa, FL 33613-3263 The Family Counseling Center is one http://www.myflorida.com/cf_web (813) 987-6700 part of an overall Children’s Behavioral http://www.gcjfs.org Health initiative designed to meet • Camelot Community Care, Inc. Tampa 1911 N US Highway 301, Ste 200 Private individual, child, adolescent, and the mental health treatment needs of family and marriage counseling young children and their families in Tampa, FL 33619-2661 • Hillsborough Kids Inc. our community. Clinical staff provides (813) 635-9765 5681 E Fowler Ave emotional support, education and http://www.camelotcommunitycare.org/ Tampa, FL 33617 guidance for a variety of concerns fl_services.asp (813) 471-0218 confronted by today’s families. Psychiatric Therapeutic foster care, in-home http://www.hillsboroughkids.org evaluations, management and counseling, outpatient counseling, case HKI is the agency managing child crisis intervention are also provided. management, assessments. welfare in Hillsborough County. Call (239)262-0388 for more information. • Children’s Crisis Services 2212 E Henry Ave • Kids’ Behavioral Helpline Hardee & Highlands (10th Circuit) Tampa FL 33610 One Crisis Center Plaza (813) 272-2882 Tampa, FL 33613-1238 • DCF Circuit 10 (Polk, Highlands, and http://www.mhcinc.org (813) 960-1010 Hardee Counties) Provides emergency psychiatric evaluation http://www.crisiscenter.com 4720 Old Highway 37 and crisis stabilization for children ages 5 Provides information and referral to Lakeland, FL 338131 to 17 experiencing acute emotional and/or programs that assist families with SED or (863) 619-4100 behavioral problems. 24-hour assessment EH children and children with substance • Daybreak Behavioral Health: services, including psychiatric evaluation abuse problem. This helpline is a joint The Counseling Center & Structured and, if needed, brief inpatient stabilization collaboration between the Crisis Center Outpatient Program of Sebring • Children’s Home Society of Florida of Tampa Bay, Inc. and Hillsborough 4023 Sun ‘n Lake Blvd Gulf Coast Division County Citizen Action Center. Sebring, FL 33872 8306 Laurel Fair Cir, Ste 160 • Mental Health America of Greater (863) 314- 4357 Tampa, FL 33610-4128 Tampa Bay

http://www.flhosp-heartland.org (813) 740-4266 12901 Bruce B Downs Blvd, MDC102 Individual and family therapy, structured http://www.chsfl.org/Locations/Gulf-Coast.aspx Tampa, FL 33612 outpatient programs for adults and a specialty (813) 972-2618 Behavioral Health Unit for senior adults. • Clinical Case Management Program- Northside Mental Health Center http://www.mhagreatertampabay.org • The Counseling Center & Structured 12512 Bruce B Downs Blvd • MHC (Mental Health Care, Inc.) Outpatient Program of Lake Placid Tampa, FL 33612 5707 North 22nd St 1346 US Highway 27 N (813) 977-8700 Tampa, FL 33610 Lake Placid, FL 33852 http://www.northsidemhc.org (813) 272-2244 (863) 699- 4357 Clinical case management, advocacy, http://www.mhcinc.org http://www.flhosp-heartland.org psychiatric and wraparound services for Adult emergency services crisis • Counseling for Hardee County Residents individuals from the age of 10 to 18 years. stabilization unit, children’s crisis (863) 773-2621 The ICM team monitors Hillsborough stabilization unit, adult emergency http://www.fhhd.org/CareAndServices/ County children who have been approved services short-term residential treatment BehavioralHealth.aspx for residential treatment by the Level of facility, residential treatment program, • Florida Hospital Heartland Medical Ctr Care Committee. INTENSIVE CASE »» Baker Act receiving facility (public) Florida Lake Placid MANAGEMENT: Offers intense super- »» FACT Teams: comprehensive community- 1210 US Hwy 27 North vision, peer support, and 24-hour access. based treatment to persons who experience Lake Placid, FL 33852 • Early Childhood FASST—Mental severe and persistent mental illness. (863) 465-3777 Health Care, Inc. • Memorial Hospital of Tampa http://www.flhosp-heartland.org 2905 E Henry Ave Attn: Behavioral Health • Gulf Coast Jewish Family Services Tampa, FL 33610-1437 2901 Swann Ave 5925 Imperial Pkwy, Ste 130 (813) 272-2888 x211 Tampa, FL 33609-4057 Mulberry, FL 33860 http://www.mhcinc.org (813) 873-6400 (863) 904-3000 An early intervention/ prevention http://www.memorialhospitaltampa.com http://www.gcjfs.org program. Serves children ages 5 and »» Baker Act receiving facility (private) Children and family services, child under with mild development delays protective Services, mentoring, and/or social / emotional issues. Services developmental services, mental health offered are primarily in the form of

13 • Northside Mental Health Center • Youth Psychological Assessment & »» 27-bed licensed specialty hospital unit, Florida Assertive Community Treatment Therapy Center 24-bed crisis stabilization unit 12512 Bruce B Downs Blvd 710 Oakfield Dr, Ste 261 »» 25-short term residential beds Tampa, FL 33612 Brandon, FL 33511 • Manatee Memorial Hospital (813) 932-5619 (813) 689-2525 206 2nd St E http://www.northsidemhc.org http://www.tampabaymentalhealth.com Bradenton, FL 34208-1042 »» Crisis stabilization unit Private practice Hospital: (941) 746-5111 »» short-term residential treatment facility specializing in the treatment of children, Behavioral Health: (941) 745-7583 adolescents, and their families. »» Baker Act receiving facility (public) http://www.manateememorial.com »» Baker Act receiving facility (private) • Silver Center Manatee (12th Circuit) 12901 Bruce B Downs Blvd, MDC 102 »» Clinical assessments, diagnosis, Tampa, FL 33612 • DCF Circuit 12 (Manatee, Sarasota treatment, counseling, and group therapy. (813) 974-1516 and DeSoto Counties) • Manatee Palms Youth Services http://health.usf.edu/medicine/psychiatry/ 9393 North Florida Ave 4480 51st St W silvercdc/index.htm Tampa, FL 33612 Bradenton, FL 34210-2857 (813) 558-5500 • St. Joseph’s Hospital (941) 792-2222 St. Joseph’s Psychiatric Care Center • Camelot Community Care, Inc. http://www.psysolutions.com 3001 W Dr Martin Luther King Blvd 239 301 Blvd E Ste A Intensive residential treatment facility for Tampa, FL 33607 Bradenton, FL 34208-3340 children ages 6 to 17. http://www.sjbhealth.org (941) 708-9764 Therapeutic foster care, in-home »» Inpatient Services (813) 870-4300 Pasco (6th Circuit) St. Joseph’s BayCare Life Management counseling, outpatient counseling, case management, assessments. • DCF Circuit 6 (Pasco and Pinellas Services Counties) 4726 N. Habana Ave, Ste 204 • Gulf Coast Jewish Family Services 9393 N Florida Ave Tampa, FL 33614 (DeSoto, Manatee, Sarasota) Tampa, FL 33612 »» Outpatient Svcs (813) 872-7582 8051 N Tamiami Trl Ste D-6 (813) 558-5500 »» Baker Act receiving facility (private) Sarasota, FL 34243 (941) 358-4242 • Carlton Manor, Inc. • Tampa Bay Academy http://www.gcjfs.org 45 Westwood Terr N 12012 Boyette Rd Mental health services St. Petersburg, FL 33710 Riverview, FL 33569-5631 (727) 343-3662 (813) 677-6700 • Manatee Children’s Services http://www.carltonmanor.org http://www.tampabay-academy.com The Flamiglio Center Community-based services to children and 453 Cortez Rd W • Tampa General Hospital families with severe emotional impairments Bradenton, FL 34207-1544 in Pinellas and Pasco Counties. Psychiatric Services (941) 345-1200 2 Columbia Dr. Crisis intervention, counseling, • Community Hospital Davis Islands residential and outpatient services Attn: Behavioral Health Tampa, FL 33601 http://www.manateechildrensservices.com 5637 Marine Pkwy (813) 844-7000 New Port Richey, FL 34652-4331 http://www.tgh.org • Manatee Glens Walk In Center (727) 848-1733 Baker Act receiving facility (private) 1404 14th St W http://www.communityhospitalnpr.com Bradenton, FL 34205 • THINKids: Success 4 Kids & Families (941) 782-4800 »» Baker Act receiving facility (private) 1311 N Westshore Blvd, Ste 302 »» Adults, Serving Pasco, Hernando, and »» Open Mon – Fri, 9am – 9pm. Tampa, FL 33607 northern Pinellas Counties Walk-ins welcome. (813)490-5490 • Florida Hospital Zephyrhills http://www.s4kf.org »» Mobil Crisis Unit, available 24 hours-a- day, 7 days-a-week. 7050 Gall Blvd THINKids is an independent case Zephyrhills, FL 33541-1399 »» Provides immediate assessment, referral management program providing (813) 788-0411 “wraparound” services to children and short-term counseling service. The Mobile Crisis unit responds to requests http://www.fhzeph.org and families. These services can be Baker Act receiving facility (private) traditional therapeutic services as well as from the police. • Gulf Coast Jewish Family Services non-traditional, individualized creative • Manatee Glens Hospital and Crisis 5744 Missouri Ave services matched to each family. Direct Center and follow up Rehabilitation New Port Richey, FL 34652 services are brokered by THINKids and Programs (727) 816-1881 and 816-1860 provided by independent contractors. 2020 26th Ave E Bradenton, FL 34208 http://www.gcjfs.org (941) 782-4600 Mental health services http://www.manateeglens.org »» Baker Act receiving facility (private)

14 • GCJFS Chatlin Home • Camelot Community Care • Children’s Crisis Stabilization Unit 2425 Chatlin Rd (727) 593-0003 401 16th St N Holiday, FL 34691 EMERGENCIES: (727) 791-3131 St. Petersburg, FL 33705 (727) 943-4847 http://www.camelotcommunitycare.org (727) 545-6477 http://www.gcjfs.org Therapeutic foster care, in-home Ad/Ch Crisis Stabilization Unit: Residential treatment counseling, outpatient counseling, case (727) 545-6477*341 • GCJFS Darlington Home management, assessments. Ch. Crises Outreach Prg: (727) 541-4628 2425 Chatlin Rd • Directions for Mental Health Fam. Emergency Treatment: (727) 662-1053 Holiday, FL 34691 1437 S Belcher Rd Ste 200 EMERGENCIES (727) 791-3131 (727) 943-4847 Clearwater, FL 33764-2829 http://www.pemhs.org/index.htm http://www.gcjfs.org (727) 524-4464 »» Baker Act receiving facility (public) Residential treatment http://www.healthehurt.com »» emergencies/evaluation (diag-nosis), • Harbor Behavioral Health Care Institute Directions serves adults, children and the short/medium term in patient recovery Adult Crisis Stabilization Unit homeless at all stages of life and regardless programs 8132 King Helie Blvd of ability to pay. • St. Anthony’s Hospital Behavioral New Port Richey, FL 34653-1435 • Florida Sheriffs Youth Ranches, Inc. Health Unit (727) 841-4455 Safety Harbor 1200 7th Ave N • Harbor Behavioral Health Care Institute 3180 Enterprise Rd E Saint Petersburg, FL 33705 Community Based Care Safety Harbor, FL 34695-5205 (727) 825-1100 or (727) 825-1124 7809 Massachusetts Ave (727) 725-4761 http://www.stanthonys.com New Port Richey, FL 34656 • Gulf Coast Jewish Family Services »» Baker Act receiving facility (private) (727) 841-4200 Community Care »» Life Management, (727) 820-7747 • Harbor Behavioral Health Care Institute Corporate office: http://www.baycare.org Children’s Crisis Stabilization Unit 14041 Icot Blvd • Sun Coast Hospital 8132 King Helie Blvd Clearwater, FL 33760 2050 Indian Rocks Rd New Port Richey, FL 34653-1435 (727) 479-1800 Largo, FL 34649 (727) 841-4455 Information Referrals: 1-800 888-5066 (727) 581-9474 http://www.baycare.org (727) 538-7460 or (727) 479-1800 - http://www.suncoasthospital.net/ Residential »» Child and adult crisis stabilization, mental »» Baker Act receiving facility (private) health, psychiatric medical services http://www.gcjfs.org Adult residential and outpatient »» Adult crisis stabilization program. »» FACT Team, adult residential • GCJFS 66th Street Group Home • Suncoast Center for Community Mental Health Pinellas (6th Circuit) 3180-3200 66th St N St. Petersburg, FL 33710 4024 Central Ave • DCF Circuit 6 (Pasco and Pinellas (727) 893-1661 St. Petersburg, FL 33711 Counties) http://www.gcjfs.org (727) 327-7656 9393 North Florida Ave Residential treatment Forensic FACT Team (727) 323-6300 Tampa, FL 33612 EMERGENCIES (727) 791 3131 • Morton Plant Hospital (813) 558-5500 http://www.suncoastcenter.com 300 Pinellas St Child/adult mental health and substance • Bay Pines VA Hospital Clearwater, FL 33541 10000 Bay Pines Boulevard abuse outpatient treatment and mental Intake: (727) 298-6402 health/social support services center, Bay Pines, FL 33744 http://www.mortonplant.com http://www.baypines.va.gov/ serving children and adults of all ages. »» Baker Act receiving facility (private) Evaluation, diagnosis, treatment, » » Baker Act receiving facility (private) »» Inpatient treatment to children, outpatient care, counseling, and case »» acute in-patient ward, in-patient adolescents, adults and the elderly management. geriatric psychiatry ward, domiciliary, suffering from a personal crisis or • Windmoor Healthcare of Clearwater mental health outpatient clinic mental illness that requires treatment in 11300 US 19 S a structured, supervised setting. • Boley Centers for Behavioral Clearwater, FL 33764 Healthcare, Inc. • PEMHS - Access Center (727) 541-2646 445 31st St N Personal Enrichment through Mental http://www.windmoorhealthcare.com St. Petersburg, FL 33713-7605 Health Services, Inc. »» Baker Act receiving facility (private) (727) 821-4819 »» Crisis Stabilization Unit-A http://www.boleycenters.org »» Full-service psychiatric facility available »» Crisis Stabilization Unit-B 24-hours a day. FACT and CCST Teams Regional Short-Term Residential • Camelot Community Care, Inc. Treatment Facility 4910 Creekside Dr, Ste D 11254 58th St N, Bldg J Clearwater, FL 33760-4034 Pinellas Park, FL 33782 (727) 596-9960 »» Crisis Stabilization Unit-C

15 Polk (10th Circuit) • Tri-County Human Services, Inc. • Compass Center (Coastal Behavioral • DCF Circuit 10 (Polk, Highlands, and Human Services, Inc. Healthcare) Hardee Counties) Administrative Offices 2750 Bahia Vista St 4720 Old Highway 37 1815 Crystal Lake Dr Sarasota, FL 34239 Lakeland, FL 338131 Lakeland, FL 33801-5979 (941) 952-1147 ext. 1107 (863) 619-4100 (863) 709-9392 http://www.coastalbh.org http://www.tchsonline.com Children’s services, outpatient services, • Center for Counseling at Lakeland Substance abuse and mental health residential services, outpatient medication Regional Medical Center disorders treatment to residents of Polk, services Center State Bank Bldg Hardee and Highlands Counties. Lakeland, FL 33804 • Coastal Behavioral Healthcare Venice (863) 687-1275 • Winter Haven Adult Outpatient 7810 S Tamiami Trl Counseling Venice, FL 34292 http://www.lrmc.com 1201 1st St. S (941) 492-4300 • Devereux Therapeutic Foster Care - Winter Haven, FL 33880-3904 http://www.coastalbh.org Polk, Hardee & Highlands Counties (863) 293-1121, ext. 1856 Case management, crisis stabilization, 175 Fifth St SW #104 • Winter Haven Hospital Behavioral counseling, residential treatment for Winter Haven, FL 33880 co-occurring disorders, FACT Teams and (863) 298-4400 Health Division: Child and Adolescent Services more. http://www.devereux.org ACCESS SERVICES • Florida Assertive Community • Florida Sheriffs Youth Ranches, Inc. Toll Free: 1-800-723-3248 Treatment (FACT): Sarasota/DeSoto Youth Villa http://www.winterhavenhospital.org/fac/ County FACT Team 3350 State Rd 60 E behavioral/child.html 1750 17th St Bartow, FL 33830-8471 24 hours per day, seven days per week Sarasota, FL 34234 (863) 533-0371 telephonic and face-to-face mental (941) 308-2936 • Gulf Coast Jewish Family Services health assessments, crisis intervention http://www.coastalbh.org 5925 Imperial Pkwy and referral information regarding BHD FACT Teams: comprehensive community- Suite 130 services for any individuals within the based treatment to persons who experience Mulberry, FL 33860 Mid-Florida service area. severe and persistent mental illness. (863) 904-3000 • Florida Center for Child and Family http://www.gcjfs.org Sarasota (12th Circuit) Development Children and family services, child • DCF Circuit 12 (Manatee, Sarasota 4610 17th St protective services, mentoring, and DeSoto Counties) Sarasota, FL 34235-1843 developmental services, mental health 9393 North Florida Ave (941) 371-8820 • Lakeland Regional Medical Center Tampa 33612 http://www.thefloridacenter.org Attn: Behavioral Health Services (813) 558-5500 Infant/young child mental health 1324 Lakeland Hills Blvd therapy, family/marital counseling, • Coastal Behavioral Healthcare North Lakeland, FL 33805-4543 behavioral support services, child Port (863) 687-1275 psychiatry/psychology services. 6950 Pan American Blvd http://www.lrmc.com/site/ North Port, FL 34287 • Florida Center for Child & Family • Peace River Center (941) 492-4300 Development Gulf Coast Center 1239 E Main St http://www.coastalbh.org 800 Gulf Coast Blvd Bartow, FL 33830 Case management, crisis stabilization, Venice, FL 34285-7812 (863) 519-0575 counseling, residential treatment for (941) 412-9186 Crisis Line (863) 519-3744 co-occurring disorders, FACT Teams and http://www.thefloridacenter.org http://www.peace-river.com more. • Gulf Coast Jewish Family Services »» Baker Act receiving facility (public) • Coastal Behavioral Healthcare, Inc. (DeSoto, Manatee, Sarasota) »» A community mental health Crisis Stabilization Unit 8051 N Tamiami Trl, Ste D-6 organization providing services Children’s Crisis Stabilization Unit Sarasota, FL 34243 to Polk, Hardee and Highlands 1451 10th St (941) 358-4242 Counties. Services offered include Sarasota, FL 34236 http://www.gcjfs.org crisis stabilization unit, outpatient http://www.coastalbh.org Mental health services counseling, psychiatric/medical, adult residential treatment, case management, »» Baker Act receiving facility (public). • Heritage Residential Treatment Facility domestic violence and sexual assault »» Case management, crisis stabilization, (Coastal Behavioral Healthcare) programs, YouthLine, and 24-hour counseling, residential treatment for 2750 Bahia Vista St crisis hotline services. co-occurring disorders, FACT Teams Sarasota, FL 34239 and more. (941) 952-1147 ext. 1150 http://www.coastalbh.org Residential services

16 • Jewish Family & Children’s Service of • Hillsborough County Sheriff’s Office • Hendry County School District Sarasota-Manatee, Inc. PO Box 3371 Director, Exceptional Student Education 7810 South Tamiami Trl, Ste A7 Tampa, FL 33601-3371 (863) 983-1507 Venice, FL 34293-5132 (813) 247-8000 • Highlands County Schools (941) 492-4717 http://www.hcso.tampa.fl.us 426 School Street http://www.jfcs-cares.org • Lee County Sheriff’s Office Sebring, FL 33870 Counseling and psychotherapy to indi- 14750 Six Mile Cypress Pkwy Director, Student Support Services: viduals and families, family life education, Fort Myers, FL 33912 (863) 471-5583 adolescent and children’s services. (239) 477-1000 • Hillsborough County Schools • Sarasota County Mental Health Court http://www.sheriffleefl.org Exceptional Student Education 1750 17th St • Manatee County Sheriff’s Office 1202 Palm Ave Sarasota, FL 34234 600 US Highway 301 Boulevard W Tampa, FL 33605 (941) 953-0000 Bradenton, FL 34205 (813) 273-7025 http://www.coastalbh.org (941) 747-3011 http://ese.mysdhc.org/ Serves consumers who have committed a http://www.manateesheriff.com • Lee County School District misdemeanor and have a mental health/ • Pasco County Sheriff’s Office Coordinator, Psychological Services co-occurring disorder. 8700 Citizen Dr. (239) 337-8186 • Sarasota Memorial Hospital New Port Richey, FL 34654-5501 »» Coordinator, Autism Spectrum Bayside Center for Behavioral Health (727) 847-5878 Disorder Program 1625 S Osprey Ave http://www.pascosheriff.org (239) 337-8326 Sarasota, FL 34239-2928 • Pinellas County Sheriff’s Office »» Exceptional Student Education Parent (941) 917-6900 PO Box 2500 Liaison http://www.smh.com Largo, FL 33779-2500 (239) 337-8621 »» Baker Act receiving facility (private) (727) 582-6200 • Manatee County, School District of »» Individual and group therapy , http://www.pcsoweb.com Exceptional Student Education outpatient growth groups, clinical • Polk County Sheriff’s Office Department assessment, Inpatient services, 215 Manatee Avenue West outpatient, support group meetings. 455 North Broadway Ave Bartow, FL 33830 Bradenton, FL 34205 (863) 533-0344 (941) 751-6550 x 2280 Justice Resources http://www.polksheriff.org http://www.schools.manatee. • Charlotte County Sheriff’s Office • Sarasota County Sheriff’s Office k12.fl.us/3130ESE1/ 7474 Utilities Road 2071 Ringling Blvd exceptional_student_education/ Punta Gorda, FL 33928 Sarasota, FL 34237 • Pasco County Schools (941) 639-2101 (941) 861-5800 7227 Land O’ Lakes Blvd http://www.ccso.org http://www.sarasotasheriff.org Land O’ Lakes, FL 34638 • Collier County Sheriff’s Office Exceptional Student Education: (813) 794-2600 3301 Tamiami Trail Ease, Bldg. J School-Based Resources Naples, FL 34112 http://www.pasco.k12.fl.us/ese/ (239) 774-4434 • Charlotte County School District • Pinellas County Schools (941) 255-0808 http://www.colliersheriff.org 301 Fourth St SW • Desoto County Sheriff’s Office • Collier County School District Largo, FL 33770 208 East Cypress St Coordinator, Exceptional Student Education ESE Department (727) 588-6000 Ext. Arcadia, FL 34266 (239) 377-0122 6032 (863) 993-4700 • DeSoto County Schools http://www.pcsb.org/ese/home.html http://www.desotosheriff.com 530 LaSolona Ave • Polk County Schools • Hardee County Sheriff’s Office Arcadia, FL 34266 1915 South Floral Ave. 900 E. Summit St (863) 494-4222 Bartow, FL 33830 Wauchula, FL 33873 ESE Director: (863) 494-1764 x 167 ESE Director: (863) 534-0930 (863) 773-0304 • Glades County School District http://www.polk-fl.net/districtinfo/ http://www.hardeeso.com Director, Exceptional Student Education departments/learning/ese/default.htm • Highlands County Sheriff’s Office (863) 946-0323 • Sarasota County Schools 434 Fernleaf Ave • Hardee County Schools 1960 Landings Boulevard Sebring, FL 33870 1009 N 6th Ave Sarasota, FL 34231 (863) 402-7200 Wauchula, FL 33873-2008 Supervisor: Phone: (941) 927-9000, ext. http://www.highlandssheriff.org Director of ESE & Pupil Services: (863) 34226 773-2600 http://www.sarasotacountyschools.net/ WorkArea/linkit.aspx?LinkIdentifier=id& ItemID=4066

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Government Agencies • Centers for Disease Control and Prevention (CDC) The CDC is an agency of the U.S. Department of Health and Human Services. It provides statistics, publications, health information, and funding announcements. http://www.cdc.gov • National Institutes on Mental Heath (NIMH) The NIMH is the largest scientific organization in the world dedicated to research focused on the understanding, treatment, and prevention of mental disorders and the promotion of mental health. Use search function to find free publications by topic and science news by topic including both mental health conditions and autism. Publications are also available in Spanish. http://www.nimh.nih.gov

Autism Resources • The Autism Society of America (ASA) The Autism Society of America web site is the largest national autism organization in the United States. Individuals can find a local chapter through the ASA website. http://www.autism-society.org • Center for Autism and Related Disabilities at the University of South Florida (CARD-USF) CARD provides support and assistance with the goal of optimizing the potential of people with autism and related disabilities. Visit our website to learn more about CARD services, training, and technical assistance. Call (800) 333-4530 for more information. http://card-usf.fmhi.usf.edu

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1. Van Ameringen, M., Mancinia, C., & Farvolden, 12. Bryson, S.E, & Smith, I.M. (1998). End Notes/ P. (2003). The impact of anxiety disorders : prevalence, on educational achievement. Journal of associated characteristics, and implications Anxiety Disorders, 17, 561-571. for research and service delivery. Mental References 2. Pavuluri, M., O’Connor, M., Harral, E., Moss, Retardation and Developmental Disabilities M., Sweeney, J. (2006). Impact of Research Review, 4, 97-103. Neurocognitive Function on Academic 13. Leyfer, O. T., Folstein, S. E., Bacalman, S., Difficulties in Pediatric Bipolar Disorder: Davis, N. O., Dinh, E., Morgan, J., et al. A Clinical Translation. Biological (2006). Comorbid psychiatric disorders Psychiatry, 60, 951-956. in children with autism: interview 3. Aluja, A., Blanch, A. (2004). Depressive Mood development and rates of disorders. and Social Maladjustment: Differential Journal of Autism and Developmental Effects on Academic Achievement. Disorders, 36, 849-861. European Journal of Psychology of 14. Cath, D. C., Ran, N., Smit, J. H., van Education, 19, 121-131. Balkom, A. J. L. M. & Comijs, H. C. (2008). Symptom overlap between 4. Grisso, T., & Barnum, R. (2000). Massachusetts autism spectrum disorder, generalized Youth Screening Instrument second social and obsessive- version: User manual and technical compulsive disorder in adults: A report. Worchester, MA: University of Massachusetts Medical School. preliminary case-controlled study. Psychopathology, 41, 101-110. 5. Trupin, E., & Boesky, L. (1999). Working 15. Munesue, T., Ono, Y., Mutoh, K., Shimoda, together for change: Co-occurring mental K., Nakatani, H. & Kikuchi, M. (2008). health and substance use disorders among High prevalence of bipolar disorder youth involved in the juvenile justice comorbidity in adolescents and young system: Cross training, juvenile justice, adults with high-functioning autism mental health, substance abuse. Delmar, NY: The National GAINS Center spectrum disorder: A preliminary study of 44 outpatients. Journal of Affective 6. Weist, M., Rubin, M., Moore, E., Adelsheim, Disorders, 111, 170-175 S., & Wrobel, S. (2007). Mental health 16. Matson, J. L., & Nebel-Schwalm, M. S. (2007). screening in schools. Journal of School Comorbid psychopathology with Health, 77 (2), 53-58. autism spectrum disorder in children: 7. Simonoff, E., Pickles, A. C., Chandler, S., an overview. Research in Developmental Loucas, T., & Baird, G. (2008). Disability, 28, 341-352. Psychiatric disorders in children with autism spectrum disorders: prevalence, 17. Abramson, R., Ravan, S., Wright, H., Wieduwilt, comorbidity, and associated factors in K., Wolpert, C., Donnelly, S, Pericak- Vance, M.A. & Cuccaro, M.L. (2005). a population-derived sample. Journal The relationship between restrictive of the American Academy of Child and and repetitive behaviors in individuals Adolescent Psychiatry, 47, 921-929. with autism and obsessive compulsive 8. Ghaziuddin, M., Weidmer-Mikhail, E. & symptoms in parents. Child Psychiatry & Ghaziuddin, N. (1998). Comorbidity Human Development, 36, 155-165 of Asperger syndrome: A preliminary 18. Lainhart, J., & Folstein, S. (1994, October). report. Journal of Intellectual Disability Affective disorders in people with autism: Research, 42, 279-283. A review of published cases. Journal of 9. American Psychiatric Association. (1994). Autism and Developmental Disorders, 24, Diagnostic and Statistical Manual 587-601. of Mental Disorders-Fourth Edition 19. Kutash, K., Duchnowski, A.J., & Lynn, N. (DSM-IV). Washington, DC: American Psychiatric Association. (2006). School-Based Mental Health: An Empirical Guide for Decision-Makers. 10. American Psychiatric Association. (2000). Tampa, FL: Research and Training Diagnostic and Statistical Manual of Center for Children’s Mental Health, Mental Disorders-Fourth Edition Text Department of Child and Family Revision (DSM-IV-TR). Washington, Studies, Florida Mental Health Institute, DC: American Psychiatric Association. University of South Florida. 11. Bryson SE. (1997). Epidemiology of Autism: 20. Rapee, R.M., Spence, S.H., Cobham, V., Prevalence, Associated Characteristics and Wignall, A. (2000). Helping Your Implications for Service Delivery. Paper Anxious Child. Oakland, CA: New presented at the Autism Workshop of the Harbinger Publications, Inc. U.S. Centers for Disease Control and Prevention and the National Alliance for 21. Bashe, P.R. & Kirby, B.L. (2005). The OASIS Autism Research, Atlanta, GA. Guide to Asperger Syndrome. New York: Crown Publishing Group. 22. Ryan, R. (2001). The Handbook of Mental Health Care for Persons with Developmental Disabilities. Canada: Diverse City Press.

19 Florida’s First Choice for Autism Support

The Center for Autism & Related Disabilities (CARD) provides support and assistance with the goal of optimizing the potential of people with autism and related disabilities.

Center for Autism and Related Disabilities Department of Child and Family Studies Louis de la Parte Florida Mental Health Institute College of Behavioral and Community Sciences University of South Florida MHC 2113A 13301 Bruce B. Downs Blvd. Tampa, FL 33612

In Florida: 1-800-333-4530 or 813-974-2532 http://card-usf.fmhi.usf.edu