Emotional Distress and/or Behavioral Problems – Depression, anxiety, tearfulness, excessive worry, irritability, not enjoying things they used to, acting out behaviors, not following rules for safety, destroying things, angry outbursts, hitting or threatening

Severity of Concern

MILD- No prior therapy and/or a new concern that I'm noticing: the symptoms have limited impact on daily life

MODERATE- Symptoms are negatively impacting daily functioning(activities?) at home, school, and/or work

SEVERE - My child's behavior or emotional distress is highly disruptive at home, school, work and/or in the community; my child has a significant psychiatric diagnosis and/or is at risk of or has had multiple hospitalizations or is being discharged from a hospital and will need a high level of therapeutic support

Has your child been diagnosed with an intellectual disability and/or autism?

Yes

Select that option that best describes your child's diagnosis

Intellectual Disability

Autism Spectrum Disorder

Both Intellectual Disability and Autism spectrum disorder