The Child Mind BlogBrainstorm
ADHD: Is the 'Epidemic' Caused by Changing Expectations for Kids?
Oct. 15, 2013 Caroline Miller
There's an excellent piece about the "epidemic" of ADHD diagnoses in this weekend's New York Times magazine by Maggie Koerth-Baker—excellent because Koerth-Baker does what a lot of people who express opinions and claim insight about ADHD don't seem to be able to do. She acknowledges two things that are both true about ADHD, though they are often described as if they were mutually exclusive.
The first is that ADHD is a real, biologically based disorder that is highly heritable, and its symptoms appear to be the result of a shortage of dopamine receptors that diminishes functioning in some parts of the brain. The evidence of heritability is seen in twin studies, and brain imaging shows the differences in brain function between kids with ADHD and other kids.
But her second point is that that the steep rise in diagnoses in the last few decades is nonetheless prompted by sociological factors, especially changes in schools and the expectations we have for children. A considerable number of the children who have been diagnosed may not actually have the disorder. Their attention and impulsivity problems may well be caused by other factors-things like anxiety and problems at home-that can't be identified in a seven-minute visit to the pediatrician. But that, as she puts it, "is not to say that ADHD is a made-up disorder."
Koerth-Baker writes very articulately about some of the factors that have contributed to the rise in diagnoses. One obvious one is the incorporation of ADHD under the Individuals with Disabilities Education Act in 1991, which meant that kids with the diagnosis could get help and accommodations at school. She also describes Dr. Stephen Hinshaw's research, which we wrote about in in July ("Are Schools Driving ADHD Diagnoses?"), linking high rates of ADHD diagnosis we see in some states to laws that tied school funding to student test scores. Since 2003 all states are affected by No Child Left Behind, which penalizes schools with poor test scores, but many states that have the highest rates of ADHD diagnosis, especially in the South, enacted similar "accountability" laws years earlier.
Koerth-Baker also mentions economic changes that I think don't get nearly enough attention when we talk about ADHD: The fact is that not going to college (not to speak of not graduating from high school) is less and less viable an option for our kids than it was decades ago. Good jobs—ones that pay a living wage—for what we used to call blue-collar workers are almost nonexistent in the 21st century, which means that school failure exacts a much higher toll now. I thought of these kids when I read an op ed piece by Joseph Stiglitz in the Times Sunday about income inequality. Among the statistics Stiglitz cited was that "men who graduated from high school but don't have four-year college degrees make almost 40 percent less than they did four decades ago."
We worry that kids who don't have the disorder are getting diagnosed and medicated for ADHD—but also we worry that many kids don't have families with the resources to figure out what else might be causing their problems in school. The hard fact is that doing poorly in school has become more and more damaging to a child's future, so it's no wonder that parents and doctors and teachers are anxious to do whatever they can to help kids succeed.View Comments | Add Comment
NYC Search for Missing Autistic Teen Intensifies, Along With Questions
Oct. 11, 2013 Beth Arky
In the week since autistic 14-year-old Avonte Oquendo went missing after running out of his school in Long Island City, Queens, questions have haunted his family and a worried community. Where could he be? How could he have eluded both his aide and teachers and a security guard? And why did it take school officials an hour to inform his mother that he had bolted?
David Perecman, the family's lawyer, said it appears that the nonverbal Avonte managed to leave the school during a transition between lunch and class; changes are often unsettling for those on the spectrum. The surveillance tape shows him darting down the hall and leaving the building. The family says a guard asked him where he was going and let him leave after getting no response. The school has yet to comment but is cooperating with authorities.
Wandering or bolting is a common autistic trait. Because of Avonte's intense interest in trains, police have been scouring the subways. (According to reports, he has been found in subway tunnels after running off.) But given that autistics are often drawn to water—in fact, autistic children and teens who wander are too often found drowned—they have also searched the shoreline of the nearby East River.
It has been a difficult week for the family, including a false report that Avonte had been found. His mother, Vanessa Fontaine, began sending her son to the Riverview School—a restrictive District 75 special-needs program located within a neighborhood zoned school—last month. She believed it would be "well-equipped to handle my child," including a one-to-one aide, she said in a television interview this morning. "And they failed me." She says it's too painful to watch the surveillance tape: "I break down and cry. It's the last time I'm seeing my son."
While Fontaine takes the family's plea to the media, Avonte's brother Daniel has been using social media, tweeting under @kingdetrick, and Avonte's photograph has been shared innumerable times on Facebook. Meanwhile, the family has taken steps toward a lawsuit against the city, charging negligence and failure to supervise. Other parents of special needs kids in the school system are also calling for accountability.
Kpana Kpoto, a special needs advocate at Special Needs Advocacy Navigator, raises another question. "When minorities go missing, they barely get a blurb on national television," she says. "This happens every time. What will it take to put some value on the lives of children of all races?" The city is making at least a belated effort, as subway riders will know. When is the last time we heard the conductor announce the details of a missing child over the loudspeakers? And his family has organized a band of volunteers to comb the city and hand out fliers.
Avonte was last seen wearing a gray striped shirt, black jeans and black sneakers. He is 5-foot-3 and weighs 125 pounds. Anyone with information is asked to contact the Police Department's Crime Stoppers hot line at (800) 577-TIPS. There is also a $50,000 reward. His mother says that if you see him, approach him gently so as not to send him running.
There is a vigil for Avonte planned for 5pm today outside of the Riverview School in Long Island City.View Comments | Add Comment
Temple Grandin on Focusing on Autistic Strengths, Not Deficits
Oct. 8, 2013 Rachel Ehmke
After receiving an autism diagnosis, kids typically begin a number of therapies targeted to compensating for their deficits. We know that autism responds well to early interventions, and there are a lot of them—occupational therapy, speech-language therapy, applied behavior analysis. But what often gets overlooked is expanding on an autistic child's strengths.
Temple Grandin gives a great example in a piece she wrote with science writer Richard Panek for Time. Autistic people have what's known as "weak central coherence," meaning that they pay a lot of attention to details and less attention to the big picture. As a result they are very good at embedded-figure tests. Grandin writes:
Several years ago, I took a test in which I had to look at large letters that were composed of smaller, different letters-for instance, a giant letter H that was built out of tiny F's. I then had to identify either the big letter or the little letter. I was much faster at identifying the little letters, a result that's far more common among autistics than among neurotypicals.
The test is a clear illustration of one of Grandin's natural strengths. (For the record she prefers the term "local bias" to weak central coherence.) In the essay she speculates that her ability to pick up on minutiae has given her an advantage in her work in animals. This is no small claim considering Grandin's visionary status in the field of animal science.
It would clearly be a very good thing if we could help more autistic people capitalize on their strengths. In Grandin's words, "For so many people on the spectrum, identifying their strengths can change their lives. Instead of only accommodating their deficits, they can cultivate their dreams."
Things are changing, if gradually. There is a steadily growing neurodiversity movement aimed at appreciating peoples' brain differences. Some companies are thinking outside the box, like Specialisterne, the international tech company with a 75% autistic work force. And of course we have people like Temple Grandin, who are able to bridge the gap and help us do it, too.
The essay is an excerpt adapted from Grandin and Panek's new book The Autistic Brain: Thinking Across the Spectrum, which is getting great reviews.View Comments | Add Comment
‘Ray Donovan’ Actor Dash Mihok on Tourette’s, Acting, and Control
Oct. 1, 2013 Harry Kimball
We're always happy when public figures "come out" and discuss their struggles with mental illness, because they can become positive role models for kids and because they can educate the public in a real and tangible way. Actor Dash Mihok (me-hawk), in addition to starring in movies like Baz Luhrmann's Romeo + Juliet and the current Liev Schreiber TV vehicle Ray Donovan, has been living with the motor and vocal tics of Tourette's syndrome since he was 6 years old. In a very nice piece on CNN, Mihok describes the work he does with an anti-bullying organization called Jayden's Challenge, talking to kids in schools about tolerance and the neurological differences that can make children targets.
Mihok also offers an illuminating take on living—and making it in Hollywood—with a disorder that too few comprehend, and many misunderstand wildly. Paradoxically, his success at acting has made people skeptical of his disorder, given that he can control his ticing when on set. "People believe that if you can shut your Tourette's off for a period of time," he tells CNN, "then you can always shut it off." Instead, he suggests people imagine "the greatest itch you've ever had and multiply that by a thousand. There's no way you can't scratch it. It's impossible. You have to do it."
Dr. Jerry Bubrick, an expert on tics, Tourette's, and OCD at the Child Mind Institute, agrees with this description and thinks it's an important starting point for better understanding Tourette's. "In most cases of tic disorders people have what's called the premonitory urge," he says. "The best way to understand it for everybody else is the feeling you get in your nose right before a sneeze, and the only way to get rid of it is to sneeze. So people with a tic disorder will have that internal discomfort or itchiness or weird sensation and doing the tic alleviates that feeling."
This leads to the misunderstanding that Mihok describes. "It's not really an involuntary action, although it can be so automatic that it seems involuntary," Dr. Bubrick continues. "But it's actually a voluntary act." This means that people with Tourette's can "recognize that they have to do the tic, and not do the tic, and stop in on their own. But it builds and builds and builds. It's not like if you don't do it once it's gone forever."
Dr. Bubrick is also excited about Mihok's potential to change attitudes because his disorder is clearly with him—the CNN report includes video of him ticing and discussing Tourette's when he was 10, and also candid contemporary video of him ticing in between takes on set. People can be skeptical "when a celebrity says they had a disorder growing up," he says, and wonder "whether it's for real. But here we have the videotape."
For his part, Mihok wants people to understand that Tourette's can be a barrier—he hid it from Hollywood for years out of fear that it would lose him parts, and many children with the disorder are tormented by bullies—but only if people don't understand it. Dr. Bubrick has seen the troubles firsthand. "There's a lot of bullying associated with it because it's so visual, so obvious," he says. Mihok's visibility and success are one way to make people rethink their attitudes. His message is another: "I'm just like you, just a little bit different," he says in the video. "And you're a little bit different from me, and I have nothing but love for you."View Comments | Add Comment
Daryl Hannah Reveals Her Autism
Sept. 26, 2013 Beth Arky
The autism community can claim a new high-profile member: Daryl Hannah, who first came on the Hollywood scene in the early '80s with iconic roles in Splash and Blade Runner. In the new issue of People, Hannah opens up about her autism and its impact on her career. The 52-year-old, who was diagnosed as a child, hid the disorder from movie executives. But her "debilitating shyness" prevented her from doing talk shows and attending her own premieres "not because I was above it," she says, "but because I was terrified."
So why pursue a movie career, something she did at 17? Hannah says that as a girl, "acting for me was about going to the Land of Oz and meeting the Tin Man. It still is." But it also meant being the center of attention, which "always freaked me out." Hannah was pushed even further into the spotlight by dating the likes of John F. Kennedy Jr. and Jackson Brown, navigating the possibly even-bumpier experience of love on the spectrum. More recently, she's been linked to Wallflowers keyboardist Rami Jaffee.
While Hannah was diagnosed, it's not uncommon for girls on the spectrum to fly under the diagnostic and/or societal radar, unless they also have cognitive or behavioral challenges like ADHD. Even though they have the same issues with social interactions, intense interests, and sensory integration problems as boys, either clinicians miss autism in girls because the latter present differently or because girls are "better able to cope with any social or communication difficulties." This may at least in part account for the disproportionate number of boys who receive autism diagnoses.
"Girls can be overlooked because it is considered more socially acceptable to be shy," says autistic advocate and education professor Elizabeth (Ibby) Grace, who blogs at tinygracenotes. Grace, who serves on the board of Special Gifts Theatre, a youth company in Chicago, says she's "delighted" that Hannah found acting, which also "changed my life. Acting teaches you safe ways to connect with yourself and others and to express [yourself]. For me as an autistic young woman, it was a wealth of information, like a key to the world. It is almost like I learned to play myself, to transmit my authentic being in ways others can understand, and not be afraid to take risks understanding others."
While Hannah continues to rock and "stim" incessantly, common autistic traits (see video of an interview she did in 1989), she says she has learned to navigate the disorder that had her childhood doctors recommending medication and institutionalization. (Her mother refused.) "I'm a grown-up now," says the actress and environmental activist, who will speak out for causes she's passionate about. "I've learned a couple of things that would've really made my life easier if I'd only known them 20 years ago."
Her possible strategies? She has created a quiet life out of the public eye, acting sporadically (Kill Bill) and living off the grid, surrounded by a menagerie of animals, including two llamas and a rescue pig named Molly.View Comments | Add Comment
ADHD or Narcissism?
Sept. 26, 2013 Rachel Ehmke
"ADHD, or Childhood Narcissism" is the title of an article that has been attracting attention—and double-takes—on The Atlantic's website. It was written by Enrico Gnaulati, a clinical psychologist concerned by what he sees as our increasing tendency to blame ADHD for typical childhood behavior—or what he calls "childhood narcissism." For the record he doesn't mean narcissism, the personality disorder, he means the "overconfident self-appraisals, craving recognition from others, expressions of personal entitlement, and underdeveloped empathy" that all kids share at some point as part of normal development. But some kids take longer to grow out of their childhood narcissism, and those kids, Dr. Gnaulti writes, often get mislabeled as having ADHD.
Part of the problem, he says, is our familiarity with the symptoms of ADHD. More than any other disorder, it's the one that comes to mind when kids are acting out or having trouble concentrating in school. We are all overly susceptible, he argues. Even parents:
Today's parents are well versed in ADHD terminology. They can easily be pressured into bypassing richer descriptions of their kid's problems and are often primed to cut to the chase, narrowly listing behaviors along the lines of the following:
Yes, Amanda is very distractible.
To say that Billy is hyperactive is an understatement.
Frank is impulsive beyond belief.
Jumping to conclusions about a child's symptoms is, indeed, dangerous, because many behaviors we associate with ADHD could also indicate anxiety, a learning disorder, or even, as Dr. Gnaulati points out, a lack of maturity. "Does Ernesto have impulse-control problems or are his emotional boundaries underdeveloped?" he asks. A poor evaluation from a harried pediatrician won't investigate the other possibilities.
Right now Dr. Gnaulati also has an essay on Salon called "That's not autism: It's simply a brainy, introverted boy" and a new book out called Back to Normal: The Overlooked, Ordinary Explanations for Kids. We support his campaign for more careful diagnosis, but we can't help thinking about how parents of the kids he's calling "normal" feel. If your child is having problems severe enough that the school is complaining, your family is suffering, and you decide to consult a doctor, ADHD or not, you need and deserve help. Telling parents that kids will "just grow out of it" if they are really impaired at school is a recipe for frustration, failure, and negative consequences as they get older.
Another recent story about the rise of "emotional intelligence" programs at schools might have the answer. The story, which was in the New York Times Magazine, discussed how some people believe that teaching students "noncognitive skills" like self-restraint, persistence, self-awareness, and emotional regulation might improve their academic ability and future lives. For kids who are less emotionally mature, getting extra help in these areas could certainly be significant. If successful, these programs could also potentially avert the kind of misdiagnosis that Dr. Gnaulti is writing about and function as an early intervention that prevents a child's anxiety from ever reaching a clinical level. The emotional intelligence movement is in its early days yet, but we're looking forward to hearing more about it.View Comments | Add Comment
How Trauma Changes Genes (and How We Can Change Them Back)
Sept. 23, 2013 Caroline Miller
We know that children who experience abuse or neglect are "off the charts at risk," as Dr. Joan Kaufman puts it, for psychiatric disorders like depression, anxiety and substance abuse. What's more, they're less likely to respond favorably to the treatments that evidence shows work well for other people. And research has shown that children who have been maltreated are also more at risk for a host of physical ailments, including heart disease, respiratory illness, diabetes, and cancer.
What's going on here? Dr. Kaufman, a trauma and resilience expert at Yale University School of Medicine, gave a talk at the Child Mind Institute Friday, explaining our current understanding of how adverse experiences affect childhood development. It was a stunning demonstration of the way insights from animal research, human genetics, and clinical studies can complement and further each other.
We know that some kids are genetically predisposed to be more resilient than others. But we now have evidence that risk for psychiatric illness can be increased by environmental factors that change not what genes you are born with but how those genes function—as Dr. Kaufman put it, "chemical modifications to the DNA that can silence certain genes." Children who have adverse early experiences have been shown to have more of these changes, which are called epigenetic, than other kids do in several sites on the genome that are involved in modulating stress responses. These epigenetic changes make them less able to absorb stress in a healthy way; essentially, the genes that work together to turn off the stress response at an appropriate time are not functioning normally.
This reflects what we know from animal studies. Dr. Kaufman cites research that looked at rats who have been denied important maternal nurturing in their first few days, either because they were removed from their mothers or because the mothers were abnormally low on "licking and grooming"—seriously, that's what they call it. Those rats who experienced low L&G as pups had significantly higher stress reactivity—aka less resilience—as adults. Brain scans of the rats show corroborating decreases in the brain activity in regions that involve processing and modulating the stress response.
Most recently Dr. Kaufman and her team were able to do DNA analysis of a group of 96 children who been removed from their parents due to abuse or neglect and 96 control children. That analysis showed significantly greater epigenetic changes in the abused children than the other kids at almost 3,000 sites, on all 23 chromosomes. While three sites have been identified that predict depression and other psychiatric problems, others may help explain the association between adverse childhood experiences and various medical problems, from heart disease to cancer.
The good news in all this is that the right combination of nurturing and treatment has been shown to reverse those epigenetic changes that affect stress reactions and make kids more prone to psychiatric and other illnesses. As Dr. Kaufman put it in her talk, "Epigenetic modifications are often long-lasting, but they are not necessarily permanent."
We'll have more from Dr. Kaufman on childmind.org about treatment that effectively helps children who have been abused recover their resilience.View Comments | Add Comment
Louis CK on 'Conan': Phones 'Toxic' for Kids
Sept. 20, 2013 Harry Kimball
Personally, my favorite part of comedian Louis C.K.'s appearance on Conan last night was his story of being overcome with emotion while driving and listening to Bruce Springsteen's "Jungleland" and pulling over by the side of the road and crying it out. I can relate to that.
But this was all in the context of a bigger discourse on preserving essential parts of our humanity in the digital age that has inspired kudos across the internet. He started with a reliably hot-button issue: kids and technology, particularly mobile devices. And he sounds like an expert in development—or at least an engaged father:
I think these things are toxic, especially for kids...they don't look at people when they talk to them and they don't build empathy. You know, kids are mean, and it's 'cause they're trying it out. They look at a kid and they go, "You're fat," and then they see the kid's face scrunch up and they go, "Oh, that doesn't feel good to make a person do that." But they got to start with doing the mean thing. But when they write "You're fat," then they just go, "Mmm, that was fun, I like that."
C.K. is spot on concerning the apparent lack of consequences and social reciprocity that comes with digital communication and leads to things like cyberbullying or the unwise sharing of delicate photos. But he also goes further, putting forward an argument for fully engaging not only with other people but with your own feelings—hence the "Jungleland" anecdote. With all the stimulus available to us from smartphones and the society that produces them, he says, "you never feel completely sad or completely happy, you just feel kinda satisfied with your product, and then you die."
That's pretty bleak, but then Louis C.K. is a pretty bleak thinker. His conclusion at least looks towards the future while being practical in a sort of metaphysical way: "So that's why I don't want to get a phone for my kids."View Comments | Add Comment
Disney Guts Special-Needs Passes
Sept. 19, 2013 Beth Arky
For the past decade, Disney has played good fairy to special-needs families with its theme parks' Guest Assistance Card program, which provides accommodations for children and teens with physical as well as cognitive, developmental, or behavioral challenges. Those have included autism, ADHD, and sensory processing issues, which make it impossible for children to endure long waits, especially in noisy and crowded places. But this week it has been reported that Disney is ending the GAC program, and substituting a system that special-needs parents see as untenable for their families.
According to the reports, GAC will be replaced next month with something called the Disabled Assistance System. While the current program offers a variety of benefits, including shorter wait times at some of the rides, DAS will require special-needs families to visit kiosks around the parks for passes for each ride, and then wait a period of time commensurate to the wait time on line before going on the ride. (For detailed information on what a GAC card can and cannot do, see Aunesty Janssen's Temporary Tourist blog.)
The changes were incited by reports of wealthy parents hiring disabled tour guides to bypass long lines. While special-needs parents recognize the need to change the system if there is substantial fraud, they protest that the new system won't work for their kids. Today, a petition appeared calling for Disney's top executives to hear the concerns of autism families over the new plan.
Jo Ashline, who wrote a heated blog about the changes for Special Needs Orange County, has two sons; Ian, 10, is neurotypical, while Andrew, 11, is severely autistic with global and cognitive delays and epilepsy.
"Maybe the Disabled Assistance Pass will benefit some people, and for them, I say hooray," she wrote. "But for families like mine, where the special needs of our loved ones are varied and require specific accommodations, this new system will be nothing short of a nightmare. Our son Andrew wouldn't last more than an hour or two and that means I can't see our family ever returning to The Happiest Place on Earth."
The possibility for meltdowns is rife under DAS, says Janssen. Now, to get her 3-year-old autistic, sensory-challenged son out of the house and on the way to Disney, "we have to discuss the plan, like shopping, rides, and the Little Mermaid. But if we veer from the pattern, we have a meltdown." Under the new system, families couldn't create such a routine since they would have to travel between kiosks to obtain passes as shorter wait times become available.
Jennifer Fortwengler, whose 13-year-old son was diagnosed with Asperger's and anxiety, commented on Facebook that she was "disappointed but not surprised" about the changes. GAC, she notes, "makes Disney World doable for us but it's easy for unscrupulous people to abuse. This new system though sounds confusing and complicated and not at all like a workable long term solution."
But Janssen, the mother of six, also sees the potential for even greater fraud. Now, special-needs families must know to go to guest services to get their GAC; there have been times she's seen distressed families who clearly weren't aware of the program. But once the general public realizes they can get special passes simply by going to a kiosk and declaring a family member has a disability, there's nothing to stop people from doing so, or even having family members split up to get passes from different kiosks. If Disney doesn't "see how that can be flagrantly abused, I don't see that they've thought this through," she says.
Janssen says that when it comes to special-needs accommodations, Disney could borrow a page from Universal and Sea World. Universal's red pass allows families to either enter a ride's express lane or receive a return card, depending on the wait. Even better, the theme park provides "Child Swap Rooms," air-conditioned waiting rooms placed at the end of the ride. "A child can see daddy go on the ride, get off, and now it's mommy and my turn," she says. At Sea World, her son can go underground to view the dolphins, getting a break from the sun, heat, and noise. "There's no reprieve at Disney," she says. "You're walking in the hot park."
Fortwengler, whose family has visited a Disney park on a nearly annual basis for years, says she isn't sure they can continue to do so. This would be a shame, given that she feels the parks have benefitted her son: "We have seen some amazing leaps in terms of language, social skills, and even physical abilities at Disney World. I hope Disney is able to work this all out so that all more families can experience the magic we've been able to."
Fortwengler isn't the only mom to feel Disney has helped her son progress. Janssen says she believes her son allowed his grandmother to finally hold him because "he got to practice the hugs with the princesses. He would choose to see Princess Aurora. Slowly, it was OK for us to touch him. Even the doctor can get more touches."
A Massachusetts mother of two boys—a 10-year-old neurotypical son and a 9-year-old diagnosed with autism, anxiety, and ADHD plus sensory issues—says she's "horrified" by the news. "There are very few typical trips or even local activities that we can do as a whole family. We joined the Disney Vacation Club because the GAC made us feel almost like a typical family for one week each year. My husband is calling Disney today to find out how to sell our shares."
She offers a picture of her son with Stitch, lamenting:,"I will probably never see this smile again."
Update, 9/20/13 Disney has released the following statement:
"Disney has long been at the forefront of making our parks accessible to all guests. At this time, we are reviewing a number of considerations and remain committed to providing accommodations for guests with disabilities."View Comments | Add Comment
-Kathleen Prihoda Manager, External Communications Walt Disney World Resort
Resources for Autism Parents in Crisis
Sept. 17, 2013 Beth Arky
An Arizona mother is charged with the murder of her two children, at least one of whom was autistic. A Michigan mother's failed murder-suicide has led to charges of attempted murder of her autistic daughter. These and other tragic cases make it clear to us that both parents and autistics are in need of supports when they are in crisis.
It's important for a parent who feels she can't handle a dangerous situation with a child—or who is so distraught that she is thinking of harming her children—to know that there are other options for getting help beyond involving the police with a 911 call. These are resources you might want to investigate when you are not in a crisis situation; sometimes, just knowing you're prepared with a back-up plan is enough to make you feel in control during difficult situations
Mobile crisis units
A mobile crisis team is made up of mental health professionals such as psychiatrists, psychologists, nurses, and social workers who can come to the home to provide a range of services to anyone who is experiencing, or is at risk of, a psychological crisis. What can they do? Emergency mental health assessment, crisis intervention, supportive counseling, information and referrals, links to community-based mental health services for ongoing treatment, and follow-up. Run by voluntary agencies and municipal hospitals, the teams may arrange transportation to an emergency room if it's deemed necessary. They will also call the police if the individual in crisis will not go to the hospital willingly and meets specified legal criteria. New York City residents can learn more about this program here; crisis units in other areas may be found via a search engine.
Medicaid waiver providers
If children and teens are covered under a Medicaid waiver, a parent in crisis may check with her service coordinator to see if temporary emergency shelter is available for the children until she can get the support she needs and the home stabilizes.
Private ambulance companies
If parents feel the crisis merits calling 911 but don't believe the police need to be involved, there is another option: a private ambulance company. This also allows parents to specify the emergency room they wish to go to, which is not the case when EMS is called. Parents may want to ask treating clinicians and other parents which pediatric mental health ER in their area has the best record in dealing with crises situations.
Autistic advocate Paula Durbin-Westby has also compiled Emergency Information: Autism Resources for both parents who feel they may harm their child and autistics who feel endangered. It includes information on such organizations as the National Domestic Violence Hotline, the National Suicide Prevention Lifeline, and the Autism Women's Network.View Comments | Add Comment