prohibit successful interactions with medical staff and require reactive measures (e.g., anxiolysis or restraint) to ensure patient safety and promote delivery of optimal care Engaging caregivers is the most successful way to facilitate treatment for individuals with ASD Appreciating how best to communicate, recognizing the difficulty for a particular child to maintain composure in a medical setting, and learning what reduces anxiety and alternatively what provokes escalating behaviors allow for simple accommodations to enable successful care delivery In general, communicate directly with the child using simple, concrete language, give brief instructions, warn about transitions, offer positive reinforcement, allow for frequent breaks, recognize when tasks are overwhelming, and limit unstructured time For children with limited verbal abilities and for those with significant anxiety (escalating behaviors), consider using visual supports to communicate expectations and structure the encounter Some children use specific picture systems at home Others are familiar with resources used in other treatment and educational settings that are easily adapted to hospitalbased care Among these are “if/then” cards, visual schedules, and Social Stories These can be quickly sketched at the bedside or printed from online templates “If/then” cards display two linked images revealing an action and then a reward if the action is completed (e.g., if you take the medicine, then you will get a sticker) Visual schedules organize simple words or pictures to seriate the steps of an event Social Stories explain the sequence of an action or activity in simple illustrations with or without accompanying text Just as a highly structured encounter offers significant support to individuals with ASD, flexibility and, at times, simple accommodations to the care environment, often reduces anxiety enough to gain compliance and ensure safe interactions Respecting and working around triggers for agitation often facilitates a cooperative experience Importantly, recognize that many behaviors are a reflection of significant anxiety and consider breaks in demands, positive behavioral support, flexibility with expectations, and at times anxiolysis to minimize distress SCREENING FOR MENTAL HEALTH PROBLEMS IN THE EMERGENCY DEPARTMENT