Thomas, a 12-year-old autistic boy has a long history of some features of anxiety and depression. For the past several months, he has been more anxious, sad, and easily overwhelmed. He seems irritable at home and school and cries often. He responds very slowly to the questions and often says "I don't know, I don't know," almost in an automatic way and he is now engaging in some repetitive hand movements which he had not done previously. He is no longer able to shower independ