Renee, a four-year-old girl, had been in Head Start for two and a half months. One of Renee's teachen found that she consistently had a blank look and was not speaking at school but did at home. Because of previous experience with a student with SM, the teacher recognized these behaviors and reported Renee to the mental health specialist. Classroom observations and assessments were initiated, and concerns were discussed with the family. Renee's mother reported that she was her youngest child, with three older siblings. Renee was raised by her parents and had no history of serious mental or physical health problems. This was her first time attending school. Her mother was shocked by the teachers' report about Renee