13 y.o. female with a Hx of Intellectual Disability (mild), Developmental Speech Delay, Craniofacial Dysmorphism (potential FASD?), GERD/GI issues, RAD, ODD, and PTSD who was brought to the ED by her foster mother due to becoming acutely agitated (on her way to PHP) and became aggressive towards foster sibling and foster mother (e.g. pulled foster sibling’s hair, attempted to bite foster sibling & mother, threw things). Current presentation appears consistent symptoms of hyperarousal (e.g. irritability, anger, agitation) likely related to her previously diagnosed ODD and PTSD. Based on her current presentation (e.g. lack of behavioral/safety issues, able to make her needs known, etc.), medication adherence, relatively limited behavioral issues in the community, and her current diagnostic picture (i.e. no significant, active symptoms of mental illness), acute inpatient psychiatric admission is not currently indicated. As she is no longer able to return to her foster home, a new placement will need to be made.