National estimates of the prevalence of emotional/behavioral difficulties in U.S. children aged 4-11 years

Introduction: Emotional/behavioral difficulties can have lasting consequences for children's academic and social development. National health surveys can provide data to monitor the overall prevalence of these difficulties and identify important disparities. Methods: The 2001-2006 National Health Interview Survey included the brief version of the Strengths and Difficulties Questionnaire (SDQ) to measure the emotional/behavioral difficulties of school-age children. A high score of 6+ was used to estimate emotional/behavioral difficulties among 14,942 children aged 4-7 and 15,010 children aged 8-11. A knowledgeable household adult, usually the mother, provided information about the child's emotional/behavioral difficulties, demographic and family characteristics, and mental health (MH) service use. Results: Prevalence of high SDQ scores varied by age and sex. Among children aged 4-7, 3.2% of boys and 2.7% of girls had high SDQ scores; among children aged 8-11, the percent was 5.6% for boys and 3.4% for girls. In both age groups, high SDQ scores were more than twice as prevalent for poor children than non-poor children (family incomes 200%+ of the poverty level). MH service use was significantly higher among children with high SDQ scores compared to those without high SDQ scores in both age groups (4-7 years: 42.5% vs. 5.4%; 8-11 years: 54.1% vs. 8.1%). Conclusion: High SDQ scores among children aged 4-11 years varied significantly by age and sex and by poverty and other measures of disadvantage. Using national data to track the prevalence of emotional/behavioral difficulties may aid in evaluating the population-level impact of child MH programs.