In the United States, the estimated prevalence rate of a diagnosable emotional disturbance with at least minimum impairment is 21% among children ages 9 to 17 (Shaffer et al., 1996).

The prevalence rate is higher for youngsters living in low socioeconomic circumstances. Data are inadequate to estimate prevalence rates for children under age 9, or to determine if prevalence rates differ among racial or ethnic groups or among particular regions of the country or types of communities (Friedman et al., 1996). These disorders, including anxiety, mood, disruptive, and substance abuse disorders, can have a long-term, even life-long, impact. Children and adolescents with serious emotional disturbances are more than four times as likely as other children to use mental health services (Friedman et al., 1996).

The need for the identification of “subthreshold” mental health problems in primary pediatric care has long been apparent. Costello et al. (1988) found that primary care pediatricians did not identify 83% of children with emotional or behavioral problems. The DSM-PC (Wolraich et al., 1996) was developed, in part, to enable clinicians to identify and treat of children whose mental health problems fell below the DSM-IV’s criteria but who nonetheless had a high level of functional impairment (American Psychiatric Association, 1994). In a later study, Costello and Shugart (1992) found that 42% of children from a pediatric clinic of a health maintenance organization met hreshold-level disorder criteria. It was estimated that fewer than one in four children with serious emotional disturbances had recently received medical care (Costello and Messer, 1995).

Prompt, clinically effective intervention can mitigate the impact of mental illness on children and adolescents (U.S. Department of Health and Human Services, 1999). The behavioral sciences have developed new resources to facilitate prompt intervention. There have been tremendous advances in understanding anxiety and depressive disorders, the impact of divorce and abuse, and the effects of attention deficit hyperactivity disorders into adulthood. Manual-based psychotherapies and newer medications (e.g., selective serotonin reuptake inhibitors and atypical antipsychotics) have come into clinical practice.

Identification, prevention, and treatment of childhood emotional and behavioral problems are pressing national needs (U.S. Department of Health and Human Services, 1999). It is likely that the overwhelming burden of approaching these mental health needs will fall to pediatric primary care providers, who may have limited prior training in mental health as well as limited access to child and adolescent psychiatrists.