Promoting Optimal Development: Screening for Behavioral and Emotional Problems

TLDR

Approximately 11–20% of U.S. children currently have a behavioral or emotional disorder, and 37–39% will be diagnosed by age 16, yet these problems are not reliably identified or treated in the health system. The report aims to increase behavioral screening and outlines practice and system changes, plus research needed to achieve this. It reviews prevalence, risk factors, current detection status, barriers to screening, and proposes practice and system‑level solutions to facilitate screening.

Abstract

By current estimates, at any given time, approximately 11% to 20% of children in the United States have a behavioral or emotional disorder, as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Between 37% and 39% of children will have a behavioral or emotional disorder diagnosed by 16 years of age, regardless of geographic location in the United States. Behavioral and emotional problems and concerns in children and adolescents are not being reliably identified or treated in the US health system. This clinical report focuses on the need to increase behavioral screening and offers potential changes in practice and the health system, as well as the research needed to accomplish this. This report also (1) reviews the prevalence of behavioral and emotional disorders, (2) describes factors affecting the emergence of behavioral and emotional problems, (3) articulates the current state of detection of these problems in pediatric primary care, (4) describes barriers to screening and means to overcome those barriers, and (5) discusses potential changes at a practice and systems level that are needed to facilitate successful behavioral and emotional screening. Highlighted and discussed are the many factors at the level of the pediatric practice, health system, and society contributing to these behavioral and emotional problems.