Mental health symptoms in school-aged children in four communities

Schoolchildren looking for traffic while waiting to cross the road

A CDC study examined mental health symptoms in four different U.S. school districts during 2014–2018. Based on teacher and parent reports, about 1 in 6 students had enough behavioral or emotional symptoms and impairment to be diagnosed with a childhood mental disorder; rates varied among the different sites. Schools, communities, and healthcare providers can use this information to plan for the healthcare and school service needs of children and adolescents with mental disorders. Screening, identifying, and referring children and adolescents to effective treatments can help prevent or lower the negative effects of mental disorders.

Read the scientific summary

Main Findings

For this study, teachers in selected school districts were first asked to complete a short questionnaire (screening) to determine a student’s risk for a mental disorder. Then, the parents of selected students were invited to complete a more structured diagnostic interview to determine if their child met criteria for a mental disorder.

  • Overall, 1 in 6 students had enough symptoms and impairment to meet the criteria for one or more childhood mental disorders.
  • Anxiety disorders were the most commonly reported mental disorders, followed by oppositional defiant disorder (ODD) and attention-deficit/hyperactivity disorder (ADHD).
  • Risk for disorders varied greatly from community to community.
  • Based on the screen done by teachers, between 1 in 6 and 1 in 3 students were at high risk for a mental disorder, depending on which community they were from. Teachers identified a higher percentage of boys, non-Hispanic Black students, and students receiving free or reduced-price lunch as high risk for mental disorders than their peers at all or most sites, but there were generally no demographic differences in the percentage of students who met the criteria for a mental disorder based on parent report. This means that estimating effects of race or income on symptoms gave different results depending on the way that symptoms were examined.

Helping Students at Risk

  • Schools may consider screening students for mental health concerns and providing effective prevention services.
  • Pediatric and family medicine clinics can use these estimates to understand how many students may need services.
  • Communities can work with schools to integrate mental health services in schools and provide referral and treatment services.
  • Public health can use these estimates to plan for healthcare and school service needs, as well as to watch changes over time.

About This Study

A study found that estimates for mental disorders were very similar when measured in one of the PLAY study communities a second time, 3 years later.

Learn more

The Project to Learn About Youth-Mental Health (PLAY–MH) was a school-based study designed to estimate how many K-12 students had specific mental disorders. Information was collected from 2014–2018 in four different school districts in four U.S. states (Colorado, Florida, Ohio, and South Carolina). The school districts were in urban, suburban, and rural areas, varied in size, and included students from different socio-economic and racial and ethnic backgrounds.

Information was collected in two stages. In Stage 1, teachers in selected school districts completed validated screening questionnaires to describe students’ emotional, behavioral, or tic symptoms. A sample of students at high risk and students at low risk were invited to participate in the second stage. In Stage 2, parents completed a structured diagnostic interview about their child’s emotional or behavioral symptoms. The information was used to determine whether children had enough symptoms and impairment to meet the criteria for a mental disorder.

Although the students come from four school districts in four states and represent a variety of backgrounds, it is not known whether the same findings would apply to students in other school districts or regions.

About Children’s Mental Health

Mental disorders among children are described as serious changes in the way children typically learn, behave, or handle their emotions that causes distress and problems getting through the day. Many children experience occasional fears and worries, or disruptive behaviors. If symptoms are severe and persistent and interfere with school, home, or play activities, the child may be diagnosed with a mental disorder. Among the more common mental disorders that can be diagnosed in childhood are ADHD, anxiety, and behavior disorders, such as ODD.

It is important to watch for mental disorders in children and understand how they are treated because they can have a significant effect on overall health and relationships throughout life. Identifying problems early can help children get the support they need.

Our Work

CDC’s National Center on Birth Defects and Developmental Disabilities (NCBDDD) works to provide a better understanding of mental, emotional, and behavioral disorders so affected children and adolescents and their families get the support they need.

More Information


  1. Danielson, M. L., Bitsko, R. H., Holbrook, J. R., Charania, S. N., Claussen, A. H., PhD; McKeown, R. E., Cuffe, S. P., Owens, J. S., Evans, S. W., Kubicek, L., & Flory, K. (2020). Community-based prevalence of externalizing and internalizing disorders among school-aged children and adolescents in four geographically dispersed school districts in the United States. Child Psychiatry & Human Development. Published online July 31, 2020. [Read summary]