Emotional and Behavioral Difficulties

Positive emotional and behavioral health is an integral part of healthy development and enhances a child's sense of well-being, supports rewarding social relationships with family and peers, and facilitates achievement of full academic potential.118 Children with emotional or behavioral difficulties may experience problems managing their emotions, focusing on tasks, interacting with family and peers, or controlling their behavior. These difficulties, which may persist throughout a child's development, can lead to lifelong problems.119 Parents play a crucial role in informing health professionals about a child's emotional and behavioral difficulties and obtaining mental health services.120

Indicator HEALTH3: Percentage of children ages 4–17 reported by a parent to have serious emotional or behavioral difficulties by age and gender, 2011–2019
Indicator HEALTH3: Percentage of children ages 4–17 reported by a parent to have serious emotional or behavioral difficulties by age and gender, 2011–2019

NOTE: Emotional or behavioral difficulties of children were based on parental responses to the following question on the Strengths and Difficulties Questionnaire121: "Overall, do you think that [child's name] has difficulties in one or more of the following areas: emotions, concentration, behavior, or being able to get along with other people?" Response choices were (1) no, no difficulties; (2) yes, minor difficulties; (3) yes, definite difficulties; and (4) yes, severe difficulties. Children with serious emotional or behavioral difficulties are defined as those whose parent responded "yes, definite difficulties" or "yes, severe difficulties." These difficulties may be similar to but do not equate with the Federal definition of serious emotional disturbance, used by the Federal government for planning purposes. In 2019, the National Health Interview Survey (NHIS) questionnaire was redesigned, and other changes were made to weighting and design methodology. Therefore, data for 2019 are not strictly comparable with data for earlier years. For more information on the 2019 NHIS redesign, see: https://www.cdc.gov/nchs/nhis/2019_quest_redesign.htm.

SOURCE: National Center for Health Statistics, National Health Interview Survey.

  • In 2019, 6% of children were reported as having serious emotional or behavioral difficulties. The percentage of parents reporting that their child ages 4–17 displayed serious difficulties with emotions, concentration, behavior, or getting along with other people was stable from 2011 to 2018. While estimates varied from 5%–6% during this period, differences were not significant.
  • In 2019, parents of children ages 8–10 (7%) and 15–17 (6%) were more likely to report serious emotional or behavioral difficulties compared with parents of children ages 4–7 (4%).
  • Among children ages 4–17 in 2019, parents were more likely to report serious emotional or behavioral difficulties for boys (7%) than for girls (4%). This pattern was reflected among children ages 4–7 (6% for boys and 2% for girls) and 11–14 (8% for boys and 4% for girls) but not among children ages 8–10 and 15–17 for which there was no significant difference.
  • In 2019, the percentage of children reported as having serious emotional or behavioral difficulties was higher among children living with a relative or guardian who was not a parent (9%) or with a single mother (8%) compared with children living with two parents (5%) or with a single father (4%).

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118 Kieling, C., Baker-Henningham, H., Belfer, M., Conti, G., Ertem I., Omigbodun O., Rohde, L.A., Srinath, S., Ulkuer, N., & Rahman, A. (2011). Child and adolescent mental health worldwide: Evidence for action. The Lancet, 378(9801), 1515–1525. https://doi.org/10.1016/S0140-6736(11)60827-1.

119 Cuellar, A. (2015). Preventing and treating child mental health problems. The Future of Children, 25(1), 111–134.

120 Ogundele, M. O. (2018). Behavioural and emotional disorders in childhood: A brief overview for paediatricians. World Journal of Clinical Pediatrics, 7(1), 9–26. http://dx.doi.org/10.5409/wjcp.v7.i1.9.

121 Goodman, R. (1999). The extended version of the Strengths and Difficulties Questionnaire as a guide to child psychiatric caseness and consequent burden. Journal of Child Psychology and Psychiatry, 40, 791–799.

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