NCHS Data Brief ■ No. 163 ■ August 2014

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Use of Selected Nonmedication Mental Health Services 

by Adolescent Boys and Girls With Serious Emotional or 

Behavioral Difficulties: United States, 2010–2012

Lindsey I. Jones, M.P.H.; Patricia N. Pastor, Ph.D.; Alan E. Simon, M.D.; and Cynthia A. Reuben, M.A.

Key findings 

Data from the National 

Health Interview Survey, 

2010–2012

• About 4% of adolescents

aged 12–17 had a serious 

emotional or behavioral 

difficulty and received 

nonmedication mental health 

services in the past 6 months.

• Nearly 71% of adolescents

with serious emotional or 

behavioral difficulties received 

nonmedication mental health 

services in the past 6 months.

• Among adolescents with

serious emotional or behavioral 

difficulties, boys were more 

likely than girls to receive 

nonmedication mental health 

services.

• Boys with serious emotional

or behavioral difficulties were 

more likely than girls to receive 

services in school settings.

• The percentage of boys and

girls with serious emotional or 

behavioral difficulties receiving 

nonschool services was similar 

for all settings except for the 

emergency department.

Mental health is a key component of a child’s overall wellbeing. Previous 

research using data from the National Health Interview Survey (NHIS) found 

that about 6% of adolescents have serious emotional or behavioral difficulties 

(1). Both medication and nonmedication services have been found to be 

effective for treatment (2–8). Two recent reports from the National Center 

for Health Statistics have presented estimates of medication use among U.S. 

adolescents (9–10). The use of prescription medication for emotional or 

behavioral difficulties was higher among boys than girls (10). This report 

describes differences between boys and girls in the use of nonmedication 

mental health services in various school and nonschool settings among 

adolescents aged 12–17 with serious emotional or behavioral difficulties.

Keywords: mental health treatment • mental health care utilization • children • 

National Health Interview Survey

Approximately 4% of adolescents aged 12–17 have a 

serious emotional or behavioral difficulty and have received 

nonmedication mental health services in the past 6 months.

1

Significantly different from girls (p < 0.05).

NOTE: Data are based on household interviews of a sample of the civilian noninstitutionalized population. 

SOURCE: CDC/NCHS, National Health Interview Survey, 2010–2012.

Figure 1. Adolescents aged 12–17 who received nonmedication mental health services for 

serious emotional or behavioral difficulties during the past 6 months, by sex: United States, 

2010–2012 Percent

Total Boys Girls

0

20

40

60

80

100

Adolescents with serious emotional

or behavioral difficulties

All adolescents

4.3 1

5.4 3.2

70.9 1

75.0

64.7
NCHS Data Brief ■ No. 163 ■ August 2014

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• Among adolescents aged 12–17, boys (5.4%) were more likely than girls (3.2%) to have a 

serious emotional or behavioral difficulty and receive nonmedication mental health services 

in the past 6 months (Figure 1).

• Among adolescents with serious emotional or behavioral difficulties, 70.9% received 

nonmedication mental health services in the past 6 months.

• Among adolescents with serious emotional or behavioral difficulties, boys (75.0%) were 

more likely than girls (64.7%) to receive nonmedication mental health services.

About one in three adolescents aged 12–17 with serious emotional or 

behavioral difficulties (37% of boys and 33% of girls) received both school 

and nonschool nonmedication mental health services. 

• Approximately 21% of adolescents received school services only, and 15% received 

nonschool services only (Figure 2).

• Boys (23.9%) were more likely to have received school services only compared with girls 

(16.2%).

• Girls (35.4%) were more likely to receive neither school nor nonschool services compared 

with boys (25.1%). 

Percent

Figure 2. Adolescents aged 12–17 with serious emotional or behavioral difficulties, by receipt of nonmedication mental 

health services during the past 6 months and sex: United States, 2010–2012

1

Significantly different from girls (p < 0.05).

NOTES: Data are based on household interviews of a sample of the civilian noninstitutionalized population. Categories "school only," "nonschool only," "both 

(school and nonschool)," and "neither" are mutually exclusive.

SOURCE: CDC/NCHS, National Health Interview Survey, 2010–2012.

0

20

40

60

80

100

Neither

Nonschool only 

School only 

Both

Total Boys Girls

32.6

16.2

15.7

35.4

36.6

1

23.9

14.4

1

25.1

35.0

20.9

15.0

29.2
NCHS Data Brief ■ No. 163 ■ August 2014

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• There was no difference between the percentages of boys and girls receiving both school 

and nonschool services, and there was no difference between the percentages of boys and 

girls receiving nonschool services only. 

Boys with serious emotional or behavioral difficulties were more likely to 

receive services in all school settings.

• In 2010–2012, boys (52.2%) were more likely to receive services for emotional or 

behavioral difficulties from a provider within a regular school compared with girls (42.2%) 

(Figure 3).

• Boys (35.4%) were more likely to receive services from a special program for children with 

emotional or behavioral difficulties within a regular school compared with girls (23.3%).

• Boys (19.7%) were more likely to attend a special school for children with emotional or 

behavioral difficulties compared with girls (12.8%).

Figure 3. Adolescents aged 12–17 with serious emotional or behavioral difficulties who received nonmedication mental 

health services from a school provider during the past 6 months, by school service setting and sex: United States, 

2010–2012

1

Significantly different from girls (p < 0.05). 

NOTES: Data are based on household interviews of a sample of the civilian noninstitutionalized population. Respondents could select more than one type of school 

service.

SOURCE: CDC/NCHS, National Health Interview Survey, 2010–2012.

0 10 20 30

Percent

40 50 60

Girls

Boys

Total

Special school for children

with emotional or

behavioral difficulties

Special program for children

with emotional or behavioral

difficulties within a

regular school

Treatment or counseling

for emotional or behavioral

difficulties from a provider

within a regular school

48.2

1

52.2

42.2

30.6

1

35.4

23.3

17.0

1

19.7

12.8
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Of all the nonschool providers, the emergency department was the 

only setting where there was a difference in use by sex, with a higher 

percentage of girls (9.3%) than boys (4.6%) receiving services.

• More than one-third of adolescents (40.2%) with serious emotional or behavioral difficulties 

received nonmedication mental health services in an office, clinic, or center in the 

community in the past 6 months (Figure 4). 

• A lower percentage of adolescents also received nonmedication mental health services in 

the home (11.9%), emergency departments (6.5%), day treatment programs in a hospital or 

community (5.9%), overnight treatment centers (7.9%), or other places (14.8%).

• There was no difference by sex in the percentage of adolescents receiving nonmedication 

mental health services provided in an office, clinic, or center in the community; the home; 

day treatment programs in a hospital or community; overnight treatment centers (including 

hospitals); or other places.

0 10 20 30 40 50

Any other place

Overnight treatment center

(including hospital)

Day treatment program in

hospital or community

Emergency department

In home

Office, clinic, or center

in the community

Figure 4. Adolescents aged 12–17 with serious emotional or behavioral difficulties who received nonmedication mental 

health services from a nonschool provider during the past 6 months, by service setting and sex: United States, 

2010–2012

1

Significantly different from girls (p < 0.05).

NOTES: Data are based on household interviews of a sample of the civilian noninstitutionalized population. Respondents could select more than one type of 

nonschool service.

SOURCE: CDC/NCHS, National Health Interview Survey, 2010–2012.

Percent

Girls

Boys

Total

40.2

41.4

38.2

11.9

11.2

12.8

6.5 1

4.6

9.3

5.9

5.6

6.5

7.9

7.3

8.8

14.8

16.3

12.4
NCHS Data Brief ■ No. 163 ■ August 2014

■  5  ■

Summary

An estimated 6% of adolescents have serious emotional or behavioral difficulties (1). During 

2010–2012, approximately 71% of adolescents aged 12–17 with serious emotional or behavioral 

difficulties received nonmedication mental health services in the past 6 months. In general, boys 

(75.0%) were more likely than girls (64.7%) to have received nonmedication mental health 

services. Overall, just over 55% of adolescents with serious emotional or behavioral difficulties 

received school services. Among adolescents with serious emotional or behavioral difficulties, 

boys (60.5%) were more likely to have received school nonmedication mental health services 

compared with girls (48.9%). 

Compared with girls, boys were more likely to receive services in each of the three school 

settings: regular school (52.2% compared with 42.2%), special school (19.7% compared with 

12.8%), and special program (35.4% compared with 23.3%). Overall, boys and girls did not 

differ in their use of nonschool nonmedication mental health services. When the settings for the 

nonschool services were examined individually, only one setting—the emergency department—

showed a difference between boys and girls. Girls (9.3%) were more likely than boys (4.6%) 

to receive nonmedication mental health services in the emergency department. There was no 

difference between boys and girls in their use of services in an office, home, day treatment 

program, overnight treatment center, or other location. 

Among adolescents with serious emotional or behavioral difficulties, a higher percentage of boys 

than girls received services in school settings. This finding may be due, in part, to the higher 

prevalence among boys of externalizing and developmental conditions such as attention deficit 

hyperactivity disorder (ADHD) and autism spectrum disorders, which negatively affect their 

school achievement and participation (11–13).

Definitions

Serious emotional or behavioral difficulties: Based on a response of “yes, definite difficulties” or 

“yes, severe difficulties” to the question, “Overall, do you think that [sample child’s name] has 

difficulties in any of the following areas: emotions, concentration, behavior, or being able to get 

along with other people?”

Receipt of nonmedication mental health services: Based on a positive response to use of at 

least one of the three school mental health services or one of the seven nonschool mental health 

services. There was no direct question on receipt of nonmedication mental health services; 

information was obtained from the questions on school and nonschool mental health services (see 

definitions below). 

Receipt of school mental health services: Based on a positive response to any one of the 

following three questions: “During the past 6 months, did [sample child’s name] a) receive 

treatment or counseling for these difficulties from school personnel; b) attend a school for 

students with difficulties with emotions, concentration, behavior, or being able to get along 

with others; or c) participate in a school program that was just for students with difficulties with 

emotions, concentration, behavior or being able to get along with others.”
NCHS Data Brief ■ No. 163 ■ August 2014

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Receipt of nonschool mental health services: Based on a positive response to any one of the 

following seven questions: “During the past 6 months, did [sample child’s name] receive 

treatment or counseling for these difficulties: a) from daycare, child care, or play group; b) in 

an office, clinic, or center in the community; c) in the child’s home; d) in a hospital emergency 

room or emergency department, crisis center, or emergency shelter; e) at a day treatment program 

in a hospital or the community; f) at an overnight facility (e.g., hospital, group home, juvenile 

detention center, foster care home, or other special type of center); or g) other.”

Data source and methods

This analysis used data from the 2010–2012 NHIS. Interviewers from the U.S. Census Bureau 

collect NHIS data continuously throughout the year for the Centers for Disease Control and 

Prevention’s National Center for Health Statistics (NCHS). NHIS includes questions about 

the health and health care of the civilian noninstitutionalized U.S. population. Interviews are 

conducted in respondents’ homes. In some instances, follow-ups to complete interviews may be 

conducted over the telephone. Questions for this analysis are from the household composition 

section and the Family Core and Sample Child components of the 2010–2012 NHIS. From each 

family in NHIS, a sample child is randomly selected, and information about the sample child is 

obtained from an adult residing in the household who is knowledgeable about the child’s health. 

From 2010 through 2012, information on the sample child was collected for 13,175 adolescents 

aged 12–17. For more information about NHIS, visit http://www.cdc.gov/nchs/nhis.htm.

NHIS is designed to yield a nationally representative sample, and this analysis uses weights to 

produce national estimates. Data weighting procedures are described in more detail elsewhere 

(14). Point estimates and estimates of corresponding variances for this analysis were calculated 

using the SUDAAN software package (15) to account for the complex sample design of NHIS. 

The Taylor series linearization method was chosen for variance estimation. All estimates shown 

in this report meet NCHS standards of reliability (relative standard error less than or equal to 

30%). Differences between percentages were evaluated using two-sided significance tests at the 

0.05 level. 

About the authors 

Lindsey I. Jones is with CDC’s National Center for Health Statistics, Division of Health Interview 

Statistics; and Patricia N. Pastor, Alan E. Simon, and Cynthia A. Reuben are with NCHS Office of 

Analysis and Epidemiology.

References

1. Federal Interagency Forum on Child and Family Statistics. America’s children: Key national 

indicators of well-being, 2013. Washington, DC: U.S. Government Printing Office.

2. Silverman WK, Hinshaw SP. The second special issue on evidence-based pyschosocial 

treatments for children and adolescents: A 10-year update. J Clin Child Adolesc Psychol 37(1):

1–7. 2008.
NCHS Data Brief ■ No. 163 ■ August 2014

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3. Jensen PS, Hoagwood K, Petti T. Outcomes of mental health care for children and 

adolescents: II. Literature review and application of a comprehensive model. J Am Acad Child 

Adolesc Psychiatry 35(8):1064–77. 1996.

4. Durlak JA, Wells AM. Evaluation of indicated preventive intervention (secondary prevention) 

mental health programs for children and adolescents. Am J Community Psychol 26(5):775–802. 

1998.

5. Jones D, Godwin J, Dodge KA, Bierman KL, Coie JD, Greenberg MT, et al. Impact of 

the fast track prevention program on health services use by conduct-problem youth. Pediatrics 

125(1):e130–6. 2010.

6. Pelham WE, Jr., Fabiano GA. Evidence-based psychosocial treatments for attention-deficit/

hyperactivity disorder. J Clin Child Adolesc Psychol 37(1):184–214. 2008.

7. Charach A, Dashti B, Carson P, Booker L, Lim CG, Lillie E, et al. Attention deficit 

hyperactivity disorder: Effectiveness of treatment in at-risk preschoolers; long-term effectiveness 

in all ages; and variability in prevalence, diagnosis, and treatment. Agency for Healthcare 

Research and Quality. Rockville, MD. 2011.

8. Maalouf FT, Brent DA. Child and adolescent depression intervention overview: what works, 

for whom and how well? Child Adolesc Psychiatr Clin N Am 21(2):299–312. 2012.

9. Jonas BS, Gu Q, Albertorio-Diaz JR. Psychotropic medication use among adolescents: 

United States, 2005–2010. NCHS data brief, no 135. Hyattsville, MD: National Center for Health 

Statistics. 2013.

10. Howie LD, Pastor PN, Lukacs SL. Use of medication prescribed for emotional or behavioral 

difficulties among children aged 6–17 years in the United States, 2011–2012. NCHS data brief, 

no 148. Hyattsville, MD: National Center for Health Statistics. 2014.

11. CDC. Prevalence of autism spectrum disorder among children aged 8 years—autism and 

developmental disabilities monitoring network, 11 sites, United States, 2010. MMWR Surveill 

Summ 63(2):1–21. 2014.

12. Bloom B, Jones LI, Freeman G. Summary health statistics for U.S. children: National Health 

Interview Survey, 2012. National Center for Health Statistics. Vital Health Stat 10(258). 2013.

13. He JP, Burstein M, Schmitz A, Merikangas KR. The strengths and difficulties questionnaire 

(SDQ): The factor structure and scale validation in U.S. adolescents. J Abnorm Child Psychol 

41(4):583–95. 2013.

14. Parsons VL, Moriarity C, Jonas K, et al. Design and estimation for the National Health 

Interview Survey, 2006–2015. National Center for Health Statistics. Vital Health Stat 2(165). 

2014.

15. RTI International. SUDAAN (Release 11.0.0) [computer software]. 2012.
NCHS Data Brief ■ No. 163 ■ August 2014

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Suggested citation

Jones LI, Pastor PN, Simon AE, Reuben CA. 

Use of selected nonmedication mental health 

services by adolescent boys and girls with 

serious emotional or behavioral difficulties: 

United States, 2010–2012. NCHS data brief, 

no 163. Hyattsville, MD: National Center 

for Health Statics. 2014.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Charles J. Rothwell, M.S., M.B.A., Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Health Interview Statistics

Jane F. Gentleman, Ph.D., Director

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