Steven Cuffe, MD, Principal Investigator, University of Florida. (Funded 2014-2016) Mental health problems are highly prevalent in youth and cause significant morbidity. While there has been concern in the media about over-diagnosis and treatment of mental disorders, many youth are not identified or treated. It is critical to determine the prevalence of mental disorders and the gaps in the treatment of these children in order to develop a cohesive system of care. Duval County Public Schools (DCPS; Jacksonville) is a large school district of 127,000 students, and includes a diversity of races, socio-economic and urban/rural areas. DCPS has a new health and mental health initiative, and received grant funding for consultation to improve services. Jacksonville also has a SAMHSA System of Care Grant. The proposed project would provide data on which to build services, and complement these existing projects. The objectives of the study are to 1) estimate the prevalence and comorbidities of psychiatric and tic disorders in children aged 5-17 within Duval County Public Schools, and estimate the rate of over/under-diagnosis and treatment, 2) determine the treatment patterns, past and present, of children with and without diagnoses to include amount and type of therapy, medication use and number of refills, and 3) estimate the level of diversion and misuse of psychiatric medications. In Stage 1, teachers will screen 5-7000 students with the BASC-2 BESS and SDQ. Three high, 3 middle and 4 elementary schools are selected to represent high, middle, and low socio-economic areas. The DCPS Supervisor of Psychology Services will assist with school and teacher engagement and help ensure that teachers complete the instruments. A random sample of 600 high and low screen students will be invited for the Diagnostic Stage using the Diagnostic Interview Schedule for Children, the Yale Global Tic Severity Scale, and instruments to measure service use. Sampling in both stages will ensure representation by age, race and sex. Year 1 will include the screening phase and approximately 15% of the diagnostic interviews. Year 2 will complete the diagnostic interviews and include data analysis using SAS-callable SUDAAN, and dissemination of results to the school district and scientific community through presentations at local and national meetings, and peer-reviewed publications.