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This study reports on the prevalence of, treatment for, and factors associated with treatment for serious psychological impairment in urban children, aged 6-18. Two samples were studied, the first a random cross-section of 1,034 Manhattan families and the second of 1,000 Manhattan families receiving welfare (Aid to Dependent Children). A significantly greater number of welfare children were seriously impaired, but the referral rate and long-term treatment rate of children in the two samples were similar. Less than 50% of the seriously unpaired children were referred, and only one in five received treatment of six months or longer. Referral rates increased dramatically as mother's education increased, whether she did or did not receive welfare. Families who referred their children were colder, less punitive, and of higher social status. Implications and solutions are discussed.

This paper presents methods of approaching mental illness which represent alternatives to the medical model and the current diagnostic system. It also points to new ways of handling such complex independent variables as race and class to more clearly delineate the critical components of those constructs for observed relationships. These approaches are briefly discussed and then exemplified in the context of a study which investigated the types and levels of stress to which children of different ethnicity were exposed and the congruence between impairment levels and stress exposure. Differential behavior patterns by ethnicity were determined, as were the relative roles of class versus ethnicity in children's disturbed behaviors. Measures were developed from questionnaire data collected from 1034 randomly selected Manhattan mothers. White children were least exposed to social stress, Spanish most exposed to marital-parental stress, and Black most exposed to stressful parental practices. While the estimated impairment rank-order was White, Spanish, and Black, both minority groups of children were significantly higher than Whites but similar to each other in impairment level. Analyses showed strong differences in behavior patterns by ethnicity and indicated that race made a stronger contribution than class to disturbed behaviors.

An inventory was constructed to screen children for psychiatric impairment. A structured questionnaire was administered to a cross-sectional sample of 1,034 mothers and a welfare sample of 1,000 mothers of children between the ages of 6 and 18 in Manhattan. One or more psychiatrists rated each of the 2,034 children on a 5-point scale of total psychiatric impairment. Factor analysis of the questionnaire items of child behavior yielded 18 factors. The 1 factors with the highest correlations with total psychiatric impairment were selected for the inventory, each represented by 5 items. The correlation of the total 35-item score and total psychiatric impairment was .82. The screening inventory significantly and substantially improved over chance in assigning children to impairment statuses in the cross-sectional sample and the sample used for cross-validation, the welfare sample. Correlations of the total score with child's treatment status and a direct clinical examination rating were expectcdly low. Presently, the instrument is recommended only for comparisons of different child and adolescent groups.