Childhood disability has a profound impact on children, education, and healthcare systems. Comprehensive assessment, legislation, and services for children and young adults with mental and physical disabilities are not well developed in Trinidad and Tobago. This study investigated the occurrences of the most common mental disabilities among primary, secondary, and vocational schoolchildren with recommendations for the improvement of services for children and adolescents with mental and physical disabilities. In a retrospective study, 349 first-contact patients, ages 4-19 years from primary, secondary, and vocational schools were reviewed using DSM IV diagnosis. All firstcontact outpatient patients between the ages of 4-19 years were interviewed and screened. Epidemiological data of diagnosis, school attended, age, gender, ethnicity, and family structure were rated for each patient The results showed an excess of male patients with disabilities at all school levels. This percentage increased with age. The most prominent diagnosis in primary school was learning disorder and ADHD (21%), whereas conduct disorders and ADHD and depression were more common over the age of 11 years. Fifty five percent (55%) of all patients lived with both parents, 18% in single-parent families, 19% with relatives, and 8% in reconstituted families. Mental disabilities appeared common in the school system. A need exists to formalize an integrated approach for those with disabilities within the mainstream system. Recommendations are made for nationwide screening, establishment of a register, intersectional service provisions with family intervention, social integration, equal opportunity legislation, and education.