Trends in parent-rated emotional symptoms, conduct problems, and hyperactivity/inattention among U.S. children and adolescents, 2004–2019

Background: Evidence suggests that the prevalence of self-rated psychological symptoms among children and adolescents has changed in the past two decades. Our objective was to examine if similar trends are apparent in parent-rated assessments of psychological symptoms. Methods: Participants were a nationally-representative sample of parents who rated psychological symptoms in their children (ages 4–17) in either the 2004 (n = 9,012) or 2019 (n = 7,092) National Health Interview Survey. Emotional symptoms, conduct problems, inattention/hyperactivity, and perceived burden of psychological symptoms were measured with the Strengths and Difficulties Questionnaire. Log-binomial regression models were used to calculate prevalence ratios (PRs) comparing the prevalence of serious psychological symptoms between 2004 and 2019. Interactions terms were included to determine if trends varied among sociodemographic subgroups defined by age, sex, and race/ethnicity. Results: In the complete sample, the prevalence of serious psychological symptoms did not change over time for emotional symptoms (PR=1.00, 95% CI=0.84–1.18), conduct problems (PR=0.90, 95% CI=0.74–1.09), or inattention/hyperactivity (PR=0.94, 95% CI=0.78–1.12). Trends did not differ significantly between sociodemographic subgroups. The perceived impact (β=-0.44, 95% CI=-0.64, -0.23) and burden of psychological symptoms (odds ratio [OR]=0.66, 95% CI=0.57–0.77) declined slightly over time. Limitations: Trends are based on cross-sectional samples from only two time-points. Conclusions: The prevalence of parent-rated emotional symptoms, conduct problems, and inattention/hyperactivity did not change between 2004 and 2019 among U.S. children and adolescents. Parent-rated assessments of psychological symptoms in youth may measure different constructs than self-rated assessments.