relationships or in cognitive, social, or emotional development (Angold, Erkanli, et al., 2002; Costello, Angold, et al., 1996).

As noted earlier, no representative population surveys of rates of the full range of MEB disorders in children in the United States have been published, although results from a survey of 13- to 17-year-olds in the NCS will be published in 2009. The NSDUH, a household survey from the Substance Abuse and Mental Health Services Administration, includes adolescents ages 12 and over. In 2005 and 2006 it included a module on major depressive episodes and found that 8.8 percent (2005) and 7.9 percent (2006) of youth reported such an episode in the past 12 months.1 NHANES has also begun to include selected modules addressing MEB disorders in young people, but no data have yet been published. In addition, more work is needed to expand epidemiological studies to include representative samples of all racial/ethnic groups in the United States, to control for socioeconomic confounds in such studies, and to develop international collaborations that provide comparisons among nations using comparable measures (see Heiervang, Goodman, and Goodman, 2008).

Cumulative Prevalence

Several longitudinal studies have calculated the proportion of the population that has received at least one diagnosis of a MEB disorder across repeated assessments, from childhood through adolescence and into early adulthood (Costello, Mustillo, et al., 2004). Jaffee and colleagues compared three such studies and found that between 37 and 39 percent of youth in the three studies had received one or more diagnoses between ages 9 and 16 (Jaffee, Harrington, et al., 2005). In later follow-ups of these studies, the cumulative prevalence rose to between 40 and 50 percent by age 21 (Arseneault, Moffitt, et al., 2000; Costello, Angold, et al., 1996). This is similar to a 46.4 percent lifetime prevalence rate based on retrospective data from the NCS of adults (Kessler, Berglund, et al., 2005). In the one study for which cumulative data are available by diagnosis (Costello, Angold, et al., 1996), rates of reporting one or more episodes of a disorder by age 21 were 16.4 percent for disruptive behavior disorders, 14.5 percent for anxiety disorders, and 10.4 percent for depressive disorders.

Comorbidity

Many children have more than one MEB disorder. Figure 2-2 summarizes the data from a meta-analysis of comorbidity among the major classes of disorder, after controlling for comorbidity between the comorbid condi-



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