When a young person and a parent each sit down for the same structured mental health interview, they frequently describe two different children. A research letter published November 11, 2026, in JAMA Psychiatry reports that when a diagnosis showed up in data from the national Adolescent Brain Cognitive Development (ABCD) Study, it usually came from only one of the two reporters. For districts designing screening, intake, and referral routines, that finding bears directly on a practical question: whose answers are you collecting?
What the JAMA Psychiatry study examined
The study, "Youth-Caregiver Discordance in Psychiatric Diagnosis and Clinical Problems in the ABCD Study," was led by researchers at UC San Diego School of Medicine with collaborators. The ABCD Study is a long-running, NIH-funded cohort that invited 11,880 children ages 9 to 10 at 21 research sites across the country and has followed them over time.
According to the UC San Diego summary of the paper, the team analyzed 11,868 youth ages 9 to 17 and their caregivers. Each youth and each caregiver answered the same diagnostic questions in separate clinical interviews, and the researchers derived DSM-5 diagnoses from each report, then compared them by diagnosis and by developmental stage.
The authors note that earlier research on this question was largely cross-sectional and limited to depressive, anxiety, and externalizing conditions. This analysis follows the same young people across late childhood, early adolescence, and middle adolescence and covers a wider range of diagnoses.
Youth and caregivers rarely named the same concern
The headline finding is the size of the gap. When a diagnosis was reported, only one informant reported it in roughly 65% to 98% of cases, depending on the diagnosis and the age group, per the UC San Diego summary.
The disagreement was not random. It ran in predictable directions:
- Youth reported more internal and private experiences, including major depressive disorder, sleep problems, and substance use. Teens' reports of depression grew relative to their caregivers' as they got older.
- Caregivers reported more of what adults can observe from the outside, including conduct problems, eating disorders, and generalized and social anxiety.
Agreement improved somewhat with age, but it stayed limited throughout adolescence. The gaps were widest among the youngest participants.
The senior author, Laika D. Aguinaldo, PhD, MSW, of UC San Diego, put the implication plainly in the university's release: "If you only ask one, you might miss the opportunity to identify a young person who needs help and to intervene early."
Two cautions belong alongside these findings. First, this is a research letter, a short format, and the full text sits behind a paywall; school teams should read it directly before building policy on specific figures. Second, the study measures agreement between reporters. It does not establish which reporter is "right," and it does not test any school practice.
Why this matters for school screening design
Schools already make informant choices every time they screen, whether or not they name them as such. A screener can be completed by the student, by a parent or caregiver, by a teacher, or by some combination.
The National Center for School Mental Health's Screening quality guide asks teams to select measures that are developmentally appropriate for the student population, and its SHAPE screening library lets teams filter tools by "reporter." The University of Washington SMART Center's 2025 universal screening guide goes further, advising districts to "consider selecting a multi-informant tool that collects student, teacher, and family ratings." It also notes that when teachers are the informants, they need four to six weeks to get to know students before the first screening window.
The ABCD findings give that guidance an evidence anchor. A screening process built only on caregiver report may under-identify the private, internal concerns adolescents are more likely to disclose themselves. A process built only on student self-report may miss observable concerns that caregivers see more clearly, especially among younger children.
Illinois is already making an informant choice
Illinois offers a live example. Under Public Act 104-0032, districts must offer mental health screenings to students in grades 3 through 12 beginning in the 2027-28 school year, according to the Illinois State Board of Education's FAQ. Screening in kindergarten through grade 2 is optional. The state-procured tool must include "a self-report option for students," and ISBE notes that screening two to three times per year is recommended, with once a year as the minimum.
Self-report fits what the ABCD data show about adolescents' willingness to describe internal experiences. The open question for Illinois districts, and for any district screening younger grades, is how caregiver and teacher perspectives will enter the process, particularly for third and fourth graders, where the study found the widest gaps between what children and adults reported.
Parental consent rules shape that answer too; we reviewed the federal position in Mental Health Screening Consent: What Districts Need Now. A consent process that already brings families into the conversation can also be a point to gather the caregiver's view.
What this means for district and school leaders
The study does not hand districts a protocol, but it supports several concrete steps.
- Map your current informants. List every screening and intake point in the district, from universal screeners to student support team referrals, and record whose report each one relies on. Many districts will find that a single informant drives most decisions.
- Match the informant to the age band. For middle and high school, keep a student self-report component; the data suggest adolescents disclose internal concerns that adults miss. For elementary grades, build in caregiver and teacher input alongside any student measure.
- Treat disagreement as information, not error. When a student's report and a parent's report diverge, route the case for a conversation rather than discarding the lower score. The NCSMH guide recommends setting triage data rules before screening begins; add a rule for informant disagreement.
- Prepare families for the possibility of a gap. Parent communication about screening can say plainly that students sometimes report things their families have not seen, and that this is common. That framing can lower the temperature when results are shared.
- Confirm follow-up capacity first. The NCSMH guide lists "the identified need will exceed our capacity" as a common barrier, and the SMART Center reminds districts that "a referral is not an intervention." Asking more informants will surface more concerns. Map who will respond, and on what timeline, before widening the net. Our earlier review of CDC data on unmet counseling need shows why that capacity question matters.
- Use the SHAPE platform to check fit. Teams can use the SHAPE screening library to compare tools by reporter, age range, and language before selecting or renewing a screener.
Looking ahead
The UC San Diego team says its next work will examine what drives these discrepancies and whether they affect young people's access to care and their outcomes. Districts do not need to wait for that answer to review whose voice their screening and referral routines rely on, and Illinois districts in particular have until the 2027-28 school year to settle how caregiver and teacher input will sit beside the required student self-report option. School-Based Healthcare Solutions Network, Inc. (SBHSN), a private grant-making organization focused on access to mental health care on school campuses, publishes this weekly review to help school leaders turn national and state developments into local decisions. Schools and districts weighing campus-based mental health capacity can review the grant solicitation and its published criteria at sbhsnetwork.com/grants. Application deadlines fall on the first Monday of July, September, November, and February; questions can be sent to grants@sbhsnetwork.com.
Sources
- Youth-Caregiver Discordance in Psychiatric Diagnosis and Clinical Problems in the ABCD Study — JAMA Psychiatry (DOI: 10.1001/jamapsychiatry.2026.3768), accessed 2026-11-12
- Youth and Caregiver Reports of Mental Health Issues Differ, But Both Perspectives Needed — UC San Diego Today, accessed 2026-11-12
- ABCD Study: Study Overview — Adolescent Brain Cognitive Development Study, accessed 2026-11-12
- FAQ: Universal Mental Health Screening — Illinois State Board of Education, accessed 2026-11-12
- School Mental Health Quality Guide: Screening — National Center for School Mental Health, University of Maryland School of Medicine, accessed 2026-11-12
- Universal Screening Best Practice Guide — SMART Center, University of Washington, accessed 2026-11-12
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