Prevalence of Mental Health and Neurodevelopmental Conditions Among School-Age Children, by Health Insurance Type

OBJECTIVE: The authors aimed to estimate trends in the prevalence of diagnosed mental health and neurodevelopmental conditions among U.S. school-age children (ages 6-17 years) and to explore variations in these trends across health insurance types (public, private, and uninsured). METHODS: The study used a cross-sectional analysis of nationally representative data from the 2018-2023 administrations of the National Survey of Children's Health (N=171,971 children). The primary outcomes were parent-reported provider diagnoses of anxiety, depression, behavior and conduct problems, attention-deficit hyperactivity disorder, and autism spectrum disorder. The authors used a multivariable logistic regression model to assess the odds of having a diagnosis by insurance type while controlling for child and parent sociodemographic characteristics, including poverty level, race-ethnicity, and education. RESULTS: Between 2018 and 2023, the prevalence of mental health and neurodevelopmental conditions rose significantly, from 18.5% to 22.5%. Publicly insured children consistently exhibited the highest prevalence rate, peaking at 27.4% in 2022. After adjustment for covariates, children with public insurance had markedly higher odds of having a diagnosis compared with those with private insurance (OR=1.70, p<0.01). CONCLUSIONS: The number of children with mental health and neurodevelopmental conditions is increasing across all insurance types, with a disproportionate burden falling on public health insurance. These findings underscore the need for stable Medicaid coverage and robust provider networks to address the rising demand for child mental health services.