An increasing number of children are affected by mental health disorders. These rates vary depending upon the type of disorder, age, and diagnostic tool used in diagnosis. Studies conducted in the United States (e. g. Costello, Costello, Edelbrock, Burns, Dulcan, Brent, & Janiszewski, 1999; Shaffer, Fisher, Dulcan, Davies, Piacentini, Schwab-Stone, Lahey, Bourdon, Jensen, Bird, Canino, & Regier, 1996), New Zealand (e. g. McGee, Feehan, Williams, & Anderson, 1992), Canada (e. g. Offord, Boyle, &

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... Racine, 1989), Puerto Rico (e. g. Bird, Canino, Rubio-Stipec, Gould, Ribera, Sesman, Woodbury, Huertas-Goldman, Pagan, Sanchez-Lacay, & Moscoso, 1988), and the Netherlands (e. g. Verhulst, Ende, Ferdinand, & Kasius, 1997) suggest that 9% - 22% percent of children have clinically severe behavioral and emotional problems. These studies also show significant differences between rates in boys and girls. Studies show that school age boys are more often diagnosed with mental health disorders than girls (Anderson, Williams, McGee, & Silva, 1987; Cohen, Cohen, & Brook, 1993; Costello, Angold, Burns, Stangl, Tweed, Erkanli, & Worthman, 1996; McGee et al., 1992). In the United States, one of the most common reasons children are referred to mental health clinics is for diagnosis and treatment of Attention Deficit Hyperactivity Disorder (ADHD). Children referred for ADHD account for up to 50% percent of all referrals to outpatient mental health clinics (Adams & Sutker, 2001).