Navigating Youth Mental Health Challenges in Today’s World: How To Determine & Support Dual Diagnoses
Today’s clinicians play a critical role in supporting the mental health and well-being of young people amid growing awareness and need. According to the September 2025 issue of Pediatrics, the journal of the American Academy of Pediatrics (AAP), 13% to 20% of children live with a mental health, emotional and behavioral challenge. An additional 19% exhibit symptoms that cause impairment or distress, but don’t meet diagnostic criteria for a specific disorder. Kids and teens are also increasingly receiving multiple diagnoses — e.g., depression and anxiety or autism and ADHD.
These statistics shed light on the growing opportunities for enhancing and expanding youth mental health support. Throughout my over 30 years of practical experience in public education, I’ve seen firsthand the importance of mental health and behavioral assessment, support and intervention in both school and clinical settings. As the demand for and complexity of accurate diagnosis and effective treatment continue to increase, clinician access to professional guidance and helpful resources will become more important than ever.
A key topic of discussion is how to support children with a dual or multiple diagnosis. Below, I provide answers to common questions on identification and intervention.
Question:
I’m working with a child who exhibits symptoms that fit with multiple disorders. How can I determine which one they may have or if they have both? If they do have a dual diagnosis, how can I help support them?
Answer:
Dual diagnoses — when an individual experiences both a mental health disorder and another neurodevelopmental or behavioral condition — are fairly common. For example, comorbidity rates between attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) range from 50% to 70%. Other common pairings include anxiety and ADHD, and depression and anxiety. The prevalence of these co-occurrences points to the importance of collecting information on a variety of mental health issues, dysfunctional behaviors and behavioral strengths when assessing kids and teens.
Question:
How do I determine if a child has a dual diagnosis?
Answer:
When conducting a health assessment of a child, incorporating broadband behavioral rating scales — such as the BASC rating scales — provides a comprehensive overview of the child's social, emotional, and behavioral functioning, which can lead to a potential diagnosis.
The BASC uses clinical indexes to compare an evaluated child to peers already diagnosed with ADHD or ASD, for example, estimating the likelihood of similar profiles. Its Functional Impairment Index is key in assessing whether social, emotional and behavioral challenges affect daily life and living skills. It also aligns symptom items with DSM-5 criteria, helping determine if a child meets ADHD or ASD criteria or both.
Some examples of BASC-3 scales that are important in identifying disorders, possible comorbidities and differentiating between disorders for ADHD and ASD include the Attention Problems scale, the Atypicality scale and other clinical scales. Here is an explanation of each:
- Attention Problems scale: This measures an inability to sustain attention and the tendency to be easily distracted from tasks requiring attention. It is highly correlated with academic problems.
- Atypicality scale: This includes items that reflect a tendency to behave in ways that are considered “odd,” disconnected or commonly associated with psychosis. It is useful in identifying autism and represents a qualification category for emotional/behavioral disturbance. Item analysis is important in the process of identifying coexisting conditions or differentiating between conditions. Applying clinical acumen in the interpretation of BASC items is crucial when interpreting elevated scales scores. A careful study of item responses can be helpful in this regard and in guiding the selection of narrowband assessment to augment the evaluation.
- Additional important clinical scales: The BASC offers additional ways to dive deeper, including scales that measure Withdrawal, Hyperactivity, Learning Problems and Conduct Problems. Vital adaptive scales include Adaptability, Social Skills and Functional Communication. Content scales, such as Anger Control, Emotional Self-Control and Resiliency, also provide valuable information.
Question:
How can I best support a child after a diagnosis?
Answer:
Healthcare professionals can utilize BASC-3 or BASC-4 to develop treatment plans, select evidence-based interventions, and effectively monitor progress. The findings help pinpoint specific behavioral and emotional challenges and communicate them in an easily understandable manner. If concerns arise, the BASC can be re-administered periodically (e.g., every 6–12 months) to compare scores, track changes, and adjust treatment accordingly.
To learn more about our tools for mental health professionals, check out our Mental Health Resource Center.