Compared with British children and adolescents with serious emotional and behavioral problems, American children and adolescents with these problems had more contacts with mental health services and mental health providers, but not with providers of general medical services. British children and adolescents had more parent-reported serious emotional and behavioral problems than American children and adolescents; however, British children and adolescents with these problems were less likely than their American counterparts to receive mental health care. More British than American children and adolescents met the criteria for emotional and conduct problems, but not hyperactivity/inattention. Prevalence was higher for all problems in 5-8-year-old British boys and for emotional problems in 13-16-year-old British girls. The Strengths and Difficulties Questionnaire (SDQ) had similar psychometric properties across the two countries. This finding supports the use of the parent version of SDQ as an initial screening measure in clinical settings in both countries. The study collected data on children and adolescents ages 5 to 16 years old who were drawn from the 2004 U.S. National Health Interview Survey (response rate of 79.4 percent) and the 2004 survey of Mental Health of Children and Young People in Great Britain (response rate of 76 percent). Emotional problems, hyperactivity/inattention, and conduct problems were assessed with the parent version of the SDQ. The psychometric properties of SDQ scales were compared across countries. 3 tables, 1 figure, and 41 references