The work of Stein and colleagues 1 based on an analysis of the 59th American Academy of Pediatrics (AAP) Periodic Survey suggests that approximately 90% of pediatricians accept the professional responsibility of identifying children with 7 conditions: attention-deficit/ hyperactivity disorder (ADHD), eating disorders, child and adolescent depression, substance abuse, behavior problems, anxiety, and learning disabilities. The demographic mix of the sample of physicians answering the survey seemed reasonable, with possibly an over-representation of those who had some additional specialized mental health training experiences. Although 70% felt they should treat/ manage ADHD, only approximately 25% felt they should treat/manage any of the other quite common diagnoses, instead indicating they would choose to refer. These results suggest 3 key questions: 1. If 90% believe they should identify and refer, why is the rate of identification within pediatric primary care approximately 20%? 2–6 Part of the answer is that pediatricians have not adopted an approach to psychosocial screening that parallels the measurement methods applied to height, weight, and other office screening procedures. A number of screening questionnaires exist—from the brief Pediatric Symptom Checklist 7,8 to the longer, more thorough Child Behavior Checklist. 9 For young children, there are also well-validated screening tests for autism, 10 and for adolescents, tests to recognize depression 11 and substance abuse. 12 In most primary care settings, pediatricians recognize psychosocial issues based on observation, 1 or 2 questions, or parental complaint. The result is a level of recognition that is low, unsystematic, and often delayed. The 2 major obstacles to a system of screening are a lack of reimbursement and concern about finding places to refer for services. We pay for what we value, and some would say that if the marketplace does not bid on an item (a house) or pay for a service (a pediatrician’s professional time), it is de facto worthless. Further, the mental health services that would follow positive screening, including pediatric management, are poorly reimbursed, if at all. We would not accept the current identification and referral rate for any other ‘‘real’’ illness. Imagine if the same results reported by Stein and colleagues 1 applied to children with diabetes or asthma: low recognition, reluctance to treat, and a 1 in 5 recognition rate. Rather than complacency, we would launch an urgent national effort based on quality and safety. 2. If approximately 80% of pediatricians said they should refer identified children, why is the referral rate from