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This study examined clinically relevant patterns of agreement between parent and child ratings of child behavior problems and factors associated with these patterns. Subjects were 274 children, ages 11 to 18 years, and their parents. Overall agreement between parent-child ratings was modest. Twenty-five percent of parent-child pairs agreed children's behavior problems were clinically elevated ("both" group), 29% agreed problems were nonclinical ("neither" group), in 39% of pairs only parents reported clinically elevated problems ("parent only" group) and in 8% of pairs only children rated clinically elevated problems ("child only" group). Maternal stress and child age, but not child gender, were associated with parent-child agreement patterns. Children with depressive/mood disorders were more likely to be in the "child only" group than in any other group. This study discusses the importance of paying attention to child reports of elevated behavior problems, particularly when parents report that child behavior problems are not clinically elevated.