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Although custodial grandchildren are believed to be at greater risk of emotional and behavioral problems than children in general, scant research has examined this important public health issue.This study involves data from 733 custodial grandmothers participating in a study funded by the National Institute of Mental Health on custodial grandparenting and 9,878 caregivers from the 2001 National Health Interview Survey (NHIS) who completed the Strengths and Difficulties Questionnaire (SDQ) in reference to target children between ages four and 17. These two data sets were used to determine if custodial grandmothers report greater emotional and behavioral difficulties, as measured by the SDQ, for custodial grandchildren than do caregivers of children from the NHIS normative sample.Custodial grandchildren fared worse than children from the NHIS sample across all domains measured by the SDQ subscales, regardless of the child's gender and whether reporters were recruited by population-based or convenience sampling methods. Comparisons within the sample of 733 custodial grandmothers showed that higher levels of difficulties were reported when grandmothers were caring for boys, were recruited by convenience versus population-based sampling, and were white. Comparisons of the banded scores computed for each SDQ subscale suggested that custodial grandchildren have different cutoff points than children in the general population for a likely diagnosis of a psychiatric disorder.Similar to other children in kinship care arrangements, custodial grandchildren are reported by their caregivers to have higher levels of behavioral and emotional disturbances than children in the overall U.S. population.