Child Behavior Checklists were completed in home interviews by parents of 7-16-year-olds in 1976, 1989, and 1999. Competence scores decreased from 1976 to 1989, but increased in 1999. Problem scores increased from 1976 to 1989 and decreased in 1999 but remained higher than in 1976. Items, empirically based scales, and DSM-oriented scales showed similar patterns for demographically similar nonreferred samples assessed in 1976, 1989, and 1999 and for national samples that included referred children assessed in 1989 and 1999. For the 114 problem items that were common to the 1976, 1989, and 1999 assessments, the Q correlation was .98 between the mean scores on the 114 items in 1976 versus 1989 and was .94 between the mean scores on the 114 items in 1976 vs. 1999. This indicated very high stability in the rank ordering of item scores across intervals up to 23 years. For all children, the 1-year prevalence rate for mental health services use was 13.2% in 1989 versus 12.8% in 1999. For children with deviant Total Problems scores, the 1989 prevalence for service use was 30.5 versus 26.6% in 1999. Neither difference was statistically significant.