We report here the first Kenyan study that used the TRIAD of CBCL, YSR and TRF on 195 children attending school in a Kenyan setting. Our findings are in agreement with most studies reviewed in the Introduction to the effect there is little agreement between CBCL, YSR and TRF. There was a greater agreement between the children and their teachers in 5 (2 internalizing disorders (affective and anxiety) and 3 externalizing disorders (somatic, ADHD and oppositional) out of the 8 conditions. Our results suggest that children and parents agreed only on somatic disorders and conduct disorders.

These findings can be understood in the Kenyan context. Somatic disorders are mainly physical symptoms, often perceived to suggest physical conditions, and not normally perceived by the parents of the children as suggestive of mental disorders [23]. Conduct disorders include substance use which the parents may have noticed and therefore agreement between parents and children even though they may not have talked about them. In the Kenyan context, in the day-school system (not boarding schools) children spend more time with teachers (8am– 3.45pm, Monday to Friday). Substantial time is spent moving from home to school (normally walking) to be in class by 8am and equally the same time to go back home. Most of the evening is taken up with homework. All of these contribute to the less time (in quality and quantity) the children spend with their parents/guardians.

On the other hand, parents and children who spend less time together than with the teachers agreed on only 2 conditions– one internalizing (anxiety) and the other externalizing (ADHD). The agreement on these 2 conditions is not surprising: anxiety is likely to result in school phobia and failure to go to school, which would be obvious to both parents and the teachers; ADHD will lead to disruptive behavior in the structured environment found in schools. The teachers immediately share this with parents all of whom may view as requiring a disciplinary approach which needs their connected effort.

Our study was on a non-clinical population. This is unlike a clinical population in which parents would have a greater role in initiating referral and therefore expected to have noticed abnormalities. This is yet another reason why parents and children agree only on externalizing processes and conduct disorders.

Our findings compare and contrast with other studies. A population study [24] similar to ours, found the mean for YSR to be higher than the mean for CBCL. We, on the other hand, found the opposite i.e. CBCL mean score higher than YSR, CBCL also higher than TRF and more similarities between YSR and TRF. It is possible that internalizing factors and some externalizing factors were highly noticeable by the parents and therefore contributed to this observation. The agreement between YSR and TRF could be a reflection of the fact that children spent more time with teachers than with parents.

Apart from time spent with children, there are other plausible and overlapping explanations for these overall disagreements between parents and teachers and parents and children: (i) Home and school environments are not the same and may lead to different expressions of the same disorder as was observed by Des Los Beyes [25], leading to different perceptions by parents and teachers; (ii) Children, parents and teachers have different perceptions on what constitutes abnormality in the behavior of the children, except when the behaviors on the part of the children are dramatic enough to catch the attention of all such as refusal to go to school on account of school phobia, truancy, etc. These may be viewed by both teachers and parents as requiring a disciplinary approach while the children perceive themselves as helpless victims as may occur in ADHD. As already explained, somatic symptoms in the Kenyan context in school-going children would be regarded by most as physical disorders [23] and not stigmatized as they would be perceived as genuine and therefore attract the attention of all players including the children. Although clinicians and researchers may be more comfortable with more agreement between different informants as pointed out in the introduction, these different disagreements are clinically important and useful as they provide a much wider scope to the understanding of the problems from different perspectives and factors thus forming a basis to work towards convergent perspectives. Our findings, therefore, suggest a family or school or combined oriented psychoeducation on mental health symptoms towards a common perspective of the problem. It calls for a multi-disciplinary team approach where the teachers, parents/guardians and service providers and the children themselves are key stakeholders. This kind of approach is no less desirable in low-resourced countries than it is in high-resourced countries. There is a need to start somewhere with the resources already available to mitigate today’s needs but there is also the need to be innovative [13]. However, part of the innovation is the ability to address both covert and overt power structures between children, teachers and parents. In the Kenyan socio-cultural context, there is a common uniting factor in these structures and that is the shared critical importance attached to the education of children as the best investment for the child, the family, the respect for the teachers and the benefits to the community. These considerations transcend power structures when it comes to matters of education for children. Indeed, we have demonstrated that it is possible to establish such a dialogue [26].

Bringing together the perceptions of teachers, parents and the children to find a common understanding on psychopathology in the child will enhance an integrated approach at clinical level. More importantly, this same approach can find a community health application that will have a critical reach in enhancing all round awareness in the key players. To achieve this, practical steps can be implemented to foster shared awareness within the community. Initiatives such as community-based awareness programs and school-based mental health interventions serve as valuable tools in this endeavor. In addition to broader community initiatives, targeted measures can be implemented to empower educators. Training programs for teachers on recognizing early signs of psychopathology are crucial components of a comprehensive approach. Equipping teachers with the necessary knowledge and skills enables them to play a proactive role in identifying and addressing mental health concerns among students. Complementary to teacher training, community outreach initiatives serve as an important means to connect with families and individuals in various socio-cultural contexts. By extending mental health support beyond the classroom, these initiatives contribute to a more inclusive and accessible system, ensuring that the broader community is well-informed and engaged in the promotion of mental wellbeing. A major limitation of this study is the small sample size. Further mitigation against this limitation is that we only worked with participants who willingly came forward to participate in the study, and provided we had data on the same students from parents and teachers.

The strengths of this paper lie in our methodology where we asked all the participants the same questions in a standardized format by trained RAs to achieve the highest possible inter-and intra-rater reliability. Another strength is that we used intervention on populations who had not been exposed to any mental health awareness, psychoeducation or clinical intervention.

We have achieved the overall aim and the specific aims. In the process, we have demonstrated the feasibility of this kind of research in Kenya and laid the grounds for future research on the possible efficacy and effectiveness of this kind of approach at the clinical level. We have built the case for integrated mental health systems comprising children, parents and teachers for the management of childhood disorders in a Kenyan setting. We have contributed to the global database by demonstrating similarities between HIC and our Kenyan findings.