In Reply We thank Berger from the Substance Abuse and Mental Health Services Administration for his interest in our work.1 We appreciate his points and offer some additional considerations to support the mental health needs of children.

We agree that co-occurring substance use disorders, developmental disabilities, and physical health conditions exacerbate challenges in access to mental health services. Children with neurodevelopmental disorders, such as autism spectrum disorder, are more likely to revisit the emergency department for mental health conditions2 and are more likely to experience boarding (prolonged emergency department or inpatient stays awaiting mental health services).3 Additionally, children with eating disorders may face challenges in accessing specialized services, as visits for these conditions have increased during the COVID-19 pandemic.4 Also, sexual and gender minority youth may face barriers in access to affirming mental health care.5 The mental health system must be tailored to support the needs of these special populations.