Internalizing Behaviors and Depression in Children

A sad young girl hiding her face on the couch
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Internalizing behaviors are common among depressed children. These behaviors are quiet and often invisible because they are internalized and are generally not disruptive to others, unlike externalizing behaviors.

Typical Internalizing Behaviors

Examples of internalizing behaviors are:

  • Being withdrawn
  • Feeling sad
  • Feeling lonely
  • Being nervous or irritable
  • Not talking 
  • Headaches, stomachaches and other physical symptoms that are not related to any physical illness
  • Having concentration problems
  • Feeling afraid
  • Feeling unloved or unwanted
  • Sleeping more or less than usual
  • Eating more or less than usual

These behaviors are similar to those of depressed children but do not necessarily mean your child is depressed.

How to Identify Symptoms

A child with internalizing symptoms keeps her feelings inside, which may manifest itself in such symptoms as:

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.

Due to the quiet nature of internalizing symptoms, children may not receive treatment as quickly as those with more disruptive or externalizing symptoms. In fact, because they are often disruptive and noticeable to others around them, externalizing symptoms in children have received quite a bit more attention and research than those of internalizing symptoms, but that is starting to change.

In general, girls display more internalizing symptoms than boys do.

Association With Depression

Not all children with internalizing symptoms are depressed. In fact, internalizing symptoms are often associated with anxiety disorders and somatization disorder as well.

However, it is generally thought that a child who displays internalizing symptoms but does not yet meet the criteria for depression is at a much higher risk of developing it in the future.

When to Seek Help

if you notice your child is showing internalizing symptoms, and even if they do not seem severe yet, talk to your child about their feelings and symptoms. It is never too early to have good communication and to understand what is going on, and/or to seek assistance. This can be looked at as preventative treatment.

If the symptoms seem severe, talk to a mental health professional, as they may be a sign of depression or an indication of future mental illness.

Treatment for Depression

Depression in children is usually treated with either medication, psychotherapy, or a combination of both. Your mental health professional or pediatrician will work with you and your child to come up with the best-individualized treatment plan for her.

Often, figuring out the best treatment for your child can take some trial and error, so try to be patient as you collaborate with your mental health professional to decide what works best for your child.

Treatment for Anxiety

Like depression, anxiety is also treated with either medication, psychotherapy, or some combination of both. Some kids have both depression and an anxiety disorder, but your mental health professional can determine if this is the case with your child. 

Causes of Depression and Anxiety

No one knows exactly what causes depression or anxiety, though there seem to be multiple potential causes. Studies have shown that genetics may play a part, so if you have a close relative with an anxiety disorder or depression, your chances are higher of developing it too.

There also seem to be differences in the way people with anxiety and depression process certain brain chemicals that lead to mood stabilization. The environment can also trigger anxiety or depression in someone who has the genetic predisposition already. 

A Word From Verywell

If you think this may sound like your child, or if you have any concerns, a good place to start is to just speak to your pediatrician. It can never hurt to have this conversation and potentially get your child help sooner than later.

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Additional Reading
  • Leslie D. Leve, Hyoun K. Kim, and Katherine, C. Childhood Temperament and Family Environment as Predictors of Internalizing and Externalizing Trajectories from Age 5 to 17. Journal of Abnormal Child Psychology. October 2005; 33(5): 505-520.
  • Reynolds, William M. Introduction to the Nature and Study of Internalizing Disorders in Children and Adolescents. School Psychology Review. 1990; 19(2): 137.
  • Tawnyea L. Bolme-Lake. Predicting Internalizing Problems in At-Risk Children and Adolescents. Dissertation. Dissertation.com; 2007.
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