Depression Symptoms Internalizing Behaviors and Depression in Children By Lauren DiMaria Lauren DiMaria LinkedIn Lauren DiMaria is a member of the Society of Clinical Research Associates and childhood psychology expert. Learn about our editorial process Updated on November 26, 2020 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Rachel Goldman, PhD, FTOS Medically reviewed by Rachel Goldman, PhD, FTOS Facebook LinkedIn Twitter Rachel Goldman, PhD FTOS, is a licensed psychologist, clinical assistant professor, speaker, wellness expert specializing in eating behaviors, stress management, and health behavior change. Learn about our Medical Review Board Print Blend Images - KidStock/Getty Images Table of Contents View All Table of Contents Typical Internalizing Behaviors How to Identify Symptoms Association With Depression When to Seek Help Treatment for Depression Treatment for Anxiety Causes of Depression and Anxiety A Word From Verywell Internalizing behaviors are common among depressed children. These behaviors are quiet and often invisible because they are generally not disruptive to others, unlike externalizing behaviors. Typical Internalizing Behaviors Examples of internalizing behaviors include: Being nervous or irritableBeing withdrawnEating more or less than usualFeeling afraidFeeling lonelyFeeling sadFeeling unloved or unwantedHaving concentration problemsHeadaches, stomachaches, and other physical symptoms that are not related to any physical illnessNot talking Sleeping more or less than usual While these behaviors are similar to those seen in children with depression, they do not necessarily mean your child is depressed. How to Identify Symptoms A child with internalizing symptoms keeps their feelings inside, which may manifest in symptoms such as: Unexplained physical symptoms Social withdrawal Suicidal thoughts or behaviors If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 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 historically 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 that 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. These steps 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 them. 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. The Best Online Therapy Programs for Kids Treatment for Anxiety Like depression, anxiety in children is also treated with either medication, psychotherapy, or some combination of both. Some kids have both depression and an anxiety disorder; 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 a 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 speaking to your pediatrician. It can never hurt to have this conversation and potentially get your child help sooner than later. 9 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Liu J, Chen X, Lewis G. Childhood internalizing behaviour: Analysis and implications. J Psychiatr Ment Health Nurs. 2011;18(10):884–894. doi:10.1111/j.1365-2850.2011.01743.x Tingstedt O, Lindblad F, Koposov R, et al. Somatic symptoms and internalizing problems in urban youth: A cross-cultural comparison of Czech and Russian adolescents. Eur J Public Health. 2018;28(3):480–484. doi:10.1093/eurpub/cky001 Rubin KH, Coplan RJ, Bowker JC. Social withdrawal in childhood. Annu Rev Psychol. 2009;60:141–171. doi:10.1146/annurev.psych.60.110707.163642 Piqueras JA, Soto-Sanz V, Rodríguez-Marín J, García-Oliva C. What is the role of internalizing and externalizing symptoms in adolescent suicide behaviors?. Int J Environ Res Public Health. 2019;16(14):2511. doi:10.3390/ijerph16142511 Chaplin TM, Aldao A. Gender differences in emotion expression in children: A meta-analytic review. Psychol Bull. 2013;139(4):735–765. doi:10.1037/a0030737 Cheung AH, Kozloff N, Sacks D. Pediatric depression: An evidence-based update on treatment interventions. Curr Psychiatry Rep. 2013;15(8):381. doi:10.1007/s11920-013-0381-4 Creswell C, Waite P, Cooper PJ. Assessment and management of anxiety disorders in children and adolescents. Arch Dis Child. 2014;99(7):674–678. doi:10.1136/archdischild-2013-303768 Dunn EC, Brown RC, Dai Y, et al. Genetic determinants of depression: Recent findings and future directions. Harv Rev Psychiatry. 2015;23(1):1–18. doi:10.1097/HRP.0000000000000054 Liu Y, Zhao J, Guo W. Emotional roles of mono-aminergic neurotransmitters in major depressive disorder and anxiety disorders. Front Psychol. 2018;9:2201. doi:10.3389/fpsyg.2018.02201 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. By Lauren DiMaria Lauren DiMaria is a member of the Society of Clinical Research Associates and childhood psychology expert. 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