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 generally not disruptive to others, unlike externalizing behaviors.

Typical Internalizing Behaviors

Examples of internalizing behaviors include:

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  • Being withdrawn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

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.

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.
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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.; 2007.

By Lauren DiMaria
Lauren DiMaria is a member of the Society of Clinical Research Associates and childhood psychology expert.