Abstract
Internalizing symptoms are a collection of feelings, behaviors, and physiological responses associated with a host of conditions that include anxiety disorders (generalized, separation, social), depression, post-traumatic stress disorder, panic disorder, and other somatic conditions. These symptoms are highly prevalent in childhood and adolescence and have been associated with a host of negative outcomes across domains of functioning. As these symptoms are often expressed internally, identification poses a unique challenge for clinicians. In the absence of prevention or intervention efforts, internalizing symptoms can be exacerbated and lead to functional impairment that can persist into adulthood. This chapter underscores the importance of understanding and addressing internalizing symptoms in youth from an integrated behavioral health perspective. The first section of this chapter addresses the prevalence and etiology of internalizing symptoms and disorders. The second section focuses on identification, prevention, and treatment. The final section provides a case example and strategies for integrated behavioral health specific to internalizing conditions.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Alfano, C. A., Beidel, D. C., Turner, S. M., & Lewin, D. S. (2006). Preliminary evidence for sleep complaints among children referred for anxiety. Sleep Medicine, 7, 467–473.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Arruda, M. A., & Bigal, M. E. (2012). Migraine and migraine subtypes in preadolescent children: Association with school performance. Neurology, 79, 1881–1888.
Birmaher, B., Brent, D. A., Chiappetta, L., Bridge, J., Monga, S., & Baugher, M. (1999). Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED): a replication study. Journal of the American Academy of Child & Adolescent Psychiatry, 38, 1230–1236.
Beck, J. S., Beck, A. T., Jolly, J. B., & Steer, R. (2001). Beck Youth Inventories for Children and Adolescents. San Antonio, TX: Pearson.
Beesdo, K., Knappe, S., & Pine, D. S. (2009). Anxiety and anxiety disorders in children and adolescents: Developmental issues and implications for DSM-V. The Psychiatric Clinics of North America, 32, 483–524.
Birmaher, B., Khetarpal, S., Brent, D., Cully, M., Balach, L., Kaufman, J., & Neer, S. M. (1997). The screen for child anxiety related emotional disorders (SCARED): Scale construction and psychometric characteristics. Journal of the American Academy of Child & Adolescent Psychiatry, 36, 545–553.
Bittner, A., Egger, H. L., Erkanli, A., Costello, J. E., Foley, D. L., & Angold, A. (2007). What do childhood anxiety disorders predict? Journal of Child Psychology and Psychiatry, 48, 1174–1183.
Burstein, M., He, J.-P., Kattan, G., Albano, A. M., Avenevoli, S., & Merikangas, K. R. (2011). Social phobia and subtypes in the national comorbidity survey-adolescent supplement: Prevalence, correlates, and comorbidity. Journal of the American Academy of Child and Adolescent Psychiatry, 50, 870–880.
Compton, S. N., Burns, B. J., Egger, H. L., & Robertson, E. (2002). Review of the evidence base for treatment of childhood psychopathology: Internalizing disorders. Journal of Consulting and Clinical Psychology, 70,1240.
Cook, N. E., & Gorraiz, M. (2016). Dialectical behavior therapy for non-suicidal self‐injury and depression among adolescents: Preliminary meta‐analytic evidence. Child and Adolescent Mental Health, 21, 81–89.
Coplan, R. J., Girardi, A., Findlay, L. C., & Frohlick, S. L. (2007). Understanding solitude: Young children’s attitudes and responses towards hypothetically socially withdrawn peers. Social Development, 16, 390–409.
Crick, N. R., & Zahn–Waxler, C. (2003). The development of psychopathology in females and males: Current progress and future challenges. Development and Psychopathology, 15, 719–742.
Crowe, A., & Brinkley, J. (2015). Distress in caregivers of a family member with serious mental illness. The Family Journal, 23, 286–294.
David-Ferdon, C., & Kaslow, N. J. (2008). Evidence-based psychosocial treatments for child and adolescent depression. Journal of Clinical Child & Adolescent Psychology, 37, 62–104.
Donnelly, C., & Amaya-Jackson, L. (2002). Post-traumatic stress disorder in children and adolescents: Epidemiology, diagnosis and treatment options. Pediatric Drugs, 4, 159–170.
Eklund, K., Tanner, N., Stoll, K., & Anway, L. (2015). Identifying emotional and behavioral risk among gifted and nongifted children: A multi-gate, multi-informant approach. School Psychology Quarterly, 30, 197.
Fernandez-Mendoza, J., Calhoun, S. L., Vgontzas, A. N., Li, Y., Gaines, J., Liao, D., & Bixler, E. O. (2016). Insomnia phenotypes based on objective sleep duration in adolescents: Depression risk and differential behavioral profiles. Brain Sciences, 6, 59.
Georgiades, K., Lewinsohn, P. M., Monroe, S. M., & Seeley, J. R. (2006). Major depressive disorder in adolescence: The role of subthreshold symptoms. Journal of the American Academy of Child & Adolescent Psychiatry, 45, 936–944.
Gillham, J. E., Hamilton, J., Freres, D. R., Patton, K., & Gallop, R. (2006). Preventing depression among early adolescents in the primary care setting: A randomized controlled study of the Penn Resiliency Program. Journal of Abnormal Child Psychology, 34, 195–211.
Goodman, R. (2001). Psychometric properties of the strengths and difficulties questionnaire. Journal of the American Academy of Child & Adolescent Psychiatry, 40, 1337–1345.
Grover, R. L., Ginsburg, G. S., & Ialongo, N. (2007). Psychosocial outcomes of anxious first graders: A seven‐year follow‐up. Depression and Anxiety, 24, 410–420.
Guarneri-White, M. E., Jensen-Campbell, L. A., & Knack, J. M. (2015). Is co-ruminating with friends related to health problems in victimized adolescents? Journal of Adolescence, 39, 15–26.
Günther, T., Holtkamp, K., Jolles, J., Herpertz-Dahlmann, B., & Konrad, K. (2004). Verbal memory and aspects of attentional control in children and adolescents with anxiety disorders or depressive disorders. Journal of Affective Disorders, 82, 265–269.
Haby, M. M., Tonge, B., Littlefield, L., Carter, R., & Vos, T. (2004). Cost‐effectiveness of cognitive behavioural therapy and selective serotonin reuptake inhibitors for major depression in children and adolescents. Australian and New Zealand Journal of Psychiatry, 38, 579–591.
Hancock, K. M., Swain, J., Hainsworth, C. J., Dixon, A. L., Koo, S., & Munro, K. (2018). Acceptance and commitment therapy versus cognitive behavior therapy for children with anxiety: Outcomes of a randomized controlled trial. Journal of Clinical Child & Adolescent Psychology, 47(2), 296–311.
Hankin, B. L., Fraley, R. C., Lahey, B. B., & Waldman, I. D. (2005). Is depression best viewed as a continuum or discrete category? A taxometric analysis of childhood and adolescent depression in a population-based sample. Journal of Abnormal Psychology, 114, 96.
Iorfino, F., Hickie, I. B., Lee, R. S., Lagopoulos, J., & Hermens, D. F. (2016). The underlying neurobiology of key functional domains in young people with mood and anxiety disorders: A systematic review. BMC Psychiatry, 16, 156.
Jacobs, D. G. (2011). Suicide assessment five-step evaluation and triage. In Best Practices Registry (BPR) for suicide prevention (pp. 83–88). SPRC (Suicide Prevention Resource Center).
James, S., & Hale, L. (2017). Sleep duration and child well-being: A nonlinear association. Journal of Clinical Child & Adolescent Psychology, 46, 258–268.
Jellinek, M. S., Murphy, J. M., Robinson, J., Feins, A., Lamb, S., & Fenton, T. (1988). Pediatric Symptom Checklist: Screening school-age children for psychosocial dysfunction. The Journal of Pediatrics, 112, 201–209.
Kamphaus, R. W., & Reynolds, C. R. (2007). BASC-2 behavioral and emotional screening system manual. Circle Pines, MN: Pearson.
Kendall, P. C., & Hedtke, K. A. (2006). Cognitive-behavioral therapy for anxious children: Therapist manual. Ardmore, PA: Workbook Publishing.
Kilgus, S. P., Chafouleas, S. M., Riley-Tillman, T. C., & von der Embse, N. P. (2014). Social, academic, and emotional behavior risk screener (SAEBRS). Minneapolis, MN: Theodore J. Christ & Colleagues.
Koffel, E., Krebs, E. E., Arbisi, P. A., Erbes, C. R., & Polusny, M. A. (2016). The unhappy triad: Pain, sleep complaints, and internalizing symptoms. Clinical Psychological Science, 4, 96–106.
Kovacs, M. (2010). Children’s Depression Inventory, second edition (CDI-2). North Tonawanda, NY: Multi-Health Systems, Inc.
Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ‐9. Journal of General Internal Medicine, 16, 606–613.
Leffler, J. M., Riebel, J., & Hughes, H. M. (2015). A review of child and adolescent diagnostic interviews for clinical practitioners. Assessment, 22, 690–703.
Lewinsohn, P. M., Solomon, A., Seeley, J. R., & Zeiss, A. (2000). Clinical implications of “subthreshold” depressive symptoms. Journal of Abnormal Psychology, 109, 345.
March, J. S., Parker, J. D., Sullivan, K., Stallings, P., & Conners, C. K. (1997). The Multidimensional Anxiety Scale for Children (MASC): factor structure, reliability, and validity. Journal of the American Academy of Child & Adolescent Psychiatry, 36, 554–565.
Martin, J. A., Kung, H. C., Mathews, T. J., Hoyert, D. L., Strobino, D. M., Guyer, B., & Sutton, S. R. (2008). Suicidal behavior in children and adolescents: Epidemiology and risk factors. Pediatrics, 121, 788.
Mattejat, F., & Remschmidt, H. (2008). The children of mentally ill parents. Deutsches Ärzteblatt International, 105, 413.
McLoone, J., Hudson, J. L., & Rapee, R. M. (2006). Treating anxiety disorders in a school setting. Education and Treatment of Children, 29, 219–242.
Merikangas, K. R., Nakamura, E. F., & Kessler, R. C. (2009). Epidemiology of mental disorders in children and adolescents. Dialogues in Clinical Neuroscience, 11, 7–20.
Perfect, M. M., Levine‐Donnerstein, D., Archbold, K., Goodwin, J. L., & Quan, S. F. (2014). The contribution of sleep problems to academic and psychosocial functioning. Psychology in the Schools, 51, 273–295.
Perfect, M. M., Levine-Donnerstein, D., Swartz, N. E., Wheeler, L., & Amaya, G. (2011). Parents’ and diabetic adolescents’ perceptions of mental health screening, assessment, and feedback. Administration and Policy in Mental Health and Mental Health Services Research, 38, 181–192.
Posner, K., Brown, G. K., Stanley, B., Brent, D. A., Yershova, K. V., Oquendo, M. A., … Mann, J. J. (2011). The Columbia-Suicide Severity Rating Scale: Initial validity and internal consistency findings from three multisite studies with adolescents and adults. American Journal of Psychiatry, 168, 1266–1277.
Quach, J. L., Nguyen, C. D., Williams, K. E., & Sciberras, E. (2017). Bidirectional associations between child sleep problems and internalizing and externalizing difficulties from preschool to early adolescence. JAMA Pediatrics, 172(2), e174363.
Reynolds, C. R., Kamphaus, R. W., & Vannest, K. J. (2015). BASC-3: Behavior Assessment System for Children. San Antonio, TX: Pearson.
Reynolds, C. R., & Richmond, B. O. (2008). The Revised Children’s Manifest Anxiety Scale, second edition (RCMAS-2). Los Angeles, CA: Western Psychological Services.
Richardson, L. P., McCauley, E., Grossman, D. C., McCarty, C. A., Richards, J., Russo, J. E., … Katon, W. (2010). Evaluation of the Patient Health Questionnaire (PHQ-9) for detecting major depression among adolescents. Pediatrics, 126, 1117–1123.
Rubin, K. H., Coplan, R. J., & Bowker, J. C. (2009). Social withdrawal in childhood. Annual Review of Psychology, 60, 141–171.
Scharfstein, L., Alfano, C., Beidel, D., & Wong, N. (2011). Children with generalized anxiety disorder do not have peer problems, just fewer friends. Child Psychiatry & Human Development, 42, 712–723.
Shaffer, D., Fisher, P., Lucas, C. P., Dulcan, M. K., & SchwabStone, M. E. (2000). NIMH Diagnostic Interview Schedule for Children Version IV (NIMH DISC-IV): Description, differences from previous versions, and reliability of some common diagnoses. Journal of the American Academy of Child & Adolescent Psychiatry, 39, 28–38.
Shahidullah, J. D., Hostutler, C. A., & Stancin, T. (2018). Collaborative medication-related roles for pediatric primary care psychologists. Clinical Practice in Pediatric Psychology, 6, 61.
Silverman, W. K., Pina, A. A., & Viswesvaran, C. (2008). Evidence-based psychosocial treatments for phobic and anxiety disorders in children and adolescents. Journal of Clinical Child & Adolescent Psychology, 37, 105–130.
Stallard, P., Skryabina, E., Taylor, G., Phillips, R., Daniels, H., Anderson, R., & Simpson, N. (2014). Classroom-based cognitive behaviour therapy (FRIENDS): A cluster randomized controlled trial to Prevent Anxiety in Children through Education in Schools (PACES). The Lancet Psychiatry, 1, 185–192.
Van Ameringen, M., Mancini, C., & Farvolden, P. (2003). The impact of anxiety disorders on educational achievement. Journal of Anxiety Disorders, 17, 561–571.
Walkup, J. T., Albano, A. M., Piacentini, J., Birmaher, B., Compton, S. N., Sherrill, J. T., … Iyengar, S. (2008). Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. New England Journal of Medicine, 359, 2753–2766.
Wang, Z., Whiteside, S. P., Sim, L., Farah, W., Morrow, A. S., Alsawas, M., … Daraz, L. (2017). Comparative effectiveness and safety of cognitive behavioral therapy and pharmacotherapy for childhood anxiety disorders: A systematic review and meta-analysis. JAMA Pediatrics, 171, 1049–1056.
Werner-Seidler, A., Perry, Y., Calear, A. L., Newby, J. M., & Christensen, H. (2017). School-based depression and anxiety prevention programs for young people: A systematic review and meta-analysis.Clinical Psychology Review, 51, 30-47.
Whitcomb, S., & Merrell, K. W. (2013). Behavioral, social, and emotional assessment of children and adolescents. Abingdon, UK: Routledge.
Wilkinson, P. O., & Goodyer, I. M. (2006). Attention difficulties and mood‐related ruminative response style in adolescents with unipolar depression. Journal of Child Psychology and Psychiatry, 47, 1284–1291.
Wisdom, J. P., Clarke, G. N., & Green, C. A. (2006). What teens want: Barriers to seeking care for depression. Administration and Policy in Mental Health, 33, 133–145.
Woodruff-Borden, J., Morrow, C., Bourland, S., & Cambron, S. (2002). The behavior of anxious parents: Examining mechanisms of transmission of anxiety from parent to child. Journal of Clinical Child and Adolescent Psychology, 31, 364–374.
Zhou, X., Hetrick, S. E., Cuijpers, P., Qin, B., Barth, J., Whittington, C. J., … Zhang, Y. (2015). Comparative efficacy and acceptability of psychotherapies for depression in children and adolescents: A systematic review and network meta‐analysis. World Psychiatry, 14, 207–222.
Zuckerbrot, R. A., Cheung, A., Jensen, P. S., Stein, R. E., Laraque, D., & GLAD-PC STEERING GROUP. (2018). Guidelines for adolescent depression in primary care (GLAD-PC): Part I. Practice preparation, identification, assessment, and initial management. Pediatrics. https://doi.org/10.1542/peds.2017-4081. e20174081.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Frye, S.S., Perfect, M.M., Graham, J.W. (2018). Internalizing Disorders. In: Forman, S., Shahidullah, J. (eds) Handbook of Pediatric Behavioral Healthcare. Springer, Cham. https://doi.org/10.1007/978-3-030-00791-1_12
Download citation
DOI: https://doi.org/10.1007/978-3-030-00791-1_12
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-00790-4
Online ISBN: 978-3-030-00791-1
eBook Packages: Behavioral Science and PsychologyBehavioral Science and Psychology (R0)