Child Psychiatry and Early Intervention: II. The Internalizing Disorders^*

Abstract

This paper uses the concepts introduced in the paper Child Psychiatry and Early Intervention: I. The Aggregate Burden of Suffering to review the internalizing disorders of childhood. This review surveys the internalizing disorders from the point of view of early intervention, for their prevalence, course, risk, early indicators, associated impairment, and responses to intervention. In general, the internalizing disorders have little effect on the community. When coupled with other disorders such as conduct disorder, or when dealing with suicide, the community's concern for these disorders increases and allocation of resources to target populations who are at risk becomes an important public health goal.

Mental Health Promotion and Early Intervention in Early Childhood and Primary School Settings: A Review

“…Signs include high novelty seeking, low harm avoidance, and irritable distress (Beitchman, Inglis, & Schachter, 1992b;Bernstein, Borchardt, & Perwien, 1996), along with argumentativeness, non-compliance, and difficulty analysing and anticipating consequences and learning from past behaviour (Holmes, Slaughter, & Kashani, 2001). Socioeconomic disadvantage has also been associated with the development of these externalising disorders, although the exact nature of this relationship is still unclear (Beitchman, Inglis, & Schachter, 1992a;Holmes, Slaughter, & Kashani, 2001). …”

“…Key indicators displayed by young children at risk of these conditions include extreme shyness, timidity, fear, withdrawal and avoidance of new situations, anxious or fearful distress, and signs of emotional restraint around unfamiliar people, places and activities (Beitchman, Inglis, & Schachter, 1992a;Bernstein, Borchardt, & Perwien, 1996;Donovan & Spence, 2000). Correlates of depressive and anxious disorders in childhood also include the experience of adverse life events, and an absence of peers in whom to confide (Burns, Andrews, & Szabo, 2002;Lagges & Dunn, 2003;Wolff, 1995).…”

“…Correlates of depressive and anxious disorders in childhood also include the experience of adverse life events, and an absence of peers in whom to confide (Burns, Andrews, & Szabo, 2002;Lagges & Dunn, 2003;Wolff, 1995). Parents who tend to model, prompt and reinforce anxious behaviours in their children, who exhibit signs of over-control, over-protection, and anxious behaviours in themselves, also place their children at high risk of developing an internalising disorder (Beitchman, Inglis, & Schachter, 1992a;Bernstein, Borchardt, & Perwien, 1996;Donovan & Spence, 2000). Teachers and parents can misinterpret or even miss anxious or depressive behaviours in children, given that these symptoms often lead to a child being compliant and nondisruptive (Holmes, Slaughter, & Kashani, 2001).…”

“…Teachers and parents can misinterpret or even miss anxious or depressive behaviours in children, given that these symptoms often lead to a child being compliant and nondisruptive (Holmes, Slaughter, & Kashani, 2001). These risk factors will have a cumulative effect on the young child, and are magnified in the context of early childhood adversity, parental depression and non-supportive school and family environments (Beitchman, Inglis, & Schachter, 1992a;Burns, Andrews, & Szabo, 2002). In contrast, the risk factors for disruptive behavioural (or externalising) disorders, are associated with behavioural disinhibition (Bernstein, Borchardt, & Perwien, 1996).…”

“…Further, childhood aggression and poor peer relationships during preschool years is predictive of delinquency, substance use, and poor academic achievement in later childhood and adolescence. It often leads to aggressive children seeking out friendships with other rejected children who may reinforce these behaviours (Beitchman, Inglis, & Schachter, 1992a). …”