Topic 2 Overview of signs and symptoms of mental health difficulties among young children and older children and adolescents, as well as an overview of early warning signs of mental health issues

Signs and symptoms of mental health difficulties among children and adolescents can be classified in to two broad categories: internalized and externalized.

The Internalized problems are defined as emotional symptoms turned toward the individual and are characterized by anxiety, depressive and somatic symptoms.

The  Externalized problems are defined as emotional symptoms turned towards individual’s surrounding and are characterized by impulsive, disruptive conduct, substance use, and other addictive symptoms.

Internalized symptoms include:

  • Being nervous or irritable
  • Withdrawing
  • Loss of pleasure in activities which previously brought joy
  • Eating more or less than usual
  • Sleeping more or less than usual
  • Feeling afraid, lonely, sad, unloved, or unwanted, feeling worthlessness or guilty
  • Low self-esteem or a negative self-image
  • Difficulty thinking, concentrating, making decisions, or remembering and difficulty completing tasks (e.g., homework)
  • Headaches, stomach aches, and other physical symptoms that are not related to any physical illness
  • Fatigue/lack of energy
  • Suicidal thoughts, intentions, plans

Externalized symptoms include:

  • Avoiding participation in social activities
  • Difficulties maintain friendships and peer rejection
  • Dysfunctional social behaviours
  • Fighting and behaving aggressively
  • Self-harm (e.g., wrist cutting)

Younger children might experience issues such as:

  • Desire of things must be done as they want
  • Social regression (loss of previously obtained social skils, like play skills and emotional expressiveness)
  • Intense preoccupation with the details of the event, wanting to always talk about what happened, hear that the event might happen again
  • Playing in violent ways
  • Hitting you or others
  • More tantrums
  • Clinginess with teachers or caregivers
  • Regression, or going back to an earlier stage of development
  • Bedwetting or other toileting issues
  • Baby talk
  • Desire to be carried or rocked
  • Having nightmares
  • Over- or under- reacting to physical contact, sudden movements, or loud sounds such as sirens and slamming doors
  • New fears and/or fears about safety

Older children and adolescents also show problems such as:

  • Frequent absence from school
  • A decline in grades
  • Defiant or disruptive behaviour; getting into arguments
  • Running away from home
  • Substance abuse
Interplay between externalised and internalised symptoms