ABSTRACT
26Most parents and teachers do not notice signs of internalizing mental health conditions like anxiety or depression in early childhood. It’s common for many parents to expect for their children to grow out of their maladaptive behaviors as they get older. On the other hand, adults usually do not recognize early signs of internalizing issues because many children who deal with sadness or anxieties do not demand much attention from grownups; they are usually quiet and complaisant. Furthermore, young children who begin experiencing conflicting and often confusing emotions are simply not able to fully understand the range and complexity of their own feelings and thoughts, and so are not necessarily able to articulate how they feel. These reasons make professionals reluctant to make a definitive diagnosis of a child who may be experiencing mental health issues.
I was first aware of my depression when I was twelve. It wasn’t that I hadn’t experienced symptoms of depression before; I just didn’t have the words or understanding to express how I felt when I was younger. But when I was in seventh grade—at a new school, getting grades for the first time, deep in the throes of puberty—I could finally label the complex feelings of anger, self-hatred, self-doubt, and sadness that pulsed through me since early childhood. Yes, part of it was entering preteen years, but part of it was also the beginnings of my mental health issues and their manifestations. It took me years to realize that I’d been dealing with anxiety and depression simultaneously for several years.
Undoubtedly, if you ask my parents, they may be able to reflect back and recognize some signs of anxiety that were there from an early age—what likely they didn’t realize were signs of childhood depression. As a preteen, I was convinced I was able to hide away how I felt so no one would worry about me. But I hadn’t developed those kinds of defense mechanisms until I was about nine or ten. The years before then are an open and blank book—one that might have much to tell, if it could have been read.
—NJ Michael Rutter, a pioneer in the field of developmental psychiatry, has written extensively about risk and resilience mechanisms and factors that can amplify or mitigate mental health issues in children. He talks about the underlying biomarkers (biological markers)—objective and quantifiable characteristics of biological processes indicative of a condition, disorder, or disease—or genetic mechanisms that are common or connected in many existing psychiatric disorders. Unfortunately, most biomarkers are unknown, because there is usually a mix of multiple genetic and multiple environmental factors that work 27together to manifest a disorder—which vary from individual to individual (1). We’ll talk a bit more about the biomarkers and biology related to trauma specifically in the next chapter. In addition, what happens during someone’s life usually influences the developmental course and expression of a mental and/or physical condition through time; in other words, mental health issues in children can change with age and over time. A child may display one or more maladaptive behaviors together or at different periods during their childhood, further complicating the matter.