Children with headache also have more internalizing disorders, particularly major depression [29] and anxiety [30, 31], than headache-free controls.
Boys with ADHD have been found to have more externalizing disorders than normal developing boys, while females tend to show more internalizing disorders in comparison to normal developing girls [ 3, 5, 9].
Andrasik [52] confirms these data finding that children that are more depressed express a greater number of somatic complaints and experiencing more internalizing behaviour disorders, such as anxiety and mood disorders.
These findings may support the differential psychopathology theory, which explains gender differences in terms of occurrence of suicidal thoughts and non-fatal suicide attempts by different rates of psychopathology with females suffering more from internalizing disorders [ 13, 20, 43].
However, there is a sex (or gender) difference in this vulnerability, with females being more prone to developing internalizing disorders and males being more likely to engage in risky behavior and drug use.
The results confirm that adolescents living with a highly psychologically distressed parent were more likely to exhibit internalizing disorders and externalizing disorders.
In general, externalizing disorders have been associated with a more negative outcome than internalizing disorders [ 16, 19, 20], with the worst outcomes being reported for co-morbid states of these disorders [ 20- 22].
With older children, parents and teachers agree more on externalizing than internalizing disorders, as might be expected because observable behavior is easier to detect than internal states [ 5, 16– 16].
Of 13 randomized clinical controlled trials included in a recent meta-analysis, psychotherapy and psychosocial support showed beneficial effects on PTSD in adults, while group psychotherapy, psychosocial and school based support showed, more generally, benefits on children with internalizing disorders [ 4].
Indeed, this is in line with the findings from other studies using the CATS, which have found that children with internalizing disorders (anxiety and depression) report more negative thoughts concerning Physical threat, Social threat, and Failure, while children with behavior disorders score higher on Hostile intent (Schniering and Rapee 2002).
The additional assessment of the SAHA measuring internalizing symptoms increased the accuracy to detect internalizing disorders among Moroccan-Dutch youth.
