Cognitive assessment of refugee children: Effects of trauma and new language acquisition

Adaptative Skills and Global Functioning of Unaccompanied Migrant Minors in Europe: A Systematised Review

Objectives

This systematised review aimed to examine European literature reporting data about adaptative skills and global external functioning of unaccompanied minors (UAMs).

Methods

We conducted a systematised screening of four databases (APA PsycINFO Ovid, Medline Ovid ALL, Embase.com and Web Of Science Core Collection) using a research strategy including social, scholarly and behavioural abilities as well as externalising problems associated with the target population of UAMs. Thirty articles were included using pre-defined inclusion and exclusion criteria.

Results

Our review showed that despite high levels of internalising disorders, socio-behavioural and educational adjustment of UAMs remained positive. It demonstrated how this population displays a strong desire for academic success and prosocial behaviours instead of aggressivity in everyday life. Nevertheless, our review drew attention to the strong tendency of UAMs to internalise their disorders and display chronic distress and problematic behaviours which increased with time spent in the host country.

Conclusion

Our study draws attention to the risk of underestimating the real mental health needs of refugees, due to preserved external functioning combined with significant settlement pressures.

Differences in Well-Being at School Between Young Students With and Without a Refugee Background

Students with a refugee background are a vulnerable group in education. Adverse experiences and unsafe circumstances that they encounter prior, during and after their flight can place a great burden on their mental health and psychological well-being. Little is known about the psychological well-being of young refugee students in kindergarten and early years of primary school. The current study examined the psychological well-being of 4- to 8-year-old students with a refugee background residing in the Netherlands (n = 136), compared to Dutch peers without a refugee background (n = 406). Primary school teachers completed three questionnaires which assessed multiple indicators of their students' psychological well-being: Strengths and Difficulties Questionnaire (SDQ), Social-Emotional Questionnaire (SEV) and Risk and Protective factors Trauma Observation School Situations (RaPTOSS). In line with the hypothesis, results showed overall lower psychological well-being among refugee students compared to non-refugee students. Teachers observed more total difficulties in socio-emotional functioning, anxious and mood disturbing behavior, ADHD symptoms, problematic social behavior and post-traumatic stress symptoms (small effects), and less developed trauma protective factors and prosocial behavior (medium effects) among students with a refugee background compared to their non-refugee peers. However, the findings also demonstrated that half of the refugee students did not have any scores that fall in the clinical range of the psychological and behavioral problems assessed. The results underline the need to promote protective factors such as positive self-image, self-regulation skills, safety and relations in the classroom and prosocial behavior among students with a refugee background.

Young children's development after forced displacement: a systematic review

OBJECTIVES

To examine the impact of displacement experiences on 0- to 6-year-old children's social-emotional and cognitive development, as well as influencing factors on reported outcomes.

STUDY DESIGN

We systematically searched MEDline, Psyndex, Cochrane Library, Web of Science, Elsevier, TandF, Oxford Journal of Refugee Studies, Journal of Immigrant & Refugee Studies, and Canada's Journal on Refugees for existing literature regarding social-emotional and cognitive outcomes in children directly exposed to forced displacement due to political violence. Results were synthesized in the discussion and displayed using harvest plots.

RESULTS

Our search generated 9,791 articles of which 32 were selected for review and evaluation according to NICE criteria. Included studies provided results for 6,878 forcibly displaced children. Measured outcomes were diverse and included areas such as peer relations, prosocial behavior, family functioning, play, intelligence, learning performance, and language development. Repeated exposure to adverse experiences, separation from parents, parental distress, as well as duration and quality of resettlement in the host country were reported as influencing factors in the reviewed studies.

CONCLUSION

As protective factors like secure and stable living conditions help to promote children's development, we call for policies that enhance participation in the welcoming society for refugee families. Early integration with low-threshold access to health and educational facilities can help to mitigate the wide-ranging negative consequences of forced displacement on young children's development.

Envisioning the future for families running away from war: Challenges and resources of Ukrainian parents in Italy

Since February 2022, 7.8 million people have left Ukraine. In total, 80% are women and children. The present quali-quantitative study is the first in Italy to (i) describe the adaptation challenges and the resources of refugee parents and, indirectly, of their children and (ii) investigate the impact of neuropsychopedagogical training on their wellbeing. The sample includes N = 15 Ukrainian parents (80% mothers, mean age = 34 years) who arrived in Italy in March and April 2022. The parents participated in neuropsychopedagogical training within the program Envisioning the Future (EF): the 10 Keys to Resilience. Before the training, participants completed an ad hoc checklist to detect adjustment difficulties. After the training, they responded to a three-item post-training questionnaire on the course and to a semi-structured interview deepening adaptation problems, personal resources, and the neuropsychopedagogical training effects. Participants report that since they departed from Ukraine, they have experienced sleep, mood, and concentration problems, and specific fears, which they also observed in their children. They report self-efficacy, self-esteem, social support, spirituality, and common humanity as their principal resources. As effects of the training, they report an increased sense of security, quality of sleep, and more frequent positive thoughts. The interviews also reveal a 3-fold positive effect of the training (e.g., behavioral, emotional-relational, and cognitive-narrative).

Addressing Mental Health and Trauma-Related Needs of Sheltered Children and Families with Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT)

Children and adolescents ("youth") experiencing homelessness are at a disproportionately high risk of exposure to potentially traumatic events (PTE). However, limited evidence exists as to what interventions are effective when implemented with this high-risk population. The purpose of this study was to (1) document the mental health and trauma-related needs of sheltered youth and their mothers, and (2) examine the feasibility/effectiveness of Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) administered within the context of a homeless shelter. Three hundred and twenty-one youth (Mage = 10.06 years, SD = 3.24 years, 56.4% male, 70.1% Black/African American, 34.6% Hispanic/Latinx) and their mothers were recruited from a homeless shelter and provided 10 weeks of TF-CBT, with the option for up to eight additional weeks of therapy based on clinical need. Families completed pre- and post-intervention assessments. Results demonstrated clinically elevated pre-intervention PTSD symptoms and rates of exposure to PTE in sheltered youth well above those previously reported in the general population. TF-CBT resulted in substantial reductions in both maternal and self-reported severity of youth PTSD symptomology, which were largely attributable to reductions in re-experiencing and arousal. Effectiveness of TF-CBT varied by age and the number of exposures to PTE. Overall, these findings illustrate the importance of assessing and addressing the mental health and trauma-related needs of sheltered youth and the feasibility and efficacy of embedding an evidence-based trauma-focused treatment protocol within a shelter environment. Additional implications of these findings are discussed.

Perspectives and feelings of refugee children from Syria and Iraq about places and relations as they resettle in Australia

Refugee children's experiences are situated in specific places where they interact with significant people. They are not usually asked about their perspectives although they are social agents with distinctive perspectives and feelings about relationships and events. We investigated the perspectives of refugee children on their experiences of places and relations as they resettled in Australia after their families fled from violence in Syria and Iraq and transitioned through Middle Eastern countries. One hundred-and-nine children chose to work with a computer program in either English or Arabic. They sorted feelings associated with home, school, and where they lived before and rated being nurtured at home. Hierarchical cluster analysis revealed five subgroups of children with distinctive patterns in their sorting of eight feelings for three places. Three subgroups had patterns of positive feelings about home and school. Two smaller subgroups had mixed, ambivalent feelings about either school or home. One subgroup was strongly positive, and two others were negative about before settlement. Subgroups identified on their sortings of feelings differed in their experiences of being nurtured, with positive feelings of places related to higher ratings of being nurtured at home. The study points to the importance of children's perspectives and feelings in how they interpret experiences with people and places and argues against assuming that refugee children are homogeneous in their experiences or perspectives.

Effects of Occupational Therapy via Telerehabilitation on Occupational Balance, Well-Being, Intrinsic Motivation and Quality of Life in Syrian Refugee Children in COVID-19 Lockdown: A Randomized Controlled Trial

We aimed to evaluate the effects of an occupational training program via telerehabilitation on well-being (WB), occupational balance (OB), intrinsic motivation (IM), and quality of life (QoL) in Syrian refugee children resettled in Turkey during the COVID-19 pandemic. This was a single-center, prospective, randomized, non-blinded trial in which children aged 13-15 years and attending a secondary school were recruited. OB, WB, IM, and QoL were evaluated via the OB Questionnaire (OBQ11), the Well-Star Scale (WSS), the IM Scale (IMS), and the Pediatric Quality of Life Inventory (PedsQL). The intervention group attended online occupational therapy classes. Online classes were carried out as five sessions per week, each session lasting 1 h, for 3 weeks. Questionnaires were performed at the outset of the study and following the training program. Overall, 52 refugee children were randomized into the intervention and control groups, each including 26 children. The mean OBQ11, WSS, IMS, and PedsQL scores significantly improved more in the intervention group than in the control group. This was the first study investigating the effects of a customized online training course on OB, WB, IM, and QoL in Syrian refugee children, also affected unfavorably by the COVID-19 lockdown. Our results showed significant improvements in all the study scales that we used to quantify the alterations in the aforementioned traits.

Special Needs Assessment in Bilingual School-Age Children in Germany

Educational and (psycho-)linguistic research on L1 and L2 acquisition in bilingual children sketches them as a group of language learners varying in many aspects. However, most studies to date have based evaluations of language proficiency or new assessment tools on data from heritage children, while studies on the appropriateness of assessment tools for school-age refugee children remain a notable exception. This study focuses on the standardized assessment tool BUEGA for primary school children, which is, among others, a widespread tool for the assessment of pedagogical support or special needs (SN) in Germany. We compare the performance of 12 typically developing monolinguals (MoTD: 7;3–12;1), 14 heritage-bilinguals (BiTD: 7;1–13;4, L1 Turkish and Arabic), 12 refugee- students (BiTD: 8;7–13;1, L1 Arabic), and 7 children with developmental language disorders (DLD: 7;7–13;9) on the subtests of grammar, word-reading, and spelling. Overall results show that refugee-BiTDs perform in the (monolingual) pathology range. No significant differences emerged between students with DLD and typically developing (TD) refugee students. Considering the assessment of school-related language performance, bilingual refugees are at risk of misdiagnosis, along with the well-known effects of educational disadvantage. This particularly applies to children with low socioeconomic status (SES). Looking beyond oral language competencies and using test combinations can help exclude language disorders in school-age children with limited L2 proficiency.

Polytraumatization in young male refugees from the Middle East and its association with internalizing and externalizing symptoms

BACKGROUND

Young Middle Eastern male refugees are currently among the most vulnerable groups in Europe. Most of them have experienced potentially traumatic events (PTEs) such as rape, torture, or violent assaults. Compared to their peers, young refugees suffer more from internalizing and externalizing symptoms, especially when unaccompanied. Little is known about the cumulative impact of experiencing different types of PTEs on mental health outcomes (polytraumatization) of young male refugees from the Middle East. We investigated (1) whether there is a dose-response relationship between multiple PTE types experienced and mental health outcomes, (2) whether individual types of PTEs are particularly important, and (3) to what extent these are differentially associated with mental health outcomes among unaccompanied or accompanied peers.

METHODS

In total, 151 young Middle Eastern male refugees in Germany (M_age = 16.81 years, SD_age = 2.01) answered questionnaires on PTEs, mental health, and post-migration stress.

RESULTS

Hierarchical regression analyses revealed, while controlling for age, duration of stay, unaccompanied status, and post-migration stress, (1) a dose-effect between PTE types on both internalizing and externalizing symptoms. Moreover, (2) regarding internalizing symptoms, violent family separation and experiencing life-threatening medical problems were particularly crucial. The latter was driven by unaccompanied refugees, who also reported higher levels of substance use.

CONCLUSIONS

The results extend findings from the literature and suggest that not only may greater polytraumatization be related to greater depression among refugees, but also to a range of other mental health outcomes from the internalizing and externalizing symptom domains. Furthermore, the results highlight the mental health risks that unaccompanied and accompanied refugee adolescents face after exposure to PTEs, and provide information for practitioners as well as researchers about event types that may be particularly relevant.

Working memory and emotional interpretation bias in a sample of Syrian refugee adolescents

The number of adolescent refugees around the world has been continuously increasing over the past few years trying to escape war and terror, among other things. Such experience not only increases the risk for mental health problems including anxiety, depression, and post-traumatic stress disorder (PTSD), but also may have implications for socio-cognitive development. This study tested cognitive-affective processing in refugee adolescents who had escaped armed conflict in Syria and now resided in Istanbul, Turkey. Adolescents were split into a high trauma (n = 31, 12 girls, mean age = 11.70 years, SD = 1.15 years) and low trauma (n = 27, 14 girls, mean age = 11.07 years, SD = 1.39 years) symptom group using median split, and performed a working memory task with emotional distraction to assess cognitive control and a surprise faces task to assess emotional interpretation bias. The results indicated that high (vs. low) trauma symptom youth were ~ 20% worse correctly remembering the spatial location of a cue, although both groups performed at very low levels. However, this finding was not modulated by emotion. In addition, although all youths also had a ~ 20% bias toward interpreting ambiguous (surprise) faces as more negative, the high (vs. low) symptom youth were faster when allocating such a face to the positive (vs. negative) emotion category. The findings suggest the impact of war-related trauma on cognitive-affective processes essential to healthy development.

Undiagnosed Phenylketonuria Can Exist Everywhere: Results From an International Survey

Many countries do not have a newborn screening (NBS) program, and immigrants from such countries are at risk for late diagnosis of phenylketonuria (PKU). In this international survey, 52 of 259 patients (20%) with late diagnosed PKU were immigrants, and 145 of the 259 (55%) were born before NBS or in a location without NBS.

Mental Health of Refugee and Non-refugee Migrant Young People in European Secondary Education: The Role of Family Separation, Daily Material Stress and Perceived Discrimination in Resettlement

While scholarly literature indicates that both refugee and non-refugee migrant young people display increased levels of psychosocial vulnerability, studies comparing the mental health of the two groups remain scarce. This study aims to further the existing evidence by examining refugee and non-refugee migrants' mental health, in relation to their migration history and resettlement conditions. The mental health of 883 refugee and 483 non-refugee migrants (mean age 15.41, range 11-24, 45.9% girls, average length of stay in the host country 3.75 years) in five European countries was studied in their relation to family separation, daily material stress and perceived discrimination in resettlement. All participants reported high levels of post-traumatic stress symptoms. Family separation predicted post-trauma and internalizing behavioral difficulties only in refugees. Daily material stress related to lower levels of overall well-being in all participants, and higher levels of internalizing and externalizing behavioral difficulties in refugees. Perceived discrimination was associated with increased levels of mental health problems for refugees and non-refugee migrants. The relationship between perceived discrimination and post-traumatic stress symptoms in non-refugee migrants, together with the high levels of post-traumatic stress symptoms in this subsample, raises important questions on the nature of trauma exposure in non-refugee migrants, as well as the ways in which experiences of discrimination may interact with other traumatic stressors in predicting mental health.

School performance of children whose parents suffered torture and war-a register-based study in Denmark

BACKGROUND

Young refugees and descendants of refugees have different preconditions for learning than their peers without refugee background. Children growing up in families where parents have suffered torture and war trauma may represent a particularly vulnerable group. This study investigates whether children of torture survivors living in Denmark achieved different test scores throughout primary and secondary school compared to children of non-traumatized parents.

METHODS

Using data from a national school test programme, tests from Grades 2-8 were compared for children whose parents had been treated for torture and war trauma as to their peers. Referral to specialized rehabilitation clinics was used to identify the traumatized parent group. The mean score difference was estimated using multilevel linear regression, and outcomes were measured within groups of parental region of origin to allow for region-specific effects. The odds of missing a test were also estimated with multilevel logistic regression.

RESULTS

The study included 854 467 children [median age (interquartile range) =12 (3.3)] of which 7809 were children of the trauma-exposed parents. The analysis revealed that children of torture survivors achieved test scores between -6% (95% CI: -0.13, 0.00) and -38% (95% CI: -0.44, -0.32) of a standard deviation compared to children of non-traumatized parents, adjusted for the main effect of region of origin. They were also more likely to miss a test [OR=4.95 (95% CI: 4.30, 5.71)].

CONCLUSIONS

The findings indicate that risk factors for poorer school performance cluster in children of traumatized refugee parents, and reveal the possible adverse educational effects of trauma across generations.

A Full Systematic Review on the Effects of Cognitive Behavioural Therapy for Mental Health Symptoms in Child Refugees

Global conflict in 2019 created record numbers of displaced children. These children have experienced multiple traumas and subsequently suffer high levels of mental health symptoms. Cognitive-behavioural therapy (CBT) is commonly used for post-traumatic stress disorder (PTSD), depression and anxiety, however the current evidence-base of CBT in child refugees is sparse, with mixed results. This study aimed to assess the effects of CBT on symptoms of PTSD, depression and anxiety in child refugees/AS. Ethics were reviewed and granted by the University of Manchester ethics committee. Medline, Embase, Cochrane, PsycINFO and CINAHL were systematically searched. Studies were included if CBT was delivered to refugee/AS children with pre and post-intervention measures of symptoms. Sixteen studies fulfilled criteria. In all studies, mental health symptom scores post-intervention had reduced, suggesting an improvement in mental health following CBT. This reduction was statistically significant in twelve studies (p < 0.001-0.5), clinically significant in eight studies and maintained at follow-up periods. No adverse effects of CBT were identified. This is the first systematic review to focus solely on CBT in child refugee populations, with unanimously positive results. Its use is cautiously recommended, however the need for more methodologically rigorous studies in this population is highlighted.

Morphosyntactic Development in First Generation Arabic—English Children: The Effect of Cognitive, Age, and Input Factors over Time and across Languages

This longitudinal study examined morphosyntactic development in the heritage Arabic-L1 and English-L2 of first-generation Syrian refugee children (mean age = 9.5; range = 6–13) within their first three years in Canada. Morphosyntactic abilities were measured using sentence repetition tasks (SRTs) in English and Syrian Arabic that included diverse morphosyntactic structures. Direct measures of verbal and non-verbal cognitive skills were obtained, and a parent questionnaire provided the age at L2 acquisition onset (AOA) and input variables. We found the following: Dominance in the L1 was evident at both time periods, regardless of AOA, and growth in bilingual abilities was found over time. Cognitive skills accounted for substantial variance in SRT scores in both languages and at both times. An older AOA was associated with superior SRT scores at Time−1 for both languages, but at Time-2, older AOA only contributed to superior SRT scores in Arabic. Using the L2 with siblings gave a boost to English at Time−1 but had a negative effect on Arabic at Time-2. We conclude that first-generation children show strong heritage-L1 maintenance early on, and individual differences in cognitive skills have stable effects on morphosyntax in both languages over time, but age and input factors have differential effects on each language and over time.

Teaching During a Pandemic: A Model for Trauma-Informed Education and Administration

Coronavirus disease 2019 (COVID-19) realities have demanded that educators move swiftly to adopt new ways of teaching, advising, and mentoring. We suggest the centering of a trauma-informed approach to education and academic administration during the COVID-19 pandemic using the Substance Abuse and Mental Health Services Administration's (SAMHSA) guidance on trauma-informed approaches to care. In our model for trauma-informed education and administration (M-TIEA), SAMHSA's four key organizational assumptions are foundational, including a realization about trauma and its wide-ranging effects; a recognition of the basic signs and symptoms of trauma; a response that involves fully integrating knowledge into programs, policies, and practices; and an active process for resisting retraumatization. Since educators during the pandemic must follow new restrictions regarding how they teach, we have expanded the practice of teaching in M-TIEA to include both academic administrators' decision making about teaching, and educators' planning and implementation of teaching. In M-TIEA, SAMHSA's six guiding principles for a trauma-informed approach are infused into these two interrelated teaching processes, and include the following: safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice, and choice; and cultural, historical, and gender issues. M-TIEA's organizational assumptions, processes, and principles are situated within an outer context that acknowledges the potential influences of four types of intersectional traumas and stressors that may occur at multiple socioecological levels: pandemic-related trauma and stressors; other forms of individual, group, community, or mass trauma and stressors; historical trauma; and current general life stressors. This acknowledges that all trauma-informed work is dynamic and may be influenced by contextual factors.

Biological and Environmental Factors Affecting Risk and Resilience among Syrian Refugee Children

More than 21 million people globally are refugees. More than half of these (>10 million) are children, representing a highly vulnerable population. Most children experience high levels of trauma exposure, including war trauma, as well as substantial migration- and resettlement-related stress. These exposures confer risk for mental health problems, including posttraumatic stress disorder (PTSD), but their relative contributions have not been fully explicated. These effects may be modulated by the developmental timing of trauma and stress exposure: childhood trauma and stress are broadly linked to worse health outcomes across the lifespan, but the developmental specificity of these effects remains uncertain. Refugee children typically experience the trauma leading up to displacement (e.g., civil war) which often lasts for decades, and for some, followed by resettlement. Longitudinal studies that follow children through this process can provide unique insight into how these experiences of trauma, displacement, and resettlement during development impact mechanisms of risk and resilience. They can also elucidate how environmental and physiological factors may modulate the effects of trauma and stress. The present study includes two groups of families (parents and their 7- to 17-year-old children): (1) Syrian and Iraqi refugee families who experienced war-zone trauma before resettling in the United States in ~2016, and (2) Arab immigrant families who did not experience war-zone trauma prior to resettlement in the United States in ~2016. We assessed symptoms of anxiety, depression, and PTSD in refugee and immigrant children and parents. Skin conductance responses, a measure of autonomic response, saliva samples for genetic and epigenetic analyses, and information about social and environmental context, including family structure, resources, and neighborhood quality, were also collected. Refugee participants provided data at three time points spanning ~3 years following resettlement in the United States: Wave 1, within 1 month of resettlement, Wave 2, 12–24 months post resettlement, and Wave 3 planned for 24–36 months resettlement. Immigrant participants will provide data once, within 3–5 years after immigration, matching the age of Wave 1. This comparison group enables us to compare mental health and biomarkers between refugees and immigrants. Results of these comparative analyses will provide insight into the impact of war trauma versus other types of trauma and adversity on biomarkers of child mental health outcomes. Results from the longitudinal analyses will address refugee mental health trajectories over time, and, in children, across development. Initial data from Wave 1 showed high levels of anxiety in refugee children, as well as high levels of PTSD symptoms and anxiety in their parents. Together, results from these comparative and longitudinal analyses will provide insight into multiple aspects of trauma and stress exposure in refugees and immigrants, including how the developmental timing of trauma exposure impacts biomarkers and mental health across development. Our assessment of multiple factors affecting childhood mental health following trauma exposure, including familial, neighborhood and social context following resettlement may identify modifiable targets for interventions to support well-being in refugees.

Social Inclusion of Refugee and Native Peers Among Adolescents: It is the Language that Matters!

This study investigated the role of refugee status and language skills for adolescents' inclusion or exclusion decisions in hypothetical intergroup scenarios. 100 German adolescents (Mage = 13.65 years, SD = 1.93) were presented three scenarios in which groups of adolescents are planning leisure time activities, and peers from their own country (Germany) versus another country (Syrian refugees) with either good or bad German skills want to join them. Whereas adolescents' inclusion decisions did not differ between the German protagonist and the Syrian one with good German skills, the Syrian protagonist with bad German skills was less likely to be included than either of the other two. These findings have implications for understanding the role of language in adolescents' inclusion decisions.

Factors Shaping the Lived Experience of Resettlement for Former Refugees in Regional Australia

Refugees experience traumatic life events with impacts amplified in regional and rural areas due to barriers accessing services. This study examined the factors influencing the lived experience of resettlement for former refugees in regional Launceston, Australia, including environmental, social, and health-related factors. Qualitative interviews and focus groups were conducted with adult and youth community members from Burma, Bhutan, Sierra Leone, Afghanistan, Iran, and Sudan, and essential service providers (n = 31). Thematic analysis revealed four factors as primarily influencing resettlement: English language proficiency; employment, education and housing environments and opportunities; health status and service access; and broader social factors and experiences. Participants suggested strategies to overcome barriers associated with these factors and improve overall quality of life throughout resettlement. These included flexible English language program delivery and employment support, including industry-specific language courses; the provision of interpreters; community events fostering cultural sharing, inclusivity and promoting well-being; and routine inclusion of nondiscriminatory, culturally sensitive, trauma-informed practices throughout a former refugee’s environment, including within education, employment, housing and service settings.

Clinical Tools for Working Abroad with Migrants

There are an estimated 68.5 million displaced persons worldwide, about one-half of whom are under the age of 18 years. The health needs of migrants are complex and dynamic along their journey. When structuring health care services for migrants abroad, there is not a one-size-fits-all approach and programming must be adaptable, practical, relevant, sustainable, and ideally integrated into the host country's health care system. In this article, we the examine clinical and public health priorities for migrant health care abroad and practical resources for health care professionals who wish to put their ideals into practice in the field.

Parental PTSD and school performance in 16-year-olds - a Swedish national cohort study

Aim: Posttraumatic stress disorder (PTSD) in parents can have severe consequences also for their children. Prevalence of PTSD is high among refugees. Refugee children have been reported to perform poorly in school. The aim of this study was to investigate the impact of PTSD in refugee and native Swedish parents on children's school performance and to compare the impact of PTSD with that of other major psychiatric disorders. Methods: Register study where multiple regression models were used to analyse school performance in 15-16-year-olds in a national cohort (n = 703,813). PTSD and other major psychiatric disorders (bipolar, depression and/or psychotic disorders) were identified from out- and in-patient hospital care. Results: Maternal and paternal PTSD were associated with lower grades, with adjusted effects of 0.30-0.37 SD in refugee and 0.46-0.50 SD in native Swedish families. Impact of PTSD was greater than that of other psychiatric disorders and comorbidity to PTSD did not increase this impact. Although the impact of PTSD on grades was greater in children in native Swedish families, consequences with regard to eligibility to secondary education were greater for children in refugee families, where 35% of these children were ineligible. Conclusions: Parental PTSD has major consequences for children's school performance and contributes to the lower school performance in children in refugee families in Sweden. Identification and treatment of PTSD in refugee parents is important for offspring educational achievement. Psychiatric clinics and treatment centres need to have a strategy for support, including educational support, to the offspring of their patients with PTSD.

Society, individual, family, and school factors contributing to child mental health in war: The ecological-theory perspective

Mental health problems are common in war-affected areas, but children have different levels of vulnerability. Based on ecological theory (Bronfenbrenner, 2005), this study analyses how factors related to the child (cognitive capacity), their family (parental depression and parenting styles), and their school (teachers' practices and peer relations) mediate the association between traumatic stress (traumatic war experiences and stressful life-events) and child mental health (posttraumatic stress and psychological distress symptoms). The participants were 303 Palestinian children (51.2% girls) of 10-13 years (M = 10.94 ± 0.50) and their parents from the Gaza Strip. The children filled in questionnaires during school classes and the parents did so at their homes. The results of structural equation modeling substantiated the hypothesis that parental depression, poor parenting and low-quality peer relations mediated between traumatic stress and children's mental health problems. Contrary to the hypothesis, child-related factors did not mediate that association. To conclude, parents and peers provide important age-salient social resources for children in war conditions, and psychosocial interventions should therefore enhance their beneficial functions.

Psychological and psychosocial interventions for refugee children resettled in high-income countries

Large numbers of refugee children are arriving in high-income countries. The evidence to date suggests that they have mental health needs that are higher than for the general population and that these are exacerbated by the numbers of traumatic events they have experienced and the post-migration stressors they continue to be exposed to. The importance of a thorough and thoughtful assessment is discussed. Treatments of note are described for post-traumatic stress disorder, family functioning, general mental health problems and school environments. Future opportunities to operationalise outcome measures, develop multimodal interventions and utilise implementation science methodology are considered.

Supporting the developmental health of refugee children and youth

The Canadian Government has announced that over 50,000 refugees from the Middle East will be resettled in Canada by 2018. More than one-third of these refugees are expected to be children. The Canadian Paediatric Society has called for the Canadian government to prepare for the influx of these children. This should include addressing developmental, behavioural, and mental health needs. The focus of this paper is the role of paediatricians and family physicians in caring for the developmental health of refugee children, as a means of supporting their developmental and learning potential. The authors suggest the use of EMPOWER (Education, Migration, Parents and Family, Outlook, Words, Experience of Trauma and Resources), a mnemonic checklist they developed for assessing developmental risk factors in refugee children. EMPOWER can be used along with online web resources such as Caring For Kids New to Canada in providing evidence-informed care to these children.

Effects of Psychiatric Symptoms on Attention in North Korean Refugees

OBJECTIVE

We investigated the performance of North Korean refugees on attention tasks, and the relationship between that performance and psychiatric symptoms.

METHODS

Sustained and divided attention was assessed using the computerized Comprehensive Attention Test in North Korean refugees and in South Koreans. All participants also completed the Beck Depression Inventory, the Beck Anxiety Inventory, the Impact of Event Scale-Revised and the Dissociative Experiences Scale-II (DES-II).

RESULTS

The North Korean refugees showed slower reaction times (RTs) on the visual sustained attention task compared to the South Koreans after controlling for age and sex. North Korean refugees had a greater number of omission errors (OEs) on the divided attention task and a higher standard deviation (SD) of RT. Total DES-II scores of the North Korean refugees were associated with the number of OEs and the SD of RT on the sustained attention task, and with the number of OEs on the divided attention task.

CONCLUSION

North Korean refugees showed poorer performance on computerized attention tasks. In addition, attention deficit among North Korean refugees was associated with their dissociative experiences. Our results suggest that refugees may have attention deficits, which may be related to their psychiatric symptoms, particularly dissociation.