Issues relevant to refugee children and adolescents

There are currently over 25 million displaced children. Because of the admirable resilience of these children and the varied way in which they present their symptoms, extra care should be taken in the assessment stage.

Despite their resilience, many experience mental health difficulties that only manifest some time after settling. In particular, PTSD may present 2-3 years after migration when the child/adolescent has developed trust in their surroundings.

Young refugees are frequently subjected to multiple traumatic events before and during their migration journey. These may include the loss of parents and siblings, extended family, friends, security and homes, as well as witnessing or experiencing extreme trauma. Ongoing stressors within the host country may exacerbate previous stress. Children are also vulnerable to the intergenerational transmission of trauma. The Cambodian and Vietnamese refugees (and some Laotians) who resettled in New Zealand in the 1970s and 1980s were a highly traumatised group and they have tended not to seek mental health intervention for a variety of reasons. So a migration history for Southeast Asian children and adolescents who present in New Zealand healthcare would be important. Some of these children may be carrying burdens of the unresolved issues of their parents and grandparents.

An awareness of relevant risk and protective factors is important. Commonly reported issues include PTSD, grief, depression, anxiety, sleep disorders, somatic complaints, conduct disorder, social withdrawal, attention problems, generalised fear, over-dependency, restlessness and irritability. In New Zealand substance abuse is a problem amongst refugee adolescents, and PTSD, depression and anxiety disorder are recognised as co-morbid features. Despite treatment, reoccurrence is common.

Refugee children are often reticent to discuss past traumas and choose to focus on the future. This should not be discouraged because a future-orientated view has been associated with lower rates of depression in refugees (Beiser & Hyman, 1997).

Please note: A significant proportion of refugees settled in New Zealand from the 1990s to the present (2012) originate from African, Middle Eastern and West Asian (Iran, Afghanistan) countries and therefore working with refugees is covered in more detail in the supplementary resource 'Working with Middle Eastern and African clients in mental health'. Some brief pointers for working with Asian children and adolescents are added here to include those children from refugee backgrounds who are from Asian backgrounds (including: Indo-Chinese groups from Cambodia, Vietnam and Laos; Sri Lankan Tamils; Nepali-speaking Bhutanese or "Lhotsampas", and Burmese groups). This serves to remind the practitioner to investigate the client's migration/refugee experience and ethno cultural background and to orient care accordingly.