Figure - available from: European Child & Adolescent Psychiatry
This content is subject to copyright. Terms and conditions apply.
Scatterplot illustrates the positive association between war traumatic events (y-axis) and allocation of surprise faces to the negative category (x-axis) for the low trauma symptom group (white circles, LTS) and high trauma symptom group (black circles, HTS)
Source publication
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-cog...
Similar publications
Abstract
Armed Forces doctors are often required to treat children affected in war, combat,
and disasters. Tender care & comprehensive tact is needed for children. Acquisition
of these qualities comes with knowledge, its application, and practicing skills.
Throughout history, children have been victims of armed conflict. War-related injuries are mo...
Citations
... 4243 On the contrary, low resilience has been negatively associated with adverse mental health outcomes such as loneliness, psychological distress, 4445 depression, 37 Bronfenbrenner, 1979. 38 Lazarus, 1993. 39 Masten, 2019. ...
Worldwide, the number of refugee children and youth is staggering. It is well-documented that refugee children face various types and varying extents of mental health challenges. Providing an overview of the mental health challenges that this population faces, this chapter discusses the current mental health status of refugee children through the lens of prominent psychological theories. A psychosocial approach to human development is introduced, moving beyond the traditional approach of diagnosis and treatment of mental health symptoms, adopting a holistic ecological approach targeting both risk and resilience factors that promote sustainable mental health and well-being in refugee children. Through the motivational theory of human needs, refugee children’s needs are outlined as their basic human rights, offering a rationale for comprehensive mental health services to be provided at the individual, family, and community levels. With the overarching aim of promoting complete mental health of refugee children towards a state of well-being, a system of interventions is outlined, which considers the complex needs of these children and their families. A family is a system of its own; however, it is also a subsystem within a larger societal system. A subsystem can thrive only if, at the societal level, an open-minded, prejudice-free, and tolerant approach is adopted towards refugee children and their families. Each child is primarily a child with human rights and deserves to thrive in a psychologically healthy environment to have a chance to achieve positive life outcomes.
... The relationship between neurocognitive de cits and forced displacement has been studied in adolescent refugees, revealing impairments in attention, visuo-spatial analysis, uid reasoning, language, and memory, with reported prevalence rates ranging from 23-78% [19][20][21][22][23][24]. However, the speci c impact of internal displacement on ID adolescents remains understudied, leaving, to our understanding, a knowledge gap of how such experiences potentially affect their cognitive and executive functioning. ...
Background
Internal displacement, where individuals are forced to flee their homes but remain within their country of origin, is a significant issue in conflict-affected countries like Colombia. Internally displaced (ID) adolescents experience disrupted living conditions, ongoing conflict exposure, and elevated rates of post-traumatic stress disorders (PTSD). Despite the impact of these factors on neurocognitive development, this area remains underexplored in ID adolescents. This study aims to evaluate the cognitive ability and executive functioning of Colombian ID adolescents compared to non-ID adolescents, and also examine how household income, parental education levels, and area of residence moderate the association between ID status and these skills.
Method
This observational case-control study will recruit two groups of adolescents (aged 12 to 16) from six high schools in a Colombian municipality affected by armed conflict. ID adolescents (n = 130) and non-ID adolescents (n = 130) will complete the Wechsler Intelligence Scale for Children-V (WISC-V) to assess cognitive ability and the 'Batería Neuropsicológica de Funciones Ejecutivas y Lóbulos Frontales-3' (BANFE-3) to assess executive functioning. Socioeconomic data will be collected from the municipal school database and a self-administered parental questionnaire. Regression analysis will be used to address the study objectives.
Discussion
This study will address the critical need for data on the impact of internal displacement on the cognitive and executive skills of ID adolescents. The findings will inform targeted interventions to mitigate the potential risk of cognitive impairments in these adolescents, thereby promoting their well-being, as encouraged and emphasized by international guidelines. Although this study will focus on Colombian ID adolescents, our results could benefit a broader panel of victims of internal displacement, the number of which has doubled globally in the last decade.
Trial registration
The study is preregistered on the Open Science Framework.
... Exposure to forced migration-related trauma and the development of PTSD have been associated with a range of consequences for health and well-being, such as for decreased cognitive skills (Mirabolfathi et al., 2022;Mueller et al., 2021;Scharpf et al., 2021), higher risks for psychiatric care and mortality (Dunlavy et al., 2023), and difficulties in education and employment (Borsch et al., 2019;Manhica et al., 2019). Owing to the severe consequences that post-traumatic stress symptoms (PTSS) may have on an adolescent's life, it is important to identify the most vulnerable adolescents and treat them without delay. ...
Background: High levels of post-traumatic stress are well documented among refugees. Yet, refugee adolescents display high heterogeneity in their type of trauma and symptom levels.
Objective: Following the recurrent plea for validated trauma screening tools, this study investigated the psychometric properties of the Children’s Revised Impact of Event Scale (CRIES-8) among refugee adolescents from Afghanistan (n = 148), Syria (n = 234), and Somalia (n = 175) living in Europe.
Method: The model fit for the confirmatory factor structures was tested, as well as measurement invariance between the three groups. The robustness of results was evaluated by testing measurement invariance between recently arrived and settled adolescents, and between different response labelling options. Reliability (α, ω, and ordinal α), criterion validity, and prevalence estimates were calculated.
Results: The intrusion subscale showed a better stable model fit than the avoidance subscale, but the two-factor structure was mainly supported. Configural measurement invariance was achieved between Afghan and Somali adolescents, and strong measurement invariance between Syrian and Somali adolescents. The results were robust considering the time living in the host country and response labelling styles. Reliability was low among Afghan and Syrian adolescents (.717−.856), whereas it was higher among Somali adolescents (.831−.887). The total score had medium-sized correlations with emotional problems (.303−.418) and low correlations with hyperactivity (.077−.155). There were statistically significant differences in symptom prevalence: Afghan adolescents had higher prevalence (55.5%) than Syrian (42.8%) and Somali (37%) adolescents, and unaccompanied refugee minors had higher symptom prevalence (63.5%) than accompanied adolescents (40.7%).
Conclusions: This study mostly supports the use of the CRIES-8 among adolescents from Afghanistan, Syria, and Somalia, and even comparative analyses of group means. Variation in reliability estimates, however, makes diagnostic predictions difficult, as the risk of misclassification is high.
... Another, potentially complementary, reason might be that a high degree of proactive control requires much more resources, and that stress and anxiety interfere with the ability to maintain information in working memory and hinder forward oriented planning (Braver, 2012;Filippi et al., 2021; see also Yang et al., 2018). In fact, recent work demonstrates that visual working memory is negatively impacted by trauma experience in Syrian refugee children residing in Turkey (Mueller et al., 2021), with performance levels much lower than what would be expected from non-war exposed Western samples. ...
... It is possible that the addition of a second button press (to both the first and second cue) taxed the participants working memory and that this is a reason why participants perform worse than what has been reported in prior Western contexts. At the same time, similar findings, with lower performance levels in Syrian refugee children living in Turkey, have previously been reported for visual working memory (Mueller et al., 2021), strengthening the notion that this finding is not an artifact of the current experimental task but instead a sign of the challenges that this group of children face due to their prior experiences and current living conditions. Another, possibly complementary, alternative is that the abstract nature of the stimuli were particularly challenging for the children that took part in this study, and that more ecologically relevant stimuli might have increased performance in this group (as previoulsy demonstrated with U.S. children exposed to violence and poverty: Young et al., 2022). ...
This study assesses the development of proactive control strategies in 100 Syrian refugee families (394 individuals) with 6–18-year-old children currently living in Turkish communities. The results demonstrate that children’s age and their mothers’ post-traumatic stress symptoms were associated with the degree of proactive control in their children, with worse mental health being associated with a larger reliance on reactive control and lesser reliance on proactive, future oriented, control (measured via d’ in the AX-CPT task). None of the following factors contributed to children's performance: fathers' experience with post-traumatic stress, parents' exposure to potentially traumatic war-related events, perceived discrimination, a decline in socio-economic status, religious beliefs, parents' proactive control strategies, or the education or gender of the children themselves. The association between mothers’ mental health and proactive control strategies in children was large (in terms of effect size), suggesting that supporting mothers’ mental health might have clear effects on the development of their children.
... Interestingly, children's emotion recognition was associated with harsher parenting practices, which is more prevalent in younger and more socially isolated mothers in this sample, hinting at potential mechanisms behind atypical emotion processing in refugee context (Peltonen et al., 2022). In another study, Syrian refugee adolescents were presented with happy, angry, and surprised facial expressions and instructed to label them as either positive or negative (Mueller et al., 2021). The authors found that higher trauma exposure increased the likelihood of perceiving surprised expressions as negative, suggesting that the increased number of traumatic events might be linked to a negativity bias, leading children to perceive ambiguous emotions as negative. ...
Over 36 million children are currently displaced due to war, yet we know little about how these experiences of war and displacement affect their socioemotional development—notably how they perceive facial expressions. Across three different experiments, we investigated the effects of war trauma exposure on facial emotion recognition in Syrian refugee (n = 130, Mage = 9.3 years, 63 female) and Jordanian nonrefugee children (n = 148, Mage = 9.4 years, 66 female) living in Jordan (data collected 2019–2020). Children in the two groups differed in trauma exposure, but not on any of our measures of mental health. In Experiment 1, we measured children’s biases to perceive an emotion using morphed facial expressions and found no evidence that biases differed between refugees and nonrefugees. In Experiment 2, we adapted a novel perceptual scaling task that bypasses semantic knowledge, and again found no differences between the two group’s discrimination of facial expressions. Finally, in Experiment 3, we recorded children’s eye movements as they identified Middle Eastern actors’ facial expressions, and again found no differences between the groups in either their identification accuracies or scanning strategies. Taken together, our results suggest that exposure to war-related trauma and displacement during early development, when reported by the caregiver but not always recollected by the child, does not appear to alter emotion recognition of facial expressions.
... However, it is interesting to note that Spinhoven et al. 18 identified a negative association between the level of trauma and the number of inconsistencies in memory, suggesting the existence of a psychological adjustment mechanism responsible for such compensation. Also addressing the relationship between trauma level and memory, Huemer et al. 20 suggested problems in the integration of autobiographical memories related to emotional factors, corroborating with the study of Mueller et al. 22 Regarding attention, Longobardi et al. 21 found performance within the expected range. ...
Objective:
This study aims to identify what existing literature has shown about possible cognitive alterations in unaccompanied refugee children.
Data sources:
The search was performed in the Web of Science, PsycInfo, Scopus, and PubMed databases, including articles published in any year and in any language. The research was submitted to the Prospero protocol (ID: CRD42021257858), and the quality of the included articles was evaluated using the Mixed Methods Appraisal Tool.
Data synthesis:
Memory and attention are the main topics identified, largely because they are related to symptoms of post-traumatic stress disorder. However, low specificity was observed in the conduction of cognitive assessments, leading to relevant inconsistencies in the collected data.
Conclusions:
The use of psychological assessment instruments that are either poorly adapted or not adapted at all to the populations studied casts doubt on the validity of the data produced so far.
... Consequently, the later stage of information processing is largely affected by the focus on frightening stimuli, which leads to attentional biases. Attentional biases are important characteristics of PTSS in children (Mueller et al., 2020;Remmerswaal, Huijding, Bouwmeester, Brouwer, & Muris, 2014). Thus, at the same level of fear of COVID-19, children with strong tendency to focus on negative information may be more likely to show PTSS than those with weak tendency to focus on negative information. ...
COVID-19 pandemic is a public health emergency with potential traumatizing effects on children. However, not many studies have been devoted to investigating the association between fear of COVID-19 and post-traumatic stress symptoms (PTSS) in children during the pandemic. Also, if the association is modulated by cognitive tendencies to focus on negative and positive information in children is unknown. The study recruited 122 native Chinese children from a primary school in mainland China. Self-reported psychological inventories were used to assess the above variables. The prevalence rate of PTSS in Chinese children was approximately 15.1%. Girls had higher post-traumatic stress levels than boys. Fear of COVID-19 was associated with higher level of post-traumatic stress in children. Only cognitive tendency to focus on negative information was significantly associated with the level of post-traumatic stress in children. Moreover, cognitive tendency to focus on negative information was a significant moderator of the relationship between fear of COVID-19 and PTSS. Generalization of the results to adults should be cautious. It was concluded that stronger fear of COVID-19 was related to more PTSS in children. The association of fear of COVID-19 with PTSS was significant only for children with strong tendency to focus on negative information. Cognitive interventions for PTSS may need to be delivered to children who have both strong fear of COVID-19 and strong tendency to focus on negative information.
... That is, the faces are not presented in a natural and ecological context. Future studies could continue this line of research with the goal to understand the best way to capture this type of bias, for example, analyzing if surprise faces (Mueller et al., 2020) capture better this bias. In addition, future studies could analyze which methodology best captures biases, for example, comparing a variety of methods in experimental research. ...
Social anxiety (SA) and depression have been associated with negative interpretation biases of social stimuli. Studies often assess these biases with ambiguous faces, as people with SA and depression tend to interpret such faces negatively. However, the test-retest reliability of this type of task is unknown. Our objectives were to develop a new interpretation bias task with ambiguous faces and analyse its properties in terms of test-retest reliability and in relation to SA, depression, and looming maladaptive style (LMS). Eight hundred sixty-four participants completed a task in which they had to interpret morphed faces as negative or positive on a continuum between happy and angry facial expressions. In addition, they filled out scales on SA, depressive symptoms, and LMS. Eighty-four participants completed the task again after 1-2 months. The test-retest reliability was moderate (r = .57-.69). The data revealed a significant tendency to interpret faces as negative for people with higher SA and depressive symptoms and with higher LMS. Longer response times to interpret the happy faces were positively associated with a higher level of depres-sive symptoms. The reliability of the present task was moderate. The results highlight associations between the bias interpretation task and SA, depression, and LMS.
... Distress in pre-school children may be expressed differently, often as non-specific behavioural and emotional reactions (e. g. including traumatic events in play rituals, developing new fears, clinginess, low frustration tolerance, aggressiveness, sleep, eating or attachment problems) [17,18]. Moreover, trauma and stress in childhood has been shown to affect developmental processes, and some studies describe how forced migration is linked to working memory, emotional processing [19][20][21] and to future educational attainment and employment rates [22,23]. Longitudinal studies show a gradual decline in distress over time [24]. ...
Almost half of the world’s forcibly displaced population are children, most commonly originating from Syria, Iraq and Afghanistan. Health disparities are well documented, especially for mental health, but not consistent across groups, time or context. Despite high exposure to trauma and stress, refugee children also show remarkable resilience. An ecological model of refugee health including both risk and resilience factors is therefore recommended. The model also includes the dynamic inter-relationship of past traumatic experiences, ongoing daily stressors and the disruptions of basic systems affecting both the individual and families as a whole, offering a framework to better understand the health disparities and appropriate interventions for refugee children.
... Given the foundational role of executive skills for individuals' well-being, examining potentially contributing factors is important to adequately plan and evaluate programs to support refugee youth in these settings. A few studies so far have investigated EF, conceptualized as WM and IC, among refugee youth living in host communities (Chen et Mirabolfathi, Schweizer, Moradi, & Jobson, 2020;Mueller et al., 2020). Only one recent study conducted in Palestine examined EF (measured with tests of WM, planning, abstract reasoning and semantic fluency) among refugee children living in camps (Fasfous, Pérez-Marfil, Miguel, Al-Yamani, & Fernández-Alcántara, 2021). ...
Executive functioning (EF) may be important for refugee youth's long-term adjustment. The current study examined associations between factors on different ecological levels (individual, family, community) and inhibitory control (IC), working memory (WM), cognitive flexibility (CF), and selective attention (SA) among 226 Burundian youth aged between 7 and 15 in three refugee camps. Multiple regression models revealed positive associations between trauma exposure and CF and between posttraumatic stress symptoms and SA and WM. Having more siblings, fathers' socioeconomic status and a better father-child relationship were related to better EF including higher SA and WM. Higher levels of maltreatment by mothers were related to lower IC. Higher peer support was related to higher WM. Being orphaned, children's emotional and behavioral problems, mothers' education, community violence and the type of camp (established vs. new) were not significantly related to children's EF. The findings underscore the importance of proximal social factors for children's EF.
