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Trauma and Psychological Distress in Latino Citizen Children Following
Parental Detention and Deportation
Lisseth Rojas-Flores, Mari L. Clements,
and J. Hwang Koo
Fuller Theological Seminary
Judy London
Public Counsel’s Immigrants’ Rights Project, Los
Angeles, California
The mental health impact of parental detention and deportation on citizen children is a topic of
increasing concern. Forced parent– child separation and parental loss are potentially traumatic events
(PTEs) with adverse effects on children’s mental health. Objective: This study examines posttrau-
matic stress disorder (PTSD) symptoms and psychological distress among 91 Latino U.S.-born
children (ages 6 to 12), living in mixed-status families with a least 1 undocumented parent at risk
for detention or deportation. Method: Multiagent (child, parent, teacher, clinician) and standardized
assessments were conducted at baseline to assess for child trauma and psychological distress.
Results: Analyses indicate that PTSD symptoms as reported by parent were significantly higher for
children of detained and deported parents compared to citizen children whose parents were either
legal permanent residents or undocumented without prior contact with immigration enforcement.
Similarly, findings revealed differences in child internalizing problems associated with parental
detention and deportation as reported by parent as well as differences in overall child functioning as
reported by clinician. In addition, teachers reported higher externalizing for children with more
exposure to PTEs. Conclusions: These findings lend support to a reconsideration and revision of
immigration enforcement practices to take into consideration the best interest of Latino citizen
children. Trauma-informed assessments and interventions are recommended for this special
population.
Keywords: PTSD, Latino children, citizen children, immigration, deportation, detention
Adverse childhood experiences (Alegría, Green, McLaughlin &
Loder, 2015) and immigration status (Castañeda et al., 2015) are
important social determinants of mental disorders. In children,
potentially traumatic events (PTEs) may lead to the development
of posttraumatic stress disorder (PTSD; Finkelhor, Ormrod, &
Turner, 2009). PTSD has debilitating effects on child development
and functioning and is a costly public health issue (U.S. Depart-
ment of Health & Human Services, 2003). This study examines the
intersection of parental immigration status and children’s mental
health. Specifically, we examined U.S.-born Latino children’s
mental health, including PTSD and psychological distress, follow-
ing parental detention or deportation.
Children of immigrants represent 25% of the 69.9 million chil-
dren in the United States (Zong & Batalova, 2015). Over 88% of
immigrant-origin children (4.5 million) are U.S.-born with a
foreign-born parent (Passel, Cohn, Krogstad, & Gonzalez-Barrera,
2014). Many of these foreign-born parents are unauthorized im-
migrants at chronic risk of arrest, detention, and/or deportation.
Enforcement efforts have taken the form of worksite and home
raids that sweep undocumented immigrants from families and
communities. From 2002 to 2014, the Office of Immigration
Statistics (2013) reported record-high deportations. In just over 2
years (July 2010 to September 2012), nearly 250,000 parents of
citizen children were deported (Wessler, 2012). The majority of
the deportees had migrated from Latin American countries, includ-
ing Mexico, Honduras, El Salvador, Guatemala, Cuba, and Brazil
(Office of Immigration Statistics, 2013).
Forced parent– child separation and parental loss are PTEs with
adverse effects on child mental health and academic functioning
(Finkelhor et al., 2009). Children may experience the loss or
potential loss of a parent as particularly traumatic if it occurs in the
context of contact with legal authorities, such as in the case of
incarceration or deportation. Parental incarceration, a recognized
PTE in childhood (Felitti, 2009), is distinguished from other ad-
verse childhood experiences by the unique combination of trauma,
ambiguity, lack of social support, shame, and stigma (Hairston,
This article was published Online First August 8, 2016.
Lisseth Rojas-Flores, Mari L. Clements, and J. Hwang Koo, Graduate
School of Psychology, Fuller Theological Seminary; Judy London, Public
Counsel’s Immigrants’ Rights Project, Los Angeles, California.
This article was developed with a generous grant from the Foundation
for Child Development’s Young Scholars Program to the first author. The
views, policies, and opinions expressed are those of the authors and do not
necessarily reflect those of the Foundation. We would like to acknowledge
the many churches, community centers, and immigration advocacy centers
that referred families to us; our committed research assistants; and the
brave Latino citizen children and their families who have contributed to our
growing understanding of child traumatic stress and the impact of immi-
gration enforcement policies on children.
Correspondence concerning this article should be addressed to
Lisseth Rojas-Flores, Graduate School of Psychology, Fuller Theolog-
ical Seminary, 180 North Oakland Avenue, Pasadena, CA 91101.
E-mail: lrojas@fuller.edu
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Psychological Trauma: Theory, Research, Practice, and Policy © 2016 American Psychological Association
2017, Vol. 9, No. 3, 352–361 1942-9681/17/$12.00 http://dx.doi.org/10.1037/tra0000177
352
2007). Mounting evidence has indicated that arrest and imprison-
ment of a parent disrupts parent– child relationships, alters familial
support networks, and impairs children’s mental health (Roberts et
al., 2014). We speculate that the detention and deportation of
unauthorized parents may have similar unintended negative effects
on their U.S.-born progeny.
Emerging research has indicated that parental detention and
deportation increase risk for mental health problems such as severe
psychological distress, anxiety, and depression (Allen, Cisneros, &
Tellez, 2015;Zayas, Aguilar-Gaxiola, Yoon, & Rey, 2015); for
underutilization of care (Chen & Vargas-Bustamante, 2011); and
for involvement with Child Welfare (Rabin, 2011). A few empir-
ical and qualitative studies have examined the effects of parental
legal status on child and adolescent development (e.g., Allen et al.,
2015;Brabeck & Xu, 2010;Dreby, 2012), but this research has
been largely descriptive or retrospective, relying primarily on
parent report of child outcomes (Allen et al., 2015;Brabeck & Xu,
2010;Chaudry et al., 2010).
To the best of our knowledge, only two empirical studies have
examined citizen children and their increased risk for psycholog-
ical distress subsequent to parental detention or deportation (Allen
et al., 2015;Zayas et al., 2015). Allen and colleagues (2015)
recruited immigrant caregivers who either were in deportation
legal proceedings, had been deported, or were unauthorized with-
out contact with immigration enforcement. In this sample of pri-
marily U.S.-born children, Allen et al. found that children with a
deported parent exhibited more internalizing problems after con-
trolling for trauma history than did children without a deported
parent.
In a recent binational study using child self-report, Zayas and
colleagues (2015) examined the psychological distress of three
groups of citizen children (ages 8 –15 years) who had at least one
parent of Mexican origin. The groups consisted of (a) children
living in Mexico with their deported parents, (b) children living in
the United States with parents affected by detention or deportation,
and (c) children living in the United States whose undocumented
parents were not affected by detention or deportation. Two signif-
icant group differences emerged. First, children with parental
history of detention or deportation reported possible attention
deficits. Second, citizen children living in Mexico with deported
parents displayed more depressive symptoms than did other chil-
dren. Furthermore, all three groups scored within the range of
probable anxiety problems. Notably, no measures of trauma were
reported. To the best of our knowledge, no studies have system-
atically assessed child PTSD symptoms and overall psychological
distress in this vulnerable population using extrafamilial infor-
mants. Using multiple informants (i.e., child, parent, teacher, cli-
nician) and standardized measures, the present study was designed
to examine the psychological impact of parental detention and
deportation on U.S.-born Latino children.
Children of unauthorized parents have been shown to be dis-
proportionally poor and in disadvantaged neighborhoods at risk for
exposure to violence, victimization, and further marginalization
(e.g., Ross & Mirowsky, 2009). In fact, unauthorized status is
highly associated with poverty and low parental education (Yo-
shikawa, Kholoptseva, & Suárez-Orozco, 2013). Emerging evi-
dence, however, has proposed that precarious parental immigration
status puts citizen children at risk for a gamut of socioemotional
disadvantages beyond the ill effects of poverty and related risk
factors (Yoshikawa et al., 2013). Immigration enforcement is a
multifaceted social issue, and its effects on Latino children’s
development need further research.
The Present Study
This study sought to build on prior research on the unintended
mental health consequences of immigration enforcement on Latino
citizen children. To address the intersectional nature of cumulative
risks, we included two comparison groups of citizen children
whose immigrant parents had no contact with U.S. Immigration
and Customs Enforcement (ICE): (a) children of unauthorized
parents with no history of detention or deportation and (b) children
of U.S. legal permanent residents (LPRs). We planned to control
for child lifetime exposure to PTEs and for maternal education as
the best indicator of family’s socioeconomic status (SES). Income
was not included as an SES indicator, because family income was
expected to be substantially reduced following parental detention
or deportation. We examined baseline multiple informant assess-
ment data to test the central hypothesis that Latino U.S.-citizen
children whose parents have been detained and/or deported would
have significantly more psychological distress and PTSD symp-
toms than would children of parents who had no contact with ICE.
Method
Study Sample
From 2013 through early 2015, undocumented and legal per-
manent resident parents born in Mexico or Central America (e.g.,
Nicaragua, Honduras, El Salvador, Guatemala), regardless of race
or socioeconomic status, were recruited. Specifically, this study
targeted mixed-status Latino families with U.S.-born citizen chil-
dren between ages 6 and 12 living in the Southwest. Citizen
children with a current major medical, neurological, or mental
health disorder (e.g., psychosis, autism, Down’s syndrome) were
excluded.
Procedures
Families with precarious legal status were recruited through a
broad network of trusted immigration advocacy agencies,
community-based programs, and churches that work with such
families. Three primary methods were used in recruiting mixed-
status families: (a) individual agency referral, (b) oral presenta-
tions at various community-based programs and Latino churches
serving the immigrant community, and (c) a short video advertis-
ing the study. Staff at these agencies identified potential study
participants. Using provided scripts, staff invited caregivers who
had at least one child who was born in the United States to
participate. Once a release of information was obtained, contact
information was passed on to the research staff, who then con-
tacted potential participants by phone to explain the study, validate
the child’s age, and schedule the initial visit. Caregivers and
children were interviewed simultaneously in separate rooms at
trusted community agencies or churches. Interviewers were bilin-
gual or bicultural (English or Spanish) master’s-level clinicians.
Interviews lasted approximately 2 hr, including snack breaks.
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353
PTSD AND LATINO CITIZEN CHILDREN
Consent and assent forms were reviewed and signed, including
parental consent to obtain school records and to mail a survey to
the child’s teacher. Adult and child participants were informed that
they could choose not to answer any question or to stop the
interview at any time. Confidentiality was discussed, including the
exception for reporting child abuse and neglect. Given the vulner-
able legal status of this study’s participants, a “certificate of
confidentiality” was deemed important and obtained. Participants
were compensated with $30 for parents or caregivers, $10 gift card
for teachers, and $15 gift cards for children. All parent and child
measures were available in Spanish and English and were read to
participants.
Measures
Child report. Children were assessed using the UCLA Posttrau-
matic Stress Disorder Reaction Index (UCLA PTSD-RI; Steinberg,
Brymer, Decker, & Pynoos, 2004). This 22-item, clinician-
administered measure is among the more extensively studied and
widely used assessments of childhood PTSD. The UCLA PTSD-RI
has strong convergent validity with the Diagnostic and Statistical
Manual of Mental Disorders (4th ed.; DSM–IV; American Psychiatric
Association, 1994) diagnosis criteria of experiencing a traumatic
event (Criterion A) and reporting symptoms related to reexperiencing/
intrusive thoughts (Criterion B), avoidance (Criterion C), and hyper-
arousal (Criterion D). This measure has excellent psychometric prop-
erties, with internal consistencies of .82 (Criterion B), .83 (Criterion
C), and .71 (Criterion D). It has been used across a variety of trauma
types, age ranges, settings, and languages, including Spanish (Rodri-
guez, Steinberg, & Pynoos, 1999;Steinberg et al., 2013). The UCLA
PTSD-RI provides PTSD symptom severity and screens for 13 PTEs
among children of 7–18 years of age, including accidents, physical
and sexual abuse, and domestic violence. In our sample, PTEs
were positively skewed (1.50), with observed scores ranging
from 0 to 8. To normalize this distribution, we recoded the five
scores above 4 to 4.
Children also completed the Center for Epidemiologic Studies
Depression Scale for Children (CES-DSC), a 20-item self-report
depression inventory with scores ranging from 0 to 60 and a
clinical cutoff of ⱖ15 (Weissman, Orvaschel, & Padian, 1980).
The Spanish version of the CES-DSC has been widely used in
epidemiological research (González et al., 2016). Cronbach alpha
in this study was .81.
Parent report. Parents completed the Behavior Assessment
System for Children–2nd Edition, Parent Rating Scales–Child
(BASC-2 PRS-C; Reynolds & Kamphaus, 2004). The BASC-2
PRS-C is a widely used and well-validated caregiver-report measure
of 160 items on a Likert-type scale ranging from 1 (never)to4(almost
always). It yields scores on a wide range of empirically based syn-
drome scales and two composite scales (Internalizing Problems and
Externalizing Problems). Scores are reported in Tscores, and percen-
tiles based on age-specific norms (clinical cutoff ⱖ70), standardized
using samples of clinical and nonclinical populations sampled to
reflect the general population (Reynolds & Kamphaus, 2004). The
Spanish version of the BASC-2 PRS-C has reliability and validity
support with Spanish-speaking parents (McCloskey, Hess, &
D’Amato, 2003). In the current study, composite score reliabilities for
the BASC-2 PRS-C Externalizing Problems and Internalizing Prob-
lems were strong, with Cronbach alphas of .88 and .76, respectively.
Parents also completed the Trauma Symptom Checklist for
Young Children—Spanish Version (TSCYC–SP; Briere, 2005), a
standardized 90-item caregiver report developed to assess trauma-
related symptoms in children ages 3–12 (Tscores with clinical
cutoff ⱖ70). The reliability and validity of the TSCYC–SP has
been established in a sample of outpatient children from Spanish-
speaking families, with reported Cronbach alphas from .67 to .93
(Wherry et al., 2014). Reliability for the TSCYC–SP scales in the
current study were strong (alphas of .79 to .85).
Teacher report. Teachers completed the BASC-2 Teacher
Rating Scales–Child (BASC-2 TRS-C; Reynolds & Kamphaus,
2004). The BASC-2 TRS-C is a 139-item scale that evaluates
children’s behavioral and emotional functioning. Like the BASC-2
PRS-C, scale scores are reported as Tscores, and percentiles are
based on normative data (clinical cutoff score ⱖ70). In this study,
composite score reliabilities for BASC-2 TRS-C Externalizing
Problems and Internalizing Problems were strong, with Cronbach
alphas of .89 and .82, respectively.
Clinician evaluation. Clinicians used the Child and Adoles-
cent Functional Assessment Scale (CAFAS; Hodges, 2006) to rate
the child’s lowest level of day-to-day functioning across critical
life domains (School, Home, Community, Moods/Emotions, and
Total Dysfunction). Cutoff scores indicating severe, moderate, and
mild impairment are 30, 20, and 10, respectively. The CAFAS has
been widely used in community mental health across the United
States as part of statewide assessments of mental health outcomes
(Bates, 2001). After being trained to 80% agreement using CAFAS
training materials and assessment (Hodges, 2006), two master’s-
level clinicians jointly rated each child participant on the basis of
information collected in the structured interviews with parent and
child, as well as the BASC-2 TRS-C scale (teacher report) and
school records.
Results
Descriptive data and correlations for main study variables are
presented in Table 1. Gender was not significantly related to
outcome variables, so it was dropped from all analyses. Surpris-
ingly, neither maternal education nor family income was correlated
with most outcome variables. Higher maternal education was
associated with lower parental TSCYC–SP depression reports
(p⫽.01), and lower income was significantly correlated with
more PTEs (p⫽.03). Thus, these SES variables were included as
covariates in analyses of only those specific outcomes. Demo-
graphic characteristics of the participant children, grouped by
parental immigration status comparisons, are presented in Table 2.
As expected, groups significantly differed on family income (p⫽
.002), with legal permanent resident (LPR) families reporting
significantly higher incomes than did either unauthorized group,
and families with a detained or deported parent having both lower
maternal education than did LPR families and more father unem-
ployment than did either LPR or unauthorized without ICE contact
families (p⫽.002 and p⬍.001, respectively).
Risk Exposure for PTEs
After controlling for family income, the groups significantly
differed on lifetime exposure to PTEs on the UCLA PTSD-RI
index by parental immigration status, as shown in Table 3, with
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354 ROJAS-FLORES, CLEMENTS, HWANG KOO, AND LONDON
Table 1
Bivariate Correlations, Means, and Standard Deviations for Major Study Variables
Variable 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1. Sex
a
—
2. Education
b
.04 —
3. Income
c
.12 .10 —
4. PTE .11 .02 .22
ⴱ
—
5. PTSD ⫺.19
a
.05 .10 .26
ⴱⴱ
—
6. CES-DSC ⫺.09 .01 .06 .26
ⴱⴱ
.52
ⴱⴱⴱ
—
7. PTS total .00 ⫺.17 .01 .08 .02 .08 —
8. Anxiety .03 ⫺.19
a
.05 .07 ⫺.08 ⫺.06 .71
ⴱⴱⴱ
—
9. Depression ⫺.06 ⫺.25
ⴱ
⫺.04 .06 ⫺.02 .08 .77
ⴱⴱⴱ
.59
ⴱⴱⴱ
—
10. Parent int .03 ⫺.12 .09 .04 ⫺.03 .04 .40
ⴱⴱⴱ
.32
ⴱⴱ
.54
ⴱⴱⴱ
—
11. Parent ext .01 .10 .11 .34
ⴱⴱ
.21
ⴱ
.13 .27
ⴱⴱ
.07 .27
ⴱⴱ
.48
ⴱⴱⴱ
—
12. Teacher int ⫺.02 .08 ⫺.04 ⫺.07 .01 ⫺.03 ⫺.13 ⫺.14 ⫺.12 ⫺.03 .22
ⴱ
—
13. Teacher ext .01 .00 ⫺.13 .21 .10 ⫺.07 ⫺.03 ⫺.01 .01 .03 .38
ⴱⴱⴱ
.55
ⴱⴱⴱ
—
14. Total dys ⫺.01 ⫺.19
a
.11 .20 .21
ⴱ
.17 .47
ⴱⴱⴱ
.43
ⴱⴱⴱ
.53
ⴱⴱⴱ
.16 .42
ⴱⴱⴱ
⫺.02 .27
ⴱ
—
15. Home .04 ⫺.08 .10 .10 .05 .04 .26
ⴱ
.16 .35
ⴱⴱⴱ
.24
ⴱ
.57
ⴱⴱⴱ
⫺.01 .27
ⴱ
.77
ⴱⴱⴱ
—
16. School .13 ⫺.07 ⫺.01 .18 .02 .05 .49
ⴱⴱⴱ
.37
ⴱⴱⴱ
.46
ⴱⴱⴱ
.08 .31
ⴱⴱ
.15 .37
ⴱⴱⴱ
.57
ⴱⴱⴱ
.26
ⴱ
—
17. Mood ⫺.07 ⫺.20
a
.09 .22
ⴱ
.42
ⴱⴱⴱ
.31
ⴱⴱ
.35
ⴱⴱⴱ
.41
ⴱⴱⴱ
.33
ⴱⴱ
.06 .19
a
⫺.14 .10 .75
ⴱⴱⴱ
.37
ⴱⴱⴱ
.29
ⴱⴱ
—
M.61 .42 1.27 1.69 20.40 22.97 51.72 54.51 50.32 51.16 47.41 48.17 49.49 13.59 1.74 2.07 6.52
SD .49 .50 1.35 1.27 16.01 10.12 10.68 11.89 10.82 11.43 10.49 10.56 10.51 19.08 4.83 5.04 7.77
n97 95 95 97 96 97 92 92 92 96 96 83 83 92 92 92 92
Note. PTE ⫽potentially traumatic event; PTSD ⫽UCLA PTSD Reaction Index total score; CES-DSC ⫽Center for Epidemiological Studies Depression Scale for Children; PTS total ⫽Trauma
Symptom Checklist for Young Children (TSCYC) posttraumatic stress total score; Anxiety ⫽TSCYC anxiety score; Depression ⫽TSCYC depression score; Parent int ⫽Behavior Assessment System
for Children–2nd Edition, Parent Rating Scales–Child (BASC-2 PRS-C) internalizing score; Parent ext ⫽BASC-2 PRS-C externalizing score; Teacher int ⫽BASC-2 Teacher Rating Scales–Child
(BASC-2 TRS-C) internalizing score; Teacher ext ⫽BASC-2 TRS-C externalizing score; Total dys ⫽clinician report of Total Dysfunction score from the Child and Adolescent Functional Assessment
Scale (CAFAS); Home ⫽clinician report of Home Behavior score from the CAFAS; School ⫽clinician report of School Behavior score from the CAFAS; Mood ⫽clinician report of Mood score
from the CAFAS).
a
Child gender (0 ⫽female, 1 ⫽male).
b
Maternal education (0 ⫽less than high school, 1 ⫽high school, GED, or some college).
c
Parental income (1 ⫽less than $15,000, 2⫽$15,000 –34,999,
3⫽$35,000 or more).
ⴱ
p⬍.05.
ⴱⴱ
p⬍.01.
ⴱⴱⴱ
p⬍.001.
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355
PTSD AND LATINO CITIZEN CHILDREN
children of detained or deported parents experiencing significantly
more lifetime PTEs than did children of LPRs (p⫽.02). Even
when child reports of parental deportation or detention as a PTE
were excluded, the groups significantly differed on PTEs, F(2,
91) ⫽3.62, p⫽.03, p
2⫽.07, again with children of detained or
deported parents reporting significantly more PTEs than did chil-
dren of LPRs (p⫽.03). Children of unauthorized parents with no
contact with ICE were not significantly different from children
with detained or deported parents but tended to have more PTEs
than did children of LPRs (p⫽.06). Overall, exposure was high
across groups, with 35% of the sample reporting exposure to one
PTE, 21% to two, 14% to three, and 12% to four or more PTEs in
their lifetime, with an average exposure of 1.69 PTEs (SD ⫽1.27).
PTSD and Psychological Distress
Child outcomes by parental immigration status were examined
in a series of univariate and multivariate analyses of variance
(ANOVAs), controlling for maternal education when indicated,
with Bonferroni pairwise post hoc comparisons (see Table 3).
Analyses were conducted both with and without controlling for
lifetime exposure to PTEs, and the results were essentially iden-
tical. Thus, for ease of interpretation, only analyses not controlling
for lifetime exposure are presented here.
Child report of PTSD symptoms. Per the UCLA PTSD-RI
child report, 29% of all child participants met criteria for full
(19%) or partial (10%) PTSD diagnoses. There were no significant
Table 2
Demographic Characteristics of Citizen Children and Their Families
Variable
Parental immigration status
Detained or
deported
(n⫽39)
Unauthorized no history
of detention or
deportation (n⫽42)
Legal permanent
resident
(n⫽16)
Inferential
statistic
Child sex 2.13
Male 21 29 9
Female 18 13 7
Mother education 12.69
ⴱⴱⴱ
⬍High school 29 22 4
High school or higher 9 19 12
Family income 17.11
ⴱⴱ
⬍$15,000 19 24 2
$15,000–$34,999 16 13 7
ⱖ$35,000 4 3 7
Father current employment 50.43
ⴱⴱⴱ
Full-time 4 28 11
Part-time 3 8 3
Unemployed 29 3 1
Mother current employment 4.48
Full-time 9 5 4
Part-time 12 10 5
Unemployed 16 27 7
Parents’ marital status 5.16
†
Married 23 33 14
Never married 14 8 2
Father’s country of origin
a
2.16
Mexico 23 28 10
El Salvador 9 3 2
Guatemala 4 6 2
Honduras 3 1 0
Nicaragua 0 1 0
United States 0 2 1
Mother’s country of origin
a
9.89
ⴱⴱ
Mexico 14 33 8
El Salvador 3 2 3
Guatemala 4 4 3
Honduras 10 2 0
Nicaragua 0 0 0
United States 6 1 2
Parent years in U.S. 2.75
†
M14.79 17.67 20.00
SD 9.91 5.41 8.42
Child age .40
M9.05 9.12 8.63
SD 1.82 2.03 1.78
Note. Inferential statistics are
2
for count data and F(2, 94) for means.
a
Due to small cell counts,
2
was computed on Mexico versus Central America countries.
†
p⬍.10.
ⴱ
p⬍.05.
ⴱⴱ
p⬍.01.
ⴱⴱⴱ
p⬍.001.
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356 ROJAS-FLORES, CLEMENTS, HWANG KOO, AND LONDON
Table 3
Citizen Children PTSD and Psychological Distress by Parental Immigration Status
Measure
Parental immigration status
Fp
2
Detained or deported
Unauthorized no history of
detention or deportation Legal permanent resident
n M SD n M SD n M SD
Child reports
UCLA PTSD-RI 38 42 16
Lifetime PTEs
a
1.97
a
1.33 1.67 1.23 1.19
b
1.11 3.84
ⴱ
.08
Total severity score 21.92 14.39 20.12 16.92 17.50 18.11 .43 .01
Criterion B 6.92 4.45 5.90 5.84 5.19 6.67 .66 .01
Criterion C 7.68 6.54 7.79 7.13 6.63 7.02 .18 ⬍.01
Criterion D 7.32 4.99 6.43 4.99 5.69 5.55 .65 .01
CES-DCS 23.95 11.33 23.32 9.94 19.69 6.77 1.05 .02
Parent reports
TSCYC
b
37 39 14
PTS overall total 57.62
a
12.40 48.56
b
7.64 46.14
b
5.35 9.70
ⴱⴱⴱ
.18
Anxiety 60.57
a
14.44 51.54
b
7.97 48.07
b
6.04 7.73
ⴱⴱⴱ
.15
Depression 56.59
a
11.76 47.18
b
8.64 43.79
b
4.04 10.21
ⴱⴱⴱ
.19
Anger/Aggression 51.59
a
8.37 47.15
b
5.23 45.93 3.85 4.67
ⴱ
.10
PTS Intrusion 56.49
a
14.27 47.41
b
8.13 47.36 6.59 5.90
ⴱⴱ
.12
PTS Avoidance 55.62
a
11.09 49.44
b
7.83 47.36
b
5.40 6.08
ⴱⴱ
.12
PTS Arousal 57.92
a
11.69 49.41
b
8.18 45.71
b
5.92 9.96
ⴱⴱⴱ
.19
Dissociation 48.22 8.00 47.69 6.74 44.93 3.36 1.23 .03
BASC-2 PRS-C 39 42 15
Int Prob total 54.67
a
12.45 49.90 10.78 45.53
b
7.25 4.17
ⴱ
.08
Anxiety 58.00 11.73 54.12 11.45 53.07 11.00 1.56 .03
Depression 54.13
a
10.84 49.17 10.84 44.47
b
7.46 5.24
ⴱⴱ
.10
Somatization 49.05
a
11.92 46.69 9.69 41.33
b
4.85 3.14
ⴱ
.06
Ext Prob total 49.41 10.37 46.81 11.15 43.87 8.07 1.66 .03
Hyperactivity 50.59 11.97 48.64 11.73 45.87 10.69 .92 .02
Aggression 47.62 8.39 44.98 9.16 43.73 6.24 1.54 .03
Conduct
problems
50.28 10.50 47.74 11.59 44.00 6.59 2.00 .04
Teacher reports
BASC-2 TRS-C 33 37 13
Int Prob total 49.61 13.54 47.49 8.36 46.46 7.24 .55 .01
Anxiety 47.52 9.57 47.35 7.95 46.62 9.00 .05 ⬍.01
Depression 50.18 10.65 47.59 7.06 46.31 6.10 1.26 .03
Somatization 51.30 15.98 49.35 8.42 48.38 9.07 .36 .01
Ext Prob total 52.48 13.53 48.24 8.15 49.49 10.51 2.66
†
.06
Hyperactivity 52.88 13.49 48.68 9.31 47.54 6.17 1.76 .04
Aggression 51.42 12.47 48.24 7.47 45.00 4.16 2.35 .06
Conduct
problems
52.36 13.39 48.19 7.87 44.46 3.48 3.25
ⴱ
.08
Clinician reports
CAFAS 35 42 15
Overall dysfunction 25.14
a
23.44 7.38
b
12.31 4.00
b
6.32 13.41
ⴱⴱⴱ
.23
Home 2.86 6.23 1.19 3.95 .67 2.58 1.60 .03
School 4.00
a
6.95 1.19
b
3.23 .00
b
.00 4.86
ⴱⴱ
.10
Mood/Emotions 11.71
a
8.22 3.33
b
5.26 3.33
b
6.17 17.10
ⴱⴱⴱ
.28
Note. Means with differing subscripts are significantly different in Bonferroni corrected pairwise comparisons. PTSD ⫽posttraumatic stress disorder;
UCLA PTSD-RI ⫽UCLA PTSD Reaction Index; PTEs ⫽potentially traumatic events; CESD-DSC ⫽Center for Epidemiologic Studies Depression Scale
for Children; TSCYC ⫽Trauma Symptom Checklist for Young Children; PTS ⫽posttraumatic stress; BASC-2—PRS ⫽Behavior Assessment System
for Children—2nd Edition, Parent Rating Scales-Child; Int Prob ⫽Internalizing Problems; Ext Prob ⫽Externalizing Problems; BASC-2 TRS-C ⫽BASC-2
Teacher Rating Scales–Child; CAFAS ⫽Child and Adolescent Functional Assessment Scale.
a
Analysis of covariance (ANCOVA) controlling for family income was conducted. Raw means and standard deviations reported.
b
ANCOVA of the total
score and multivariate analysis of variance of the scale scores were conducted for TSCYC, controlling for maternal education. Raw means and standard
deviations are presented here.
†
p⬍.10.
ⴱ
p⬍.05.
ⴱⴱ
p⬍.01.
ⴱⴱⴱ
p⬍.001.
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357
PTSD AND LATINO CITIZEN CHILDREN
differences by parental immigration status on total PTSD symp-
toms, F(2, 93) ⫽0.43, p⫽.65, p
2⫽.01, or individual criteria
(Wilks’s ⫽.96), F(6, 184) ⫽0.68, p⫽.67, p
2⫽.02.
Parent report of PTSD child symptoms. Five families had
invalid TSCYC–SP Response Level and Atypical Response Scale
scores and were dropped from TSCYC–SP analyses. Controlling
for maternal education, total symptoms differed by parental immi-
gration status, F(2, 86) ⫽9.70, p⬍.001, p
2⫽.18. Similarly, a
multivariate analysis of covariance of TSCYC–SP Anxiety, De-
pression, Anger/Aggression, Intrusion, Avoidance, Arousal, and
Dissociation controlling for maternal education indicated a signif-
icant multivariate effect of parental immigration status (Wilks’s
⫽.64), F(12, 168) ⫽3.53, p⬍.001, with significant univariate
effects for all scales except Dissociation. In each case, per parent
report, children of detained and deported parents demonstrated
higher levels of trauma symptoms than did children of either LPR
parents (ps ranging from ⬍.001 to .03) or unauthorized parents
with no ICE contact (ps ranging from ⬍.001 to .01; see Table 3).
Child reports of psychological distress. There was no effect
of parent immigration status on child self-reports of depression on
the CES-DSC, F(2, 94) ⫽1.05, p⫽.35, p
2⫽.02.
Parent report of child psychological distress. As shown in
Table 3, there was a significant univariate effect of parent immi-
gration status on BASC-2 PRS-C total internalizing, F(2, 93) ⫽
4.17, p⫽.02, p
2⫽.08, with children of detained or deported
parents reported to have more internalizing problems than did
children of LPRs (p⫽.02). Multivariate analysis of variance
(MANOVA) analyses revealed a marginal main effect of parent
immigration status on the three BASC-2 PRS-C internalizing
subscales (Wilks’s ⫽.88), F(6, 182) ⫽2.05, p⫽.06, with
children of detained or deported parents scoring higher on Depres-
sion (p⫽.009) and Somatization (p⫽.04) per parent report than
did children of LPRs.
In contrast, there were no significant effects of parent immigra-
tion status on parent-reported total externalizing, F(2, 93) ⫽1.67,
p⫽.20, p
2⫽.03, or on Hyperactivity, Aggression, or Conduct
Problems (Wilks’s ⫽.95), F(8, 182) ⫽0.83, p⫽.55.
Teacher report of child psychological distress. Univariate
and MANOVA results demonstrated no significant effects for
parental immigration status on teacher BASC-2-TRS total inter-
nalizing score, F(2, 80) ⫽0.55, p⫽.58, p
2⫽.01, or on the
Anxiety, Depression, or Somatization scales (Wilks’s ⫽.95),
F(6, 156) ⫽0.61, p⫽.72 (see Table 3).
Teacher reports of total externalizing symptoms were only margin-
ally different by group, F(2, 80) ⫽2.66, p⫽.08, p
2⫽.06. A
MANOVA analysis of Hyperactivity, Aggression, and Conduct Prob-
lems was also not significant (Wilks’s ⫽.90), F(6, 156) ⫽1.35,
p⫽.24, but a significant univariate effect was found for Conduct
Problems, with children of detained or deported parents tending to
have more of these problems than did children of LPRs (p⫽.06).
Clinician report of overall child functioning. There was a
significant univariate main effect for parental immigration status on
clinician’s CAFAS overall child dysfunction, F(2, 89) ⫽13.41, p⬍
.001, p
2⫽.23, with children of detained or deported parents exhib-
iting poorer functioning than did children of both LPRs and unau-
thorized parents with no ICE contact (ps⬍.001). Similarly,
MANOVA analyses of the Home, School, and Moods scales revealed
a significant effect of parent immigration status (Wilks’s ⫽.69),
F(6, 176) ⫽5.87, p⬍.001, with children of detained or deported
parents having poorer scores on School Behavior than did children of
LPRs (p⫽.03) or unauthorized parents with no ICE contact (p⫽
.04), and poorer scores on Moods than did children of either LPRs or
unauthorized parents with no ICE contact (ps⬍.001).
Multiple Informant Comparisons
The correlations between ratings of internalizing constructs
were typically modest. For instance, teacher, parent, and child
ratings of depression were uncorrelated, as were parent and child
reports of PTSD symptoms. In contrast, clinician CAFAS ratings
of Moods and Emotions were significantly correlated with both
parent TSCYC–SP Depression, r(92) ⫽.36, p⬍.001, and child
CES-DSC, r(92) ⫽.31, p⫽.003. Adult reports of externalizing
problems were more consistently and strongly related, with corre-
lations among parent and teacher BASC-2 Total Externalizing and
between BASC-2 and clinician CAFAS Home Behavior and
School Behavior ranging from .37 to .57 (all ps⬍.001). Direct
comparisons of means were possible for only parent and teacher
BASC-2 scores. Parents reported higher Total Internalizing than
did teachers, t(83) ⫽3.70, p⫽.03, but reports of Total External-
izing did not differ, t(83) ⫽⫺1.40, p⫽.17.
Discussion
The need to detect children with PTSD-related symptoms and
psychological distress is pertinent given the evidence for the
detrimental effects of early childhood adversity in the overall
mental health of children. This is significant for Latino citizen
children whose parents are undocumented and at high risk for
detention or deportation, which often lead to forced parent– child
separation. In light of complex immigration policies, our findings
provide some support for the need for clinical and public policy
interventions on behalf of this vulnerable child population.
Impact of Parental Detention or Deportation on
Citizen Children’s PTSD
Taken together, the reports of multiple informants (parent,
teacher, clinician, and child) indicate that citizen children of de-
tained and deported parents experience more psychological distress
and trauma compared to peers whose parents had no involvement
with immigration enforcement. Higher levels of parent-reported
PTSD symptoms in children of detained and deported parents
imply that forced parental separation resulting from immigration
enforcement is particularly detrimental to children’s mental health.
The unpredictability and uncertainty associated with such separa-
tions may have exacerbated PTSD symptoms (see Grillon et al.,
2009). As such, our findings suggest that the current and height-
ened enforcement of immigration laws poses a serious public
health challenge to U.S.-born children of undocumented parents.
Not only is PTSD recognized as a high priority public health issue
(U.S. Department of Health & Human Services, 2003), but child
PTEs, such as losing a parent, pose serious risks for lifelong
mental and medical illnesses (Felitti, 2009;Putnam, Harris, &
Putnam, 2013).
Specifically, the children of detained and deported parents were
rated on the TSCYC–SP as endorsing more symptoms in all three
DSM–IV PTSD criterion domains as well in total posttraumatic
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358 ROJAS-FLORES, CLEMENTS, HWANG KOO, AND LONDON
symptoms. Although to the best of our knowledge, no other study
has used the TSCYC–SP with this population, our results seem
congruent with those of prior studies reporting on the validity of
the TSCYC–SP (e.g., Wherry et al., 2014). TSCYC–SP scores
were significantly correlated with BASC-2 internalizing problems
but not with child self-ratings, consistent with research document-
ing divergence in such child and parent reports (Briere, 2005;De
Los Reyes & Kazdin, 2005).
Impact of Parental Detention or Deportation on
Citizen Child Psychological Distress
Children of detained or deported parents were rated by parents
and clinicians as higher in internalizing problems and in negative
moods and emotions compared to children of LPRs and parents
who had no contact with ICE. The overlap of depressive and
anxious symptoms with PTSD is significant, and thus these find-
ings are consistent with the findings of prior empirical research in
showing significantly increased rates of depression and anxiety
problems among children with PTSD symptomatology (Samuel-
son, Krueger, Burnett, & Wilson, 2010). Depression and anxiety
pose immediate developmental challenges to child functioning
(Kendall et al., 2010) and pose higher risk for future mental health
problems (Lopez, Turner, & Saavedra, 2005). Furthermore, our
findings corroborate and extend those of Zayas et al. (2015) and
Allen et al. (2015) and are also congruent with findings of previous
studies documenting the negative mental health outcomes associ-
ated with parental separation (Chaudry et al., 2010;Suárez-
Orozco, Bang, & Kim, 2011).
Children with more PTEs were also rated by parents and teach-
ers as having more externalizing problems (BASC-2) and by
clinicians as having more total dysfunction (CAFAS). This finding
aligns with previous research showing that children with trauma-
related symptoms are at risk of misdiagnosis (e.g., with attention
deficit/hyperactivity disorder or conduct difficulties), particularly
in the absence of assessments for complex trauma (e.g., Kletzka &
Siegfried, 2008). Our findings underscore the need for educating
parents and teachers on symptoms associated with PTEs.
Intersection Between Poverty, Exposure to PTEs, and
the Loss of a Parent
Exposure to multiple PTEs was common across our sample,
with 35% of the children reporting experiencing one PTE and 47%
endorsing two or more PTEs. This high prevalence of PTE expo-
sure is concerning given the negative short- and long-term conse-
quences of childhood PTE exposure (Appleyard, Egeland, van
Dulmen, & Sroufe, 2005). Consistent with the literature, more
PTEs were related to increased child PTSD scores. Although there
were no differences by parental immigration status, the PTSD
prevalence in our sample was high (19% of the children meeting
all DSM–IV criteria and 10% meeting partial criteria) per child
report.
Emerging research in childhood adversity describes synergy as
the interaction of two or more PTEs, or adverse events, so that
their combined effect is greater than the sum of their individual
effects (Putnam et al., 2013). Putnam and colleagues (2013) doc-
umented the synergy of adverse events with loss of a parent among
adult males with three or more PTEs. They found that poverty, the
most potent adverse childhood event in males, is synergistic with
the loss of a parent. Putnam and colleagues’ research is particularly
relevant to citizen children of detained or deported parents who
have lost, or have the impending possibility of losing, a parent due
to U.S. immigration enforcement. These findings thus call for a
reconsideration and reduction of unnecessary detainment of un-
documented parents and consequent parent– child separation.
Implications for Health Services, Policies, and
Future Directions
Researchers have argued that child PTEs are the most prevent-
able causes of debilitating mental illnesses, such as PTSD, depres-
sion, and anxiety (Finkelhor, Ormrod, & Turner, 2007;National
Research Council & Institute of Medicine, 2009). Particularly for
children who have been multiply victimized, preventing future
PTEs may be the most effective intervention (Finkelhor et al.,
2007). This is notable for our sample of citizen children. A call for
action to prevent forced parental separation and constant threat of
potential loss of a parent due to immigration enforcement is
gravely needed.
Given the high endorsement of PTEs in our sample, more
trauma-informed, developmentally appropriate systems placed at
multiple levels (e.g., home, school) would assist Latino citizen
children and their families. Trauma-informed intervention and
prevention programs for this vulnerable population should target
synergistic adverse events, such poverty and loss of a parent.
Furthermore, affordable and culturally relevant services are war-
ranted not only for children of detained or deported parents but
also for citizen children of parents living in the shadows. A
reevaluation of immigration policies that have significant effects
on access to health services is also extremely relevant to the
well-being of Latino citizen children (for a review see Rodríguez,
Young, & Wallace, 2015).
On the basis of findings with children of incarcerated parents
(Roberts et al., 2014), we suspect that witnessing parental detain-
ment may be particularly detrimental. Future research should in-
vestigate the effects of witnessing the arrest or detention of undocu-
mented parents on child PTSD symptoms, and this information
should be used in reviewing policies involving undocumented immi-
grants with children. Arrest protocols should consider the children’s
best interest.
Study Strengths and Limitations
The cross-sectional nature of this study and its relatively small
sample size limit the ability to infer causation and to generalize
findings to other ethnic and racial immigrant groups. Future stud-
ies should also examine South American Latino groups. Statistics
show undocumented South American immigrants tend to fare
better economically in the United States, in part due to higher
levels of education and different migratory routes than for immi-
grants coming from the Central American cone (Stoney, Batalova
& Russell, 2013). Such SES dynamics would be important to
understand in their interaction with immigration enforcement and
child well-being.
Finally, some children exposed to PTEs, including parental
detention or deportation, do not exhibit high levels of mental
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359
PTSD AND LATINO CITIZEN CHILDREN
health symptoms. These findings highlight an underlying resil-
ience in the face of adversity that should be understood and
supported in all children of immigrants, regardless of parental legal
status. Future research should explore mediating factors, such as
family or community support, religious coping, hope, and cogni-
tive processing of PTEs.
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Received November 6, 2015
Revision received June 28, 2016
Accepted July 1, 2016 䡲
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