Standardized developmental screening of refugee children is recommended

1. The concept of childhood development may be foreign to refugee communities, hindering early diagnosis of disabilities and therapy.

2. Establishing trust and providing in-person interpretation services may be critical to the successful implementation of developmental screening in refugee populations.

Study Rundown: Refugee children may be at an increased risk for developmental delay and disability as a result of their disrupted childhoods. Although Western measures exist to diagnose such conditions, developmental screening in this population may be difficult due to cultural, religious, educational, and language barriers. To better understand how the refugee community views developmental screening and to gauge how such screening might be effectively implemented, researchers conducted a qualitative study using the Health Belief Model (HBM). Results from interviews and focus groups with refugee parents, medical interpreters, clinicians, and community collaborators suggested that refugee parents may not track the achievement of developmental milestones and that culture and religion may influence when a child with a developmental disability comes to clinical attention. Trust was identified as an essential feature of the parent-clinician relationship; thus, developmental screening on the first visit likely should be avoided. Encouragingly, study participants believed that the Parents’ Evaluation of Developmental Status (PEDS) could be administered effectively (with modifications) to screen for developmental disabilities in their communities. Limitations of this study included its small sample size, lack of an immigrant, non-refugee sample for comparison, and the inability to quantitate results. However, the qualitative findings provide an optimistic outlook: through cultural awareness, the creation of a safe space for dialogue, and with slight modifications to the typical screening procedure, standardized developmental screening in this vulnerable population could be successful.

Click to read the study, published today in Pediatrics

Relevant Reading: Developmental screening with recent immigrant and refugee children: a preliminary report

Study Author, Abigail L.H. Kroening, MD talks to 2 Minute Medicine: Department of Pediatrics, Golisano Children’s Hospital, University of Rochester Medical Center, Rochester, New York.

“Worldwide, there are approximately 30 million children who have been displaced from their homes (UNHCR data); this displacement contributes to disrupted education, inadequate nutrition, poor health, and trauma experiences – all of which can significantly impact a child’s developmental trajectory. Our study provides a culturally considerate and refugee-focused framework that medical students, residents, and fellows can use when thinking and asking questions about child development, to guide screening for developmental delays or disabilities among children of refugee status.”

In-Depth [qualitative study]: Purposive sampling was used in the refugee resettlement city of Rochester, New York to identify participants from 4 groups: parents of refugee status (N = 7), medical interpreters working with refugee families, themselves refugees (N = 9), clinicians of refugee children (N = 6), and community collaborators (N = 7). Participants included individuals from the Afghan, Bhutanese-Nepali, Burmese, Chin, Iraqi, Karen, Karenni, and Somali communities. Key-informant interviews and focus groups were organized to identify common themes within 4 HBM-related domains. Such domains included beliefs, values, and perceptions on child development and disability and targeted questioning on the PEDS as a developmental screening aid. Analysis elucidated 21 themes and 11 subthemes, such as trust, family structure, schooling, and in-person interpretation. Transcript review revealed that child development (often referred to as “growth” for lack of a synonymous, native term) is viewed differently across cultures; language and behavioral issues were found to be the most concerning and only severe disabilities were thought to warrant special treatment/services and only in some cases. Additionally, although refugees appeared to appreciate the potential for long-term consequences as a result of traumatic childhood experiences, the concept of “mental health” may not be familiar. Cultural differences, language barriers, and lack of transportation were thought to hinder developmental screening; however, participants believed that the PEDS could be implemented successfully and identified in-person interpreters, visual aids, and healthcare “navigators” as beneficial strategies for overcoming these challenges.

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