Cognitive evaluation in unaccompanied refugee children: a systematic review

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.

Keywords:
Child; Refugee; Psychological tests; Cognition; Systematic review

Author, year	Study design	Sample	Countries of origin	Conclusions
Childs, 2021¹⁴14. Childs S, Given-Wilson Z, Butler S, Memon A, Gudjonsson G. Vulnerability to interrogative suggestibility from negative life events. A comparison of separated asylum-seeking youth and age-matched peers. Pers Individ Dif. 2021;173:110600. https://doi.org/10.1016/j.paid.2020.110600 https://doi.org/10.1016/j.paid.2020.1106...	Case-control	8 M/5 F Age: 16–23 years Mean age: 18±2 years	Sudan (23%), Afghanistan (15%), Ethiopia (15%), Eritrea (15%), Albania (8%), Cameroon (8%), Somalia (8%), Vietnam (8%)	Separated youth had significantly lower IQ scores. No differences in verbal memory were observed compared to the control group.
Wolff et al., 1995¹⁵15. Wolff PH, Tesfai B, Egasso H, Aradomt T. The orphans of Eritrea: a comparison study. J Child Psychol Psychiatry. 1995;36:633-44. https://doi.org/10.1111/j.1469-7610.1995.tb02318.x https://doi.org/10.1111/j.1469-7610.1995...	Case-control	39 M/35 F Age: 4–7 years Mean age: 5.7 years	Eritrea	Orphans showed not only higher cognitive performance than the accompanied refugee children but also greater behavioral symptoms. No children showed language deficits.
Huemer, 2012¹⁶16. Huemer J, Völkl-Kernstock S, Karnik N, Denny KG, Granditsch E, Mitterer M, et al. Personality and psychopathology in African unaccompanied refugee minors: repression, resilience and vulnerability. Child Psychiatry Hum Dev. 2012:44:39-50. https://doi.org/10.1007/s10578-012-0308-z https://doi.org/10.1007/s10578-012-0308-...	Case-control	35 M/6 F Age: 15–18 years Mean age: 17±1 years	Somalia, Algeria, Nigeria, Gambia, Ghana, Niger, Guinea-Bissau, Mali, Eritrea, and Kenya	Significant positive correlation between attention problems and symptoms of stress, anger, and anxiety.
Pfeiffer, 2019¹⁷17. Pfeiffer E, Sukale T, Müller LR, Plener PL, Rosner R, Fegert JM, et al. The symptom representation of posttraumatic stress disorder in a sample of unaccompanied and accompanied refugee minors in Germany: a network analysis. Eur J Psychotraumatol. 2019;10:1675990. https://doi.org/10.1080/20008198.2019.1675990 https://doi.org/10.1080/20008198.2019.16...	Cross-sectional	334, 90.7% M Mean age: 16±2 years	31 countries, including Afghanistan (42%), Syria (19.1%), Eritrea (6.2%), Somalia (6.2%), Gambia (4.1%), Iraq (2.9%), Iran (2.6%) Guinea (2.1%), Morocco (1.4%), Albania (1.2%), Ethiopia (1.2%), and Nigeria (1.2%)	Investigating post-traumatic stress disorder, topological overlaps between sleep disturbances and concentration problems (sustained attention) were indicated.
Spinhoven, 2006¹⁸18. Spinhoven P, Bean T, Eurelings-Bontekoe L. Inconsistencies in the self-report of traumatic experiences by unaccompanied refugee minors. J Trauma Stress. 2006;19:663-73. https://doi.org/10.1002/jts.20152 https://doi.org/10.1002/jts.20152...	Longitudinal	920 (73% M) Age: 12–18 years Mean age: 17±2 years	48 countries, predominantly Angola (43%), Sierra Leone (10%), and China (8%)	Memory inconsistencies do not differ from other population groups.
Wolff and Fesseha, 1999¹⁹19. Wolff PH, Fesseha G. The orphans of Eritrea: a five-year follow-up study. J Child J Child Psychol Psychiatry. 1999;40:1231-7. https://doi.org/10.1111/1469-7610.00539 https://doi.org/10.1111/1469-7610.00539...	Case-control	20 M/20 F Age: 9–12 years Mean age: 11 years	Eritrea	Orphans scored more than unaccompanied refugee children on most cognitive tests. There was no difference in performance on the Raven’s Matrices or the Token Test.
Huemer, 2016²⁰20. Huemer J, Nelson K, Karnik N, Volkl-Kernstock S, Seidel S, Ebner N, et al. Emotional expressiveness and avoidance in narratives of unaccompanied refugee minors. Eur J Psychotraumatol. 2016;7:29163. https://doi.org/10.3402/ejpt.v7.29163 https://doi.org/10.3402/ejpt.v7.29163...	Case-control	35M/6F Age: 15–18 years Mean age: 17±1 years	Somalia, Algeria, Nigeria, Gambia, Ghana, Niger, Guinea-Bissau, Mali, Eritrea, and Kenya	Highly emotionally charged verbal content, but significantly lower word count than the control group.
Longobardi, 2017²¹21. Longobardi C, Veronesi TG, Prino LE. Abuses, resilience, behavioral problems and post-traumatic stress symptoms among unaccompanied migrant minors: an Italian cross-sectional exploratory study. Psychiatr Psychol Klin. 2017;17:87-92. https://doi.org/10.15557/pipk.2017.0009 https://doi.org/10.15557/pipk.2017.0009...	Cross-sectional	18 M/1 F Age: 16–17 years	Egypt (26.3%), Albania (26.3%), Senegal (15.8%), Bangladesh (10.5%), Gambia (10.5%), Morocco (5.3%), Mali (5.3%)	Attention results within the reference range (normal).

Author, year	Instruments	Cognitive functions
Childs, 2021¹⁴14. Childs S, Given-Wilson Z, Butler S, Memon A, Gudjonsson G. Vulnerability to interrogative suggestibility from negative life events. A comparison of separated asylum-seeking youth and age-matched peers. Pers Individ Dif. 2021;173:110600. https://doi.org/10.1016/j.paid.2020.110600 https://doi.org/10.1016/j.paid.2020.1106...	Gudjonsson Suggestibility Scale (GSS); Wechsler Abbreviated Scale of Intelligence (WASI)	Memory, intelligence
Wolff et al., 1995¹⁵15. Wolff PH, Tesfai B, Egasso H, Aradomt T. The orphans of Eritrea: a comparison study. J Child Psychol Psychiatry. 1995;36:633-44. https://doi.org/10.1111/j.1469-7610.1995.tb02318.x https://doi.org/10.1111/j.1469-7610.1995...	The Leiter International Intelligence Scale; The Raven Progressive Matrices; Token Test (Short Term); Grooved PegBoard Test for Children; Expressive One-Word Picture Vocabulary Test	Intelligence, perception, language, memory, and attention
Huemer, 2012¹⁶16. Huemer J, Völkl-Kernstock S, Karnik N, Denny KG, Granditsch E, Mitterer M, et al. Personality and psychopathology in African unaccompanied refugee minors: repression, resilience and vulnerability. Child Psychiatry Hum Dev. 2012:44:39-50. https://doi.org/10.1007/s10578-012-0308-z https://doi.org/10.1007/s10578-012-0308-...	Weinberger Adjustment Inventory (WAI); Youth Self-Report (YSR)	Attention
Pfeiffer, 2019¹⁷17. Pfeiffer E, Sukale T, Müller LR, Plener PL, Rosner R, Fegert JM, et al. The symptom representation of posttraumatic stress disorder in a sample of unaccompanied and accompanied refugee minors in Germany: a network analysis. Eur J Psychotraumatol. 2019;10:1675990. https://doi.org/10.1080/20008198.2019.1675990 https://doi.org/10.1080/20008198.2019.16...	The Child and Adolescent Trauma Screen (CATS)	Attention
Spinhoven, 2006¹⁸18. Spinhoven P, Bean T, Eurelings-Bontekoe L. Inconsistencies in the self-report of traumatic experiences by unaccompanied refugee minors. J Trauma Stress. 2006;19:663-73. https://doi.org/10.1002/jts.20152 https://doi.org/10.1002/jts.20152...	Hopkins Symptom Checklist (HSCL); Reactions of Adolescents to Traumatic Stress Questionnaire (RATS); Stressful Life Events Questionnaire (SLE)	Memory
Wolff and Fesseha, 1999¹⁹19. Wolff PH, Fesseha G. The orphans of Eritrea: a five-year follow-up study. J Child J Child Psychol Psychiatry. 1999;40:1231-7. https://doi.org/10.1111/1469-7610.00539 https://doi.org/10.1111/1469-7610.00539...	The Kaufman Assessment Battery for Children (KABC); The Raven Progressive Matrices; Token Test (Short Term); Expressive One-Word Picture Vocabulary Test	Intelligence, memory, executive functions, perception, and language
Huemer, 2016²⁰20. Huemer J, Nelson K, Karnik N, Volkl-Kernstock S, Seidel S, Ebner N, et al. Emotional expressiveness and avoidance in narratives of unaccompanied refugee minors. Eur J Psychotraumatol. 2016;7:29163. https://doi.org/10.3402/ejpt.v7.29163 https://doi.org/10.3402/ejpt.v7.29163...	Mini-International Neuropsychiatric Interview for children and adolescents (MINI Kid); Youth Self-Report (YSR); UCLA Child/Adolescent PTSD Reaction Index; Facts About You; Stress-Inducing Speech Task (SIST)	Language, memory
Huemer, 2016²⁰20. Huemer J, Nelson K, Karnik N, Volkl-Kernstock S, Seidel S, Ebner N, et al. Emotional expressiveness and avoidance in narratives of unaccompanied refugee minors. Eur J Psychotraumatol. 2016;7:29163. https://doi.org/10.3402/ejpt.v7.29163 https://doi.org/10.3402/ejpt.v7.29163...	Mini-International Neuropsychiatric Interview for children and adolescents (MINI Kid); Youth Self-Report (YSR); UCLA Child/Adolescent PTSD Reaction Index; Facts About You; Stress-Inducing Speech Task (SIST)	Language, memory
Longobardi, 2017²¹21. Longobardi C, Veronesi TG, Prino LE. Abuses, resilience, behavioral problems and post-traumatic stress symptoms among unaccompanied migrant minors: an Italian cross-sectional exploratory study. Psychiatr Psychol Klin. 2017;17:87-92. https://doi.org/10.15557/pipk.2017.0009 https://doi.org/10.15557/pipk.2017.0009...	Strengths and Difficulties Questionnaire (SDQ); Trauma Symptom Checklist for Children (TSCC)	Attention

Study designs	Authors	Are the participants representative of the target population?	Are there complete outcome data?	Are measurements appropriate regarding both the outcome and intervention?	During the study period, is the intervention administered (or exposure occurred) as intended?	Results (%)
Quantitative nonrandomized	Childs, 2021¹⁴14. Childs S, Given-Wilson Z, Butler S, Memon A, Gudjonsson G. Vulnerability to interrogative suggestibility from negative life events. A comparison of separated asylum-seeking youth and age-matched peers. Pers Individ Dif. 2021;173:110600. https://doi.org/10.1016/j.paid.2020.110600 https://doi.org/10.1016/j.paid.2020.1106...	Yes	Yes	Yes	Yes	100
	Wolff et al., 1995¹⁵15. Wolff PH, Tesfai B, Egasso H, Aradomt T. The orphans of Eritrea: a comparison study. J Child Psychol Psychiatry. 1995;36:633-44. https://doi.org/10.1111/j.1469-7610.1995.tb02318.x https://doi.org/10.1111/j.1469-7610.1995...	Yes	Yes	Yes	Yes	100
	Wolff and Fesseha, 1999¹⁹19. Wolff PH, Fesseha G. The orphans of Eritrea: a five-year follow-up study. J Child J Child Psychol Psychiatry. 1999;40:1231-7. https://doi.org/10.1111/1469-7610.00539 https://doi.org/10.1111/1469-7610.00539...	Yes	Yes	No	Yes	75
	Huemer, 2016²⁰20. Huemer J, Nelson K, Karnik N, Volkl-Kernstock S, Seidel S, Ebner N, et al. Emotional expressiveness and avoidance in narratives of unaccompanied refugee minors. Eur J Psychotraumatol. 2016;7:29163. https://doi.org/10.3402/ejpt.v7.29163 https://doi.org/10.3402/ejpt.v7.29163...	Yes	No	No	Yes	50
		Is the sample representative of the target population?	Is the sampling strategy relevant to address the research question?	Are the measurements appropriate?	Is the statistical analysis appropriate to answer the research question?	Results
Quantitative descriptive	Huemer, 2012¹⁶16. Huemer J, Völkl-Kernstock S, Karnik N, Denny KG, Granditsch E, Mitterer M, et al. Personality and psychopathology in African unaccompanied refugee minors: repression, resilience and vulnerability. Child Psychiatry Hum Dev. 2012:44:39-50. https://doi.org/10.1007/s10578-012-0308-z https://doi.org/10.1007/s10578-012-0308-...	Yes	Yes	No	Yes	75
	Pfeiffer, 2019¹⁷17. Pfeiffer E, Sukale T, Müller LR, Plener PL, Rosner R, Fegert JM, et al. The symptom representation of posttraumatic stress disorder in a sample of unaccompanied and accompanied refugee minors in Germany: a network analysis. Eur J Psychotraumatol. 2019;10:1675990. https://doi.org/10.1080/20008198.2019.1675990 https://doi.org/10.1080/20008198.2019.16...	Yes	Yes	No	Yes	75
	Spinhoven, 2006¹⁸18. Spinhoven P, Bean T, Eurelings-Bontekoe L. Inconsistencies in the self-report of traumatic experiences by unaccompanied refugee minors. J Trauma Stress. 2006;19:663-73. https://doi.org/10.1002/jts.20152 https://doi.org/10.1002/jts.20152...	Yes	Yes	Yes	No	75
	Longobardi, 2017²¹21. Longobardi C, Veronesi TG, Prino LE. Abuses, resilience, behavioral problems and post-traumatic stress symptoms among unaccompanied migrant minors: an Italian cross-sectional exploratory study. Psychiatr Psychol Klin. 2017;17:87-92. https://doi.org/10.15557/pipk.2017.0009 https://doi.org/10.15557/pipk.2017.0009...	Yes	Yes	No	No	50

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[1] Corresponding author. E-mail: achamdan@ufpr.br (A. C. Hamdan).