who weren’t, although the effects waned within five years of
reunification (Journal of Adolescent Research, 2011).
Those who have not been reunited once in the United States,
or who were without parents for a long time, “have issues of
separation, issues of neglect, issues of attachment,” says Jose
Hidalgo, MD, a Boston psychiatrist who works with immigrant
The high rates of victimization and exposure to trauma that
unaccompanied refugee children experience, combined with
limited access to mental health treatment services, is likely to
put them at higher risk for a host of long-term consequences,
such as PTSD, says Ernestine Briggs-King, PhD, who directs
the Trauma Treatment and Research Program at the Center
for Child and Family Health and is a professor at Duke
University. Unaccompanied minors are likely to have “more of a
complex presentation of PTSD symptoms,” she says, including
difficulty regulating emotions and behaviors, which may manifest
as difficulty with rage, fear, shame, substance abuse and/or
self-injury. They also may experience difficulty concentrating,
learning problems, dissociation and low self-esteem.
Symptoms may vary with age, says Briggs-King. Young
children may be clingy, fearful of new situations, frightened
and difficult to console, while older kids may display problems
with aggression and impulsivity. Many have difficulty sleeping.
Gender also can play a role in how children react, researchers
say. “More than likely, you will see boys who are more ‘closed,’
and they will not share as much as girls,” says Ivelisse Torres
Fernandez, PhD, an assistant professor in the department of
counseling and education at New Mexico State University.
Children may be disconnected from their feelings and may
list somatic complaints. “They’ll say things like, ‘When I think
about it, it hurts in my heart or it hurts in my tummy, and I
Alisa Miller, PhD, a research associate at the Refugee Trauma
and Resilience Center at Boston Children’s Hospital, notes
that those who work with unaccompanied immigrant children
describe them as “little men and little women” because they’ve
had many adult responsibilities from a young age and they
have the goals of adults — to work and support their families.
To suddenly have to sit in a classroom and discuss the War of
1812 can seem irrelevant to them, given that they’ve had to deal
with life-and-death situations or adult responsibilities, such as
finding food and shelter for themselves and family members.
Other educational challenges include the language barrier —
most don’t speak English — and being placed in classrooms
based on age, rather than academic skill level, where they may
be well behind. Some may also experience bullying, teasing and
shaming over their lack of language fluency.
Public schools can, however, be a way for undocumented
children to get social services, including mental health
counseling, especially since they typically do not qualify for
Medicaid and couldn’t otherwise afford treatment. However,
psychologists point out, school systems are not always prepared
to deal with the influx of these children since they may be
serving high-need populations already and have trouble just
affording the basics of education, much less counseling services.
“That is the challenge,” says Chavez-Dueñas. “The school is
the perfect setting, but many children go to schools that are very
poorly funded, where they may not have even one counselor or
social worker who can advocate for their needs.”
How are practicing psychologists helping? One key is building
trust with these children. However, undocumented children
The high rates of victimization and exposure to trauma
that unaccompanied refugee children experience, combined
with limited access to mental health treatment services,
is likely to put them at higher risk for a host of long-term
consequences, such as post-traumatic stress disorder.