Australian Psychologist, March 2009; 44(1): 615

Effects of trauma and the refugee experience on psychological assessment processes and interpretation

IDA KAPLAN
Victorian Foundation for Survivors of Torture, Melbourne, Victoria, Australia

Abstract All psychological assessments occur in a cultural context, whoever the participants. When the participant being assessed is someone of refugee background, several contextual domains, both current and historical, require close attention. Those domains are the effects of torture, violence and traumatic loss; pre-arrival hardships such as poor nutrition, inadequate shelter, lack of access to health services and disruptions to schooling; settlement stresses involving unfamiliarity with Australian systems and discrimination; and family functioning and fractures to family nurturance, maintained by ongoing separation from and dangers to signicant others left behind. Given that the purpose of psychological assessment is to formulate appropriate interventions for promoting mental health, learning and wellbeing for individuals presenting with special needs, professional expertise demands a comprehensive analysis of the causes of identied problems.

Key words: Attachment, cognitive assessment, cultural diversity, ethnic, psychological assessment, mental health, refugee, school performance.

This paper came about as a result of the growing awareness among mental health service providers that some refugee children and adolescents who were performing very poorly at school were receiving diagnoses of intellectual disability and low intelligence quotients that were not consistent with their level of everyday functioning. Such assessments could mean access to special assistance but could potentially preclude them from receiving the necessary and appropriate interventions if the diagnosis was not correct. There are two main likely causes of poor performance in addition to the possibility of an intellectual disability. The rst is a constellation of cognitive, emotional and behavioural effects that are the result of trauma. The second is the inherent cultural bias of standardised tests of ability, including a refugee students sheer lack of experience with the range of cognitive tasks that underpin test performance. The educational and academic needs of refugee children and adolescents in Australia require consideration of both sets of causes. In regard to the effects of trauma, the academic research literature

and the work of the international community, United Nations (UN) bodies and non-government organisations have been very active in increasing awareness of the developmental and emotional impact of war, displacement, violence and human rights violations on children and adolescents. Refugee experience and trauma Since World War II, more than 700,000 people with refugee backgrounds have arrived in Australia under Australias Humanitarian Program. Over the last few years at least half of the intake has been under the age of 25 years. The term refugee background is used in this paper to include people dened as refugees under the UN Convention Relating to the Status of Refugees and other people in humanitarian need who are offered resettlement as a means of protection (Department of Immigration and Multicultural and Indigenous Affairs, 2005). (The Convention denes refugees as people who are outside their country of nationality and unable or unwilling to return because of a well-founded fear of persecution on the grounds

Correspondence: Dr I. Kaplan, Foundation House, 6 Gardiner Street, Brunswick, Vic. 3056, Australia. E-mail: kaplani@foundationhouse.org.au ISSN 0005-0067 print/ISSN 1742-9544 online The Australian Psychological Society Ltd Published by Taylor & Francis DOI: 10.1080/00050060802575715

The refugee experience and psychological assessment of race, religion, nationality, membership of a particular social group or political opinion. Under the Australian Humanitarian Program there is a visa category called Refugee, which is a permanent visa for people offshore who are subject to persecution and in need of resettlement and who are selected in cooperation with the UN High Commissioner for Refugees [UNHCR]. People who are refugees as dened by the Convention are also admitted under other Humanitarian Program visa categories.) The Humanitarian Program for refugees and others with humanitarian needs has been set at approximately 13,000 new places each year. The intake for 20082009 is planned to be 13,500. The majority of those granted Humanitarian visas are selected offshore, that is, overseas. A minority of visas are granted to people who apply onshore, when they are already in Australia (Refugee Council of Australia, 2007). The national origins of people entering under the Humanitarian Program alter signicantly over time, reecting changing zones of conict in the world. In 19981999, nearly 50% of the offshore resettlement program came from Europe; 30% came from the Middle East and South West Asia and 16% from Africa. The order was reversed in 20022003: nearly 50% came from Africa, 37% were from the Middle East and South West Asia and around 10% were from Europe. In 20052006 approximately 65% of offshore humanitarian arrivals came from Africa and approximately 35% from the Middle East and South West Asia. By 20072008 this pattern changed again. Karen and Chin communities from Myanmar (Burma) formed the largest number of new arrivals, followed by people from the Middle East. People from Africa comprised the third-largest group (Department of Immigration and Citizenship, 2008). It is important to recognise which countries have been sources of Australias humanitarian intake in earlier decades as well, because adults in the Australian community may well have arrived as refugee children and have been affected by those experiences. Much can be gleaned regarding the traumatic experiences that individuals and families are likely to have suffered, from an examination of the nature of conict, persecution and war that has characterised life in the aforementioned countries and regions of the world. Children and adolescents, whose family country of origin is Burma, for example, are likely to have spent their whole lives displaced from their homes. Typically they have lived in refugee camps for long periods of time or lived in constant danger. Children and adolescents from Iraq come from a war-torn region where there is no distinction between children and adults when it comes to victims of bombings. Children are also targeted for

kidnapping and extortion (United Nations Childrens Fund, 2008). In general, children and young people of refugee background will have experienced a wide range of traumatic events prior to their arrival in Australia. These may have included coming under combat re and bombing; destruction of home and schools; separation from and disappearance of parents, family members and friends; witnessing of violence and death; prolonged danger, and perilous journeys. Some children and young people will have experienced forced conscription, arrest, detention, sexual assault and torture. The Annual Report of the Victorian Foundation of Survivors of Torture (VFST, 2007a) indicated that the under-18-year-old client group had experienced a high degree of physical and psychological trauma, with 44% experiencing combatant re, 33% experiencing severe beatings, 78% experiencing warrelated loss and separation, and up to 94% having experienced harm to their family (VFST, 2007a). The frequency of harm and threatened harm are very high. Such experiences are compounded by a range of pre-arrival hardships that include poor nutrition, inadequate shelter, lack of access to health services and disruptions to schooling. Settlement in Australia Once in Australia, there are many stressors that constitute risk factors for psychological and social problems. They include ongoing grief associated with the separation from family members, home and community, and guilt about family members remaining in difcult circumstances overseas (Jaques & Abbott, 1997; Kinzie, Boehnlein, & Sack, 1998). Material circumstances are typically difcult as a result of unemployment or under-employment and the high cost of housing and utilities (VFST, 1998). Many everyday experiences, including learning a new language, adjusting to a new culture and dealing with the practical tasks of establishing life in a new country, can also contribute to stress. Social support networks can be limited because of the small size of refugee communities and fragmentation within those communities. Other experiences are potentially retraumatising, such as exposure to racist and xenophobic behaviour (Beiser & Hou, 1996; Porter & Haslam, 2005; Thomas & Lau, 2002). Effects of exposure to traumatic events on learning and cognitive performance There are many cognitive functions that underpin learning ability and the demonstration of that ability through performance. These include attention and concentration; comprehension; understanding

I. Kaplan Other characteristic effects of exposure to traumatic events alterations in states of consciousness, amnesia, hyperamnesia, dissociation, hypervigilance, depersonalisation, derealisation, ashbacks, sleep disturbances including nightmares, conditioned reactions to reminders of the past, and re-enactments of past trauma all severely interfere with information processing and a sense of inner stability (Streeck-Fischer & van der Kolk, 2000). Numerous studies have shown that children and adolescents with PTSD have problems with attention, concentration, executive function skills and abstract reasoning (Beers & de Bellis, 2002; Dunmore, Clark, & Ehlers, 2001; Pynoos, Steinberg, & Wraith, 1995; Toth & Cicchetti, 1998). Eth and Pynoos (1985) purport that underachievement at school is caused by: (a) intrusive memories connected to the traumatic event that cause the child to be distracted from the academic task, (b) the development of a style of forgetting, associated with an inhibition of spontaneous thought, which dispels reminders of the traumatic event, and (c) the interference of depressed affect on mental processes. They present the lament of one second grade girl who reported I hear everything at school, and then its just gone. What happened to my mommy comes right back to me (Eth & Pynoos, 1985, p. 44). Developmental impact of traumatic events early in life The impact of trauma on cognitive, emotional and social domains can have cumulative developmental consequences depending on the age of the child, the duration of traumatic experiences and the presence or absence of protective factors. Studies of early development indicate an association between early abuse and neglect, and subsequent cognitive and language problems (Cichetti & Toth, 1997; GarciaColl, 1990). Other studies also show an association between exposure to war-based traumatic events and early loss with poorer cognitive processes and language development (Hildyard & Wolfe, 2002; McFayden & Kitson, 1996). One of the most important major pathways that link trauma and cognition is the insecure attachment pattern (Lynch & Cicchetti, 1992; van der Kolk & Fisler, 1994). The absence of a caregiver who protects and nurtures a child is considered to constitute danger, unpredictability and uncontrollability for that child (Cichetti & Lynch, 1995). Attachment is important for the acquisition of developmental competencies including self-regulation of emotions and behaviour, integration and processing of information, expressive and receptive communication and formation of stable schemas of self, others and the world (Cook, Blaustein, Spinazzola, & van der

instructions and input, which may be a language based-problem; working memory, including the holding of information and instructions in the process of problem solving; committing knowledge to long-term memory; organisation of information and category formation; shifting from the abstract to the concrete and from the concrete to the abstract; generating a range of strategies to a problem; exibility, and demonstrating a solution to others (Elliott, 2000; Massachusetts Advocates for Children [MAC], 2005). Trauma can detrimentally affect most of these cognitive functions and there is considerable empirical evidence for an association between trauma, violence or neglect and school achievement, including intelligence test performance (Delaney-Black et al., 2002; Saigh, Mroueh, & Bremner, 1997; Saltzman, Weems, & Carrion, 2006; Shonk & Cicchetti, 2001). These effects are not accounted for by social factors such as poverty (Delaney-Black et al., 2002). There is also a range of non-intellective factors that can affect learning. They include creative play, anticipation of failure, the capacity for both emotional and behavioural self-regulation, reection, ability to prot from adult guidance, motivation, frustration tolerance, self-condence, and access to parental mediation of learning (Elliott, 2000; Tzuriel, 2001). There are many pathways that can explain this association: the psychological and cognitive sequelae of traumatic events, the developmental impact of traumatic events early in life and the quality of ongoing family relationships. These factors are further discussed below. Psychological and cognitive sequelae of traumatic events Experience of traumatic events, whether violence, abuse or neglect, can cause cognitive, emotional and behavioural changes that affect learning. Post-traumatic stress disorder (PTSD), which occurs frequently among chronically traumatised children (Entholt, Smith, & Yule, 2005; VFST, 2007b), consists of a number of symptoms that could directly and indirectly interfere with learning. Poor concentration, for example, which is one of the symptomatic criteria of PTSD (American Psychiatric Association, 2004), would adversely affect both the acquisition of new information and cognitive skills, and the capacity to demonstrate their acquisition. The possible causes of interference with a relatively straightforward function such as concentration are numerous. They include depression, grief, anxiety, the disruptive effects of intrusive images and memories, numbing, and cognitive constriction (Athey & Ahearn, 1991; Beers & de Bellis, 2002).

The refugee experience and psychological assessment Kolk, 2003). If emotional regulation is poor, overstimulation occurs easily and physiological arousal is excessive. Processing of information can be severely affected as a consequence. Responses to novel stimuli are particularly affected: the child becomes oversensitive to potentially threatening stimuli and is non-responsive to innocuous stimuli. Expressive and receptive language development is also highly dependent on attuned and responsive parents (van der Kolk, 1987). If caregivers cannot be relied upon, infants experience excessive anxiety and anger that can become extreme enough to precipitate dissociation, fragmentation of emotions and cognitions with little expectancy of being understood or comforted, with a poor sense of inner agency (Cassidy & Mohr, 2001; Cook, Blaustein, Spinazzola, & van der Kolk, 2003; Lyons-Ruth, & Jacobovitz, 1999). As van der Kolk (1987) describes, security, which is the basis for curiosity, may never develop. The long-term interpersonal effects can include uncertainty about the predictability of others, distrust, suspiciousness and problems with intimacy (Cook, et al., 2003). For some researchers, reactivity to stress in children who have had insecure attachments is understood in neurobiological terms (Perry & Pollard, 1998; Teicher, Andersen, & Polcari, 2002). Biologically, there is evidence of hippocampal atrophy in traumatised children, which may well be related to memory and learning decits (Schore, 2001). It is unclear whether these effects can be reversed, but there are encouraging ndings to suggest that such effects may be reversible (Pynoos, 1993). Refugee children, like all children, are at risk of suffering the adverse effects of disrupted attachment patterns. A number of factors, which are associated with the refugee experience, make such disruptions likely. First, refugee parents, if they are depressed or suffering PTSD in response to traumatic events, may not be attuned to their children (Fonagy, 1999; Westermeyer, 1986). Second, some children lose their relationship with their signicant caregiver at a very early age and replacement caregivers may not be available (Kinzie, Boehnlein, & Sack, 1998; Maksoud, 1993). There is little empirical data to indicate levels of disrupted attachment in refugee children. There are also few data regarding how many refugee children and adolescents have deceased or missing parents and caregivers. In Greece, a country that has provided temporary protection to refugees, the incidence of loss of a parent among children who had ed the war in Bosnia was 28% (Papageorgiou et al., 2000). A consideration of the detailed descriptions of the protracted nature of conict and persecution in the countries from which refugees originate, and an analysis of the accounts of dangerous ight and conditions in refugee camps,

would strongly suggest that severe disruptions to parent/caregiver and child relationships occur frequently (UNHCR, 2008). Quality of family functioning Aside from its impact on early attachment, the quality of family functioning can mitigate adverse effects on cognitive functioning and performance by acting as a protective barrier when a child is exposed to traumatic events (Anthony & Cohler, 1987). Typically, several members of a family from a refugee background have experienced traumatic events over a long period of time, and the protective factor of a secure relationship to a caring adult over time can be disrupted, if not absent (Simpson, 1993). Conversely, nurturing family relationships and parental support have been found to contribute to cognitive competence, school achievements, and mental health and wellbeing in children (Prevatt, 2003; Punamaki, Qouta, & El Sarraj, 1997), and buffer children from the adverse effects of violence and war (Barber, 2001). Dysfunctional family relationships and poor support are detrimental to academic achievement and wellbeing (Overstreet, Dempsey, Graham, & Moely, 1999). Parental symptoms of stress, depression and PTSD have been found to be correlated with similar symptom patterns in children (Laor, Wolmer, & Cohen, 2001; Punamaki, 2002; Qouta, Punamaki, & El Sarraj, 2005; Smith, Perrin, Yule, Hacam, & Stuvland, 2002). One would expect the relationship to be bi-directional: traumatised parents often have reduced capacity for emotionally supporting and protecting children and children become concerned for their parents (Garbarino & Kostelny, 1996). Children and adolescents may also become parentied. New traumas can arise in the country of settlement. Traumatisation for the family continues with bad news from the country of origin, and extreme disturbances in parents such as violent behaviours in the home become new traumas for family members (Gordon &Adam, 2005). The challenges of settlement can create enormous stress in families, which in turn could be passed on to children. Such challenges include the dramatic changes in roles and responsibilities within the family, nancial difculties and inter-generational conict, dislocation from culture and tradition and language barriers (Colic-Peisker, 2006; Rousseau, Rufagari, Bagilishya, & Measham, 2004). People from the same country of origin can be perceived as a threat if they are associated with political factions or other ethnic groups who perpetrated violence in the country of origin or country of transit. Children are often taught not to trust anyone, and guilt associated with leaving family behind disrupts emotional recovery for all family members (VFST, 1998).

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I. Kaplan families, looking after younger siblings as well as habitually taking precautions against threats of violence. The cognitive abilities underlying those survival problem-solving skills have not been studied. Standardised tests are biased against culturally diverse populations The cultural specicity of cognitive tests, which can lead to bias in interpretation, continues to be underestimated. This is obvious for verbal tasks. As mentioned above, non-verbal tasks are still culturally biased. Furthermore, norms are based on predominantly Western samples (Hill, 2005), and where there are local norms available, they do not apply to the backgrounds from which children with refugee backgrounds in Australia come. More fundamentally, Greeneld (1997) pointed out that Western-based IQ and ability tests cannot be used cross-culturally when the social conventions underlying those tests differ between the tester and the participant. The social conventions refer to the domains of values and meaning, knowledge and communication. By illustration, Greeneld provides the example of an object-sorting task administered to participants in Liberia. They sorted objects, for example, a potato and a knife, into functional pairings, making reference to what a wise man would do. When the researchers asked, how a fool would do it, participants sorted objects into food and tools categories. Knowledge of other cultures and knowledge of the level of participation in formal schooling can be used as a guide to judge the degree to which testing is suitable. (Greeneld, 1997). Adaptations to testing conditions can provide considerable scope for interpreting general ability and strengths and weaknesses (Georgas, Weiss, Van de Vijver, & Saklofske, 2003; Kaufman, 1990). Some practitioners administer tests in the childs rst language through the use of an interpreter (Whitelaw, 2008). This might provide an indication of the childs vocabulary and facility with language, but appreciating the quality of an answer is very dependent on interpreter accuracy and it would be impossible to accurately use the norms and scaling regarding item difculty (Pena, 2007). Implications for assessment The aforementioned concerns have long received considerable attention in the research and theoretical literature, in no small part due to the fact that IQ results have been used to fuel arguments about the intellectual inferiority of some races. The IQ debate is alive and well in regard to imputed race differences. In a recently published book, IQ and

Assessment of cognitive and intellectual functioning in a refugee population Although there is no systematic research evidence regarding the performance of refugee students in the classroom in Australia (Department of Education and Early Childhood Development, 2008), observations based on schools outreach work conducted by VFST (2007c), and other authors in this series indicate that refugee children are being referred for intelligence testing with a query about intellectual disability. Although there is no reason why intellectual disability rates among refugee children would not be equivalent to rates for children in the Australian or any other population, practitioners are raising concerns about the appropriateness of diagnosing intellectual disability without due consideration of a range of factors that would inuence performance on tests and affect the meaning that can be given to scores obtained. Such factors might include the lack of experience with cognitive tasks pertinent to standardised tests and cultural biases that are intrinsic to many such tests. Relevance of experience with cognitive tasks to learning and cognitive performance A child or adolescent of refugee background may have had little prior experience of cognitive skills relevant to performance on tests or classroom-based academic achievement. Elliott, Lauchlan, and Stringer (1996) predicted that relatively new arrivals in the United Kingdom would be likely to experience signicant difculties in understanding test instructions. Communication errors can occur when testing a child from a background where children are meant to listen and not speak. Answering an adult can violate norms of acceptable behaviour (Greeneld, 1997). The experience of VFST staff, while working with children from East Timor during operation Safe Haven (VFST, 2000), was that the children had little experience of using paper and pencils because of the unavailability of those materials in their country. Many refugee children, more generally, would have little or no experience of drawing, manipulating blocks or working with time pressures (Hill, 2005). Their parents may not be literate in their own language or they may come from an oral tradition in which characteristics of thinking are less linear and factual than those of written cultures (Ong, 2002). Conversely children, adolescents and parents of refugee background may have cognitive skills that are not recognised, or are under-utilised in the acquisition of new skills (Osterling, 2001). Many refugee children and adolescents have been responsible for procuring food and essential material goods for their

The refugee experience and psychological assessment the wealth of nations (Lynn & Vanhanen, 2002, cited by Berhanu, 2007), poverty of African nations was attributed to lower IQs (Berhanu, 2007). As proof, Ethiopians were described as having an average IQ score of 63. This was based on an Israeli study that reported IQ test scores for recently arrived Ethiopians. Berhanu outlined that the Ethiopian cohort were 15-year-olds who had lived most of their lives in the countryside with little knowledge of schoolrelated tasks. Many lost their near relatives . . . and many more were unattended, solitary children (Berhanu, 2007, p 6). Extrapolating intelligence levels from scores on standardised tests given the background of such a cohort was inappropriate. Evidence that minority groups are overrepresented in special education in England, the United Sates and the Netherlands (Hill, 2005) can also be misused to infer intellectual inferiority of some ethnic groups (Osterling, 2001). The potential misuse of IQ scores is an important reason for the judicious use of tests in a crosscultural context, even in the case of an individual child. Elliott (2000) has expressed concern that caution in the use and interpretation of tests is frequently ignored. As described by Elliott (2000), it is something of a paradox that despite the repeated attacks upon IQ testing, its use by educational psychologists in the UK and the United States appears to be little diminished (p 60). Hill (2005) suggests that a conservative climate and higher demands for professional accountability may be part of the reason for continued reliance on traditional psychometric methods of assessment. Hill (2005) also proposes that intelligence tests such as the Wechsler scales provide professional security because of their extensive research proles. Intelligence tests such as the Wechsler scales should not guide intervention although they might identify need. They are administered presumably for the purpose of identifying students who require additional support via special education programs. This was in fact the purpose of Binets pioneering work (Hill, 2005). Remedial strategies, however, based on information about specic cognitive abilities and learning style are not routinely provided in educational assessments. Tests can be valuable for planning interventions for children of refugee background if they are used to provide a prole of abilities and learning style. In order to provide that prole, adaptations to standardised tests are needed. When adaptations are not sufcient to understand a child or adolescents abilities or make a valid diagnosis, alternative assessment processes can be useful. In addition, consideration of non-intellective causes of cognitive difculties is paramount to ensure appropriate interventions. Adaptations to standardised tests

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In view of the difculties with using standardised intelligence tests with children and adolescents of refugee background, it is important to consider how appropriate assessments could be conducted. Tests such as the Wechsler scales or other batteries of tests can still be useful given that they enable observation of subtest variability in performance, analysis of the types of errors being made and adaptations such as extending time limits to test the nature of performance decits. The scales, however, should not be used to generate scores. A qualitative analysis of difculties would lead to further testing to assess whether cognitive difculties exist across a number of domains, and enable an assessment to determine if difculties were emotionally based. Tests such as the Wechsler Intelligence Scale for Children were in fact designed to be used in this way (Georgas et al., 2003; Kaufman, 1990). How a subtest and its items are completed enables a detailed analysis of the cognitive and emotional bases for test performance because it is recognised that no one individual subtest is a pure measure of any specic cognitive process or ability (Pritera, Saklofske, & Weiss, 2004). Such a hypothesis-testing approach is familiar to any clinician or professional conducting specialised assessments for learning difculties or cognitive decits. Any assessment should include observations of learning ability in the classroom, the factors that enhance learning and the obstacles to learning (Guthke, Beckmann, & Dobat, 1997). Some refugee students have received one-to-one extra tuition at school, which enables such observations to be made. Based on the authors experience with referrals, however, this is not always the case and the testing situation is often used as the principal form of assessment. This is in contrast to the situation for children from an English-speaking background, where a large amount of observational data from their history of schooling, and information from the family is usually available. In general it is this history that suggests an intellectual disability and it is the level of their functioning that needs to be carefully assessed for the purpose of qualifying for remedial assistance (Hart, Kingsley, & Willems, 1999). Because history of functioning in a classroom situation is not readily available in the case of refugee children, this is an important reason to recommend that assessments be conducted over time and in a number of situations other than a formal testing situation. Alternative assessment approaches During the last several decades practitioners and researchers who work with minority and culturally diverse groups have in fact promoted alternative

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I. Kaplan a basis for receiving educational assistance. As Whitelaw (2008) pointed out, while prescriptive procedures are in place, educational psychologists are faced with the dilemma of presenting overall scores of questionable validity or risk precluding the provision of remedial assistance. This dilemma could be addressed by not requiring that scores or a specic diagnosis be given. This is a development that is in place in some states in the United States, where a child with a disability is dened as a child who is experiencing developmental delays and who needs special education and related services (Valdivia, 1999). Prior to 1997 a diagnosis was required in some US states for services to be received (Valdivia, 1999). A similar approach could be adopted for children and adolescents with a refugee background, who have resided in Australia for less than a few years. Implications for interventions Interventions need to be tailored to address the causes of cognitive or learning difculties and academic underachievement. Some children will need special education because of an intellectual disability or signicant learning problems, but it is critical that children and young people do not miss out on the most appropriate intervention (Masten & Coatsworth, 1998). As argued, for refugee children there is likely to be a constellation of contributing factors. When trauma is an important vulnerability factor, specialised therapy is likely to be needed to treat a range of symptoms representing emotional and behavioural difculties. Whenever trauma is implicated, the fundamental conditions of safety, predictability, trust and a caring relationship need to be established and maintained. This applies to the therapeutic context, but these conditions may also need to be fostered by a number of school personnel. The whole of the school environment is important to enabling recovery from trauma, as may be seen in the following case example:
An 8-year-old boy from Iraq showed marked concentration difculties at school and appeared to be very withdrawn. He was having trouble learning despite intense motivation to do so. When the family was seen by a counsellor it emerged that he had been kidnapped for several months at the age of 5. He made a lot of progress as a result of weekly play therapy, but therapy was prematurely terminated as a result of family conict. The school continued to provide support and attention to his learning difculties. He has been followed up as a young adolescent. His academic achievements are good despite ongoing family difculties.

assessment processes to that of standardised tests (Cole & Scribner, 1974; Hessels, 1997; Tzuriel, 2001). One example of an alternative method is dynamic assessment, which is an interactive approach in which testing and teaching are integrated in order to improve cognitive functioning (Tzuriel & Klein, 1987). The teacher or practitioner assesses thinking, perception, learning and problem solving and provides training in skills that have been identied in initial testing as lacking. After training, performance is reviewed with a retest. In this way the ability of the student to respond to interventions is assessed. Training procedures can vary from a problem-solving focus, such as that needed to solve matrices, to incorporation of curriculum-based approaches (Elliot et al., 1996; Farr & Trumbull, 1997; Lidz, 1991). Comprehensive approach to cognitive assessment In addition to a qualitative approach or interactive approach to cognitive assessment, a comprehensive psychosocial history should always be undertaken in the case of children and adolescents with a refugee background to exclude a trauma, or other psychological bases for learning and cognitive difculties. A developmental history including history of signicant attachment relationships, the history of exposure to violence and traumatic events, and medical history are all important. Current psychosocial circumstances, current family functioning and current health of family members are also important, because it is not unusual for such circumstances to pose considerable difculties. It can also lead to children carrying the burden for family stresses and losses (VFST, 2007b). Because probing questions may not be welcomed by parents, young people or children, it is possible to gain much relevant information about pre-arrival experiences, such as the likely duration of exposure to violence and hardship, by knowing the country of origin, the year of ight, the duration of time in a country or region of displacement, and the date of arrival in Australia (VFST, 2007b). To gain more information about a history of traumatic events, reecting some knowledge may be helpful. A useful question is I understand many people from your country have experienced terrible things I do not need to have the details but have your children witnessed or experienced such things? Assessment guidelines applicable to refugees and asylum seekers can be found in Australian guidelines for the treatment of adults with acute stress disorder and posttraumatic stress (Australian Centre for Post Traumatic Mental Health, 2007). The nal assessment implication centres on the importance of having an alternative to an IQ score as

It is beyond the scope of this paper to describe the range of interventions that are suitable for children

The refugee experience and psychological assessment and adolescents suffering the adverse effects of trauma. In general, however, the following phasebased components, articulated by the Complex Trauma Task Force (Cook et al., 2003), are applicable. They are: safety in ones environment; skills development in emotion regulation and interpersonal functioning; meaning-making about past traumatic events so that youth can have more adaptive views about themselves and the future; and enhancing resiliency and integration into social networks. Many therapeutic methods and approaches can be used to achieve the phase-based goals summarised above. They include short-term interventions (Eth & Pynoos, 1985), parenting programs (Galante & Foa, 1986; Garbarino & Kostelny, 1986), parent and infant interactions (Lyons-Ruth & Jacobvitz, 1999), and group programs. Several of these programs have been manualised (Cook et al., 2003). Approaches have been developed that integrate interventions for trauma specic effects and cognitive difculties. Streeck-Fischer and van der Kolk (2000) make the important point that because trauma has been interpersonal, safety and mastery need to be initially built through computer games, nature, athletic pursuits, music and listening to stories on tapes. Acquisition of elementary skills then enables the child to benet from play and social interaction (Streeck-Fischer & van der Kolk, 2000). Programs with a dedicated emphasis on remediation include the Instrumental Enrichment program developed for Ethiopian children in Israel, which provides experiences in universal learning strategies and problem-solving skills (Kozulin, Feuerstein, & Feuerstein, 2001). This program was developed as a result of a number of studies that showed that Ethiopian Israeli children were performing poorly in language, literacy and mathematics skills. The fundamental premise, that it is through relationships that the child learns, is similar to that of Vygotsky (1986). Studies have shown that children have made large improvements as a result of program participation (Farr & Trumbull, 1997; Tzuriel, 2001). Whole-of-school approaches are important. The report Helping traumatised children learn prepared by MAC (2005) is an educational and policy agenda to enable schools to become supportive environments. The VFST (2007c) publication Schools in for refugees has a similar goal for the Australian school context. Prominent researchers and policy makers in the eld of child and adolescent trauma consistently make recommendations regarding the importance of recognising the problem, the need for interventions integrated across the systems of family, school and the community, and advocating for implementation of prevention and intervention programs (Cook et al., 2003). Conclusion

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This paper has examined the relationship between trauma and other hardships associated with the refugee experience, and cognitive functioning and test performance. Tests based on a traditional psychometric model need to be applied cautiously, if at all, given the range of factors that can inuence test performance. Nevertheless, when need is identied, comprehensive assessment is required. In this way, causes of problems in cognitive functioning can be ascertained and incorporated into clinical conclusions. A child or adolescent may require specialised interventions for emotional, behavioural and cognitive effects of past and present traumatic events, as well as assistance with current stressors related to family functioning and/or material and social circumstances. Professionalism needs to uphold certain principles as part of best practice. Foremost is the need to respect and reinforce human rights in a culturally responsive way, especially when the service user has been subjected to extreme human rights violations.
We pass through this world once. Few tragedies can be more extensive than the stunting of life, fewer injustices deeper than the denial of an opportunity to strive or even to hope, by a limit imposed from without, but falsely identied as lying within (Gould, 1996, cited in Berhanu, 2007).

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I. Kaplan
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