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Background

Developmental assessment in refugee/asylum seeker children can be complex, requiring an understanding of child development, additional language acquisition, language transitions in relation to development, the impact of forced migration, trauma, and settlement, family and community constellations, and support services available. The aetiology of developmental issues may be complex in refugee/asylum seeker children, and routine neonatal, vision and hearing screening is unlikely to have been completed. There are specific challenges with formal language or cognitive assessments for children with English as an Additional Language (EAL).ÌýDevelopment assessments take time and require close liaison with families andÌýthe help of skilled interpreting.ÌýAlso seeÌýÌý(school-aged children) and Disability ²µ³Ü¾±»å±ð±ô¾±²Ô±ð.Ìý

Developmental assessment is a common reason for referral, and there is increased risk of autism and intellectual disability in children of immigrant and refugee backgrounds ().Ìý Recent audits from our service have shown high prevalence of neurodevelopmental concerns in Ìý(2019), (2024), and Afghan cohorts (2025, submitted for publication).Ìý

Assessment

Background and current function

• Parent concern about development issuesÌý- this is specific, but not necessarily sensitive in the early stages of resettlement. Developmental concerns may not be raised in initial visits, health and settlement issues often take priority.Ìý Ìý Ìý Ìý Ìý Ìý Ìý Ìý Ìý Ìý Ìý Ìý Ìý Ìý Ìý Ìý Ìý Ìý Ìý Ìý Ìý Ìý
  
• Early developmentÌýand current developmental level - gross motor milestones and major language milestones (e.g. speaking in sentences) appear to be remarkably constant across languages and cultures. Children may not have had access to books/pens/paper/zips/buttons - these are culturally bound markers.Ìý
  
  • Cultural expectations of adaptive function differ; toilet training at 2 years may be late in a child from Myanmar but would be considered relatively early in Australia.
    
  • Ask specifically about vision, hearing and balance and plan for earlyÌýaudiologyÌýand visual screening if there is any concern, or if there is developmental delay.
    
  • Ask the family if they feel the child's skills were late or early, and whether they obtained skills at the same time as their siblings or other children in their community. Check specifically for developmental regression.
    
• Antenatal and perinatal historyÌý- consider pre-, peri- and post-natal contributors to development.
• Early medical historyÌý- also consider additional risk factors for developmental problems related to the refugee experience. Ask specifically about hospital admissions, any severe illnesses or coma, accidents/trauma, seizures, cerebral malaria and nutritional status. It is surprising how frequently these issues are not raised.
  • In recent years, an increasing proportion of new arrival children have complex developmental presentations, with a range of neurodevelopmental and genetic conditions.
  • Cerebral (Pl. falciparum) malaria is associated with long term cognitive impairment and problems with attention.^1,2
  • Severe early malnutrition is associated with lower IQ and problems with behaviour and school performance in school-aged children.³ Ask about weight/nutrition in the first 2 years, chronic diarrhoea, and any time in camp hospitals/feeing centres.
  • Consider iron deficiency, low B12, lead exposure and hypothyoidismÌý(neurodevelopmental impacts), and vitamin D deficient rickets (gross motor delay) as contributors.
• Family history and consanguinityÌý- be sensitive in asking about family demographics, family members may be missing or deceased. It is usually easier to ask 'Who is in your family in Australia?' and 'Do you have family overseas?' rather than enquire about specific family members. Ask about consanguinity.
• Trauma/mental health historyÌýand parent mental health - in our experience it is (still) uncommon to get a history of significant trauma in refugee families during the initial health assessment, whereas trauma and mental health problems are often immediate concerns in asylum seeker children/families and may be overwhelming. Families who have come from direct conflict zones, and families who had babies in detention are at extreme risk.Ìý
• Current behavioural, emotional or mental health concerns, also consider attachment issues.
• Sleep, screen time, dietary history - sleep problems are common, and often multifactorial, and affected by household arrangements, and mental health issues, especially for asylum seeker children. A healthy diet and family mealtimes are important supports for all children/families and should be encouraged and celebrated.

Pre-arrival education and language history

• Parent education and professionÌýÌý- people of all backgrounds flee situations of humanitarian conflict, and people may work within refugee camps. Asking someone's background is informative and respectful - we see a relatively high proportion of families where a parent worked in a professional capacity overseas.
• Languages spoken, preferred language and timing of acquisition of language(s) - consider language acquisition in the context of major developmental transitions.
• Education (more for school age children) - explore any any early childhood education or playgroup experience overseas.

Post arrival settlement and early childhood service access

• Families' settlement or asylum experienceÌýand moves post arrival.ÌýClarify pathways for asylum seeker families (detention has not been a feature in recent years).
• Home and family environment - families may be living in crowded or unstable conditions which affect routines, sleep and access to space for homework. New arrival families commonly stay in short term accomodation after arrival, often for months, which affects service linkages.Ìý
  
• Access to:
  • Ìý
  • Childcare - adult Humanitarian entrants are eligible for 510 hours free English language tuition in the Adult Migrant Education Program. Free childcare is provided with these classes.
  • Kindergarten - Ìýin Victoria
  • Case managementÌýis provided for all new refugee arrivals through the (Ìýand subcontractors in Victoria, usually for 6 months). Consider referral to Ìýfor longer term or complex needs.
  • Mental health/trauma services, including .

Examination

• Assess growth and head circumference - plot height, weight and head circumference percentiles and correlate with parent measurements.
• General examination, look for pallor, goitre, nutritional status, syndromal features, neuro-cutaneous stigmata, full physical examination including ENT, and assessment of language, social skills, play, self regulation, and interaction with parents/siblings.
  

Screening

Investigations

• Early investigationsÌý(some are part of refugee screening)
  • General - thyroid function, FBE, iron studies, B12/folate, vitamin D (risk factors/rickets/gross motor delay), consider blood lead levels, CK (gross motor delay).
  • Genetic tests - SNP microarray, Fragile X screening, exome sequencing can usually be performed later (now much easier with saliva testing) and rarely change initial management.
  • Consider metabolic disorders in children with regression, or where there is history/exam suggesting metabolic disease (lethargy/coma with intercurrent illness, food aversion, seizures, family history including unexplained deaths, syndromal features, hepatosplenomegaly) - venous blood gas, lactate, ammonia, LFT, plasma amino acids, urine amino/organic acids, MPS screening, others pending advice from metabolic team.
    
• Vision and hearing screeningÌý- refugee/asylum seeker infants have often missed screening for visual or hearing problems (even in Australia).ÌýIf there is any concern about vision, hearing or development complete screening early.Ìý
  

Developmental screening and formal assessments

• Developmental screening - there is a lack of validated developmental screening tools, and in practice we rely on the clinical history. Possibilities include:
  • (SDQ) - Ìý(2-17 years).Ìý
  • Ages and Stages QuestionnaireÌý(ASQ)Ìý- see Ìýfor which tests to use.
  • . Also seeÌý Parent Arabic, Parent follow-up Arabic, Teacher Arabic, Teacher follow-up Arabic. Also see
    • ADHD fact sheets -ÌýADHD Arabic versionÌý(English), andÌýADHD ways to help at school and home Arabic versionÌý(English)
      
  • Ìý- also has translated versions and online scoring
  • (M-CHAT). Ìý
    

• Formal assessment (e.g. language testing, cognitive testing) is often only completed prior to school entry and should be accompanied by a comprehensive paediatric assessment. These tests may be required in order to access supports in school, and they can provide useful information when considered in the context of a comprehensive developmental assessment.Ìý
  • There is no prescribed timing for completing testing -Ìýwe recommend that children with a clear history of developmental delay are assessed at school entry to maximise supportÌý(after appropriate counselling) and that they are reassessed at a later date. Ìý
  • In children with normal early development, it is nearly always appropriate to watch and wait, and liaise with the schoolÌý- provided a paediatric assessment and initial investigations have been completed.
  • Cognitive and formal language testing is generally not validated for use in non-English speaking children, or for use with an interpreter.ÌýAny test result needs to be interpreted with extreme caution, families need appropriate pre-test and post test counselling. If cognitive assessment has already occurred - check families understanding of testing, and whether an interpreter (and which language) was available for testing and feedback sessions. This resource on IQ test scoresÌýcan be helpful to explain results.

Management

All refugee and asylum seeker children

• Ensure adequate sleep, and encourage a healthy dietÌý- see nutrition resources.
• Limit screen time - provide advice on appropriately .
  
• Encourage first language development at home and expressing respect for the language skills within the family.
  • Local libraries will have multilingual books.
  • Talking about books and telling the story in the first language (i.e. byÌýdescribing pictures) is likely to be of benefit.
  • National Literacy Trust (UK) -Ìý- includes resources to support early literacy and school readiness (Arabic, Kurdish, Somali, Urdu, others).
    • Arabic language -ÌýTalk to your baby in your language,ÌýSharing books with your baby,ÌýPlaying with your baby,ÌýTalking with your baby,ÌýMaking the most of television.
• Encourage play, including outside play,Ìýand children's involvement in daily family activities.
  
  • can be a useful resource.
• Link families withÌýÌý- MCH provide advice on playgroups and community programs, some MCH services provide immunisation.Ìý Routine checks are due at birth, 2w, 4w, 8w, 4m, 8m, 12m, 18m, 2y and 3.5yrs.
  
• ConsiderÌý also noting some families prefer unselected local playgroups.
• Consider early childhood education/childcare - childcare can be a great support for children/families and child development.Ìý.Ìý
  • is a targeted program for three-year-old children from families with complex needs.
  • may be an option for vulnerable children, providing 13 weeks childcare.
• Ensure children are enrolled in kindergarten.Ìý
  • All children are entitled to , see Ìý
  • SeeÌýÌýand pre-school field officer () contacts.Ìý
    
  • Children need to meet eligibility criteria (viaÌý)Ìýin order to be approved for a second year of 4-year old kinder.Ìý
    
  • (FKA)Ìýprovides support for bilingual children in childcare, kindergarten, out of school hours care and holiday programs.
• Ìý(by postcode).
  
• Ìýprovides useful parenting resources and aÌý.

Additional supports for children with developmental delays/disability.

• Childcare/early childhood education -Ìýcan be a major support for children with delay/disability - seeÌýÌýand .
  • Additional support may be available through theÌýÌý(initiated by the education setting).
• Kindergarten - ensure enrolment ()ÌýandÌýcontactÌý, additional support throughÌý, and Ìý
• Ìý(includes specialist education) also seeÌýÌýÌý
  
  
• Ìý- Ìýidentify children 0-12 years with an identified delay in one or more areas of development as the target population, however in practice, most community health services seem to prioritise children 0-6 years, with delays in one area only.
• Early childhood approach (NDIS)Ìý- for permanent residents/citizens - seeÌý,
  • ,Ìý .
  • Asylum seekers and others on temporary visas are not eligible for NDIS,Ìýbut may be eligible for non-resident 'continuity of support' pathways in Victoria (seeÌýDisability guideline).
• Ìý(through GPs) can provide access to 5 allied health sessions each calendar year.
  
  
• Ìý-Ìýhumanitarian entrants are eligible for carers allowance/payment if they meet usual criteria.ÌýCentrelink have multicultural liaison officers to help families complete forms (Ìýphone 13 12 02).ÌýÌýare available.
  • Asylum seekers and people on temporary visas are not eligible for Carer allowance. People on a TPV/SHEV are eligible for a health care card.

• Vision checksÌýcan be accessed at commercial bulk-billing optometrists for children with Medicare, or atÌý Ìý( and ), the ACO also has affordable glasses.
• Hearing checksÌýcan be accessed at audiology servicesÌý Hearing aids are available through .
  
  
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_{Immigrant health resources. Author: Georgie Paxton, Shidan Tosif. Updated July 2025. Contact: georgia.paxton@rch.org.au}