Journal of Immigrant and Minority Health

, Volume 22, Issue 1, pp 22–33 | Cite as

Mental Health Needs of Refugee Children in Specialized Early Education and Care Programs in Germany

  • Thimo BuchmüllerEmail author
  • Hanna Lembcke
  • Francesca Ialuna
  • Julian Busch
  • Birgit Leyendecker
Original Paper


Refugee children are at risk to develop mental health problems, which have rarely been investigated in educational contexts. We conducted three studies in childcare programs for refugees in Germany. Children’s behavior was assessed by educators on site (n = 84) and online (n = 50) using a two-stage-cluster sampling and on site (n = 107) using complete samples. In Study 1 and 2, children showed elevated attention problems ranging from medium to large effect sizes, r = 0.2 and r = 0.5, respectively, and aggressive behavior problems ranging from small to large effect sizes, r = 0.1 and r = 0.5, respectively, when compared to norm data. In Study 3, children showed elevated peer-problems, r = 0.5. Future research needs to investigate whether these problems are a consequence of adapting to a novel context or a precursor of a psychopathology caused by risk factors in the context of forced displacement.


Refugee children Early education and care Mental health C-TRF SDQ 



The study was funded by the Ministry for Children, Families, Refugees and Integration of the state of North Rhine-Westphalia (Ministerium für Kinder, Familie, Flüchtlinge und Integration des Landes Nordrhein-Westfalen) and by the educational trust RuhrFutur (Bildungsinitiative RuhrFutur).

Author Contribution

T.B. contributed to the study by conceptualization, data collection, data analysis and interpretation and by drafting the article. H.L. contributed by drafting parts of the manuscript, by data analysis and interpretation of the article. F.I. contributed by drafting parts of the manuscript and by data collection. J.B. contributed by conceptualizing the study. B.L. contributed in supervising the project. All authors provided critical feedback on the manuscript and gave their final approval of the version to be published.

Compliance with Ethical Standards

Conflict of interest

We declare that we have no conflict of interest.

Ethical Approval

All studies were approved by the Ethics Committee of the Faculty of Psychology of the Ruhr University Bochum.


  1. 1.
    UNHCR. Global trends: Forced displacement in 2017. Geneva: UNHCR.Google Scholar
  2. 2.
    Fazel M, Reed RV, Panter-Brick C, Stein A. Mental health of displaced and refugee children resettled in high-income countries: risk and protective factors. Lancet. 2012;379:266–82.CrossRefGoogle Scholar
  3. 3.
    Reynolds AJ, Temple JA, White BAB, Ou S-R, Robertson DL. Age 26 cost-benefit analysis of the Child-Parent Center Early Education Program. Child Dev. 2011;82:379–404.CrossRefGoogle Scholar
  4. 4.
    Slone M, Mann S. Effects of war, terrorism and armed conflict on young children: a systematic review. Child Psychiatry Hum Dev. 2016;47:950–65.CrossRefGoogle Scholar
  5. 5.
    Bornstein MH, Hahn C-S, Haynes OM. Social competence, externalizing, and internalizing behavioral adjustment from early childhood through early adolescence: developmental cascades. Dev Psychopathol. 2010;22:717–35.CrossRefGoogle Scholar
  6. 6.
    Kien C, Sommer I, Faustmann A, Gibson L, Schneider M, Krczal E, et al. Prevalence of mental disorders in young refugees and asylum seekers in European countries: a systematic review. Eur Child Adolesc Psychiatry. 2018. .CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Wiegersma PA, Stellinga-Boelen AAM, Reijneveld SA. Psychosocial problems in asylum seekers’ children: the parent, child, and teacher perspective using the Strength and Difficulties Questionnaire. J Nerv Ment Dis. 2011;199:85–90.CrossRefGoogle Scholar
  8. 8.
    Nielsen SS, Norredam M, Christiansen KL, Obel C, Hilden J, Krasnik A. Mental health among children seeking asylum in Denmark—the effect of length of stay and number of relocations: a cross-sectional study. BMC Public Health. 2008;8:293.CrossRefGoogle Scholar
  9. 9.
    Bean TM, Eurelings-Bontekoe E, Spinhoven P. Course and predictors of mental health of unaccompanied refugee minors in the Netherlands: one year follow-up. Soc Sci Med. 2007;64:1204–15.CrossRefGoogle Scholar
  10. 10.
    Montgomery E. Trauma and resilience in young refugees: a 9-year follow-up study. Dev Psychopathol. 2010;22:477–89.CrossRefGoogle Scholar
  11. 11.
    Thabet AAM, Karim K, Vostanis P. Trauma exposure in pre-school children in a warzone. Br J Psychiatry. 2006;188:154–8.CrossRefGoogle Scholar
  12. 12.
    FRA – European Union Agency for Fundamental Rights. Fundamental Rights Report 2017. 2017. Accessed 25 Apr 2018.
  13. 13.
    Bakker L, Dagevos J, Engbersen G. The importance of resources and security in the socio-economic integration of refugees. A study on the impact of length of stay in asylum accommodation and residence status on socio-economic integration for the four largest refugee groups in The Netherlands. J Int Migr Integr. 2014;15:431–48. Scholar
  14. 14.
    Sangalang CC, Becerra D, Mitchell FM, Lechuga-Peña S, Lopez K, Kim I. Trauma, post-migration stress, and mental health: a comparative analysis of refugees and immigrants in the United States. J Immigr Minor Health. 2018. Scholar
  15. 15.
    Federal Office for Migration and Refugees. Flüchtlinge (BAMF): Aktuelle Zahlen zu Asyl: Ausgabe Dezember 2016.Google Scholar
  16. 16.
    UNHCR. Global Trends. Accessed 4 Apr 2018.
  17. 17.
    Milcher S. Poverty and the determinants of welfare for roma and other vulnerable groups in southeastern Europe. Comp Econ Stud. 2006;48:20–35.CrossRefGoogle Scholar
  18. 18.
    Walsh CA, Este D, Krieg B, Giurgiu B. Needs of refugee children in Canada: what can Roma refugee families tell us? J Comp Fam Stud. 2011;42:599–613.CrossRefGoogle Scholar
  19. 19.
    Becker R, Tremel P. Bildungseffekte vorschulischer Betreuung, Erziehung und Bildung für Migranten im deutschen Schulsystem. In: Becker R, editor. Integration durch Bildung: Bildungserwerb von jungen Migranten in Deutschland. Wiesbaden: VS Verlag für Sozialwissenschaften/Springer Fachmedien Wiesbaden GmbH, Wiesbaden; 2011. p. 57–70. Scholar
  20. 20.
    Becker A, Woerner W, Hasselhorn M, Banaschewski T, Rothenberger A. Validation of the parent and teacher SDQ in a clinical sample. Eur Child Adolesc Psychiatry. 2004;13(Suppl 2):II11–6.PubMedGoogle Scholar
  21. 21.
    Achenbach TM. Commentary: definitely more than measurement error: but how should we understand and deal with informant discrepancies? J Clin Child Adolesc Psychol. 2011;40:80–6.CrossRefGoogle Scholar
  22. 22.
    Busch J, Buchmüller T, Lembcke H, Bihler L, Leyendecker B. Building bridges to safe havens: transition of young refugee children to early childcare. Manuscript submitted for publication. 2018.Google Scholar
  23. 23.
    Achenbach TM, Rescorla LA. Manual for the ASEBA preschool forms & profiles. Burlington: Asenbach System of Empirically Based Assessment (ASEBA); 2000.Google Scholar
  24. 24.
    Achenbach TM, Rescorla LA. Multicultural Supplement to the Manual for the ASEBA Preschool Forms & Profiles: Child Behavior Checklist for Ages 1 1/2/-5, Language Development Survey, Caregiver-teacher Report Form; an Integrated System of Multi-informant Assessment; 2010.Google Scholar
  25. 25.
    Petermann U, Petermann F, Schreyer I. The German Strengths and Difficulties Questionnaire (SDQ). Eur J Psychol Assess. 2010;26:256–62.CrossRefGoogle Scholar
  26. 26.
    Goodman R, Scott S. Comparing the strengths and difficulties questionnaire and the Child Behavior Checklist: is small beautiful? J Abnorm Child Psychol. 1999;27:17–24.CrossRefGoogle Scholar
  27. 27.
    Woerner W, Fleitlich-Bilyk B, Martinussen R, Fletcher J, Cucchiaro G, Dalgalarrondo P, et al. The Strengths and Difficulties Questionnaire overseas: evaluations and applications of the SDQ beyond Europe. Eur Child Adolesc Psychiatry. 2004;13(Suppl 2):II47–54.PubMedGoogle Scholar
  28. 28.
    youthinmind. SDQ. 17.10.2006. Accessed 27 Nov 2018.
  29. 29.
    Niclasen J, Skovgaard AM, Andersen AM, Sømhovd MJ, Obel C. A confirmatory approach to examining the factor structure of the Strengths and Difficulties Questionnaire (SDQ): a large scale cohort study. J Abnorm Child Psychol. 2013;41:355–65.CrossRefGoogle Scholar
  30. 30.
    Enders CK. A primer on maximum likelihood algorithms available for use with missing data. Struct Equ Model. 2001;8:128–41.CrossRefGoogle Scholar
  31. 31.
    Vostanis P. Strengths and Difficulties Questionnaire: research and clinical applications. Curr Opin Psychiatry. 2006;19:367–72.CrossRefGoogle Scholar
  32. 32.
    youthinmind. SDQ. 17.10.2006. Accessed 13 Dec 2018.
  33. 33.
    Allansson M, Melander E, Themnér L. Organized violence, 1989–2016. J Peace Res. 2017;54:574–87.CrossRefGoogle Scholar
  34. 34.
    Abdi H. Holm’s Sequential Bonferroni procedure. In: Encyclopedia of research design. Thousand Oaks, CA: Sage.Google Scholar
  35. 35.
    Buchmüller T, Lembcke H, Busch J, Kumsta R, Leyendecker B. Exploring mental health status and syndrome patterns among young refugee children in Germany. Front Psychiatry. 2018;9:212.CrossRefGoogle Scholar
  36. 36.
    de Los Reyes A, Kazdin AE. Informant discrepancies in the assessment of childhood psychopathology: a critical review, theoretical framework, and recommendations for further study. Psychol Bull. 2005;131:483–509.CrossRefGoogle Scholar
  37. 37.
    Scheeringa MS, Myers L, Putnam FW, Zeanah CH. Diagnosing PTSD in early childhood: an empirical assessment of four approaches. J Trauma Stress. 2012;25:359–67. Scholar
  38. 38.
    Maercker A, Michael T, Fehm L, Becker ES, Margraf J. Age of traumatisation as a predictor of post-traumatic stress disorder or major depression in young women. Br J Psychiatry. 2004;184:482–7. Scholar
  39. 39.
    de Young AC, Kenardy JA, Cobham VE. Diagnosis of posttraumatic stress disorder in preschool children. J Clin Child Adolesc Psychol. 2011;40:375–84. Scholar
  40. 40.
    Hodges M, Godbout N, Briere J, Lanktree C, Gilbert A, Kletzka NT. Cumulative trauma and symptom complexity in children: a path analysis. Child Abuse Neglect. 2013;37:891–8. Scholar
  41. 41.
    Sirin SR, Rogers-Sirin L. The educational and mental health needs of Syrian refugee children: young children in refugee families. Washington, DC: Migration Policy Institute Press; 2015.Google Scholar
  42. 42.
    Seidman E, Allen L, Aber JL, Mitchell C, Feinman J. The impact of school transitions in early adolescence on the self-system and perceived social context of poor urban youth. Child Dev. 1994;65:507.CrossRefGoogle Scholar
  43. 43.
    Rimm-Kaufman SE, Curby TW, Grimm KJ, Nathanson L, Brock LL. The contribution of children’s self-regulation and classroom quality to children’s adaptive behaviors in the kindergarten classroom. Dev Psychol. 2009;45:958–72.CrossRefGoogle Scholar
  44. 44.
    Ponitz CC, McClelland MM, Matthews JS, Morrison FJ. A structured observation of behavioral self-regulation and its contribution to kindergarten outcomes. Dev Psychol. 2009;45:605–19.CrossRefGoogle Scholar
  45. 45.
    Moffitt TE, Arseneault L, Belsky D, Dickson N, Hancox RJ, Harrington H, et al. A gradient of childhood self-control predicts health, wealth, and public safety. PNAS. 2011;108:2693–8.CrossRefGoogle Scholar
  46. 46.
    Panter-Brick C, Grimon M-P, Eggerman M. Caregiver-child mental health: a prospective study in conflict and refugee settings. J Child Psychol Psychiatry. 2014;55:313–27.CrossRefGoogle Scholar
  47. 47.
    King S, Laplante DP. The effects of prenatal maternal stress on children’s cognitive development: Project Ice Storm. Stress. 2005;8:35–45.CrossRefGoogle Scholar
  48. 48.
    McMahon SD, Grant KE, Compas BE, Thurm AE, Ey S. Stress and psychopathology in children and adolescents: is there evidence of specificity? J Child Psychol Psychiatry. 2003;44:107–33.CrossRefGoogle Scholar
  49. 49.
    Allwood MA, Bell-Dolan D, Husain SA. Children’s trauma and adjustment reactions to violent and nonviolent war experiences. J Am Acad Child Adolesc Psychiatry. 2002;41:450–7.CrossRefGoogle Scholar
  50. 50.
    Keles S, Friborg O, Idsøe T, Sirin S, Oppedal B. Resilience and acculturation among unaccompanied refugee minors. Int J Behav Dev. 2017;42:52–63.CrossRefGoogle Scholar
  51. 51.
    Sirin SR, Ryce P, Gupta T, Rogers-Sirin L. The role of acculturative stress on mental health symptoms for immigrant adolescents: a longitudinal investigation. Dev Psychol. 2013;49:736–48.CrossRefGoogle Scholar
  52. 52.
    Crijnen AAM, Bengi-Arslan L, Verhulst FC. Teacher-reported problem behaviour in Turkish immigrant and Dutch children: a cross-cultural comparison. Acta Psychiatr Scand. 2000;102:439–44.CrossRefGoogle Scholar
  53. 53.
    Bongers IL, Koot HM, van der Ende J, Verhulst FC. The normative development of child and adolescent problem behavior. J Abnorm Psychol. 2003;112:179–92.CrossRefGoogle Scholar
  54. 54.
    Porter M, Haslam N. Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: a meta-analysis. JAMA. 2005;294:602–12.CrossRefGoogle Scholar
  55. 55.
    Fazel M, Wheeler J, Danesh J. Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. Lancet. 2005;365:1309–14.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Center for Child and Family Research, Faculty of PsychologyRuhr University BochumBochumGermany

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