Avaliação cognitiva em crianças refugiadas desacompanhadas: uma revisão sistemática

Chierici, Dienifer Katrine; Hamdan, Amer Cavalheiro

doi:10.1590/1984-0462/2023/41/2022079

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Original Article • Rev. paul. pediatr. 41 • 2023 • https://doi.org/10.1590/1984-0462/2023/41/2022079 linkcopiar

Avaliação cognitiva em crianças refugiadas desacompanhadas: uma revisão sistemática

Autoria SCIMAGO INSTITUTIONS RANKINGS

Objetivo: Identificar o que a literatura tem apresentado a respeito de possíveis alterações cognitivas em crianças refugiadas desacompanhadas.

Fontes de dados: Foi realizada uma busca nas bases de dados Web of Science, PsycInfo, Scopus e PubMed, que incluiu artigos indexados produzidos em qualquer período e em qualquer idioma. A pesquisa foi submetida ao protocolo do International Prospective Register of Systematic Reviews — Prospero (ID: CRD42021257858), e a qualidade dos artigos selecionados foi avaliada por meio do Mixed Methods Appraisal Tool.

Síntese dos dados: Memória e atenção foram os principais tópicos identificados, em grande parte por sua relação com sintomas de transtorno do estresse pós-traumático. Contudo, foi observada baixa especificidade na condução dos testes cognitivos, levando a importantes inconsistências entre os dados coletados.

Conclusões O uso de instrumentos de avaliação psicológica mal adaptados ou inadaptados para as populações estudadas coloca em dúvida a validade dos dados produzidos.

Palavras-chaves:
Criança; Refugiado; Testes psicológicos; Cognição; Revisão sistemática

Author, year	Study design	Sample	Countries of origin	Conclusions
Childs, 2021¹⁴	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., 1995¹⁵	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, 2012¹⁶	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, 2019¹⁷	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, 2006¹⁸	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, 1999¹⁹	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, 2016²⁰	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, 2017²¹	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, 2021¹⁴	Gudjonsson Suggestibility Scale (GSS); Wechsler Abbreviated Scale of Intelligence (WASI)	Memory, intelligence
Wolff et al., 1995¹⁵	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, 2012¹⁶	Weinberger Adjustment Inventory (WAI); Youth Self-Report (YSR)	Attention
Pfeiffer, 2019¹⁷	The Child and Adolescent Trauma Screen (CATS)	Attention
Spinhoven, 2006¹⁸	Hopkins Symptom Checklist (HSCL); Reactions of Adolescents to Traumatic Stress Questionnaire (RATS); Stressful Life Events Questionnaire (SLE)	Memory
Wolff and Fesseha, 1999¹⁹	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, 2016²⁰	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, 2016²⁰	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, 2017²¹	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, 2021¹⁴	Yes	Yes	Yes	Yes	100
	Wolff et al., 1995¹⁵	Yes	Yes	Yes	Yes	100
	Wolff and Fesseha, 1999¹⁹	Yes	Yes	No	Yes	75
	Huemer, 2016²⁰	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, 2012¹⁶	Yes	Yes	No	Yes	75
	Pfeiffer, 2019¹⁷	Yes	Yes	No	Yes	75
	Spinhoven, 2006¹⁸	Yes	Yes	Yes	No	75
	Longobardi, 2017²¹	Yes	Yes	No	No	50

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[TNFN1] M: male; F: female.