Suitability of tools assessing adverse childhood experiences in young refugees – a systematic review

BACKGROUND: With the persistence of ongoing crises and subsequent displacement of individuals, including children, gaining knowledge about adversities experienced in this context is crucial - given the harmful effects of adverse childhood experiences (ACE) on mental and physical health. While questionnaires for ACE in children exist, it is uncertain if they comprehensively address adversities faced by refugee children. This review's objectives are to (1) identify and analyze current ACE questionnaires and determine if they are suitable for assessing refugee children's adversities, and (2) identify and analyze those previously used among refugee populations. METHODS: A systematic literature search was conducted in 2022 across five databases for articles published since 2010, including studies using an ACE questionnaire that recognized multiple adversities in healthy children and were published in English. RESULTS: A total of 103 ACE questionnaires were identified in 506 studies. Only 14 of the 103 questionnaires addressed a refugee-specific adversity with exposure to war/conflict and family separation being addressed most frequently (10 and 7 questionnaires). Their ability to capture refugee children's experiences was limited: available questionnaires used a maximum of three items to assess refugee-specific adversities, covering only a fraction of forms of adversities relevant to refugee children. Out of the 14 questionnaires that included a refugee-specific adversity, only three had reported psychometric properties. In addition, only two ACE questionnaires were used within a refugee population. CONCLUSIONS: With the tools currently available, it is not possible to comprehensively assess the exposure to and severity of the adversities faced by refugee children. Adequate tools of exposure assessment are essential in order to understand refugee children's wellbeing and develop targeted mitigation strategies for those at risk. KEY MESSAGES: • Adverse childhood experiences (ACE) can harm mental/physical health. Adequate tools assessing ACE exposure in flight contexts are needed in order to develop mitigation strategies for those at risk. • With the tools currently available, it is not possible to comprehensively assess the exposure to and severity of the adversities faced by refugee children before, during and after flight.