Beyond Developmental Supports for a Child Refugee.

Area of Science:

• Pediatrics
• Developmental Psychology
• Public Health

Background:

• A 10-year-old Syrian refugee boy, Zahid, presented with developmental concerns noted from 9 months of age, including delayed speech and response to name.
• Concerns for autism spectrum disorder (ASD) were raised at age 3 in Syria, but diagnosis was delayed due to perceived trauma-related behaviors.

Observation:

• Zahid was diagnosed with ASD in the U.S. 18 months after immigration.
• The family faces significant socioeconomic and logistical challenges, including limited English proficiency, unemployment, and transportation difficulties, hindering access to recommended applied behavior analysis (ABA) therapy.
• Zahid exhibits safety-related behaviors such as elopement and operating kitchen appliances, increasing household risk.

Findings:

• Despite an Individualized Education Program (IEP) and acceptance into an ABA program, Zahid has not commenced therapy due to transportation issues.
• The family refused in-home ABA services.
• The father, concerned about his ability to manage appointments and employment, requested a physician's letter for exemption from work/training programs.

Implications:

• This case underscores the critical need for culturally sensitive and accessible support systems for refugee families with children diagnosed with ASD.
• Addressing practical barriers like transportation and providing tailored parental support are crucial for effective intervention.
• Physician advocacy may be necessary to navigate complex systems and ensure families receive appropriate services and accommodations.