Assessing learning issues in refugee and asylum seeker students is often challenging. Like any other student, a developmental and family history is essential; however there are different aetiologies to consider in developmental/learning problems in this group. Assessment must also consider previous education and language transitions in relation to development, missed schooling, the impact of forced migration and trauma, additional language acquisition, education pathways in Victorian schools, and support services available.

UNHCR data (2021) show only 68% refugee students have access to primary education and 34% have access to secondary education.¹ Australian studies show 33-67% refugee background and asylum seeker students have had interrupted or no prior schooling,^2-6, most asylum seekers missed significant schooling in Australian detention,^5-7 and delays to enrolment in Victorian education are frequent, affecting 35-54% of recent cohorts.^4,8 Basic screening for contributors to learning issues, such as nutritional and sleep issues, mental health issues and vision/hearing problems, is frequently missed. There are complex issues around the timing and validity of formalised language or intelligence testing in a child's additional language, and for ADHD and autism assessments. Finally, birthdates may be incorrect, with implications for assessment and grade level placement. Ultimately an assessment takes time, and requires close liaison with the family and the help of a skilled interpreter.

This guideline is intended for paediatricians/paediatric trainees working with refugee-background or migrant children referred for learning issues, and to be used in conjunction with other guidelines and training on assessments for intellectual disability, autism and ADHD. Also see Developmental assessment (younger children) and Disability guidelines, and our systematic review of learning problems in refugee background children (Graham et al, 2016).⁹

Key points

• Comprehensive assessments - a refugee focused medical and developmental assessment should be performed in conjunction with any educational or psychology assessment. 
• If there is a clear history of developmental delay/disability, we suggest early formal assessment and accessing support (school, +/- NDIS) after careful explanation and counselling of parents on the process and limitations of testing, and a discussion on the harm/benefit of making a formal diagnosis. 
• Consider grade placement proactively - it is usually appropriate to place new arrivals with the same age children in a younger grade level, especially if they have experienced interrupted education. 
  

Clinical assessment

Current function

• Parent concern about learning and development - this is specific, but not necessarily sensitive in the early stages of resettlement. These concerns are often not raised in the initial visits, health and settlement issues seem to take priority. Learning concerns may present some years after arrival.
  
• Current behavioural, attention, emotional or mental health concerns and impact/presentation in the home and school setting. 
• Vision and hearing - refugee children/adolescents have often missed screening for visual or hearing problems (even in Australia). Middle ear disease is common and may be prolonged/severe, deafness can occur due to extreme noise exposure. Refractive errors and problems with visual acuity are frequent. 
• Sleep, screen time, dietary history - sleep problems are common, often multifactorial, and affected by screen time, household arrangements and mental health issues. Regular sleep and wake times and limited screen are important foundations, and a healthy diet and family mealtimes are supports for all children/families.
• Strengths and resilience factors - it is useful to ask families what is their child good at, and to reflect on strengths and resilience within the family - this is helpful to shape the clinical consultation.

Background

• Check age (see guideline) - documented birthdate may be incorrect in refugee background children. Double check birthdate at school enrolment and if age normed testing is completed.
  
• Early development - gross motor milestones and major language milestones (e.g. speaking in sentences) appear to be remarkably constant across languages and cultures. 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 for developmental regression.
  
• Early medical history - check antenatal and perinatal history, and consider additional risk factors for developmental problems related to the refugee experience. Ask specifically about hospital admissions, severe illnesses/coma, accidents/trauma, seizures, cerebral malaria and nutritional status. It is surprising how frequently these issues are not raised.
  • In recent years, we have seen an increasing proportion of new arrival children with complex developmental/disability presentations, with a range of neurodevelopmental and genetic conditions.
  • Cerebral (Pl. falciparum) malaria is associated with long term cognitive impairment and problems with attention.^10,11
  • Severe early malnutrition is associated with lower IQ and problems with behaviour and school performance in school-aged children.¹² Ask about weight/nutrition in the first 2 years, chronic diarrhoea, and any time in camp hospitals/feeding centres.
  • Consider iron deficiency, low B12, lead exposure and hypothyoidism as contributors to learning/neurodevelopmental issues. 
• Family history and consanguinity - 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, and family history of development/disability.
  
• Trauma/mental health history and 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, unaccompanied minors and families who spent time in detention will have experienced extreme trauma. Trauma histories may emerge over time, and adolescents may make new meaning of what has happened for them. Consider early life attachment issues and periods of family separation. 

Pre-arrival education and language history

• Parent education and profession - 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. Asking parents if they had access to school themselves is  an easier/more respectful question than asking about completed year level. 
• Languages spoken, preferred language and timing of acquisition of language(s)  - consider language acquisition in the context of major developmental transitions; for instance moving country and languages at age 2-3y (when children would typically start speaking in sentences) then again at the start of schooling (which then commences in another language) is likely to have more significant effects on education than attending continuous first language schooling in a stable school situation. Some children/families are from backgrounds with predominantly oral language traditions, and recent/limited written languages.
• Schooling history overseas - access to school, type and quality of school (varies widely - ask what the classroom was like and local schooling conditions), attendance and continuity of schooling, level achieved, any repeat levels (often a marker for learning issues, in many settings repeating a grade is compulsory if the student does not pass assessments), the language the schooling was in (which may not be the child's language). Children with no/limited experience of school need to learn class rules/structures, as well as acquire a new language, establish friendships and start to learn academic content. 
  • Missed schooling is common in refugee background students. Australian studies have shown 2/3 of Syrian and Iraqi students,^2,6 and 33% general cohort⁷ had interrupted schooling overseas, 44% Afghan students had no prior schooling.³ Studies of asylum seeker cohorts in Australia show 46%-89% had interrupted education including during detention (100% offshore cohort).^1,4
• Print literacy in other languages for the child and parents. 

Post-arrival education and settlement history

• Families' settlement or asylum experience, time to school enrolment and moves post arrival. Families may be accommodated in 'short term accomodation' after arrival and many families will move in the post arrival period. As of 2025, many new arrival children are missing months of schooling in Victoria, especially children with disability.    
  
• Previous access to kindergarten and school - clarify access and attendance, English language school access/duration, subsequent school pathways, amount of English as an Additional Language (EAL) support, and the demographics of the school they attend (other children or multicultural education aides speaking the same language) 
• Consider the impact of the Covid pandemic (2020-21) which highlighted divides in digital literacy and technology access, it is helpful to document grade levels impacted.
• Home and family environment  Families may be living in crowded or unstable conditions which affect routines, sleep and access to space for homework. Consider family violence and chronic environmental stressors. 
• Experience and impact of racism - unfortunately racism experience remains common, although there are few recent studies on prevalence. 
• Access to case management (AMES) and/or mental health/trauma services, including Foundation House.
  

Investigations

• Consider investigations (some are part of refugee screening) including thyroid function, FBE, iron studies, B12/folate, consider blood lead levels. Genetic testing can usually be performed later (now much easier with saliva testing) after formal assessments.
• Vision and hearing screening - if there is any learning concern, complete screening early. Vision checks can be accessed at commercial bulk-billing optometrists for children with Medicare, or at  Australian College Optometry ( ACO associated clinics and regional access), the ACO also has affordable glasses. Hearing checks can be accessed at audiology services  Hearing aids are available through Hearing Australia.
  

Formal assessments

Like any other student group, a proportion of refugee children will have disabilities and additional learning needs compared to other children of similar background, however all refugee children have risk factors for educational disadvantage (language transitions, displacement) and many have additional, cumulative risk factors (trauma, lack of/interrupted prior schooling, mental health issues). This may lead to significant educational impairment in cognitively typical children.

Cognitive assessments 

• There is no prescribed timing for completing cognitive assessments; we recommend that children with a clear history of developmental delay are assessed early to optimise support (after appropriate counselling) and that they are reassessed at a later date. 
• In children with typical early development, it is nearly always appropriate to watch and liaise with the school - provided a paediatric assessment and initial investigations have been completed.
• Cognitive testing is culturally bound and is usually not validated for use in non-English speaking children, or for use with an interpreter. Different formats are utilised, however any test result needs to be interpreted with extreme caution, and families need appropriate pre-test and post test counselling.  Non-verbal tests are periodically favoured as assessment tools, however these tests also have language and cultural loading and require verbal processing, gesture based instructions may be misunderstood (summarised in¹³). 
  
  • 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, and that this is documented (if not documented, write to schools and ask for an updated report including this information). 
  • This resource on IQ test scores can be helpful to explain results. 
  • We suggest seeking copies of cognitive assessment for the family with consent. For children with intellectual disability, these reports are important for NDIS supports in the longer term, but are often not provided to families.

ADHD rating scales

• There is a complex interplay between learning issues, trauma and attentional difficulties. Inadequate sleep and excess screen time have compounding effects on attention and behaviour, and these presentations may also reflect exposure to chronic stressors, including family violence. Despite this complexity, assessment and management of ADHD (as a primary diagnosis or comorbidity) can have major positive impacts for the child and family. 
• NICHQ Vanderbilt Assessment for ADHD, ODD and CD. Also see  Parent Arabic, Parent follow-up Arabic, Teacher Arabic, Teacher follow-up Arabic. ADHD fact sheets - ADHD Arabic version (English), and ADHD ways to help at school and home Arabic version (English).

Autism assessments

• Autism assessments are not covered in this guideline, but the background history above is relevant to the comprehensive assessment required for an autism spectrum disorder. See National Autism CRC guidelines (need to register).
  

Supports

Practical suggestions

• Attention to grade level placement.
• Encourage language school attendance in new arrivals.
• Consider 3-year VCE programs, VCE Vocational Major (VCE-VM) and Victorian Pathways Certificate (VPC) for older students, provide early advice on Special Entry Access Scheme (SEAS) for VCE students, and asylum seeker scholarships for older students seeking asylum.
• Encourage ongoing first language development at home, explaining additional language acquisition, and expressing respect for the language skills within the family.
  • Local libraries should have multilingual books - for early learners, talking about books and telling the story in the first language (i.e. by describing pictures) is likely to be of benefit.
• Khan academy is a free, multilingual resource for catching up with maths/science/other subjects.
• Informing parents of their rights to access interpreters in the school setting.
• Encouraging activities where students experience success and can enjoy peer relationships, without academic or language pressure, e.g. sport or art.
• Allowing time for exercise, play, rest and to adapt to life in Australia.
• Ensure adequate sleep, limiting screen time, and encouraging a healthy diet.
• Encourage parents to access English language classes to build their confidence in supporting their children and interacting with schools.
• Addressing medical needs and providing long term care as needed.

Our previous systematic review of learning issues in refugee background students⁸ found resource factors for success are high academic and life ambition, motivational narratives within the family, parent involvement in education, family cohesion and a supportive home environment, accurate education assessment and grade placement, teacher understanding of linguistic and cultural heritage, culturally appropriate school transition, supportive peer relationships and successful acculturation. Risk factors included parent misunderstanding of education style/expectation, low teacher expectations, bullying and racism, pre-/post-migration trauma and forced detention. A more recent 2023 Canadian 'meta-synthesis' of qualitative studies of refugee students in Canada and the US found similar risk factors, including inappropriate grade placement, 'deficit thinking' of teachers, language barriers, lack of trauma-specific counselling, and misunderstandings in family-school communication.¹⁴ 

Grade placement

• Age ranges within any class vary - many children repeat or delay kindergarten entry and start school in Victoria aged 6 years.
  
• Grade placement in refugee- background children should consider age, prior education, overseas experience, development, settlement, psychological factors and parent preference - it is usually appropriate to consider placement with same age children in the younger grade level.
• • Kindergarten should be considered as an option for children age 5 years. 
  • 6 yr old children may be better placed to start in Foundation (understanding many other Foundation students will also be aged 6 yrs) - this principle extends through the year levels - e.g. 8 yr olds can be placed with the other 8 yr olds in grade 2; 11 yr olds can be placed with other 11 yr olds in grade 5. There is generally no need for refugee background students to be the youngest in their year levels, and we suggest avoiding this situation.
• The exception to younger grade level placement is students with disability entering specialist education, where grade levels are matched more closely to age, with more defined transition points for finishing school at 17 years. 

Compulsory schooling - in Victoria, schooling is compulsory for children who have turned 6 years until they turn 17 years (in all types of schooling). Students aged 17 years (turning 18 years during the school year) can only enrol in school if they fall in an exception/exemption category or if they are granted an exemption. Exception categories include students (17 turning 18 years) enrolling in language school, and students 17 turning 18 years and 18 turning 19 years) completing an accredited senior secondary course (VCE, VCE-VM, VPC, International Baccalaureate). 

Disability funding - schools

Both Government and Catholic education have now transitioned to the Nationally Consistent Collection of Data systems of support for students with disability. Schools have to provide evidence that an adjustment (substantial or extensive) has been required for a minimum of 10 weeks, for at least one of the 4 categories of disability (physical, cognitive, sensory, social/emotional). 

• Government schools - Disability inclusion policy and Disability inclusion profile (government schools). In practice, this means any child with disability has to wait 10 weeks for supports. We have seen multiple refugee background children excluded from school while waiting for assessments, or during the 10-week period because there are no supports in place to facilitate their safe attendance.
•  Catholic education - Disability funding.

School resources

Department of Education and Training (DET)

• English as an additional language, EAL handbook and EAL provision for new arrivals (includes list of language schools)
• Supporting students of refugee background
• Help with school costs and fees
• Navigator program
• Preventing and addressing racism policy
  
• VCE, VCE Vocational Major and Victorian Pathways Certificate
• SEAS - Special Entry Access Scheme
• Government school finder (includes specialist schools)
  

Catholic Education

• New arrivals program
• Catholic education school finder (includes Catholic specialist schools)

Other

• All schools directory (includes independent schools)
• River Nile School - independent secondary school, trauma informed education for young women of refugee and asylum seeker background
• Independent schools Australia - Disability, Independent schools Victoria Research report on NCCD
• Victorian Deaf Education Institute, Victorian College for the Deaf, and Visiting teacher services
• Statewide Vision Resource Centre and Education Vision Assessment Clinic

Other supports

• NDIS - Early childhood approach and broader NDIS - and see Disability guideline.
• Non-resident pathways for disability support - see Disability guideline.
• Chronic condition management plans (through GPs) can provide access to 5 allied health sessions each calendar year.
  
• Carer's allowance and payment - humanitarian entrants are eligible for carers allowance/payment if they meet usual criteria. Centrelink have multicultural liaison officers to help families complete forms (multilingual service phone 131202). Treating doctor reports are available. Asylum seekers and people on temporary visas are not eligible for Carer allowance.
  
• Foundation House Schools program and counseling, school-based counselling may be an option. Also see School's in for refugees Professional learning resources.
• Asylum seeker scholarships - University of Melbourne, Monash University, Deakin University, Latrobe University, RMIT, Swinburne, Victoria University
• Asylum seeker VET program.
• Bilingual health professional directories 
  • Clinical psychologists. 
    
  • Social workers (advanced search preferred language).
    
  • Speech pathologists (advanced search languages other than English).
    

Notes

Students of a refugee background are only exempt from benchmark testing for 12 months after arrival in both the Government and Catholic school systems in Victoria. 

References

• References

_{Immigrant health resources. Initial: Georgia Paxton, updated Jul 2025. Contact georgia.paxton@rch.org.au}