Asylum-seeking children in shutdown: Neurobiological models

Abstract

Asylum-seeking children presenting in the shutdown state have been the subject of much discussion and controversy—on both government and medical system levels—in Australia and in Sweden. In this article, we conceptualize the shutdown state as an evolutionary response to extreme threat. We adopt a neuroscience approach to present five plausible models for explaining this shutdown state, their strengths and shortcomings, and the overlaps between them. Model 1—the sustained autonomic arousal model—draws on polyvagal theory. Model 2—the innate-defence model—draws on research pertaining to animal and human innate defence responses. Model 3—the catatonia model—draws on clinical and research data with patients presenting with catatonia. Model 4—the hypometabolic model—draws on an emerging body of work pertaining to hypometabolic states in animals and humans. Model 5—the defence cascade model of dissociation—draws on clinical research pertaining to human trauma states that present as dissociation. At present, each of the models provides a plausible pathophysiological explanation—or a component of a potential pathophysiological explanation—and none of them, for the moment, has enough evidence to be either accepted or disregarded. We hope that our discussion of the models advances scientific discussion and opens up possibilities for effective treatment.

Dismantling racism through partnership with resettled refugee communities.

“…In short, leaving communities and their children without adequate resources for healthy development has the potential for grave costs. Glaring examples of some of the worst possibilities include the alarming incidence of “resignation syndrome,” a catatonic-type state observed in asylum-seeking children in Sweden and Australia (Kozlowska et al, 2021; von Knorring & Hultcrantz, 2020), or the wide range of harms caused by the U.S. zero tolerance policy enacted in 2018, deemed unconscionable by global entities and medical experts, forcibly separating children from their parents at the U.S. border for weeks, months, and years, often with no plan for how to reunite them (Edyburn & Meek, 2021).…”

The neurobiology of functional neurological disorders characterised by impaired awareness

“…RS would then be a confluence of the dissociative, innate defensive and autonomic/interoceptive activation factors listed by Koslowska et al ( 29 ) and summarised in Table 1 below. A key point is the overlap between the models proposed by these workers, whilst these categories provide structure for clinically assessing patients with suspected severe FIAD.…”

“…Social, psychological, biological factors, and comorbidities should be documented and a biopsychosocial framework adopted since pathophysiology occurs in a body that cannot be considered an isolated system, as we have seen regarding the acquisition of prior beliefs. The five clinical models described by Koslowska et al ( 29 ) constitute hypotheses for biological components of this biopsychosocial approach. Detailed clinical documentation and research need to map their features in severe FIAD, and pharmacotherapeutic trials may help distinguish dissociative from catatonia-like patients, when a difference is indeed found.…”

“…The neurobiological theory that we will delineate nuances the rigid distinction between culture-bound and functional disorders of awareness that the major classifications demand. To furnish data for this unified theory, we turn to FIAD described worldwide ( 31 , 34 ), and describe Resignation Syndrome (RS) ( 28 , 29 ), Traumatic Withdrawal Syndrome (TWS), Grisi Siknis (GS), and non-epileptic seizures (NES).…”

Thinking about young refugees’ mental health following the Russian invasion of Ukraine in 2022

“…Other severe disorders may occur such as psychosis, which is significantly more prevalent in refugees, due to high stress (Hollander et al, 2016). There are also reports of ‘pervasive refusal’ (resignation syndrome) in asylum seeking children, which can be dangerous as symptoms include cessation of eating and drinking (Kozlowska et al, 2021; Ngo & Hodes, 2020). Some of the individuals with these severe disorders may require inpatient or day-patient services, seen at the top of the pyramid in Figure 1.…”