01-06-2025
'Just naughty' or misunderstood? How mental disorders in migrant children can be misread
Back in Hong Kong, Wing Siu worked nine to 12 hours a day.
Like many other working mothers, she only saw her daughter for a short time after work each day during the week.
But that changed when the family moved to Australia in 2021.
"I became a full-time housewife," said Mrs Siu.
While she was busy adjusting to her new environment, Mrs Siu believed her 17-year-old daughter was also struggling, albeit silently, to adapt.
"Her English teacher was the first to mention it, and I thought it may be a learning issue like dyslexia. But after doing the assessments, she was diagnosed with ADHD.
"We were so shocked … we never expected that."
Experts said it was not uncommon for migrant parents to mistakenly attribute their child's behavioural problems to their struggles with adapting to a new environment.
Shurong Lu, a researcher from the University of Melbourne's School of Population and Global Health, told the ABC that parents might sometimes think their child is "just naughty" when they may have a neurodevelopmental disorder or a mental health condition.
"Sometimes they take even stricter parenting [approaches] and make the situation even worse,' she said.
ADHD, which stands for attention deficit hyperactivity disorder, is a neurodevelopmental disorder characterised by patterns of inattentive, impulsive, and sometimes hyperactive behaviour.
It can coexist with other disorders like autism, or mental health conditions like depression or anxiety.
Smruthy Nair, a psychologist who migrated from India, said the lack of words or phrases to describe ADHD or mental health conditions in some languages made it difficult for migrant children to express themselves and parents to recognise the symptoms.
The stigma around mental health conditions in some cultures also created a challenge, Dr Nair added.
"I come from a culture where you don't talk about your mental health openly, we seldom express negative emotions," she said.
"There is a lot of shame and stigma associated with it."
It was a feeling Takeo Kameoka could relate to.
After migrating to Australia from Japan after the Fukushima nuclear disaster, the then 11-year-old struggled with his new school environment but thought it was taboo to talk about his feelings.
He also didn't want to worry his parents after the move.
Now a clinical psychologist, Mr Kameoka said he recognised that he had symptoms of depression when he was a boy.
"[I] went through the early experiences of racism and discrimination, but lacked social support," he said.
Mr Kameoka said there was — and still is — a lack of information and education about mental health conditions in migrant communities, especially for more recent migrants.
A 2023 report from the National Mental Health Commission found more than 50 per cent of children in Australia with mental health conditions were not receiving professional help.
Mr Kameoka said current mental health education and training needed to be more culturally responsive.
"The lack of diversity in education and academia also just really is something that probably needs to change in the first place," he said.
But it's not just enough for providers of mental health services to employ people from multicultural communities, said Dr Nair.
"You need to work with communities, be open to learning, and embed this learning in communities, not just give them information," she said.
Kin Chan, a creative therapist and migrant parent, understands the importance of culturally responsive practice.
Since migrating to Australia from Hong Kong in 2022, he has been running events and seminars on mental health for immigrant families.
The workshops raise awareness around mental health challenges children face, and provide support to both children and parents.
Mr Chan said part of the issue was that migrant parents tend to focus on "solving the problem" rather than "understanding the problem".
"Children have to readapt completely to the local culture, the school's culture, the education system," said Mr Chan.
He said changes in family dynamics due to the move could have an impact on children's emotional wellbeing.
Mr Chan said not only did "children always learn from their parents", they also often mirrored their parents' emotions.
For example, if the parents feel anxious after moving to a new country, the children may feel anxious too.
When it comes to mental health, Nepalese migrant Reshma Manandhar is making sure her children are informed on the topic and feel comfortable asking for help.
"I have made it very clear, we talk about it openly at home," she said.
Mrs Manandhar's effort with her children was inspired by her own mental health challenge.
She experienced postnatal depression after the family moved to Australia in 2002.
Ms Manandhar said while children could access mental health support at school, migrant parents needed to "normalise" discussion.
"A lot more work needs to be done to take that stigma out of the mental health issue in a non-English speaking, diaspora community," she said.
"We have to normalise it and say, 'It's OK, you can get help'."
Mrs Siu agreed, adding that ADHD needed to be normalised in daily conversations, and not treated as something taboo or shameful.
She said friends and family can also play a supportive role by speaking about neurodivergence in a positive light.
To assist people with limited English language skills understand the signs and symptoms of mental health, AMES Australia has developed resources with Beyond Blue.
The resources also help those working with migrants to identify when a new arrival is experiencing a mental health issue, not just culture shock.
"It's another part of the orientation to Australian society and then our health system," said Lucia Halliburton from AMES, an organisation that helps migrants and others settle in Australia.
"And it definitely signals that positive mental health and discussing mental health is not stigmatised in Australia," she said.
