# Interpreter Child Syndrome Leading to Parentification and Anxiety in a Refugee Girl: A Case Report

## TL;DR

A Syrian refugee girl experienced anxiety and emotional stress from being her mother's main interpreter, highlighting the risks of child language brokering in refugee families.

## Contribution

This case report identifies interpreter child syndrome as a clinically significant phenomenon in refugee children.

## Key findings

- The girl showed moderate anxiety and emotional difficulties due to excessive language brokering.
- Intervention with therapy and professional interpreters led to significant improvement in her symptoms.
- The case underscores the need for screening and support for refugee children in language brokering roles.

## Abstract

Language brokering, in which children interpret for non-native-speaking parents, is common among refugee families but is often overlooked as a potential psychosocial stressor. Studies indicate that 75-90% of immigrant and refugee children serve as language brokers, with 18-20% experiencing clinically significant psychological distress related to this role. Excessive or emotionally charged interpreting may lead to parentification, anxiety, and developmental disruption.

We present a case of a nine-year-old Syrian refugee girl who developed anxiety, somatic symptoms, academic decline, and emotional over-responsibility after serving as her mother's primary interpreter for nearly all daily interactions, including sensitive gynecological and mental health appointments. Her interpreting load averaged 10-15 h per week, resulting in role reversal, secondary traumatization, and premature emotional maturity characterized by excessive worry about adult matters, suppression of age-appropriate needs, and assuming responsibility for parental emotional well-being. Psychological evaluation showed moderate anxiety (Pediatric Anxiety Rating Scale {PARS} 18/25, clinical threshold ≥11) and borderline emotional difficulties (Strengths and Difficulties Questionnaire {SDQ} total 16, clinical range ≥17). She was diagnosed with adjustment disorder with mixed anxiety and depressed mood. Intervention included psychoeducation, restructuring family boundaries, prohibition of child interpreter use in medical settings, referral to professional interpreter services, and cognitive-behavioral/play therapy. Cognitive behavioral therapy (CBT) consisted of the following 12 weekly 50-minute sessions: sessions one to three focused on psychoeducation and rapport-building, sessions four to eight addressed cognitive restructuring, and sessions nine to 12 implemented behavioral strategies. Four family therapy sessions were conducted at weeks two, six, 10, and 14. Over six months, her anxiety, somatic complaints, and academic functioning improved significantly. While this single case cannot establish causation or prevalence, it suggests a potentially important clinical phenomenon requiring further investigation. The case highlights the psychological risks of using minors as interpreters in healthcare settings and suggests the importance of routine screening for language brokering roles among refugee children. Access to professional interpreter services may be essential to protect child wellbeing and maintain appropriate parent-child boundaries.