Response to interpellation 2024/25:289 on asylum-seeking children with reactive attachment disorder
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
KD considers that children with reactive attachment disorder is a complex issue where expert authorities, not politicians, should determine diagnoses in the classification system 1. KD argues that it is not appropriate with additional measures beyond the authorities' current efforts 1, that health and medical care should assess medical needs 2 and that the child's best interests must come first 2. KD emphasizes that the government has a strategy against child abuse 3 and that care should be based on evidence 3. SD considers that it is high time to investigate the issue to gain clarity on responsibility 4. SD argues that the diagnosis was introduced despite insufficient scientific evidence 5.
Written by AI in advance and may contain errors. The numbers lead to the speech a statement builds on; check against the text below.
Socialministern Jakob Forssmed (KD)
Mr. Speaker! Clara Aranda has asked me whether I and the government intend to further examine the phenomenon of asylum-seeking children with resignation syndrome and the obviously deficient management that has occurred within, for example, health and medical care. Furthermore, Clara Aranda has asked me what direct measures I and the government consider necessary to prevent children from being subjected to this specific type of criminal acts in the future. In addition, Clara Aranda has asked me whether I believe there are grounds to task Socialstyrelsen with investigating whether the criticized diagnosis should remain in the Swedish classification system.
Children with abandonment syndrome is a complex issue.
Hopelessness syndrome was introduced as a separate diagnosis in the Swedish version of the classification system ICD-10 in 2014. Most recently in 2020, the National Board for Medical and Social Evaluation (SBU), following a request from the National Board of Health and Welfare (Socialstyrelsen), conducted a review of the scientific studies available regarding the diagnosis and treatment of hopelessness syndrome in children. SBU stated in its report that the state of knowledge on the issue is unclear and that clinical research on diagnosis and treatment effects is therefore desirable. SBU and Socialstyrelsen follow the issue continuously and act in accordance with the development of knowledge in the field. No further action, beyond the authorities' efforts, do I consider relevant at the current stage.
When it comes to the question of which measures may become relevant to prevent children from being subjected to violence or abuse, including child abuse through the falsification of symptoms, I want to emphasize that there are clear rules for how both health and medical care and other actors should act if a child is suspected of being at risk. If it is a question of a suspected crime, a report to the police must be made immediately. That is the procedure that applies, and shall apply, for all cases where it is suspected that a child may be at risk or if it is suspected that a crime is occurring or has occurred.
Regarding the question of whether Socialstyrelsen should be tasked to investigate whether the diagnosis oppositional disorder should remain in the Swedish version of the current classification system, a process is currently underway with an update of the international classification of diseases, based on important advances in science and medicine. I mean that the order where it is expert authorities, both at the Swedish and international level, and not politicians who decide which diagnoses should be included or removed, should remain.
Clara Aranda (SD)
Mr. Speaker! I have submitted an interpellation to the responsible Minister to debate more extensively the phenomenon of so-called asylum-seeking children with depressive syndrome, by many also called apathetic refugee children. I would first like to thank the Minister for the answer to my questions.
The so-called apathetic refugee children were the subject of a fierce debate in the early 2000s. The debate received great media attention and has repeatedly flared up for various reasons over the years, but now the debate seems to have fallen silent.
I have submitted the interpellation because I believe it is high time to investigate what has actually happened in the matter since then in order to gain clarity on whether and how responsibility has been taken, but also to ensure that we do not move forward before we have handled the matter thoroughly. That being said, it may be appropriate to take a look back.
The first documented case of a refugee child who stopped eating, walking, and speaking is from 1998. It was a 15-year-old boy from Chechnya who appeared to be incurably ill. After nine months, the boy's family received a residence permit, and he was discharged. Shortly thereafter, the staff at the BUP department were invited to the family's home for a large party. The boy, who was still apathetic, lay in a room next door. A contact person began after that to take long walks with the boy, who sat in a wheelchair. He woke up after a couple of days and was completely healthy when four weeks had passed.
Five years later, the country's BUP clinics were completely overloaded. In some places, half of the resources went to the apathetic children. Doctors and staff simultaneously testified to frustration and helplessness.
Mr. Speaker! At a political level, a national coordinator was appointed on September 2, 2004, with responsibility for children in the asylum process with learned helplessness syndrome. The following year, the national coordinator published a knowledge overview and a mapping of asylum-seeking children with symptoms of learned helplessness, and subsequently, an in-depth study was released. In the study, the fact is highlighted that there is no consensus among experts regarding a diagnosis. Since the phenomenon has been rare or has not occurred nationally, it has not been described in the diagnostic manual DSM, which, together with WHO's ICD system, is the most widespread system for categorizing psychiatric diseases and conditions.
As the Minister also mentions in his response, the Swedish Council for Medical and Social Evaluation (SBU) conducted a literature review in 2020 for the purpose of investigating the state of knowledge regarding both the diagnosis and treatment of so-called "hopelessness syndrome" in children. As previously mentioned, SBU then found that there was a lack of scientific studies providing answers on how to diagnose hopelessness syndrome. Likewise, there was a lack of evidence for an effective treatment.
I agree that we should have an arrangement where expert authorities shall decide which diagnoses shall remain in the Swedish classification system. It is not a matter for us politicians. On the other hand, we must take responsibility and dare to problematize serious deficiencies. Therefore, I want to ask the Minister what he considers to be a correct measure to ensure that diagnoses introduced into the Swedish classification system are based on scientific evidence and proven experience in order to avoid arbitrariness and external influence, which, for example, a polarized public debate can entail.
Sara Gille (SD)
Mr. Speaker! The syndrome of resignation among asylum seekers is an extremely serious issue. It concerns children who are claimed to have been so traumatized that they fell into an apathetic state during the asylum process. But we know now that in many cases, the truth was completely different. Several adults have come forward and told how, as children, they were forced by their parents to play sick just to increase the chances of staying here in the country. These children became victims in a game where their lives and health were used as stakes to influence the authorities' decisions.
What distinguishes Sweden is not only the high number of reported cases of asylum seeker syndrome but also that these cases almost exclusively occurred during the asylum process. This is a unique situation that should have raised questions about the root causes of the phenomenon and about the legitimacy of the diagnosis.
Critical voices from doctors and psychologists pointed out that many of the reported cases involved manipulation from parents rather than a real medical or psychiatric diagnosis. Healthcare staff also raised alarms about forged symptoms and manipulation, but these warnings were chosen to be ignored.
The National Board of Health and Welfare has itself admitted that the reporting of the diagnosis was not fully stable even during the first year, which means that the figures reported likely underestimated the actual number of cases.
The Minister argues that it is the expert agencies that should decide which diagnoses should be included in the classification system. I agree that expertise is important, but what happens when the experts already made assessments on a flawed basis from the very beginning? The diagnosis "dissociative identity disorder" was introduced despite insufficient scientific evidence and has been used in a situation where political decisions on generous migration policy created a space for manipulation.
Mr. Speaker! Previous governments bear a heavy responsibility for this. With their policy of open borders and lack of control, they enabled this systemic failure. Instead of examining the problems, they handed out permanent residence permits as if they were candy, without reflecting on the consequences. The result was a system that undermined both the rule of law and the trust in the Swedish asylum system.
Despite this, the Minister argues that further measures are not relevant and refers to existing rules and routines. But reality has shown that these are not sufficient. We know that suspicions of manipulation and abuse were not always reported and investigated. It requires more than trusting that the system will function as intended. We must ensure that it actually does.
We must act powerfully to ensure that it is not possible to manipulate the Swedish asylum system. Clearer rules and better controls are required. We also need to review how diagnoses are used in the asylum process and ensure that they are based on a scientific foundation. In addition to this, improved cooperation between healthcare personnel, authorities, and the justice system is required to identify and stop these abuses in time.
Therefore, I want to ask the Minister what the government is doing to ensure that the Swedish asylum system protects children from being exploited, that the diagnoses used are scientifically grounded, and that the loopholes that enable manipulation are closed once and for all.
Nima Gholam Ali Pour (SD)
Mr. Speaker! The interpellator highlights one of many irregularities that occurred as a consequence of Sweden's previous liberal migration policy. It concerns the so-called apathetic refugee children or children with abandonment syndrome. The diagnosis itself exists only in Sweden and is related to the residence permit.
Children within families where the family lacked grounds for asylum used to get this disease, and many residence permits were granted because the children were exploited in this way. The same groups who often remind everyone that they care about the children created a situation where the child's only purpose became that the family should be granted residence permits. Naturally, this resulted in many children feeling worthless. It is not healthy, neither physically nor mentally, to be made into a tool so that the family should be granted residence permits. Many of these children had to go through physically taxing periods when their health deteriorated, and it was their own family that caused this.
The journalist Ola Sandstig wrote about this in an award-winning article from 2019. He described how a twelve-year-old boy who was forced by his parents to sit in a wheelchair to appear apathetic finally had enough. Instead of continuing to be subjected to this torture, he chose to attempt suicide by hanging himself with a cord.
This is not just terrible - I do not want people to listen to this and just think it is terrible. This was a result of a migration policy where residence permits were distributed to those they felt sorry for. This was a result of a migration policy where asylum activists set the agenda.
The reason why parents harmed their children in this way was so that they would receive certificates from doctors stating that deportation would jeopardize the child's health. The politicians and the media did not make life easier for these children. There were then, around 2005, several parties in the Swedish Riksdag that actually demanded that all apathetic children should be granted permanent residence permits.
Another organization that wanted amnesty for apathetic children was Rädda Barnen. Instead of actually saving the children from the torture they were subjected to, they prolonged the Rädda Barnen torture. It is not the case that anyone has come and apologized for all of this and for these children being treated in this way. It is important to remember this when we are changing the migration policy today. There is a reason why we are doing it, and there have been victims of the liberal migration policy.
A restrictive migration policy also signals that there are no shortcuts to residence permits. This in itself contributes to the fact that foreigners will not even consider harming their children to obtain a residence permit.
Socialministern Jakob Forssmed (KD)
Madam Speaker! I maintain that this is a complex issue and that much has happened in the discussion since we had a very large number of children with symptoms of despair.
At the same time, we can observe that there are such cases further back in time. Symptoms of resignation were documented among children as early as the 50s. This can also occur in other conditions, which then need to be ruled out. It could, for example, be about depression, anxiety, catatonia, or eating disorders, but also about malingering. There is a complex picture here, and it includes cultural factors. There is, of course, also pure malingering in this.
As pointed out by a debater, in recent years important journalistic investigations have been made regarding this, where children have come forward and testified that they have been subjected to what must be regarded as abuse. A parent who forces their child to play sick, or who makes their child sick, can indeed be guilty of a crime. It is something that the government takes very seriously. We have also changed the legislation so that the prescription period only begins to apply when the child is 18 years old in the type of incidents that can be criminal.
My starting point is, of course, that every child who needs care should receive it. It is a task for the health and medical care system to assess who has a medical need and what treatment may be relevant. It is the child's best interests and the child's needs that should determine which interventions are implemented. As politicians, we need to trust the profession when it comes to the assessment of conditions and treatment, even in matters of a complex and complicated nature.
It is naturally important to point out that some of the symptoms of burnout syndrome can occur in other types of conditions. However, malingering can also occur, and this needs to be ruled out. It needs to be ruled out that it could be a case of a child being harmed or that some type of crime is present.
In all situations, one must consider the best interests of the child. Health and medical care and the authorities must put the child's rights and well-being first. This includes ensuring that all involved parties work to protect the child. If there is concern that a child is at risk of harm or that a crime has been committed, a report must, naturally, be made immediately to the relevant authority.
SBU has compiled a summary of the state of knowledge. There are also studies conducted thereafter, for example one from 2021 which I believe was conducted in Uppsala, which indicate that treatment of this is not necessarily facilitated by being with family. Sometimes it may be required that one is separated, precisely to exclude this type of manipulation and other things that may have occurred. In this context, it is important to emphasize that these are complex and difficult issues.
A review of the classification system is also taking place in Sweden, and it is naturally reasonable that this is reviewed in connection with making different types of diagnoses. I see no reason for politics to interfere in that, and I note that the interpellator fundamentally shares the same view.
Clara Aranda (SD)
Madam Speaker! I see a major problem in the fact that, overall, it is actually the case that the nationally limited phenomenon that arose in Sweden could occur and did occur because it was legitimized by an authority.
The debate on the apathetic refugee children has for many years been very inflamed. For a long time, a number of decision-makers, doctors, psychiatrists and journalists have had to engage in a more emotion-driven than scientific debate regarding the apathetic refugee children.
When people who are adults today have now dared to step forward and testify about the abuse and torture they were forced to endure for several years, it is, as has been pointed out for a long time, not deniable, as the Minister pointed out. We have victims who tell about how they tried to take their own lives as children because they could not bear the horrific torture it meant to be forced to act apathetic, as well as about how the betrayal from the care system and adults resulted in a lost childhood. It is not possible to ignore the fact that many children have been exploited at a high price because the family has quite obviously been able to increase their chances of obtaining permanent residence permits in Sweden.
Both research and experience show that a positive message implying that the family gets to stay in the host country and thus receives a permanent residence permit has been an effective measure to improve the condition of the apathetic refugee children. Experts and investigators have, at least judging by the information I have obtained, also not been able to find a single case description of apathetic refugee children outside Sweden – not even in large refugee camps in the Middle East with tens of thousands of children, where many are severely traumatized.
Madam Speaker! The fact that these children were left to their fate is serious. As the Minister mentioned in his answer, a suspected crime shall be reported to the police. There are clear rules for how healthcare and other actors should act if a child is suspected of being in danger. This is the reason why I question why it has not functioned in a purposeful way and why I request further review. It is about giving all these children redress by ensuring that something similar never happens again.
My conclusion, after having reviewed a great deal of material, is that we are not finished with this issue. There is a need for concrete measures.
We primarily need to carry out a new comprehensive review regarding the management of children with abandonment syndrome in order to rectify the obvious deficiencies that have existed within, for example, healthcare, where there is a clear need to review their routines.
It is also of the utmost importance to listen to the expertise that exists within the profession. They know best what needs the healthcare system actually has. I therefore regret that the Minister makes the assessment that there are no grounds for further measures at the current stage. I would therefore like to receive an answer as to whether the Minister considers that we are protected from something similar occurring in the future. Can we really ensure that children are not exploited in that way again?
Sara Gille (SD)
Madam Speaker! The testimonies from adults who were forced to simulate illness as children are a frightening reminder of how far the manipulation of our asylum system has actually gone.
The previous government's policy of open borders worsened the situation. Despite healthcare personnel and experts sounding the alarm, the choice was made to turn a blind eye. The result was a system that prioritized political gains over children's rights and the credibility of the asylum system.
The government should initiate increased cooperation between Socialstyrelsen, Migrationsverket, and the justice system so that suspicions of manipulation in the asylum process can be identified and investigated at an early stage. This requires clear guidelines, continuous follow-up, and independent evaluation of how the changes function in practice. We need a system where no children risk falling through the cracks due to a lack of cooperation or distribution of responsibility.
Mandatory training is also required for healthcare personnel and agency staff working with asylum cases so that they can recognize signs of manipulation and abuse and report suspicions in a correct manner.
Furthermore, an independent review must be carried out to ensure that all diagnoses used in asylum processes are based on a scientific foundation. Diagnoses without sufficient support shall not be able to influence decisions in migration cases.
Finally, stricter penalties should be introduced for parents or others who deliberately exploit children to manipulate the asylum system. It sends a clear signal that such actions are not accepted in Sweden.
Nima Gholam Ali Pour (SD)
Madam Speaker! Adjustment disorder in asylum-seeking children is an example of how parents who at all costs want to obtain a residence permit harm their children.
Another example that we can see today is illegal migrants. The children who live a life outside of society have not chosen this, but it is their parents who have chosen an illegal stay in Sweden. Due to the parents' choice, the children are forced to live a miserable life in Sweden.
I think the government should look at what measures should be taken against parents who harm their children during the migration process. It is reasonable to ask whether an illegal migrant is a suitable parent at all.
If you expose your child to the life that illegal migrants live in instead of simply following a deportation order and leaving Sweden, you harm your child. These children need to be protected.
Then I think it needs to be better documented how healthcare and social services could fail and allow parents to harm their children in the way that was permitted regarding the apathetic children.
Another reason why this must be scrutinized more is that today we have parties that still deny that the apathetic children were subjected to any form of abuse by their parents. These children, who were robbed of their childhood, have not even received an acknowledgment for their suffering.
I think the government should work towards some form of white paper on this incident, because what happened to the children is shameful. Society failed the children in order to preserve the liberal migration policy of that time.
Socialministern Jakob Forssmed (KD)
Madam Speaker! Some of these questions concern asylum and migration policy in a more general sense. When it comes to persons living without permission in Sweden, it is perhaps primarily other ministers who should answer those types of questions.
My starting point in the issue we are now discussing is that we need to both provide children with adequate care when it is needed and protect children when it is needed. It is about ensuring, on one hand, that children with trauma or abandonment receive the care they need, and on the other hand, that children receive immediate support and help if it turns out to be a case of child abuse.
As I mentioned in my previous speech, it is the child's best interests that should determine all measures taken by the relevant social institutions. There must be no compromising when it comes to reporting concern or crime. In these parts, I want to be crystal clear.
It is important that we continue to follow the issue continuously, which the authorities are doing. We can gladly state that we have had very few cases in recent years, during 2023 and 2024.
This is a question that can be subject to research in various ways now that we are launching a large research program on issues concerning mental health, which includes how different diagnoses are viewed. It is a strongly reinforced research program that the government is implementing together with Sverigedemokraterna. It is an important piece of the puzzle in the work to increase knowledge about diagnostics and effects of treatment within the area of mental health, and it is, of course, based on customary principles for state research funding.
I state once again that ongoing updates of classifications and classification systems are taking place, and the authorities follow the current state of knowledge when that type of update is carried out.
Clara Aranda (SD)
Madam Speaker! Let us do a current situation assessment. As I initially raised, the debate about the apathetic refugee children has now fallen silent. There are, of course, several reasons for this. One fact is that Vårdsverige and the pediatricians have largely shifted their position on the issue. We can state that it is also not a very large clinical problem in the current situation.
As the Minister said, there have been few new cases recently. This is because many today realize that it is contextual factors rather than purely pathological, physiological, or biological ones that lie behind the phenomenon. We also know that the incentives are no longer the same, not least due to the Swedish Migration Agency's later changed routines and a more restrictive policy in the migration area.
Madam Speaker! A symbol of a cold and inhuman refugee policy – that was how the apathetic refugee children were often described previously. The massive resistance against any potential questioning created an unsustainable situation for the profession. Doctors have testified to the fear of being portrayed as racist and that they therefore did not dare to speak out about what had long been obvious.
That children in some cases have been allowed to be severely abused because it has been taboo to be critical is nothing less than a scandal. My point is therefore that this issue is much broader. It is about what an aggressive social debate can result in and about how children once again become victims of political opinions, even though care and treatment must always be based on science and proven experience, not arbitrariness and political correctness.
With this said, I would like to thank the Minister for the debate and the opportunity to highlight the importance of this issue being addressed.
Socialministern Jakob Forssmed (KD)
Madam Speaker! Thank you, Clara Aranda, for the discussion on an important and pressing issue!
It is extremely important that we look out for the best interests of children and that we have the ability to provide care when required for different types of complex conditions and diagnoses that children can be affected by, but that we also have the ability to see when children are suffering and symptoms are even manipulated. It is very important.
The government has adopted a strategy to counteract violence against and abuse of children in every way. We have also extended the statute of limitations so that it begins to run only when the child turns 18. This extension of time shall ensure that there is enough time to investigate any suspected crimes in various types of contexts.
It is extremely important that care rests on evidence and proven experience and that we constantly develop our knowledge of how to exclude different conditions and see what is contained within different conditions, but also what is the best care and treatment. The authorities are doing that work, and now a review of the classification system is underway. I will continue to follow the issue.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.