Bullying

The statistics on bullying are sobering:

• 70 percent of all high school students say they have been bullied. (source: American Psychological Association)
• 90 percent of all fourth through eighth graders have been bullied. (National School Safety Center)
• Approximately 160,000 U.S. students miss school each day because they are being bullied.(National Education Association)
• 42 percent of children have been cyberbullied and 53 percent admit to cyberbullying someone else. (i-SAFE Inc.)
• 9 in 10 lesbian, gay, bisexual or transgender (LGBT) students have experienced some form of bullying at school. (It Gets Better Campaign and Stop Bullying Now!)
• Victims of bullying are up to 9 times more likely to contemplate suicide. (Yale University)

Here are some of the specifics about what bullying entails, and what makes it very different from typical childhood “growing pains”:

What is bullying, exactly? How is it different from the scuffles and disagreements all kids get into from time to time?
Bullying can be physical or verbal, and it can take place in person, behind someone’s back or on a phone or computer.

Unlike the occasional shoving match or argument, bullying is harmful behavior toward another individual that:

• is not an isolated incident
• involves a perpetrator (who has more power in the situation) and a victim (who has less). Bullying can also involve multiple perpetrators.
• is done deliberately

What is cyberbullying and why is it getting so much attention nowadays?
We live in an era characterized by readily accessible digital technology, and children of all ages spend a lot of time using cell phones and computers. As a result, cyberbullying has become the most prevalent type of bullying behavior.

Cyberbullying means that a child or teen is subjected to text messages, emails or online posts (on Facebook, Twitter, blogs or other websites) to and/or about them that are any of the following:

• cruel
• threatening
• defamatory (saying things that aren’t true)
• deliberately misleading (for example, claiming to be from someone other than the actual sender)

Cyberbullying is widespread partly because it seems more “stealthy” from the bully’s vantage point. (It’s also much easier to taunt someone from the perceived distance of sitting behind a computer or phone, compared to face-to-face.) The good news is that cyberbullying virtually always leaves a digital fingerprint that is traceable by law enforcement back to the perpetrator.

Can bullying be prevented?
While there is no way to guarantee that your child will never be bullied (or be a bully), some measures have proven very effective in reducing bullying on a broader scale:

• Parents should start talking to their children about bullying—including why it is wrong and hurtful, and what to do if they see someone else being bullied—at a very early age.
• Parents should strive to create an atmosphere of tolerance, respect and compassion at home.
• Schools should increase adult supervision (especially on the playground, on the bus and in the hallways between classes).
• Schools should get parents involved in bullying prevention discussions and initiatives.
• Schools, school districts and legislators should work together to create—and enforce—clear, strict anti-bullying policies. For example, Massachusetts now has a law that requires all school employees, from teachers to support staff, to report any incident of bullying to the school principal. Principals are also required to report any potentially criminal behavior to law enforcement officials.

Causes

What causes a child to become a victim of bullying?
It’s crucial to understand that no victim of bullying deserves to be treated this way. If your child is being bullied, remind and reassure him that it’s not his fault—it’s the fault of the person or people doing the bullying, and reflects on the perpetrators, not on him.

Children of both genders and of all ages, appearances, backgrounds, cultures, personalities and social groups are bullied. However, research has shown that children and adolescents who have neurodevelopmental conditions—like ADHD, Asperger’s syndrome and other autism spectrum disorders, Tourette’s disorder and learning disabilities—are especially vulnerable to being bullied. That’s because many of these children are socially delayed, and can have trouble understanding or responding appropriately to social cues.

In addition, studies suggest that lesbian, gay, bisexual or transgendered (LGBT) youth are at a higher risk of being verbally or physically harassed.

What causes a child to become a bully?
Just like their victims, bullies come from all backgrounds (though they tend to be popular more often than not). There is no “one size fits all” approach when it comes to bullies, but what they usually have in common is:

• a need to dominate others
• excessive impulsivity
• problems managing anger, anxiety, jealousy and other negative emotions
• difficulty tolerating other children who are perceived as somehow “different”

Because of their difficulty controlling feelings and impulses, children with conditions such as ADHD and oppositional defiant disorder are more likely to bully others. Bullies often also come from families where parents or other relatives:

• demonstrate little warmth and interest
• use force, threats, humiliation or intimidation to get their way
• are overly permissive (tending to “look the other way” when the child shows aggression or violence)

Signs and symptoms

What are the warning signs that a child might be a victim of bullying?
Children often hide or even deny the fact that they are being bullied. They may be ashamed or embarrassed, or they might worry about escalating the situation if an adult gets involved.

For these reasons, it’s important to be observant when it comes to your child’s moods, routines and behavior. Be on the lookout for any of the following:

• unexplained bumps, cuts or bruises
• damaged or missing clothing or possessions
• reluctance to talk about her day or how school is going
• reluctance or refusal to go to school
• sudden deterioration in school performance
• suddenly asking to switch schools or move to a different neighborhood
• fearfulness about taking the bus (including suddenly wanting rides to and from school)
• frequent visits to the school nurse’s office
• sudden change in sleep patterns (trouble sleeping, or sleeping too much)
• frequent self-criticizing (“I’m so ugly,” “No one likes me”)
• sudden changes in mood, such as:
  • becoming withdrawn
  • seeming sad or depressed
  • frequent crying
  • heightened anxiety
  • irritability
  • oversensitivity
• sudden weight loss or weight gain
• becoming excessively preoccupied with physical appearance, or the opposite—neglecting personal hygiene, wearing ill-fitting clothing

Above all, talk to your child and let her know you’re always there to listen. If you’re worried that something might be bothering her—ask. (And if you suspect that your child might be so upset or hopeless that she’s contemplating suicide, seek immediate professional help.)

What are the warning signs that a child might be bullying others?
Most parents of bullies have no idea that their child is involved in such destructive behavior—but it’s vital to find out if your child is a perpetrator; if he is, chances are he needs help just as much as his victims do.

If your child is a bully, here are some of the traits you might observe, or hear about from others (such as teachers or fellow parents):

• he is socially immature
• he is quick to get angry
• he has difficulty building and maintaining relationships with classmates
• he blames others for his mistakes
• he refuses to accept responsibility or consequences for his actions
• he is disruptive in class
• he resists or actively challenges authority
• he needs to be “in control” at all times, and displays anxiety or frustration when he isn’t
• he tends to be a “follower” who is very susceptible to peer pressure

If you suspect your child might be bullying others, ask him—in a non-threatening, non-judgmental way—what’s going on. Let him know that bullying is wrong and won’t be tolerated, but that you’ll work with him to get help and turn his behavior around. 

FAQ

Q: What are the most common types of bullying behavior?
A: The 2009 Indicators of School Crime and Safety reported that, among all adolescents and teens experiencing bullying at school:

• 20 percent were verbally insulted/made fun of
• 18 percent were the subject of malicious gossip or rumors
• 11 percent were physically attacked
• 6 percent were threatened with violence
• 5 percent were deliberately excluded from social settings
• 4 percent were threatened or coerced into doing something they did not want to do
• 4 percent had their personal property vandalized or destroyed
• 4 percent were cyberbullied

Q: Is bullying really that serious? Don’t all kids go through it as part of the growing-up process?
A: For many decades, bullying was either viewed as a relatively harmless “rite of passage”—or ignored altogether. Sadly, it has taken high-profile acts of school violence and youth suicide to change the public perception of bullying behavior, and to reach an understanding of what it actually is: a form of physical, emotional and/or psychological abuse.

While it is difficult to pinpoint the exact correlation between bullying and suicide, the authors of the book Bullycide: Death at Playtime estimate that every half hour, a child who has been bullied commits suicide somewhere in the world.

And consider some of these facts about other repercussions of bullying (courtesy of the National School Safety Center):

• 1 out of every 10 students who drops out of school does so because of repeated bullying.
• Child and teen murderers are more than twice as likely as their victims to have been bullied.
• Up to 75 percent of all school shootings are somehow tied to bullying behavior.

Q: How common is bullying that targets lesbian, gay, bisexual or transgendered (LGBT) kids?
A: Unfortunately, very: According to a survey conducted by the Gay, Lesbian and Straight Education Network, 84.6 percent of all LGBT students reported being verbally harassed at school about their sexual orientation within the past year, while 40 percent reported being physically attacked. Learn more.

Q: Why are children with neurodevelopmental disorders more likely to be affected by bullying?
A: While many children will be victims of bullying at some point in their lives, research has shown that those with neurodevelopmental disorders like autism and Asperger’s syndrome are at an especially high risk. Many of these children are socially delayed, and they may have difficulty understanding or responding appropriately to social cues.

At the same time, poor impulse control and issues managing anger, anxiety and other negative emotions can make children with conditions such as ADHD and oppositional defiant disorder more likely to bully. And children can also wear both hats, acting as bullies sometimes while being victimized at others. We refer to these kids as “bully/victims.”

Q: How can I get my child to open up to me about bullying?
A: Remember that kids who are being bullied (or are bullying others) often don’t talk about what’s happening. They might be ashamed or humiliated, or scared that getting an adult involved will only make the situation worse.

In addition to being aware of possible telltale signs of bullying, you should:

• make a point of routinely asking your child about his day
• get to know his teachers, his friends and their parents
• let him know you’re always ready to listen, and will never judge him for anything he tells you

Q: How can a pediatrician help children deal with bullying?
A: If a child is being bullied, the pediatrician should try to get as much information as possible about the situation. Next, a simple note from the doctor to the school principal can help set the wheels in motion to put a stop to the bullying. (Remember: if you are in Massachusetts, state law requires all schools to have a system in place for documenting and responding to bullying.)

In addition—if a child is being cyberbullied—pediatricians should advise families to save all related e-mails, text messages, voice mails and online posts. These “electronic fingerprints” are essential in documenting the abuse and helping law enforcement identify the perpetrator(s). 

Q: What is the long-term outlook for a child who has been victimized by bullying?
A: Though every child is different, victims of bullying may experience lasting difficulties with:

• self-esteem
• trusting others
• forming relationships
• depression
• anxiety
• anger

If left unresolved, these issues can lead to suicidal ideation. Some bullying victims also report symptoms of post-traumatic stress disorder (PTSD), while others have been shown to have a higher risk of developing psychotic thinking.

The sooner a child who is bullied gets help—making the bullying stop, and giving him an outlet to talk about and come to terms with his feelings about the ordeal—the more likely he is to make a full recovery and lead an emotionally healthy adult life.

Q: What about a child who has been a bully?
A: Studies have shown that bullying in childhood is often a “gateway behavior” that leads to serious problems later in life, including:

• truancy
• school failure
• law-breaking behavior
• substance abuse
• destructive personal relationships
• difficulty maintaining employment
• cruelty to animals
• violent crime

In fact, a study of 3,913 children published in the Canadian Medical Association Journal found that aggressive children had 8 percent more medical visits as adults compared with their peers, 10 percent more injuries and hospital admissions and 12 percent more Emergency Department visits. Aggressive children also experienced 44 percent more lifestyle-associated diseases as adults.

For all of these reasons, it’s imperative that a child who bullies others receives immediate help. Parents, teachers and school officials all play an essential role in identifying bullying behavior and taking steps to intervene. Here at Boston Children’s Hospital BACPAC, our mantra is that efforts need to be more therapeutic than punitive: Both the victim and the bully are developing children who need our help to become successful, well-adjusted adults. 

Questions to ask your doctor

As a parent, you are a key member of your child’s medical team. It’s important that you share your observations and ideas with your child’s healthcare provider, and that you have all the information you need to fully understand the doctor’s explanations and recommendations.

It’s often very helpful to jot down your thoughts and questions ahead of time and bring them with you, along with a notebook, to your child’s appointment. That way, you will have all of your questions in front of you when you and can make notes to take home with you. (If your child is old enough, you can encourage him or her to write down questions, too.)
 
Initial questions to ask your doctor might include:

• What are the short-term and long-term goals for resolving this situation?
• What are the first steps I should take in getting my child’s school involved?
• Do I need to involve law enforcement?
• How can I encourage my child to talk to me about his experience and his feelings?
• Should I confront the bully or bullies myself? What about their parents?
• What are the warning signs that my child may be continuing to struggle with bullying?
• What are the warning signs that my child may be experiencing clinical depression or anxiety related to bullying?
• Does my child need psychotherapy to help him through the effects of the bullying?
• Does anything in my child’s day-to-day routine need to change?
• Do we need to consider switching schools or homeschooling?
• How can I tell if my child is making progress?
• How should I talk about bullying to my other children?
• How can my family and I best support my child over the long term?
• How long will it take for my child to start feeling “back to normal”?
• What other resources can you point me to for more information?