Bullying

Bullying is a serious societal issue that can have long-lasting effects on both the victim and the bully. Recognizing and knowing how to address bullying is the first step to prevention. Here are some of the specifics about what bullying entails, and what makes it different from typical childhood “growing pains”:

Bullying is any kind of physical or verbal abuse that:

• Happens more than once
• Involves an imbalance of power (the victim is unable to, or afraid to, defend him/herself)
• Is done on purpose, with an intent to cause harm

It can take many different forms, including:

• Physical attacks (for example, shoving into lockers, punching, or kicking)
• Verbal attacks (calling names, making cruel remarks about someone, teasing, making threats)
• Social attacks (spreading rumors, sabotaging friendships, or deliberately excluding others)
• Online attacks, or cyberbullying (texting, emailing, or posting on social media anything that is cruel, untrue, or otherwise harmful about a person)

Estimates vary on the percentage of students who have been victims of bullying. However, there is no doubt that the statistics are sobering.

• About one out of every three students (28%) report that they have been bullied at school or cyber bullied in the past year (U.S. Department of Education, National Center for Education Statistics, 2014).
• About one out of every five (19.6%) high school students in the U.S. say they were bullied at school in 2013 (Centers for Disease Control and Prevention).
• In Boston, 38.8% of middle school students say they were bullied on school property in 2013 (Centers for Disease Control and Prevention).
• 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).
• Nine 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!)

Anyone can be a victim of bullying, however some children are at a higher risk of being bullied than others. Children that are less popular and have fewer friends tend to be victims of bullying while children that are popular are more likely to be bullies. Other risk factors associated with being bullied include:

• Having physical features that are different from peers, e.g. being overweight or underweight, wearing glasses or braces, having a physical disability, being from a different racial group, wearing clothes kids consider to be "uncool"
• Having a cognitive disability
• Identifying as lesbian, gay, bisexual, or transgender
• Being seen as annoying
• Being seen as weak or defenseless and unlikely to fight back
• Perceived as socially awkward and having few friends

However, having any of these characteristics does not automatically mean that a child will be bullied.

Disorders that increase the risk of bullying (either as a bully or a victim):

• ADHD
• Autism spectrum disorders
• Learning disabilities
• Oppositional defiant disorder (ODD)
• Tourette syndrome

Bullying affects both the victim and bystanders. Victims of bullying are at risk of having psychological disorders such as depression, anxiety, psychosomatic symptoms, eating disorders, and substance abuse. Worsening feelings of isolation and depression can contribute to suicidal behavior and other forms of self-harm.

Bullying can have serious negative effects on bystanders and witnesses as well. They learn to perceive their school or environment as unsafe, may also develop anxiety or depression from witnessing it and may start to avoid school.

It is helpful to know what signs to look for if you suspect your child may be a victim of bullying. Some warning signs include:

• He is reluctant to go to school or outright refuses to go.
• She frequently reports headaches, stomach aches, or feeling sick, but there appears to be no underlying medical reason.
• He has trouble sleeping and frequent nightmares.
• She shows little interest in hanging out with friends and avoids social situations.
• He comes home with unexplained injuries.
• She appears to have low self-esteem, shuts herself in her room, seems irritable.
• He reports that books, electronics, or other belongings are lost or destroyed.
• She eats less, sometimes skips breakfast or dinner, or binge eats.
• His grades are declining, he seems uninterested in school.

Be aware that sometimes a child may not show any sign that they are being bullied. To stay tuned in to what is going with your child in school, talk to them regularly. Be interested in their school day and ask them specific questions about bullying. E.g. “Are there mean kids in your class? Who do they tend to pick on? Is anyone being mean to you?”

Unlike the occasional argument, shouting match, or scuffle, bullying happens repeatedly; it is not an isolated event. It involves a physical or social power imbalance between two people or two groups, with the perpetrator(s) having more power and the victim(s) having less. It also involves one person trying to intentionally harm the other. It can be physical (shoving, punching, kicking) or verbal (name-calling, gossiping, spreading rumors), and it can also happen through social media such as Facebook, Twitter, or Instagram.

Asking children specifically about problems with bullying during routine office visits — “Is anyone being mean to you?” — is the first and most important step. Pediatricians should also be on the lookout for signs of stress, such as:

• A sudden decline in grades
• School refusal
• An abrupt change in sleep patterns
• Unexplained weight loss or weight gain
• Frequent visits to the school nurse’s office

Treatment related depression and anxiety

Knowing that your child is struggling with her thoughts and feelings is an upsetting experience for any parent — but you can rest assured that at Boston Children’s Hospital , your child and your family are in good hands.

Our team of psychiatrists, psychologists, and social workers can help you, your child, and your family by:

• Tailoring therapy plans according to your child’s age, specific symptoms, family and school situation, and overall medical history
• Using psychotherapy (such as cognitive behavioral therapy), or a combination of medication and therapy, to help your child feel and function better

Boston Children’s Department of Psychiatry and Behavioral Sciences has a team of expert psychiatrists, psychologists, and social workers ready to help your child cope with bullying and mental health issues related to bullying. We’ll work closely with her — and with you and your family — to:

• Devise a plan for stopping the abuse
• Help your child rebuild her self-esteem
• Teach her constructive thought patterns to help her succeed in the present and plan for the future

In addition, our Boston Children’s Hospital Neighborhood Partnerships provides a range of services to children in seven Boston-area schools and four community health centers, tackling bullying directly in the schools.

Psychotherapy

Psychotherapy is designed to help your child identify, express, and manage her feelings about being bullied. It will also teach her important new skills for overcoming those feelings, rebuilding her self-esteem, and feeling optimistic and confident about the future.

Your child may receive individual therapy, or may participate in group sessions with other kids working through similar issues. We also offer family counseling, which allows parents, siblings, and other family members to take part in a child's therapy sessions and learn new strategies as a team.

Medication

If your child’s depression, anxiety, or stress do not adequately respond to psychotherapy, your clinician may recommend adding an anti-anxiety or antidepressant medication to his treatment plan. These medications can help your child feel more relaxed and comfortable while he is working on learning and practicing coping skills in therapy.

Here at Boston Children’s, we never prescribe mental health medication as a standalone treatment. Instead, we always consider medication as part of a two-pronged approach, with psychotherapy as a necessary component. Our Psychopharmacology Clinic can help determine whether medication might be a useful addition to your child's therapy.

Help at schools and in the community

Boston Children’s Hospital Neighborhood Partnerships (BCHNP) is the community mental health program in the Department of Psychiatry and Behavioral Sciences at Boston Children’s Hospital. Established in 2002, BCHNP places Boston Children’s Hospital clinicians in Boston-area schools and community health centers to provide a comprehensive array of mental health services to children and adolescents where they live and learn.

Consistent with Community Systems of Care principles, Boston Children’s Hospital embraces community settings for mental health service delivery. By offering high-quality services in environments that are convenient and familiar to children and their families, BCHNP plays an important role in improving the health and well-being of children in Boston’s most underserved communities.

Preventing depression and suicide

The Swensrud Prevention Initiative includes the prevention and promotion components of the BCHNP School-Based Program. The initiative also fosters the development, implementation, and evaluation of innovative prevention strategies having the potential for far-reaching public health impact, such as raising awareness of depression and suicide among teens through the Break Free From Depression program.

This program is a specially designed depression awareness program for use in schools. It applies an innovative and engaging format and proven cognitive behavioral techniques to teach young people how to effectively cope with difficult life circumstances, how to identify signs of depression in themselves and their peers, and how to seek help.

A groundbreaking collaborative: BACPAC (Bullying And Cyberbullying Prevention & Advocacy Collaborative) is a multidisciplinary anti-bullying collaborative based at Boston Children’s Hospital — the first hospital-based program of its kind anywhere in the U.S. BACPAC:

• Serves as a source of expert information on bullying for schools, families, and other healthcare providers
• Operates a clinic that performs comprehensive evaluations of children with neurodevelopmental disorders (like ADHD, Tourette syndrome, intellectual disabilities, Asperger’s syndrome, and autism) who are affected by bullying, either as victims or perpetrators
• Provides customized guidance and recommendations to meet the needs of the individual child
• Works in partnership with each child’s family, school, and primary care provider to resolve the issue

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.

Bullying can have long-lasting social, psychological, and health effects on victims. Children who experience bullying continuously are at greater risk for:

• Depression and suicidal thoughts during adulthood
• Anxiety disorders including panic disorders and agoraphobia (fear of public places) during adulthood
• Problems with physical activities like walking, running, or participating in sports
• Poorer physical health (sometimes as a result of harmful activities like disordered eating or using drugs)
• Dropping out of school, which is likely to have long-lasting negative effects on their education and career
• Lower wages later in life
• Future unemployment or reduced work participation

The good news is that supportive relationships with families, peers, and mentors can make a difference and mitigate the negative effects of bullying (American Psychological Association).

Our Boston Children’s Hospital Neighborhood Partnerships (BCHNP) has clinicians in seven schools across Boston tackling bullying directly where it is most likely to occur. BCHNP provides a range of services including on-site consultations to teachers and administrators, crisis interventions, individual counseling, and evidence-based violence prevention groups to help promote peaceful school environments.

BACPAC (Bullying And Cyberbullying Prevention & Advocacy Collaborative) is a groundbreaking collaborative that operates a clinic for children and adolescents with neurodevelopmental disorders (including attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorders) who are being bullied, or are involved in bullying others.