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BULLYING AND CYBER BULLYING

MAIN TOPIC
Descriptions

  • Bullying is hurtful behavior perpetuated by a person or group of people that targets a person or group of people
    • Both direct aggressive behavior (eg, threats and intimidation) and indirect aggressive behavior (eg, exclusion, rejection) that
      • Have harmful intent
      • Occur repeatedly
      • Result in an imbalance of power
  • Since the advent of the internet bullying has changed to become less physical, more emotional, more cyber bullying

Classification or dimensions of bullying

  • Physical bullying
    • Punching, pushing, tripping, kicking
    • Stealing or defacing someone else's property
    • Unwanted familiarity eg, kissing or touching
  • Verbal and emotional abuse
    • Oral or written communication such as teasing, name calling, verbal put downs, teasing, ridiculing, intimidation
    • Overt threats
    • Stalking
  • Social or relational bullying
    • Direct or indirect actions intended to harm the victims' reputation and relationships
    • Social ostrasization from social contact, friendship, conversation, privileges, eg, not inviting someone to social occasions
    • Physically or electronically posting embarrassing images of the victim
    • Stopping a conversation when someone walks in the room
    • Talking critically about the target eg, rumor spreading, gossiping, bitching, or talking about someone either to their faces often in front of friends or "behind their back"

Location of bullying

Clinical presentation

History

  • Proactive questions to establish if bullying is present
    • “Do you like school?”
    • “Do you like the people at school?”
    • “Is there anyone you do not like?”
    • “How are your treated at school? Are you popular?”
    • “What do you do at lunch time?”
    • “Do you have friends at school? What are their names?”
    • For younger children
      • “Is there anyone who makes your feel sad or cry, teases you or calls you names at home, at school or online?”
    • For older children or adolescents
      • “Do you have a hard time at home or school or online?”
      • “Is there anyone in your life causing a problem?”
  • Determine if it’s at school, at home or online
    • “Do you feel more anxious at school or at home? Why?”
    • “Do you go on the internet?” Have you had any problems with people online?”
    • “Are there ever any problems at home or at school?”
  • Explore child's self-esteem and emotional state
    • "Have you felt so bad recently that you thought about hurting yourself?"
  • Identify if the child is being targeted or is one of several children receiving similar treatment
    • “Do they say those things to other kids?”
  • Isolate if the other child is angry all the time and angry with the victim
    • “Is the other child angry all the time?”
      • “Are they always angry with you?”
  • Identify the situation
    • “When did it last happen. What exactly happened?"
    • “Who specifically is involved?”
    • “How is that a problem?”
  • If the child is a victim, ask the parent/s if they knew about it and if they have done anything to address the bullying

SCHOOL BULLYING
Description

  • Bullying is a pervasive problem affecting school-age children
    • Serious social and public health problem
  • Abusive bullying behaviors begin in elementary school, peak during middle school, and begins to subside in high school

Epidemiology

  • Bullying involves a large proportion of elementary, middle, and high school students
    • 22% of students grade 3 to 5 pupils in an urban school district on the West Coast of the USA reported involvement in bullying as a bully, a victim, or a bully/victim

Prevention

  • Most schools have very good anti-bullying programs and policies but these alone will not solve the problem
    • They can only provide a supportive and protective environment to minimize the problem and allow the child to better resist the bullying which will likely continue in one from or another
  • Evidence shows that over half of school based intervention programes reduce bullying rates
  • Evidence shows that effective school based intervention programes can only reduce bullying and victimization rates by up to 20%

CYBER BULLYING
Description

  • Teasing or hurting someone online using technology, via email, chat rooms, text messages, discussion groups, online social media, instant messaging or websites
    • Posting unpleasant comments, pictures or videos on social media or websites
    •  Identity theft of screen name or password in order to obtain false identity to hurt someone else
  • Most definitions require repeated behavior intended to harm another person
  • Applies to use of internet service and mobile technologies such as web pages and discussion groups as well as instant messaging or SMS text messaging
  • Cyber bullicide: suicide indirectly or directly influenced by experiences with online aggression

Types of cyber bullying

  • Most cyberbullying falls into one or more of the following categories:
    • Flaming: online fights using electronic messages with angry and vulgar language
    • Harassment and stalking: repeatedly sending cruel, vicious, and/or threatening messages
    • Denigration: sending or posting gossip or rumors about a person to damage his or her reputation or friendships
    • Impersonation: breaking into someone’s e-mail account and using it to send vicious or embarrassing material to others
    • Outing and trickery: engaging someone in instant messaging, tricking him or her into revealing sensitive information, and forwarding that information to others
    • Exclusion: intentionally excluding someone from an online group

Epidemiology

  • In 2009, Australia-wide survey of 7,418 students found that 4.9% of students in Year 4 reported being cyber bullied compared to 7.9% in year 9
    • Rates for admitting to cyber bullying others were 1.2% and 5.6% in Years 4 and 9
  • A Canadian study found that 23% of middle-schoolers surveyed had been bullied by email and 41% by text messages on their cell phones although 41% did not know the identity of the perpetrators
  • A 2009 European Union study estimated that approx 18% of young people had been "bullied/harassed/stalked" via the internet and mobile phones
  • In 2008, 10% of 2000 respondents from a large school district in the southern US had been cyber-bullied in the previous 30 days while over 17% reported being cyber-bullied at least once in their lifetime
  • Cyber bullies equally male and female
    • Older teens rather than primary school children

Prevention

  • Parents have a primary role due to their direct influence over access to electronic devices
    • Parents may have to monitor their child online connections
    • Talk regularly with children about their online activities
    • Educate about that cyberbullying is harmful and unacceptable behavior
    •  Talk to children about reaching out to an adult at the first sign of an online threat
      • Less than 10% of teens who have been bullied online have told their parents
      • Fear that their internet or cell phone use will be removed or restricted
    • Tell children that you may review their online communications if there is any reason for concern
    • Have clear expectations for responsible online behavior
      • Never post anything on the internet (including images) that you would not want the whole world to see
    • Logical consequences for violations of internet etiquette
    • Consider establishing a parent–child internet use contract
    • Consider installing parental control filtering software and/or tracking programs
      • Do not rely solely on these tools
  • Manage social media eg block people online, limit access to certain Apps or at certain times of the daytimes of the day
  • Community awareness campaigns
  • School curriculums incorporating internet etiquette and appropriate usage
  • Legislation against cyberbullying

Whether your child is a tween or a teen, talk to them about responsible Internet use:

  • Encourage reporting of abuse
    • Most social media sites provide tools to report inappropriate content
  • Report online bullying to your Internet or cell phone service provider and to local police
    • Save any harassing messages and forward them
  • Stop the activity be it chat room, online game, instant messaging, social networking site, etc.
  • Block the sender’s messages
    • Never reply to harassing messages

PERSONALITY PROFILES

  • Almost every child will undergo periods of teasing or bullying in school or during other activities
    • Most children are able to overcome the challenge but many do not have the skills to do so
    • Those with poorly developed social and emotional skills are vulnerable to bullying
      • Immature or poor fit with peer group
      • Do not know how to or cannot deal with conflict
      • Lack assertiveness and self-confidence
    • Victims of bullying report depression, social anxiety, and loneliness
    • Victimization is associated with deficits in social competence, feelings of powerlessness, rejection by peers
  • Bullies tend to be more aggressive and dominant in contrast to victims
    • In a study with a sample of 23,345 students in elementary, middle, and high school comparing bullies and noninvolved youth logistic regression analyses found that bullies were more likely to endorse reacting to provocation with aggression
      • Bully/victims were most likely to display internalizing symptoms, problems in peer relationships, and have poorer perceptions of the school environment
      • Both frequent bullies and bully/victims displayed aggressive-impulsive behavior and endorsed retaliatory attitudes
      • High-school students frequently involved in bullying tended to display the greatest risk for internalizing problems, but less risk for aggressive impulsivity
      • Bullies often have a low level of school commitment and are at increased risk of dropping out and using substances
    • Some bullies have difficulty expressing feelings and empathy
    • Some bullies have disinterested parents who are tolerant of child's aggression
    • Some bullies have been or are subjected to physical punishment themselves
  • Manifestations in the victim include: anger, aggression, low self esteem, anxiety, and depression
    • Suicidal ideation in both victims and bullies associated with weekly or more frequent bullying
  • Changes with age in boys more so than girls
    • Decreases at puberty in boys perhaps because boys have less impulse control and victims may retaliate for the first time

DIFFERENTIAL DIAGNOSIS

COMPLICATIONS

  • The impact of bullying can last longer than the bullying itself. Experiencing bullying can increase a person’s chances of developing anxiety or depression
  • Compared with youth who reported no involvement in bullying, those youth who reported involvement as bullies, victims, or bully/victims reported poorer psychosocial adjustment
  • See OBESITY
    • Occasional to frequent bullying at age 14 years associated with increased risk of obesity at age 21 years compared with adolescents never bullied
  • See SUBSTANCE ABUSE
  • See SUICIDE AND SELF HARM
    • Increasing media reports of teenage suicide after being harassed and mistreated over the internet

ASSOCIATIONS

PARENTAL VIGILANCE

  • Good communication between parents and children is important
    • Several studies suggest relatively low rates of disclosure of bullying events
      • Younger children are more likely to disclose bullying events to their parents while older youth are more likely to disclose to their peers or try to handle it themselves
  • Parents should make an effort to be aware of what is happening with your child
    • Have a regular family meeting to discuss where are we at, what do we need to do
    • Family dinners offer an important opportunity for parent-youth communication and youth disclosure of significant events
  • Reluctance to use the computer or go to school may be an indication of bullying
  • See CYBER BULLYING

PARENTAL RESPONSE

  • Common parental response is protective anger leading to attempted intervention to stop the bullying +/- punish the perpetrator
    • Makes the parent feel better but not a long term solution for the child
    • May embarrass the child and exacerbate poor self-esteem and depression
  • Parents often send mixed messages about responding to fighting and bullying
    • Parents have a tendency to advocate for aggression and violent response to bullying
    • Retaliatory attitudes either directly communicated or modeled through parent engagement in retaliatory aggression in the home (eg, verbal, relational, and physical aggression)
  • Ask your child “Do you need me to step in or can you handle this yourself?”
  • Set up an environment to encourage your child to try new things
  • Encourage the child to write in their journal
  • If situation is serious, do whatever it takes to take the child out of the situation including changing schools

TIPS FOR DEVELOPING A PLAN

  • Answer the following questions in a private journal or App
    • What is it that you do not respect about the bully?
    • When did you lose respect for the bully?
    • What do you respect about the bully?
      • This is likely to be a challenge, however you might see a different perspective
    • What have you learned about yourself as a result of the bullying?
    • Write a list of negatives and positives from the bullying situation
    • What can you change to get a positive result?
  • Focus attention away from the bullying by helping the victim move beyond the bullying situation
    • People including parents, siblings, friends, teachers, coaches
    • Groups to join in person or online
    • Things to do eg reading, activities, hobbies, music or sports
    • Things to borrow or buy eg books, games
    • Places to go where you feel comfortable and secure eg a local park, resource center
    • Manage social media eg block people online, limit access to certain Apps or at certain times of the daytimes of the day
  • Evaluate the effectiveness of the plan

ARMING THE VICTIM

  • Caregivers and counselors should equip the child with improved resilience, mental toughness and courage and provide the skills to encourage the child to display these attributes when bullied
    • Requires time and effort to learn and practice social and emotional skills, assertiveness and problem solving that gives the child sufficient self-confidence to respond appropriately
    • Children need to learn how to manage and cope with people who are angry, hurtful, unfair, mean, aggressive, unkind, bossy
  • Help the victim develop insight and understanding
    • Ask the patient what is a bully
      • What is being mean or cruel
    • What is the bullying situation from their perspective
    • How they feel and what emotions come up in this situation
    • What has made them the most upset and why
      • What does this mean to you?
  • Teach problem solving tactics and help the child develop a plan
    • If a child learns to “shrug” off the torments of a bully they are likely to decrease or even cease bullying
    •  'Bat mobile' strategy for young victims where they squeeze a squash ball in their pocket and imagine the bat shield coming over and all the barbs bounce off
  • Brainstorm various responses and work with the child to determine which will work best
    • Removing themselves from the situation or the person completely if possible
    • Limit contact and interaction with the bully
    • Protecting your space
    • Take time to find friendly and supportive people or activities or groups to join
    • Spend some time alone in a place you feel comfortable and secure
  • Play out a typical bullying scene at home with parents and siblings
    • Practice assertiveness (eg, "Stop")
      • Break the response strategy into steps that the child can remember and follow
  • Discuss that not everybody will like you and that's OK
    • Place less importance on what people think of them
    • 33% rule: 33% like, 33% not like, 33% indifferent
    • Not everybody will treat you well and it is normal for some people not to like you
    • It is not your fault if someone else is being unkind, angry, aggressive, unfair or cruel
    • Not everyone will treat you well
    • Some people might say hurtful things to you or about you
    • A bully pushes you to the point that you are so uncomfortable your have to figure out how to handle the situation
    • All situations are temporary
    • There is always a solution to a problem
    • There is always some action you can take
    • It is OK to be by yourself sometimes
    • It is important to not try and fit into every group of people

PREVENTION
Changing societal norms

  • Public health and school based education to make bullying and victimization a social stigma
    • Conceptualize bullying as a public health problem rather than a fact of life
  • Legislation related to identification and reporting of bullying

Intervention programs

  • Only half of school based intervention programs are effective
  • Effective school based intervention programs
    • Include the whole school
    • Support both targets and perpetrators
    • Work at multiple levels: in the classroom, school-wide, and in connection with parents and the surrounding community
    • Teaching wise online decisions and ethically and responsibly use of technology
    • Teaching adolescents to think before they act when they are communicating online
    • Supporting involvement in responsible online communities

EVIDENCE
Evidence supported by DynaMed Systematic Literature Surveillance

  • Eaton DK, Kann L, Kinchen S, et al; Centers for Disease Control and Prevention. Youth risk behavior surveillance - United States, 2011. MMWR Surveill Summ. 2012 Jun 8;61(4):1-162
    • The Youth Risk Behavior Surveillance System includes 2011 Youth Risk Behavior Survey conducted by CDC and 43 state surveys, and 21 large urban school district surveys conducted among students in grades 9 to 12
      • In the 12 months before the survey, 20.1% had ever been bullied on school property
      • 7.8% had attempted suicide
  • Evans CBR, Fraser MW, Cotter KL. The effectiveness of school-based bullying prevention programs: A systematic review. Aggression and Violent Behavior 2014 Sep:19,(5):532-44
    • Systematic review of 32 randomized controll trials (RCT) published from June, 2009 through April, 2013, providing aggregated effect measurements on bullying perpetration and bullying victimization
      • 17 assessed both bullying and victimization, 10 victimization only, 5 bullying only
      • 11 of the 22 (50%) examining bullying perpetration observed significant effects
      • 18 of 27 (67%) examining victimization reported significant program effects
      • Studies conducted outside of the USA were more likely to report significant findings
      • Studies with racially homogenous samples were more likely to report significant findings
      • Only one study with a comprehensive definition of bullying reported significant effects
      • Studies are often compromised by lack construct validity and measurement of different types of bullying behavior and lack of a comprehensive definition of bullying
  • Farrington DP, Ttofi MM: School-based programs to reduce bullying and victimization: A Systematic Review. Campbell Systematic Reviews 2009
    • Meta-analysis of 44 bullying interventions tested in controlled trials showed that, on average and when compared with routine school services, these programs decreased bullying rates between 20% and 23% (odds ratio 1.36) and reduced victimization between 17% and 20%
      • Studies using more rigorous designs produced lower effect estimates
      • Bullying reduction odds ratio 1.10 for randomized experiments, 1.60 for before–after experimental control, 1.20 for other experimental-control, and 1.51 for age-cohort designs
      • Programs focused on children aged 11 years or older) had larger effect sizes
      • Programs implemented in Europe were more successful than programs implemented in the USA
  • Mamun AA, O'Callaghan MJ, Williams GM, Najman JM. Adolescents bullying and young adults body mass index and obesity: a longitudinal study. Int J Obes (Lond). 2013 Aug;37(8):1140-6
    • Reporting of occasional to frequent bullying at age 14 years associated with increased risk of obesity at age 21 years compared with adolescents never bullied based on retrospective cohort study of 1,694 adolescents provided bullying data at 14 years old had physical assessment at 21 years old
      • For males (odds ratio 2.54, 95% CI 1.58 to 4.09)
      • For females (odds ratio 2.18, 95% CI 1.4 to 3.39)

EVIDENCE
Evidence supported by DynaMed Systematic Literature Surveillance

  • Eaton DK, Kann L, Kinchen S, et al; Centers for Disease Control and Prevention. Youth risk behavior surveillance - United States, 2011. MMWR Surveill Summ. 2012 Jun 8;61(4):1-162
    • The Youth Risk Behavior Surveillance System includes 2011 Youth Risk Behavior Survey conducted by CDC and 43 state surveys, and 21 large urban school district surveys conducted among students in grades 9 to 12
      • In the 12 months before the survey, 20.1% had ever been bullied on school property
      • 7.8% had attempted suicide
  • Evans CBR, Fraser MW, Cotter KL. The effectiveness of school-based bullying prevention programs: A systematic review. Aggression and Violent Behavior 2014 Sep:19,(5):532-44
    • Systematic review of 32 randomized controll trials (RCT) published from June, 2009 through April, 2013, providing aggregated effect measurements on bullying perpetration and bullying victimization
      • 17 assessed both bullying and victimization, 10 victimization only, 5 bullying only
      • 11 of the 22 (50%) examining bullying perpetration observed significant effects
      • 18 of 27 (67%) examining victimization reported significant program effects
      • Studies conducted outside of the USA were more likely to report significant findings
      • Studies with racially homogenous samples were more likely to report significant findings
      • Only one study with a comprehensive definition of bullying reported significant effects
      • Studies are often compromised by lack construct validity and measurement of different types of bullying behavior and lack of a comprehensive definition of bullying
  • Farrington DP, Ttofi MM: School-based programs to reduce bullying and victimization: A Systematic Review. Campbell Systematic Reviews 2009
    • Meta-analysis of 44 bullying interventions tested in controlled trials showed that, on average and when compared with routine school services, these programs decreased bullying rates between 20% and 23% (odds ratio 1.36) and reduced victimization between 17% and 20%
      • Studies using more rigorous designs produced lower effect estimates
      • Bullying reduction odds ratio 1.10 for randomized experiments, 1.60 for before–after experimental control, 1.20 for other experimental-control, and 1.51 for age-cohort designs
      • Programs focused on children aged 11 years or older) had larger effect sizes
      • Programs implemented in Europe were more successful than programs implemented in the USA
  • Mamun AA, O'Callaghan MJ, Williams GM, Najman JM. Adolescents bullying and young adults body mass index and obesity: a longitudinal study. Int J Obes (Lond). 2013 Aug;37(8):1140-6
    • Reporting of occasional to frequent bullying at age 14 years associated with increased risk of obesity at age 21 years compared with adolescents never bullied based on retrospective cohort study of 1,694 adolescents provided bullying data at 14 years old had physical assessment at 21 years old
      • For males (odds ratio 2.54, 95% CI 1.58 to 4.09)
      • For females (odds ratio 2.18, 95% CI 1.4 to 3.39)

REFERENCES
Topic supported by DynaMed Systematic Literature Surveillance

SEE ALSO