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Title: Bullying: An Old Problem in a New Era
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URL Source: http://www.medscape.com/viewarticle/749448
Published: Sep 20, 2011
Author: Muhammad Waseem, MD; Nicholas D. Caputo,
Post Date: 2011-09-20 06:25:57 by Tatarewicz
Keywords: None
Views: 69
Comments: 4
Most adults can recall a situation in life when they have been bullied. A substantial proportion of children and adolescents are victimized by their peers at some point during their school years. Generally, these events are limited to playgrounds and hallways of elementary and high schools. However, in recent years, bullying has evolved from what used to be thought of as the "big kid picking on the little kid" to a growing and serious psychosocial and behavioral disorder. The evolution of bullying coincides with the growing access to mobile devices and Internet-based social networking. Management of bullying behavior poses complex social and policy questions for all who are affected, including students, parents, teachers, schools, law enforcement, healthcare providers, and policy-makers. More Than Just Physical Prowess While there are several different ways to define bullying, 3 criteria must be present. First, there must be aggressive behavior with an intention to harm.[1,2] Second, bullying is carried out repeatedly and over time.[3] Third, there must be an interpersonal relationship that is characterized by an imbalance of power.[4] Combined, these 3 elements make bullying distinct from other forms of aggressive behaviors. How Often Does Bullying Really Occur? As many as 30% of school-aged children are bullied.[5] Boys are generally more likely to both bully and be bullied.[6,7] Boys typically use physical measures in bullying such as punching or kicking.[8] Girls, on the other hand, use more psychosocial tactics such as spreading rumors or excluding other girls from social events.[9-11] Although bullying can occur in any setting, it commonly occurs at school and its forms will likely continue to evolve and instances increase as cyber bullying becomes more prolific.[12] Social networking sites have provided new arenas in which bullies can enact harm on others. Predictors of Bullying and Victimization Bullying behavior has multiple causes that are related not only to the individual child but also to factors in the social and family environment. Predictors of Bullying Violence. Violent homes are the perfect grounds in which this behavior thrives.[13] Exposure to both domestic violence and violent crime is associated with bullying behavior. Additionally, children exposed to domestic violence or who experience physical abuse may model their own behavior on such acts of aggression.[14] Domestic violence is also a strong predictor for the development of antisocial behavior.[15] Exposure to interparental violence is associated with both bullying and victimization and may persist even after controlling for violence and abuse directed toward the child.[16] Other factors related to the family or the social circumstances including parental styles, attitudes toward bullying, and peer pressure may predict bullying.[17] Family functioning. Poor family functioning may promote bullying behavior.[18] For example, if parents show little care for their children, children may develop low empathy toward others. In addition, families with an imbalance of power and aggression are also at risk of promoting bullying. Consequently, children learn to dominate others in the home.[19] Friends. An association between the presence of an aggressive friend and bullying behavior has also been reported.[20] Child traits. Not surprisingly, children who are more aggressive tend to be bullies.[17] Bullying is likely to occur concurrently with more serious aggressive behavior.[21] Predictors of Bully Victimization Child factors. Peer status and social competence have been reported to be the factors with the largest effect on a child's becoming a victim of bullying.[22] Children who lack aggressive tendencies tend to be bully victims.[10] It has also been reported that children with poor social skills are at risk of being bullied.[23] Finally, low self-esteem or self-regard and reduced assertiveness may be risk factors for victimization.[24,25] Environmental factors. Although bullying occurs in the specific social setting of schools with a defined peer group, it is also influenced by multiple environmental factors.[26] Children who are victimized in their homes may be targeted by peers as bully victims.[27] Exposure to interparental violence negatively affects behavior of children.[28] Children from inner-city neighborhoods who are exposed to various physical and psychosocial stressors such as crime, violence, and poverty are at risk for peer aggression, bullying, and victimization.[29] Many of these environmental high risk factors are often present simultaneously in the same families. For example, economic disadvantage, domestic violence, and child maltreatment problems often coexist in the same home.[30] Long-term Impact of Bullying Children who experience bullying are at risk for poor school performance and absenteeism that negatively affects school achievements.[31] The psychological distress may influence attention, behavior, and emotions and impair a child's ability to concentrate and learn. Bully victims may feel anxious and insecure. They may also report difficulties with interpersonal relationships such as making friends, dating, and marriage.[32] Poor emotional adjustment has been reported in both bullies and victims.[33] The consequences of bullying can be life-long. Being bullied can lead to serious psychological and mental health problems.[34] There is substantial evidence confirming a link between involvement in bullying and the development of specific psychological symptoms at later ages. Research has demonstrated that school-age children involved in bullying have a higher risk of developing antisocial psychiatric symptoms in adolescence.[35] It has been reported that not only being a bully victim, but bullying itself, increases the risk for suicide.[36,37] In 2006, the age-adjusted suicide rate in the United States among youth aged 10-19 years was 4.16 per 100,000 persons, making suicide the third leading cause of death in this age group.[38] For this reason, it is critical that healthcare professionals, especially those in pediatrics, primary care, and emergency departments, recognize bullying-related behaviors. Recognizing the Bully and the Bully Victim The Bully A characteristic feature found in bullies is the presence of aggression toward others. They may manifest academic difficulties, a negative attitude toward others, and a positive attitude toward violence.[39] Bullies tend to enjoy being "in control" and dominating others. Table 1 describes characteristics of the bully and bully victim profiles. The Bully Victim Being bullied is stressful for children. They may not report bullying episodes to adults, making it important to recognize the characteristics of a bully victim. A bully victim may present with internalizing symptoms, inadequate social skills, difficulties in solving social problems, and rejection by peers.[40] These children lack friends, rendering them vulnerable and an easy target for a bully.[41] Table 1. Profile of Bully and Bullying Victim Bully Victim Externalizing symptoms Internalizing symptoms Aggressive and hyperactive Depression Dominates or manipulates peers Anxiety Enjoys being in control Low self-esteem Antisocial behavior Feeling of insecurity Dysfunctional families Feelings of rejection, loneliness, and social isolation Lack of friends Positive attitude toward violence Negative attitude toward violence Worry, sadness, or nightmares Self-harm behavior and suicidal ideations Managing the Bully and the Bully Victim Bullying is a complex problem and, therefore, interventions must be approached from several fronts. A multidisciplinary effort involving healthcare, including mental healthcare, professionals, parents, teachers, school officials, and social workers is required to develop effective interventions to prevent bullying. The first step is assessment of the patient. Once recognized, safety of the patient becomes the priority. These children should be screened for psychological distress and receive a formal psychiatric evaluation if indicated. Important steps in the evaluation of children with bullying are noted in Table 2. Table 2. Evaluation of Children Involved in Bullying Recognize profile of bullies and victims Identify the problem Assess severity of symptoms and situation Provide support to the child Assure safety of child, other patients, and staff Facilitate disclosure to parents Evaluate suicidal risk Obtain social and/or psychiatric evaluation Develop a multidisciplinary action plan The Bully First, talk with the child. Many children and adolescents are willing to discuss and provide important information if reassurance regarding confidentiality is provided. Obtain a detailed history including living situation, schoolwork, friends, and extracurricular activities and hobbies. If the child is found to engage in bullying behaviors, let him or her know that their behavior is bullying. Ask them about why they behave the way they do. It is important to listen because they may provide clues to underlying conditions that may be causing this behavior. There are many reasons children bully others. They may have been previously bullied or abused. Addressing the underlying issue is critical for treating bullying behavior. The important step is to remember not to blame or criticize the child. A consideration that must always be kept in mind is the importance of evaluating for suicide risk. Has the child ever thought of hurting him or herself? If they have, do they have a plan and is that plan available to them? An adolescent boy who plans to shoot himself with an uncle's gun that is stored unlocked in a home he visits frequently is a more immediate risk than the one who plans to overdose on sleeping pills but has no access to these medications. Both children, however, warrant immediate mental health intervention. The Bully Victim Again, the first step is to talk with the child. Once again, obtain a detailed history including living situation, schoolwork, friends, and extracurricular activities and hobbies. This information will provide subtle clues to the underlying problem and may also help to diagnose comorbid conditions such as other behavioral and psychiatric problems. Involving a social worker in the case may help to manage issues such as domestic violence and difficulties in the home as well as in school. The more information obtained, the better the chance of helping the child overcome this behavioral problem. Coordinating Care Involving Parents It is important to encourage victims to disclose their experiences to their parents or adult caregivers. It is understandable that some children may not want to reveal this information to adults. However, providing choices, such as offering to be with them or suggesting other opportunities to discuss this with a responsible adult, can facilitate the process by empowering children. Clinicians can be supportive during this disclosure. Parental support can be protective against bullying. Positive parenting, particularly warm and supportive parental relationships, is associated with children's social and emotional well-being even in the presence of exposure to adversities.[42,43] A discussion with parents should include an assessment of the home environment. Encourage support at home as well as engagement in the child's activities in school. These strategies will not only help the child to cope with their behavior but will also help parents to recognize signs and behavioral characteristics of bullying.[14] It may be helpful to involve social services in the home assessment. Involving Schools Teachers play a central role in the detection of bullying.[14] Providing teachers with the skills to recognize the signs of a bully or a bullying victim may be helpful in early detection. Identifying children at risk for bullying is the first and most important step and teachers have a responsibility to support and protect these at-risk children. Schools should develop policies and procedures for the behavioral standards required in school. Schools also should develop clear rules against bullying that should be consistently enforced by both teachers and staff in the schools. Legislation Many countries enforce a legal requirement for schools to have an antibullying policy.[44] In the United States, an important step toward prevention of bullying is the recent passage of an Antibullying Bill of Rights in New Jersey.[45] This is an unfunded mandate requiring schools to develop comprehensive antibullying policies and programs to improve school climate and security. It also requires schools to appoint an antibullying coordinator. Firm, fair, and consistent enforcement of antibullying initiatives are important measures. These steps, along with the coordinated efforts of parents, teachers, counselors, and health professionals, may prove unparalleled in helping to prevent bullying.[46,47] Table 3 notes a number of organizations involved in bullying prevention efforts that offer resources for healthcare providers, teachers, schools, parents, and, most importantly, children. Table 3. Antibullying Resources Organization Resources Connected Kids A program from the American Academy of Pediatrics directed at healthcare providers that offers information on anticipatory guidance National Bullying Prevention Center Offers information for kids, parents, and schools and sponsors National Bullying Prevention Month StopBullying.gov Includes downloadable tip sheets and resources for health professionals, law enforcement, and community leaders It Gets Better Project Specifically directed at gay and lesbian youth, this site enlists the services of a number of prominent figures in entertainment and sports. Connect for Respect An effort launched by the National Parent Teacher Association in March 2011 offers resources for parents and other adults involved in school antibullying efforts. Conclusion No Longer Just a Bully But a Serious Problem Until recently, bullying was thought of as a childhood behavior that would be eventually outgrown. However, the ever shrinking social world brought about via the Internet, networking sites, and electronic devices has contributed to the evolution of this childhood problem of "the big guy picking on the little guy" into a growing psychosocial behavioral disorder. Bullying and its outcomes may lead to lifelong adjustment or psychiatric problems. It is important to face this problem head on with a multidisciplinary approach that includes parents, teachers, and health professionals. This "safety net" could help to catch those children at risk for bullying or victimization by a bully before it even starts. References
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#1. To: Tatarewicz (#0)
I had more than my share of opportunities to see first hand bullying. As a matter of fact I found a cure for it.
I don't participate in the FEDERAL FRAUD but if I did my bumper sticker would state: "Screw em all - VOTE RON PAUL"
thanks for the interesting post.
"Even to the death fight for truth, and the LORD your God will battle for you". Sirach 4:28
ha, i like that. Interesting that the non aggressive are targeted.The deranged think the quiet kids are weak. I was a very timid peaceful kid. The metamorphasis into adulthood was interesting, to say the least.
"Even to the death fight for truth, and the LORD your God will battle for you". Sirach 4:28
Some kid tried to pick on me when I was six and I hit him in the head with a croquet mallet.
"Terrorism is when the innocent are murdered due to the evil actions of the guilty." -- Turtle
#2. To: Tatarewicz (#0)
#3. To: noone222 (#1)
#4. To: Tatarewicz (#0)
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