BHIPP Bulletin

Volume 8, Issue 3

September 2022

This month's BHIPP Bulletin is a contribution from

Rick Ostrander, EdD, Associate Professor in the Department of Psychiatry and Behavioral Sciences at Johns Hopkins School of Medicine,

Founder of Pediatric Medical Psychology Program at Johns Hopkins Children's Center and BHIPP Consultant.

Children can sometimes be impulsive and even rude to others. These episodes may include isolated displays of anger towards peers and include harsh words or accusations. Such isolated displays of irritation or annoyance can be distressing and should be an opportunity for teaching children more appropriate ways of expressing their frustration with other children. However, bullying is not represented by an isolated display and typically involves behavior that is more intense and ongoing. Rather than brief impulsive acts that derive from a child’s frustration, bullying involves repeated acts of aggression that are intended to harm. Rather than an isolated harsh word or deed, bullying includes ongoing acts and are typically perpetrated by someone that is in a position of strength relative to the victim. The bully typically has a superior physical or social advantage over the victim and transforms this advantage into a potent weapon to bully their victim (Bear, Homan & Harris, 2019). 

Some may think that bullying is limited to physical acts of aggression; however, bullying can also be verbal or social. For example, hitting, shoving, stealing, or damaging property may be more obvious acts of aggression; however, bullying can also include cruel comments or threats. Sometimes, bullying may include rejecting or isolating the victim or involve reputational forms of aggression such as spreading rumors. With the internet becoming an important platform for social engagement, cyberbullying has likewise increased. It is important to note that bullying has become commonplace, with national studies suggesting that approximately 20% of students ages 12 to 18 report having been bullied (U.S. Department of Education, National Center for Education Statistics, 2017).

Low self-esteem, depression and anxiety are common among victims of bullying; however, even more concerning, reactions can include more troubling considerations, such as self-harm or suicide. However, the negative outcomes associated with bullying are not limited to psychiatric or psychological symptoms, but also leads to the victim displaying increasing social isolation and withdrawal, academic under achievement, declines in school engagement; and “acting out” behaviors (Rueger & Jenkins, 2013). Bullying can also indirectly impact teachers, peers, and family functioning by contributing to a negative school or family climate (Bear, Homan & Harris, 2019). While school, home, community, and societal factors can contribute to bullying, the individual characteristics of the victim, bully, or bystanders can uniquely influence each situation as well. However, there are student characteristics and certain classroom or school characteristics that are particularly important areas to consider (Bear, Homan & Harris, 2019)

Student Characteristics

There is no uniform way to predict who will become a victim; however, important risk factors are related to a perception that the student is somehow set apart from their peers. For example, children with disabilities and/or those with impaired social skills, are more likely to be targets of bullying (Bear et al., 2015). There is also research suggesting that children who are smaller or over-weight may have higher rates of being bullied; likewise, individuals that have a different sexual or gender orientation are also at greater risk for being targets of bullying (Bear, Homan & Harris, 2019; Birkett, Espelage, & Koenig, 2009). Some children are targeted for bullying when they exhibit behaviors (e.g., impulsivity and hyperactivity) that annoy others. 

There is also no uniform set of characteristics that are associated with bullies. In some cases, they value aggression and power and show a lack empathy or guilt (Jolliffe & Farrington, 2006). Sometimes they bully to impress peers, particularly if peers reinforce such behaviors. In addition, bullies could have experienced problems in their home life (e.g., abuse or neglect) that interfere with their social development. Sometimes bullies are victims themselves, but this is far from uniform (Gini, 2006). Still, it is important to consider whether the bully can also be a victim, and thus have attributes of both.

Classroom and school characteristics can also greatly influence the prevalence of bullying. For example, classrooms and schools that employ an authoritative approach to management and school discipline experience less bullying (Cornell, Shukla, & Konold, 2015). This approach includes social support (including an emphasis on building and maintaining positive relationships) with structure (e.g., clear behavioral expectations, close monitoring of behavior, and rules and consequences that are clear and fair) (Bear, Homan & Harris, 2019).

RECOMMENDATIONS

Recent reviews have noted that several supports and interventions can be important considerations in addressing bullying. These are arranged in two general categories: (a) preventing bullying and (b) responding to bullying (Bear, Homan & Harris, 2019).

1. Instilling positive social skills are critical for preventing bullying. Therefore, social skills should be highlighted in the regular curriculum. These skills should be a part of the fabric of the school climate and can be highlighted in the activities, presentations and communications provided by the school. Likewise, these skills can also be folded into the content found in reading and social studies curriculum. 
2. The schools should directly teach students about what bullying means and the related negative outcomes. While the schools should make students aware about how bullying can result in a range of negative outcomes, it is also important to teach students that not all acts of aggression constitute bullying. Using the term bullying indiscriminately can lead to unfair allegations and trivialize the profound outcomes associated with true incidents of bullying.
3. How victims can respond to bullying. Victims are unlikely to stop the bullying because of their direct action. However, telling the bully to stop in an assertive way may help; other times, treating verbal bullying as a joke can be effective. In other instances, the victim may need to get a teacher or other person in authority involved, or they could avoid negative interactions with a bully by staying close to adults or friends when the bully is nearby. 
4. The expectations, rules, and consequences pertaining to bullying should be explicitly stated as a matter of school policy. The school can lead this effort by using multiple methods, including presentations to students and parents, printed materials, websites, and signed contracts. 
5. Be vigilant for the behaviors often displayed by victims and those that bully. Many students are reluctant to report bullying. Victims might feel ashamed or embarrassed, and both victims and witnesses might fear retaliation. Thus, it is important that teachers, other staff, and parents watch for signs that a student is a victim or an aggressor. The federal website stopbullying.gov gives explicit warning signs.
6. Have a system for students to report bullying. To protect against retribution from the bully, make sure the reporting system allows the victim to report bullying without having to reveal themselves. 
7. Create a learning environment that fosters greater supervision. In particular, the physical structure of the classroom should separate the victim from the bully. 
8. Positive teacher–student relationships prevent bullying. In addition, victims are more likely to report bullying to adults with whom they have good relationships (Cortes & KochenderferLadd, 2014)
9. Teachers and parents should ensure that they exhibit prosocial behaviors. Teachers and parents that use sarcastic, humiliating, or otherwise hurtful comments encourage similar behavior in children and may inadvertently encourage bullying.
10. Parents can help prevent and stop bullying. Parents should understand what constitutes bullying. In addition to their involvement with parents on a case-by-case, schools and pediatricians can help disseminate information through printed materials, websites, presentations, and conferences. 
11. School-wide prevention programs can increase prosocial behavior and decrease a variety of negative behaviors, including bullying. Positive Behavioral Intervention and Supports (PBIS) is one program that has been a particularly effective school-wide prevention program for holding down the rate of negative behaviors more generally; however, other school wide programs are particularly designed for addressing bullying (Bear, Homan & Harris, 2019).

How to Respond to Bullying

The following recommendations have been offered to help teachers and other adults respond appropriately when someone reports or observes potential bullying (Bear, Homan & Harris, 2019). Of note, many schools have a clear process for reporting and investigating bullying, and the policies and procedures of a school or district often dictate how and by whom reports are handled.

1. It is important to take the situation seriously and communicate that the behavior will not be tolerated.
2. Assess the safety of those involved and the extent of any injuries. 
3. It is best to address the behavior in private. Trying to settle the problem in front of others could make the situation worse. It typically embarrasses the victim and may cause the bully to seek revenge.
4. Try to determine what has happened. Listen to both the victim and the aggressor separately and talk privately to others that observed what happened. The focus should be: “What exactly happened? What triggered or contributed to it? What are the perspectives of those involved?” Act efficiently but do not rush the process.
5. Decide if the behavior is bullying and identify the appropriate response. The people or team investigating the incident needs to determine if the behavior qualifies as bullying. Regardless of the determination, the students’ needs should be considered, and any special education considerations should be addressed.
6. Develop a plan that includes everyone involved. While the victim and the bully obviously need to be involved in any plan, it is also important that teachers, other staff, and parents should share responsibility. It is important for the victim and their parents and teachers to coalesce around a plan that includes actions for both students and adults. Formulate a similar plan for the bully.
7. Avoid certain messages and advice that can make the situation worse. Don’t blame the victim, or simply tell the victim to ignore the bullying. Don’t encourage the victim to “work it out” with the bully on their own, or encourage the victim to retaliate. 
8. Emphasize it is the behavior that it the problem, not the person that displays bullying behavior. A student can change his or her behavior but being labeled a bad person is suggestive of a fixed personality characteristic. 
9. Emphasize the negative impact of the bully's behavior on the victim. Encourage the bully to assume the perspective of the victim, especially how the victim could or did feel. 
10. Punitive consequences to bullying behavior is often appropriate. However, punitive techniques should always be used in combination with educational, reparative, and positive consequences.
11. Include an educational component to the intervention. Require the student that bullies to read a book or watch a video on bullying, write an essay or research report, mentor (with adult guidance) a younger student, or lead a discussion about bullying and the importance of not harming others.
12. Address the harm done by bullying. Challenge and help the bully to repair harm done to the victim by apologizing to the victim (preferably in writing), replacing a broken or stolen items, or doing an act of kindness for the victim or others.
13. Provide positive consequences for countervailing skills and behaviors. Be sure to praise, teach and reinforce behaviors that are inconsistent with bullying. For example, praise the victim for assertiveness, or praise the bully for prosocial behaviors.
14. Consider the need for more significant interventions and supports. This is most important when the victim or the bully exhibits internalizing behaviors (e.g., depression)—or when the bully's externalizing behaviors (e.g., physical aggression) do not cease when the recommendations above are implemented. They should also be individualized— guided by an assessment of the student's needs— and implemented by a mental health specialist who works closely with the student, teachers, and family.

As always, if you have questions about the behavioral health needs of your patients, we encourage you to call the BHIPP consultation line at 

855-MD-BHIPP (632-4477), open 9am-5pm Monday-Friday, for resource/referral networking or consultation support.

We will keep you informed about all our services and training events through our website (www.mdbhipp.org) and monthly e-newsletters. Additionally, BHIPP is on LinkedIn, Twitter, and Facebook. We invite you to follow us there to stay up-to-date on upcoming training events, pediatric mental health research, and resources for providers, families and children.

RECOMMENDED RESOURCES

School Programs

These school-wide prevention programs have several empirical studies supporting their use.

• Positive Behaviors interventions and Support- https://www.apbs.org
• Olweus Bullying Prevention Program— http://www.violencepreventionworks.org
• Second Step—http://www.secondstep.org/
• KiVa Bullying Prevention Program— http://www.kivaprogram.net/program

Websites https://www.stopbullying.gov  

The U.S. Department of Health and Human Service has a number of resources for helping address the issues associated with bullying. It includes suggestions on what schools, caregivers, and children can do to prevent bullying. It also provides information on research, training, and state laws. https://cyberbullying.org/bullying-laws

This website for the Cyberbullying Research Center offers suggestions for educators and parents on cyberbullying.

Books

Swearer, S. M., Espelage, D. L., & Napolitano, S. A. (2009). Bullying prevention and intervention: Realistic strategies for schools. New York, NY: Guilford Press.

This book provides research supported materials for preventing and responding to bullying and cyberbullying.

REFERENCES

Bear, G. G., Homan, J., & Harris, A. (2019). Bullying: Helping handout for school. In G.G. Bear & K.M. Minke (Eds.), Helping handouts: Supporting students at school and home. Bethesda, MD: National Association of School Psychologists. 

Bear, G., G., Mantz, L. S., Glutting, J. J., Yang, C., & Boyer, D. E. (2015). Differences in bullying victimization between students with and without disabilities. School Psychology Review, 44, 98–116. 

Birkett, M., Espelage, D. L., & Koenig, B. (2009). LGB and questioning students in schools: The moderating effects of homophobic bullying and school climate on negative outcomes. Journal of Youth and Adolescence, 38, 989–1000. 

Cornell, D., Shukla, K., & Konold, T. (2015). Peer victimization and authoritative school climate: A multilevel approach. Journal of Educational Psychology, 107, 1186–1201. 

Cortes, K. I., & Kochenderfer-Ladd, B. (2014). To tell or not to tell: What influences children's decisions to report bullying to their teachers? School Psychology Quarterly, 29(3), 336–348. 

Gini, G. (2006). Social cognition and moral cognition in bullying: What's wrong? Aggressive Behavior, 32, 528–539. 

Jolliffe, D., & Farrington, D. P. (2006). Examining the relationship between low empathy and bullying. Aggressive Behavior, 32, 540–550. 

Rodkin, P. C., Espelage, D. L., & Hanish, L. D. (2015). A relational framework for understanding bullying: Developmental antecedents and outcomes. American Psychologist, 70, 311–321. 

Rueger, S. Y., & Jenkins, L. N. (2013). Effects of peer victimization on psychological and academic adjustment in early adolescence. School Psychology Quarterly, 29(1), 77–88. 

Ttofi, M. M., & Farrington, D. P. (2011). Effectiveness of school-based programs to reduce bullying: A systematic and meta-analytic review. Journal of Experimental Criminology, 7, 27–56. 

U.S. Department of Education, National Center for Education Statistics. (2017). Indicators of School Crime and Safety: 2016 (NCES 2017-064), Indicator 11.

The BHIPP Mental Health Crisis Training Series begins this Thursday. There is still time to register for this session and all others in the series through the link below!

Mark your calendar for this upcoming BHIPP TeleECHO^TM Clinic:

Check out our BHIPP Resilience Break for October!

Have you found BHIPP effective in helping you address your patients’ behavioral health? Let us know what you think in the Health Resources and Services Administration surveys coming next month!