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BULLYING AND ADOLESCENTS: DEFINING THE PROBLEM, EXPLORING SOLUTIONS Jennifer Caudle, DO Director of the section of Family Medicine Sinai Hospital/Johns Hopkins Univ. Program in Internal Medicine Baltimore MD. Background. Background Student Perspective > 50,000 students, parents, educators

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  1. BULLYING AND ADOLESCENTS: DEFINING THE PROBLEM, EXPLORING SOLUTIONS Jennifer Caudle, DODirector of the section of Family MedicineSinai Hospital/Johns Hopkins Univ. Program in Internal MedicineBaltimore MD

  2. Background • Background • Student Perspective • > 50,000 students, parents, educators • Student Letters

  3. Bullying Workshops

  4. Bullying Workshops Brick Public School District Brick, NJ Brookside Upper Elem School Westwood , NJ Central High School Davenport , IA Colonial Middle School Plymouth Meeting, PA Cunningham Elementary School Vineland , NJ Dennis Twp Elem. School Dennis Township , NJ Dionne Warwick Institute East Orange , NJ Drum Point Elementary Brick, NJ East High School Des Moines , IA Eisenhower Middle School Bridgewater , NJ Evergreen Ave. School Woodbury , NJ Florham Parks School District Florham Parks , NJ Franklin Elementary Schools Summit , NJ Gloucester Twp Middle Sch. Gloucester Twp , NJ Jersey City Public Schools Jersey City , NJ Kittatinny Regional High School Newton , NJ Lakeside Middle School Pompton Lakes , NJ Lincoln-Hubbard Elem School Summit , NJ Lindenwold High School Lindenwold , NJ Mary Bray School Mt. Ephraim , NJ Southern Reg. Middle School Manahawkin ,NJ Springville Elementary School Marlton , NJ St. Joseph ’s School Maplewood , NJ Teaneck School District Teaneck , NJ UMDNJ- School of Osteo. Medicine Stratford , NJ West End Ave. School Woodbury , NJ Westampton Middle School Westampton , NJ WestAmwell School Lambertville , NJ Williams Junior High School Davenport , IA Williamstown Middle School Williamstown , NJ William McGinnis School Perth Amboy, NJ Robert Wilentz School Perth Amboy, NJ Haines Middle School Browns Mills, NJ Olivet Elementary School Pittsgrove, NJ Swimming River School Tinton Falls, NJ Gov. Charles C. Stratton Sch. Woolwich Twp, NJ Central Regional High School Bayville, NJ Memorial Middle School Willingboro , NJ North Plainfield School District Plainfield , NJ N. Burlington Cty Reg. Mid. Sch. Columbus , NJ Roosevelt Middle School West Orange , NJ Sioux City Public School District Sioux City , IA

  5. Bullying Workshops Memorial Middle School Willingboro , NJ Fountain Woods Elementary School Burlington, NJ William Annin Middle School Basking Ridge, NJ Carl Sandburg Middle School Matawan, NJ Raymond Kershaw School Mount Ephraim, NJ Waterford Township Elementary Waterford, NJ Spruce Street School Lakewood, NJ Holly Hills Elementary Westampton, NJ Brimm Medical Arts High School Camden, NJ Walnut St. Elementary Woodbury, NJ Midstreams Elementary School Brick, NJ Lakewood High School Lakewood, NJ Boone Middle School Haines City, FL Memorial Middle School Willingboro , NJ North Plainfield School District Plainfield , NJ Brick Public School District Brick, NJ Brookside Upper Elem. School Westwood , NJ Florham Parks District Florham Parks , NJ Washington Township High School Sewell, NJ Teaneck School District Teaneck , NJ Bernards Twp Health Dept. Basking Ridge, NJ Girl Scout Council Bergen County, NJ Gloucester Cty Minority Recruitment Office Sewell, NJ New Jersey School Counselors Association Cherry Hill , NJ New Jersey State Interscholastic Athletic Association Robbinsville , NJ New Jersey Principals and School Administrators Conference Monroe Township, NJ Phi Delta Kappa Organization

  6. Objectives • Part I • Epidemiology • Defining bullying • Why is it important to discuss? • Part II • The Youth Perspective • Part III • How do we help our patients?

  7. Do You Remember a Bully?

  8. Bullying Test Your Bully IQ

  9. Question 1 What percent of middle/high school students have experienced bullying?¹ a) 10% b) 25% c) 33%

  10. Answer: Question 1 33% 1. US Department of Education

  11. Question 2 What percent of school-age bullies end up with criminal records? a) 15% b) 20% c) 25%

  12. Answer: Question 2 25% The National Resource Center for Safe Schools reports that by age eight, bullies are: 1) 6 times more likely than non-bullies to be convicted of a crime by age 24 2) 5 times more likely to have serious criminal records by age 30.

  13. Question 3 How many students nationwide skip school on any given day to avoid being teased or picked on?¹ a) 20,000 b) 80,000 c)160,000

  14. Answer: Question 3 160,000 National Education Association, 2003

  15. Epidemiology Defining Bullying Why is Bullying Important to Discuss? Part I

  16. Bullying • “Boys will be boys…?” • Bullying = Rite of Passage? • Bullying has negative consequences for all involved

  17. Epidemiology In 1999, the US Dept of Education estimated that almost 1 million students 12-18 years of age were afraid of being attacked or harmed in the school vicinity during the previous six months. Lyznicki J, et. Al. Childhood Bullying: Implications for Physicians. American Family Physician 2004; 70: 1723-1727.

  18. Defining Bullying • “The act of threatening to hurt or frighten someone. It may be physical, verbal, emotional, or sexual in nature”¹ (emotional bullying= rejection, humiliation, exclusion, ranking based on race, ethnicity, sexual orientation, and isolation) • Imbalance of power² • Repetitive • US Department of Education • American Medical Association

  19. Defining Bullying • DSM IV- Criteria for Conduct Disorder Repetitive and persistent pattern of behavior in which either the basic rights of others or major age-appropriate societal norms or rules are violated • Aggression to people and animals • 1) often bullies, threatens, or intimidates others • 2) often initiates physical fights • 3) Has used a weapon that can cause serious physical harm to others

  20. Defining Bullying Physical: Kicking, hitting, punching (boys) Emotional: exclusion, gossiping, silent treatment, slandering reputation, self-esteem attacks, “if you’re my friend, you can’t be her friend.” (girls) Cyberbullying: Facebook, email, MySpace, Cell phones:3rd graders, 5000 text messages

  21. Who are the Players? • Bullies • Victims • Bully-Victims • Bystanders

  22. Why Is Bullying Important? 1) “Boys will be boys?” - Emotional, Safety, Academic, Health consequences 2) Bullying behaviors are detrimental to bullies, victims and bully-victims.

  23. Why Is Bullying Important? 1) Emotional Impact • Talk shows • Effect on adults • Effect on children, #1

  24. Why Is Bullying Important? 1. Vossekuil B, et. al. U.S.S.S. Safe School Initiative: An Interim Report on the Prevention of Targeted Violence in Schools. Washington, DC: US Secret Service, National Threat Assessment Center; 2000 2) Safety • In 2000, the US Secret Service reported that 2/3 of all school shootings in the last decade have occurred by an attacker who felt “bullied, attacked, threatened, or persecuted.”¹

  25. Why Is Bullying Important? 2) Safety, cont’d From 1994-1999, 220 school associated violent deaths occurred in the US. 172 were committed by students; these students were 2.6 times more likely to have been bullied than their victims.² 1. Anderson, et al. School-associated violent deaths in the United states, 1994-1999. JAMA 2001; 286: 2695-702.

  26. Why Is Bullying Important? 1. Klomek, et. al. Bullying, Depression and Suicidality in Adolescents. J.Am. Adol. Child Adolescent Psychiatry. 46:1, Jan 2007 2) Safety, cont’d • Suicide is 3rd leading cause of death among teens • “Bullycide” • A study involving 2,342 high school students demonstrated that bullies and victims were at a higher risk for depression, suicidal ideation and suicide attempts than those not involved.¹

  27. Why Is Bullying Important? 2) Safety, cont’d • Teen Violence: Columbine, Teen burned 1. Anderson, et al. School-associated violent deaths in the United states, 1994-1999. JAMA 2001; 286: 2695-702.

  28. Why Is Bullying Important? 3) Academic Performance • A study of 204 Midwestern American middle / high school students found that 90% said they had a drop in grades…as a result of bullying¹. • A small study conducted in elementary schools (Stanford Achievement Test scores found a significant association between low scores and being a victim of bullying². • 1. Sharp S. How much does bullying hurt? Educ Child Psychology. 1995;12:81-8 • 2. Hazler R, Hoover J, Oliver R. What kids say about bullying. Exec Educator. 1992; 14:20-22

  29. Why Is Bullying Important? 1. Bullying, Psychosocial Adjustment, and Academic Performance in Elementary School. Gwen M. Glew, MD et. al. Arch Pediatrics and Adolesc Med. 2005;159:1026-1031 3) Academic Performance cont’d • A study surveying 3,530 third, fourth, and fifth grade students found that victims and bully-victims had achievement scores significantly lower than those of bystanders… and would endorse cheating if they could get away with it compared to bystanders¹.

  30. Why Is Bullying Important? 1. Minne Fekkes, MSc., et al. Bullying behavior and associations with psychosomatic complains and depression in victims. Pediatrics 2004;144 4) Health • Victims • Psychosomatic complaints, experience social distress, marginalization and low self esteem. • A study of 2766 students age 9-12 years old showed that victims were at greater risk for aggression, headache, sleeping problems, abdominal pain, bedwetting, feeling tired, anxiety, and depression than children not involved in bullying¹. • Substance Abuse

  31. Why Is Bullying Important 1. Nickel, et. al. Anger, Interpersonal Relationships , and Health-Related Quality of Life in Bullying Boys who are Treated with Outpatient Family Therapy; A Randomized, Prospective, Controlled Trial with 1 Year of Follow-up. Pediatrics 2005; 116; e247-e254. 4) Health, cont’d • Bullies • Increased anger, poor interpersonal relationships and poor quality of life.¹ Reports of depression. • A 2002 study published in JAMA examined bullying among 6th-10th graders and found that bullies were more likely to drink and smoke.

  32. Why Is Bullying Important? 1. Juvonen, et. al. Bullying Among Young Adolescents: The Strong, the Weak and the Troubled. Pediatrics. 2003; 112; 1231-1237. 4) Health cont’d • Bully-Victims • High Risk • Most likely to display conduct problems, be least engaged in school, socially ostracized by peers and be lonely.¹ They are also noted to have psychosomatic complaints.

  33. Why Is Bullying Important? 4) Health, cont’d • A study of 2,540 boys in Finland followed bullies, victims and bully-victims from 8 years old until 18-23 years old. Sourander, et al. What is the Early Adulthood Outcome of Boys Who Bully or Are Bullied in the Childhood? The Finnish “From a Boy to a Man” Study. Pediatrics, 2007; 120; 397-404.

  34. Why is Bullying Important? Bullies, victims and bully-victims experience long-term consequences.

  35. Clear-Cut? 1. Juvonen, et. Al. Bullying Among Young Adolescents: The Strong, the Weak and the Troubled. Pediatrics. 2003; 112; 1231-1237. • Studies; Self-reporting • Crossover between categories: bully, victim, bully-victim • Crossover: Characteristics • Study of 1,985 predominantly Latino and Black 6th graders • Bullies had fewest number of adjustment problems • Bullies had high social status among classmates

  36. The Youth Perspective Part II

  37. The Youth Perspective • “Bullying: Stories from Our Young People” • #2-7 • “The In-Crowd and Social Cruelty” (shown with permission from Films for the Humanities and Sciences)

  38. How Do We Help Our Patients? Part III

  39. How to Help Our Patients 1. Lyznicki, et al. Childhood Bullying: Implications for Physicians. American Family Physician. November 1, 2004. Volume 70, Number 9. According to a 2004 American Family Physician article, “there is no one accepted psychological profile or assessment method to predict bullying behavior.¹”

  40. How to Help Our Patients 1) Identify risk factors for violence 2) Ask children about bullying 3) Understand barriers 4) Talk with parents about bullying 5) Refer appropriately 6) Involve the School 7) Become advocates

  41. How to Help our Patients American Academy of Pediatrics, Task Force on Violence. The role of the Pediatrician in Youth Violence Prevention in Clinical Practice and at the Community Level. Pediatrics. Vol 103, No. 1 January 1999 1) Identify Risk Factors for Violence • Hx of mental illness, domestic violence, substance abuse • Family stressors • Level of supervision and support systems • Exposure to violence in the home or community • Access to firearms • Presence or signs of poor self-esteem or depression • Poor school performance, physical, emotional or developmental disabilities

  42. How to Help Our Patients 2) Ask children about bullying • During routine physical exams • When psychosomatic complaints are present (from child or parent). • When a child has problems at school • When a child shows signs of depression/ anxiety • When parents have concerns • Assess for bullies, victims and bully-victims.

  43. How to Help Our Patients • Questions to ask: • Have you ever been teased in school? • What kinds of things do others tease you about? • What do you do when others pick on you? • Have you ever told your teacher or other adult? What happened? • Do you know of others who have been teased? • At recess, do you usually play with other children or by yourself? Glew G, Rivara F, Feudners C. Bullying: Children Hurting Children. Pedriatr Rev 2000; 21:186

  44. How to Help Our Patients • Questions to ask, cont’d • Do you tease or make fun of others? • Do you ever hit or push others? • Why do you act this way towards others? • What do you do when you seen others being teased or picked on?

  45. How to Help Our Patients 3) Understand Barriers: • Ask questions • Listen • “Fear Factor” • Give children “permission” to report. Let them know this is expected

  46. How to Help Our Patients 4) Talk with Parents about bullying • Educate parents • “Sticks and Stones” • #8

  47. How to Help Our Patients 4) Talk with Parents about bullying, cont’d • Encourage parents to go to “the ends of the earth” • Be supportive: Studies suggest that positive parental behaviors and support protect adolescents from bullying others and being bullied¹. • Involve the school (counselors, bus drivers) • Role play solutions at home • Learn to text message, Facebook, etc. • Consider mental health services Wang, et. Al. School Bullying Among Adolescents in the United States: Physical, Verbal, Relational and Cyber. Journal of Adolescent Health 45 (2009) 368-375

  48. How to Help Our Patients 5) Refer appropriately: • Mental Health Services: • Psychiatry, Counseling, Family Therapy • Social Work • School Interventions

  49. How to be Advocates 6) Involve the School • Bullying laws • > 40 states • The Safe Schools Reporting Act of 2005 requires the Maryland State Department of Education to require reporting of bullying incidents against students in public schools. • Maryland’s Model Anti-Bullying, Harassment, and Intimidation Policy requires school systems to submit copies of their anti-bullying policies to the State Superintendent for review. • School-wide Programs • Dan Olweus • Lack of standard evaluation practices

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