Becky Hashim, Ph.D. Attending Psychologist Behavioral Consultation Team Assistant Professor

1. Becky Hashim, Ph.D. Attending Psychologist Behavioral Consultation Team Assistant Professor Departments of Psychiatry and Pediatrics Children’s Hospital at Montefiore rhashim@montefiore.org Bullying, sadness and worry: Knowing what to watch out for and when to be concerned

2. Goals of Presentation Review of Turner Syndrome, social competence, and self-esteem Definition of bullying Differentiating between normal child conflict and bullying Warning signs for depression and anxiety How you can help your child (and yourself!)

3. Turner Syndrome (TS): Psychological research data Research on psychosocial development has documented adjustment problems in the following areas: Immaturity Poor concentration Increased activity level Peer relationship problems Negative self-concept Negative body image Delays in cognitive maturation (nonverbal processing) Family struggle in accepting the diagnosis Low self-esteem Limited access to resources and support Immaturity and anxiety are most common in adolescence

4. TS, self-esteem, and self-concept Girls with Turner Syndrome have high motivation for social relationships, but perform more poorly than their peers on several measures of social competence and social cognition (Hong et al., 2011) Impairments in sensing reciprocal social behaviors, using expressive social communication, interpreting social cues Link between impaired social performance and decreases in self-esteem and self-concept Social contexts become much more subtle and demanding with age (adolescence)

5. Simply stated, bullying… Is intimidating or subjecting a person to hostility or ill treatment Involves actions which cause another person to feel afraid, humiliated, embarrassed, threatened or shamed Occurs in a relationship in which there is an imbalance of power Is repeated over time

6. Bullying Happens in Four Ways • Verbal • Teasing, jokes, ignoring/isolation, gossip, threats • Physical • Blocking someone’s path, physical restraint, pushing/kicking, hazing • Sexual • Teasing, touching, slapping, pictures, emails, graffiti, sexual assault • Property • Hiding belongings, theft, arson, extortion, vandalism, destruction

7. Bullying is NOT… • A normal childhood activity • A rite of passage • The target’s fault

8. Differentiating Bullying from NormalPeer Conflict/Mean Behavior Normal conflict/mean behavior • Equal power or are friends • Happens occasionally • Accidental • Not serious • Equal emotional reaction • Not seeking power • Remorse-will take responsibility • Effort to solve the problem Bullying • Imbalance of power • Repeated negative actions • Intentional • Physical or emotional harm • Unequal emotional reaction • Seeking control/material things • No remorse-blames target • No effort to solve the problem

9. For the target, bullyingis a “loss” experience LOSS of safety LOSS of self-esteem LOSS of belonging LOSS of control over their own life

10. Effects of Bullying on the Target Physical Effects • Stomach aches • Weight loss/gain • Headaches • Drop in grades • Drug or alcohol use • Sexual activity • Physical aggression • Suicidal • Homicidal Emotional Effects • Alienation • Low self-esteem • Insecurity • FEAR • Depression • Withdrawn • Aggression • Anger • Vengeful

11. Warning signs that your child may be the target of bullies Frequently teased, taunted belittled, ridiculed, intimidated threatened, dominated or subdued Has a derogatory nickname Regularly has bruises or injuries that can’t be explained Has belongings taken or damaged Few or no close friends at school

12. Warning Signs Frequently socially isolated Less assertive or lacks the skills to respond to others’ teasing or harassment Appears weak or easily dominated Tries to stay close to a teacher or other adult at recess or breaks Talk with your child about bullying!

13. What to do if you suspect your child is being bullied Talk with your child If your child is being bullied, they need to have a voice in how the situation is handled Contact the school Set up a meeting with your child’s teacher(s) or counselor Consider including the school resource officer if applicable Develop a plan for keeping your child safe, particularly during vulnerable times (class breaks, lunch, recess). Find out what activities or counseling options are available for your child Contact police or school resource officer… If the actions are criminal (assault, theft, serious threats, vandalism)

14. Recommendations if you suspect your child is being bullied Don’t encourage your child to fight back—two wrongs don’t make a right! Listen to your child; do not ignore your child’s plea for help. Don’t confront the parents or the other child directly. Avoid bringing your child and the bully together to elicit an apology or resolve the issue.

15. “Sad” vs “Depressed” • How do we know when we’re depressed? • difficulty concentrating, remembering details, and making decisions • fatigue and decreased energy • feelings of guilt, worthlessness, and/or helplessness • feelings hopeless • Trouble sleeping OR sleeping too much • irritability, restlessness • loss of interest in activities or hobbies that you once enjoyed • overeating or appetite loss • persistent sad, anxious, or "empty" feelings • Not just every now and then – really gets in the way of your functioning

16. “Worry” vs “Anxiety” • How do we know when we’re anxious? • Feelings of nervousness or dread • Trouble concentrating • Feeling tense and jumpy • Anticipating the worst • Irritability • Restlessness • Watching for signs of danger • Feeling like your mind’s gone blank • Physical symptoms (pounding heart, sweating, stomach or headaches, etc.) • Not just every now and then – really gets in the way of your functioning

17. Caregiver support! • It’s normal to have concerns about your child’s health, social interactions, friendships, education and general well-being • Stay connected (#1): Establish and maintain quality relationships with friends and family • support groups composed of other people experiencing similar challenges • will not only aid your own well-being, but also provide rewarding opportunities for you to help others

18. What can you do to help your child? • Pay attention to your child’s social functioning • If you sense any problems, act quickly! • Carefully develop and nurture social skills and relationships • Group therapy: Peer groups for girls with TS can help reinforce your daughter's self-esteem and provide her with a social network of people who understand her experience • Create a “buddy system” with other parents who have TS children • Increase self-esteem • Encourage activities that your child feels she is good at and/or enjoys