Professor Neil Humphrey School of Education, University of Manchester, UK

1. Bullying of children and young people with autistic spectrum disorders (ASD) – what do we know and how can we help? Professor Neil Humphrey School of Education, University of Manchester, UK neil.humphrey@manchester.ac.uk

2. Overview • What is bullying? • Definition and conceptualisation • Outcomes associated with exposure to bullying • Bullying of children with ASD • Peer relationships and social exclusion • Prevalence • Risk factors • Experiences and outcomes • Opportunities for intervention • Students with ASD • The peer group • Teachers and support staff • School culture and climate • Acknowledgement: Thanks to Judith Hebron!

3. What is bullying? • Some conceptual issues… • Distinctions between ‘bullying’, ‘teasing’ and ‘victimisation’? • Physical, verbal, relational • Direct vs. indirect • Traditional vs. cyber • Some essential ingredients? • Intention • Repetition • Imbalance of power • Social setting • Unprovoked • Some measurement problems • Source of information (pupils, teachers, parents, peers) • Response format and time frame • Where to ‘draw the line’

4. What is bullying? • “The consequence of acts of intentional aggression, by a peer (or group of peers) operating from a position of strength or power, and directed at a victim who is viewed as relatively weak. The aggressor’s goal is to damage status and/or social relationships. The victim may or may not have had a role in provoking the aggression. As a consequence of the aggression, the victim perceives him/herself as having been hurt or abused, and the victimisation significantly decreases his/her well-being. These negative acts occur over a period of time and are viewed by victims as comprising a pattern of aggressive behaviour” Brock et al (2006, p.5)

5. What is bullying? • Social-ecological model of bullying (Richard et al, 2012; Swearer et al, 2010)

6. What is bullying? • Prevalence • Large amount of variation due to conceptual and methodological issues (see earlier slide), but also cultural variation and individual difference • Makes comparison across studies very difficult! • Around 1 in 10 children and young people in England report being bullied every day in school (Chamberlain et al, 2010) • Outcomes • Suicidal ideation (Klomek et al, 2007) • Mental health problems (Turner, Finkelhor &Ormrod, 2006) • Lower attainment (Green, Collingwood & Ross, 2010) and attendance at school (Kochenderfer & Ladd, 1996)

7. Bullying and ASD • Why might children and young people with ASD be considered “perfect victims” (Klin, Volkmar & Sparrow, 2000, p.6)? • Socio-cognitive profile (Moore, 2007) • Peer relationships and social exclusion (Humphrey & Symes, 2010; 2011) • ‘Hidden’ disability • Broader school factors • Typical victim profile from general bullying research • Difficulties in social understanding (Garner & Stow Hinton, 2010) • Low social status (Card & Hodges, 2007) • Perceived ‘difference’ or deviation from peer group norms (Horowitz et al, 2004) • Passive/submissive vs. provocative victims (Olweus, 1993)

8. Peer relationships and social exclusion • Social status • Young people with ASD are more rejected and less popular than their typically developing peers (Jones & Frederickson, 2010)and those with other SEND (Symes & Humphrey, 2010) • Peer interaction • They spend more time engaged in solitary behaviours, less time in positive interactions with peers, and more time engaging in reactive aggression than other students • Fewer instances of rough and tumble play, more instances of social initiation and instrumental verbal aggression (Humphrey & Symes, 2011) • Social support • Students with ASD report significantly lower levels of social support from parents, classmates, and friends (but not teachers) than other students (Humphrey & Symes, 2010a) • Friendship • Fewer friends (Cairns & Cairns, 1994) and more limited social networks (Chamberlain et al, 2003) • Lower centrality, acceptance, companionship and reciprocity (Chamberlain et al, 2007)

9. Peer relationships and social exclusion • Reciprocal Effects Peer Interaction Model (REPIM) (Humphrey & Symes, 2011)

10. Bullying and ASD • Students with ASD more likely to be bullied than typically developing peers (Wainscot et al, 2008) • However, what about children and young people with other SEND? • Pupils with SEND more likely to be bullied than those without SEND (Chamberlain et al, 2010; Thompson, Whitney & Smith, 1994) • Need for analysis which compares ASD vs. other SEN vs. typically developing peers (Humphrey & Symes, 2010a)

11. Bullying and ASD • Humphrey and Symes (2010a) – bullying of adolescents with ASD, dyslexia (DYS) and no difficulties (CON) in mainstream secondary schools (N=120) using self-report • Pupils with ASD experienced significantly greater bullying than both comparison groups • No significant difference between DYS and CON

12. Bullying and ASD • Humphrey and Squires (2010) – bullying among children with SEND as part of Achievement for All evaluation (N=10,341) • Children with ASD second only to those with BESD in extent of exposure to bullying in both teacher and parent informant report

13. Prevalence • Prevalence estimates of bullying among children and young people with ASD • Little (2002) (USA) parent informant report (N=411) • 94% reported that their child had been bullied, of whom 75% had been subject to physical or relational bullying in last year • Reid & Batten (2006) parent informant report (N=1400) • 40% reported that their child had been bullied at school • Van Roekel et al (2010) (Netherlands) adolescents with ASD in special schools (N=230) • 7% peer-report • 17% self-report • 30% teacher report • Reid (2011) self-report (N=295) • 34% reported that being picked on was one of the worst things about school • Sterzing et al (2012) (USA) parent informant report (N= 1100) • 46% reported as victims, plus 9% as bully-victims

14. Prevalence • Hebron (2012) prevalence rates by nomination, role, frequency, mean exposure using teacher (N=722) and parent (N=121) informant report using baseline date from Achievement for All evaluation (Humphrey & Squires, 2010, 2011a/b) Parentheses refer to the average across all SEND groups

15. Risk factors • Children and young people with ASD are more likely to be bullied than their typically developing peers AND most children with other SEND • However, there is still likely to be a significant amount of variation in exposure to bullying within this group • Research which identifies risk factors can therefore be a useful means of developing our knowledge and understanding of bullying of pupils with ASD (Hebron, 2012) • Some basic indicators • Age • Little (2002) found a peak at age 13 • Sex • Reid and Batten (2006) found higher rates for boys • Educational placement • Reid and Batten (2006) found higher rates among children in mainstream schools • Diagnostic category • Reid and Batten (2006) found higher rates among children with a diagnosis of Asperger syndrome • However, there may be confounds among these factors • Need for research which examines (and controls for) multiple risk factors simultaneously

16. Risk factors • Sofronoff et al (2011) (Australia) parent informant report (N=133) • Multiple regression analysis • Predicted 34% of the variance in bullying • Social vulnerability (e.g. getting tricked into things, believing others to their own detriment) was the only independent predictor of exposure to bullying • Sterzing et al (2012) • Logistic regression analysis involving computation of odds-ratios (OR) of being nominated as a victim of bullying. Significantly increased ORs were found for the following: • Non-Hispanic ethnic origin • ADHD co-morbidity • Lower social skills • Higher conversational ability (compared to no conversational ability) • Attending mainstream classes for 76% or more of time (compared to 25% or less)

17. Risk factors • Hebron (2012) multiple regression analysis • Teacher model • Explained 43% of variance in bullying exposure • Significant risk factors included increased behaviour problems, reduced positive relationships, attending mainstream school, using public transport to get to school, and being in Y5/7/10 (compared to Y1) • Parent model • Explained 38% of variance in bullying exposure • Significant risk factors included increased behaviour difficulties, higher parental engagement, being in Y5/7/10 (compared to Y1), and being at School Action Plus (compared to having a Statement of SEND)

18. Cumulative risk • Hebron (2012) contd – examination of cumulative risk • Teacher model demonstrates exponential increase, parent model is linear

19. Experience of bullying • Humphrey and Lewis (2008) interview study with adolescents with ASD (N=20)

20. Experience of bullying • Hebron (2012) case studies of children and adolescents with ASD (N=5)

21. How do young people with ASD respond to bullying? • Humphrey and Symes (2010b) interview study with adolescents with ASD (N=36)

22. Outcomes of bullying for young people with ASD • Reid and Batten (2006) • School refusal, changing/missing school • Diminished social skills and relationships • Mental health difficulties and damaged self-esteem • School work suffered • Hebron and Humphrey (2012) • Mental health difficulties

23. Opportunities for intervention

24. Some starting points for addressing bullying of pupils with ASD • Build upon what is known about how to prevent bullying in general terms, and think about the specific group needs of those with ASD • Use what we know from existing ASD/bullying research • e.g. why are young people with ASD particularly vulnerable? • e.g. what risk factors increase their exposure to bullying? • Make use of broader, social-psychological theory and research • e.g. attribution theory, social comparison theory

25. Some starting points for addressing bullying of pupils with ASD • Bullying of children with ASD has complex, multi-faceted roots (e.g. social-ecological model) and approaches to intervention should reflect this. • Focusing on a single aspect in isolation (e.g. social skills training) is unlikely to yield successful outcomes in the long term • Approaches need to be integrated into existing systems and practices in schools if they are to be sustainable • Need to avoid the ‘programme for every problem’ phenomenon • Strategies to prevent bullying should be assimilated within a broader approach designed to facilitate social inclusion of pupils more generally

26. How effective are school-based bullying prevention programmes? • No shortage of evidence! • Several systematic reviews and meta analyses (e.g. Smith et al, 2004; Merrell et al, 2008; Ferguson et al, 2007) • However, effects not always practically significant and are more likely to influence knowledge and attitudes rather than actual bullying behaviour (Merrell et al, 2008) • Slightly better outcomes for programmes which include a component targeting students considered to be ‘at risk’ (Ferguson et al, 2007) • “It appears that the most effective approaches for preventing or minimizing bullying in schools involve a comprehensive, multilevel strategy that targets bullies, victims, bystanders, families and communities” (Whitted & Dupper, 2005, p.169) • e.g. a social-ecological approach!!! • Essential ingredients (Whitted & Dupper, ibid) • School-level to change culture and climate • Classroom level targeting teachers and other adults • Student level targeting victims, bullies, bystanders

27. Reducing risk, increasing protection for students with ASD • Some common themes • Positive relationships with peers as a protective resource (e.g. Humphrey & Symes, 2010a; Hebron, 2012) • The importance of social skills (e.g. Sofronoff et al, 2011; Sterzing et al, 2012) • The mainstream school environment (e.g. Hebron, 2012; Sterzing et al, 2012) • Peak in early adolescence (e.g. Hebron, 2012; Little, 2002) • Contexts in which bullying is most likely to occur, such as outside/on way to school (e.g. Chamberlain et al, 2010; Hebron, 2012) • The above can be used to inform and adapt approaches to intervention as a means of reducing risk and increasing protective factors • Four key areas in which we need to think about the specific needs of children and young people with ASD • Students with ASD • Peer group • Teachers and support staff • School culture and climate

28. Students with ASD • Focused intervention to develop social skills and understanding in relation to bullying • Tailored to needs of specific child, but may include: • Developing understanding of bullying to prevent over/under reporting • Developing understanding of social cues in order to prevent social vulnerability/naivety • Identifying areas in which child is most vulnerable to bullying and providing avoidance strategies • Role playing bullying situations to teach response strategies • Teaching generic prevention strategies (e.g. safety in numbers) (Biggs, Simpson & Gaus, 2010)

29. Students with ASD • Numerous social skills interventions available • Bellini et al (2007) school-based interventions meta-analysis (N=55) • Interventions focusing on • Collateral skills (e.g. play skills, joint attention, language) • Peer-mediated • Child specific • Comprehensive (e.g. combination of the above) • Overall, interventions found to be “minimally effective” • Key issues • Dosage (threshold of 30 hours of instruction over 10-12 weeks) • Intervention setting/context (lower effects in interventions using withdrawal model) • Matching strategy to skill deficit (design intervention to meet needs of child vs. forced fit) • Fidelity to treatment model (higher fidelity = better results) • Wang and Spillane (2009) meta analysis (N=36) • Interventions included • Social stories • Peer-mediated • Video modelling • Cognitive behavioural training • Analysis of studies of social stories, peer-mediated and video modellingsuggested they met the criteria for evidence-based practice defined by Horner et al (2005)

30. Students with ASD • Tse et al (2007) (Canada) social skills training for adolescents with ASD (N=32) • 12 weekly sessions of 1-1.5 hours • Check in/review/new skill/role play/activity/close • Social skills covered in the group directly relevant to bullying prevention: • Awareness and expression of feelings • Recognition of non-verbal communication • Negotiating with others • Responding to bullying and teasing (e.g. ignoring, stating feelings, “comebacks”) • Significant effects on social cognition, communication, motivation and other domains, with small-medium effect sizes

31. Students with ASD • Beaumont and Sofronoff (2008) (Australia) RCT of multi-component social skills intervention (“Junior Detective Training Programme”) (N=49) • Seven weekly 2 hours sessions; intervention included • Computer game designed to teach emotion recognition, emotional regulation and social interaction • Small group therapy sessions to facilitate generalisation and teach additional social and problem solving skills • Teacher handouts with recommendations • Session content directly relevant to bullying prevention • Differentiating friendly joking from mean teasing • Dealing with bullying • Positive effects on parent and teacher reports of social skills • Significant improvement in emotion management strategies in relation to bullying/teasing (“Dylan is being teased” task) • Treatment gains maintained at 5 month follow up

32. The peer group • Campbell et al (2004) (USA) combined effects of descriptive and explanatory information on 3rd-5th grade peers’ attitudes and behavioural intentions towards children with ASD (N=576) • Random assignment to watch videos of child engaging in typical or autistic behaviours • ‘Typical’ rated more favourably • Provision of combined descriptive and explanatory information • improved 3rd and 4th grade children’s attitudes • improved behavioural intentions across all grades • girls more responsive than boys

33. Teachers and support staff • “You, the teacher, can make a huge difference – positive or negative – in the way other students view a child with AS… be careful not to set a tone that gives others a license to bully that child” [parent] (Sciutto et al, 2012, p.183) • Quality of teacher-pupil interactions influence relationships, which in turn have a bearing on peer acceptance for those with ASD (Robertson, Chamberlain & Kasari, 2003) • Key teacher qualities that have a positive impact (Sciutto et al, ibid): • Tolerance, acceptance and encouragement of differences and individuality rather than conformity • Overcoming initial impressions and recognisingthat the ‘usual’ will not work • Showing empathy, respect and liking for student with ASD • Taking the time to understand individual needs

34. Teachers and support staff • Fewer bullying episodes among children in schools where there are more positive student-teacher relationships (RasKauskas et al, 2010; Richard et al, 2012) • Changing teacher beliefs? • Teacher beliefs influence the strategies they use (Ladd & Pelletier, 2008) • Normative – less likely to intervene • Avoidant – “avoid them; stay out of their way” (but also more likely to intervene) • Assertive – “stand up to them; handle it on your own”

35. Teachers and support staff • Typical deployment model of teaching assistants (TAs) may hinder social inclusion of students with ASD (Symes & Humphrey, 2012) • e.g. Peers address questions to TA rather than child • e.g. Child works with TA rather than other children in group-based activities • Need to rethink how many TAs are deployed in the classroom?

36. Facilitating social inclusion: a multi-component approach • Etherington (2007) intervention developed in response to bullying of adolescent with Asperger syndrome • Recruitment of up to 6 ‘peer supporters’ – including students identified as bullies • 6 week training programme incorporated • Peer supporters: raising awareness and understanding of difference/diversity and ASD, social skills and difficulties, identifying key strategies to support student with ASD • Student with ASD: consultation on support plan, understanding of ASD • Expanded to provide 6 session programme to be delivered by form tutors in PSHE lessons • Immediate and significant reduction in bullying • “By knowing what a person’s thinking or how they react to things, it helped us realise what its about – how he’s a bit different to everyone else and how he might react to things” (Peer supporter) • “I feel safe to come to school now. My supporters are there for me and I can go to them if I need help or if I need to talk about something” (Student with ASD)

37. Facilitating social inclusion: a multi-component approach • Symes (ongoing, 2012-2014) pilot intervention based on REPIM (Humphrey & Symes, 2011) • Derived from approaches taken in ‘good practice’ schools (e.g. Morewood, Humphrey & Symes, 2011) • Three elements • 1:1 social skills training for adolescents with ASD (to include input on bullying) • Peer awareness and understanding campaign • Training of teaching assistants to support 1 and 2 and facilitate social interaction and generalization • Small scale RCT, outcome measures include • Sociometric status of pupils with ASD • Peer group attitudes, awareness and knowledge of ASD

38. School culture and climate • Respect for diversity/difference • Don’t avoid it – celebrate it! • Zero-tolerance for bullying • Staff have to model values • Challenge stereotypes and raise expectations • Maintaining a positive focus

39. School culture and climate • Whole-school saturation model (Morewood, Humphrey & Symes, 2011)

40. The ‘bottom line’