Wednesday, August 28, 2002

Bullying poses serious health threat to many school children

Parents urged to watch for signs, consult a professional for help

As millions of children head back to school this fall, bullies and violence should be the last thing on their minds.

But unfortunately for many children, another school year brings a chance they could be the target of verbal insults, physical assault or social sabotage. According to a recent American Medical Association report, 10 percent of school children are bullied regularly by a classmate. Surveys show that up to half of all school children are bullied at some time during their education.

"Although adults often dismiss it as a case of 'kids being kids,' bullying is a serious public health problem that can have long-term effects on a victim's psychological well being," said Dr. Ronald Davis, an AMA trustee and a preventive medicine and public health physician in Detroit.

The report by the AMA's Council on Scientific Affairs calls on physicians to join parents and school officials in working to identify students who are bullies or who are being bullied. It recommends that physicians be vigilant for signs of bullying in young patients and counsel affected patients and their families.

The report defines bullying as "a negative behavior that involves a pattern of repeated aggression; deliberate intent to harm or disturb a victim despite apparent victim distress; and a real or perceived imbalance of power ... with the more powerful child or group attacking a physically or psychologically vulnerable victim." There are three forms of attack: physical attacks involving bodily harm or damage to property, verbal attacks seeking to damage self-esteem through name-calling, insults and teasing, and relational attacks that persuade others to reject or exclude the victim.

About 7 percent to 15 percent of school children are considered bullies, and they share common personality traits. Most have been the victims of physical abuse or bullying themselves, usually at home. They are aggressive, controlling and dominating with an over-inflated self-image, and often have difficulty empathizing with others. Both boys and girls can be bullies.

Victims, on the other hand, are introverted, passive and easily intimidated. Sometimes classmates perceive them as "different" in some way, such as race, ethnicity, sexual orientation, exceptional academic ability or even haircut or clothing style.

"In two-thirds of the school shootings of the past few years, the shooters were carrying out revenge on bullies," Davis said. "As a result of these tragedies, researchers are turning their attention to bullying, and we are beginning to understand its consequences."

Victims may exhibit psychosomatic symptoms such as sleep disturbance, bedwetting, abdominal pain and headaches, in addition to cuts, bruises and other injuries that could be inflicted by physical confrontations. Adolescent victims may also resort to alcohol or drug abuse, and some may be driven to suicide, according to the report.

Sue Clendening, principal of Graham Elementary School in the Chicago suburb of Naperville, has her own prescription for dealing with bullying. She goes straight to the source the students. For the past three years, students in third, fourth and fifth grade have taken a survey asking them to name three classmates who they think most need a friend.

The school compiles a highly confidential list of the children named most often on the survey, and teachers take subtle steps to help them succeed in the social arena. Clendening said this "buddy list" works well because it helps teachers catch potential victims they might not have noticed otherwise, and also because having a friend is one of the best protections against bullying.

"The kids know first if a child is bullied or seems to need friends," she said. "Kids are very honest. They may name a really shy, quiet child in the back of class that the teacher never may have even thought of. So we take the names the kids gave us and then the teachers get together. We think, 'How can we throw some really positive things in this child's way?'"

Teachers at Graham Elementary are doing more group projects and activities where they try to pair socially isolated children with potential friends. "We arrange that as much as we can without being pushy," Clendening said. "We try to put social success in the way of these kids."

Even though bullying is found in playgrounds all over the United States, many school administrators don't know that there is a problem at their school.

"Bullying is underreported for several reasons," Davis said. "Some children don't want to tell an authority figure because they are afraid the bully will retaliate with greater force. Others are discouraged by adults' dismissive reactions."

Clendening said research indicates that teachers see about 50 percent of bullying incidents, but only 36 percent of those incidents that are seen are addressed. "The most important thing a teacher can do is address it say 'we don't do that here' or give the bully a dirty look. By not addressing it, you are condoning it," she said.

At home, parents should watch for the warning signs and take appropriate action, the AMA report says. Signs your child may be bullied include avoidance of certain people or situations, sudden changes in behavior or academic performance, signs of injuries, damaged self-image and threats of suicide.

If you think your child is the victim of a bully:

It is essential that you believe him or her about being bullied, the AMA says. When discussing the situation, ask questions, listen and respond with caring and reassurance.

Talk to your child's teacher and school principal and ask them to investigate. According to the American Academy of Child and Adolescent Psychiatry (AACAP), confrontations with bullies usually occur in unsupervised or undersupervised areas such as hallways, bathrooms, locker rooms, school buses and playgrounds. Increased supervision may alleviate the problem.

Teach your child how to be assertive and seek help from an adult immediately when confronted by a bully. Role playing or rehearsing responses to teasing can help some children feel more confident. However, don't encourage your child to fight back. Tell him or her to simply walk away, the AMA report says.

Encourage your child to join sports teams, music groups or extracurricular clubs according to his or her interests. Involvement in these activities cultivates self-confidence by sharpening social skills and allowing children to develop new abilities, the AMA report says.

Make sure your child has a friend. Graham Elementary's "buddy list" is based on observations that children with friends are less likely to be bullied.

If you think your child is a bully:

Talk to your child's teacher, school administrator or school counselor if they are not aware of the behavior. They can monitor your child at school and alert you about any discipline problems.

Seek the help of a mental health professional if your child's aggressive behavior continues. A pediatrician or family physician can provide a referral to a counselor, child psychiatrist or someone to help you learn strategies for dealing with her behavior. If you can't afford a psychiatrist, your child's school can set you up with a social worker.

"Parents and teachers are the first line of defense for identifying and preventing bullying, and physicians are here to help them do that," Davis said. "The earlier we can identify a child who is a bully or who is being bullied, the better chance there is of stopping the behavior."

For more information, visit www.ama-assn.org.