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
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Background
 Student
Perspective
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> 50,000 students, parents, educators
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Student Letters
Bullying Workshops
Bullying Workshops
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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
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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
Bullying Workshops
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Memorial Middle School Willingboro , NJ
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Memorial Middle School Willingboro , NJ
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Fountain Woods Elementary School Burlington,
NJ
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North Plainfield School District Plainfield , NJ
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Brick Public School District Brick, NJ
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William Annin Middle School Basking Ridge, NJ
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Brookside Upper Elem. School Westwood , NJ
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Carl Sandburg Middle School Matawan, NJ
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Florham Parks District Florham Parks , NJ
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Raymond Kershaw School Mount Ephraim, NJ
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Washington Township High School Sewell, NJ
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Waterford Township Elementary Waterford, NJ
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Teaneck School District Teaneck , NJ
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Spruce Street School Lakewood, NJ
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Bernards Twp Health Dept. Basking Ridge, NJ
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Holly Hills Elementary Westampton, NJ
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Girl Scout Council Bergen County, NJ
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Brimm Medical Arts High School Camden, NJ
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Walnut St. Elementary Woodbury, NJ
Gloucester Cty Minority Recruitment Office
Sewell, NJ
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Midstreams Elementary School Brick, NJ
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Lakewood High School Lakewood, NJ
New Jersey School Counselors Association
Cherry Hill , NJ
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Boone Middle School Haines City, FL
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New Jersey State Interscholastic Athletic
Association Robbinsville , NJ
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New Jersey Principals and School Administrators
Conference Monroe Township, NJ Phi Delta
Kappa Organization
Objectives
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Part I
 Epidemiology
 Defining
bullying
 Why is it important to discuss?
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Part II
 The
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Youth Perspective
Part III
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How do we help our patients?
Do You
Remember a
Bully?
Bullying
Test Your
Bully IQ
Question 1
What percent of middle/high school
students have experienced bullying?¹
a) 10%
b) 25%
c) 33%
Answer: Question 1
33%
1. US Department of Education
Question 2
What percent of school-age
bullies end up with criminal
records?
a) 15%
b) 20%
c) 25%
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.
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
Answer: Question 3
160,000
National Education Association, 2003
Part I
Epidemiology
•Defining Bullying
•Why is Bullying Important to Discuss?
•
Bullying
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“Boys will be boys…?”
Bullying = Rite of Passage?
Bullying has negative consequences for all involved
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.
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
1. US Department of Education
2. American Medical Association
Defining Bullying
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DSM IV- Criteria for Conduct Disorder
Repetitive and persistent pattern of behavior in which
either the basic rights of others or major ageappropriate societal norms or rules are violated
 Aggression
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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
Defining Bullying
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Physical: Kicking, hitting, punching (boys)
Emotional: exclusion, gossiping, silent
treatment, slandering reputation, selfesteem attacks, “if you’re my friend, you
can’t be her friend.” (girls)
Cyberbullying: Facebook, email,
MySpace, Cell phones: 3rd graders, 5000
text messages
Who are the Players?
 Bullies
 Victims
 Bully-Victims
 Bystanders
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.
Why Is Bullying Important?
1) Emotional Impact
 Talk
shows
 Effect on adults
 Effect on children, #1
Why Is Bullying Important?
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
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
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.
Why Is Bullying Important?
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
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1. Klomek, et. al. Bullying, Depression and Suicidality in Adolescents. J.Am. Adol. Child Adolescent Psychiatry. 46:1, Jan 2007
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.
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.
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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
Why Is Bullying Important?
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.
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
Why Is Bullying Important?
4) Health
 Victims
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Psychosomatic complaints, experience social distress,
marginalization and low self esteem.
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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.
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Substance Abuse
1. Minne Fekkes, MSc., et al. Bullying behavior and associations with psychosomatic complains and depression in
victims. Pediatrics 2004;144
Why Is Bullying Important
4) Health, cont’d
 Bullies
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Increased anger, poor interpersonal relationships and
poor quality of life.¹ Reports of depression.
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A 2002 study published in JAMA examined bullying
among 6th-10th graders and found that bullies were
more likely to drink and smoke.
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.
Why Is Bullying Important?
4) Health cont’d
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Bully-Victims
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High Risk
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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.
1. Juvonen, et. al. Bullying Among Young Adolescents: The Strong, the Weak and the Troubled. Pediatrics. 2003; 112; 1231-1237.
Why Is Bullying Important?
4) Health, cont’d
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A study of 2,540 boys in Finland followed bullies, victims and
bully-victims from 8 years old until 18-23 years old.
Bullies
Antisocial
Personality
X
Anxiety
X
Substance
Abuse
X
Depression
X
Victims
Bully-Victims
X
X
X
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.
Why is Bullying Important?
Bullies, victims and bully-victims experience
long-term consequences.
Clear-Cut?
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Studies; Self-reporting
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Crossover between categories: bully, victim,
bully-victim
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Crossover: Characteristics
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Study of 1,985 predominantly Latino and Black 6th graders
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Bullies had fewest number of adjustment problems
Bullies had high social status among classmates
1. Juvonen, et. Al. Bullying Among Young Adolescents: The Strong, the Weak and the Troubled. Pediatrics. 2003; 112; 1231-1237.
Part II
The Youth Perspective
The Youth Perspective
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“Bullying: Stories from Our Young People”
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#2-7
“The In-Crowd and Social Cruelty”
(shown with permission from Films for the Humanities and
Sciences)
Part III
How Do We Help Our Patients?
How to Help Our Patients
According to a 2004 American Family Physician
article, “there is no one accepted
psychological profile or assessment method to
predict bullying behavior.¹”
1. Lyznicki, et al. Childhood Bullying: Implications for Physicians. American Family Physician. November 1, 2004. Volume 70, Number 9.
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
How to Help our Patients
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

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
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.
How to Help Our Patients
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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?
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Glew G, Rivara F, Feudners C. Bullying: Children Hurting Children. Pedriatr Rev 2000; 21:186
How to Help Our Patients
 Questions
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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?
How to Help Our Patients
3) Understand Barriers:
 Ask
questions
 Listen
 “Fear Factor”
 Give children “permission” to report. Let them know
this is expected
How to Help Our Patients
4) Talk with Parents about bullying
 Educate
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parents
“Sticks and Stones”
#8
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
How to Help Our Patients
5) Refer appropriately:
 Mental

Health Services:
Psychiatry, Counseling, Family Therapy
 Social
Work
 School Interventions
How to be Advocates
6) Involve the School
 Bullying
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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
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Programs
Dan Olweus
Lack of standard evaluation practices
How to be Advocates
7) Be an advocate
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http://stopbullyingnow.hrsa.gov
 www.aap.org/connectedkids
 www.safeyouth.org
 Public
Awareness Campaigns
 Hope, #9
Thank you
jcaudle@lifebridgehealth.org
www.jennifercaudle.com