Bullying is a pervasive public health concern among youth in the United States. In 2015, approximately 1 in 5 students ages 12-18 reported being bullied at school during the school year, translating to millions of youth being impacted across the country.

Because bullying is a form of aggressive behavior, it can be traumatizing and negatively affect children’s development, social functioning, educational performance, and mental and physical health. Kids who bully others often get into trouble – including physical fights – at school.  Kids who get bullied may themselves begin to bully others.

How Common Is Bullying

●    About 20% of students ages 12-18 experienced bullying nationwide.

●    Students ages 12–18 who reported being bullied said they thought those who bullied them:

○    Had the ability to influence other students’ perception of them (56%).

○    Had more social influence (50%).

○    Were physically stronger or larger (40%)

○    Had more money (31%)

Bullying in Schools

Nationwide, 19% of students in grades 9–12 report being bullied on school property in the 12 months prior to the survey.

●    The following percentages of students ages 12-18 had experienced bullying in various places at school:

○    Hallway or stairwell (43.4%)

○    Classroom (42.1%)

○    Cafeteria (26.8%)

○    Outside on school grounds (21.9%)

○    Online or text (15.3%)

○    Bathroom or locker room (12.1%)

○    Somewhere else in the school building (2.1%)

●    Approximately 46% of students ages 12-18 who were bullied during the school year notified an adult at school about the bullying.

Cyberbullying

●    Among students ages 12-18 who reported being bullied at school during the school year, 15 % were bullied online or by text.

Types of Bullying

●    Students ages 12-18 experienced various types of bullying, including:

○    Being the subject of rumors or lies (13.4%)

○    Being made fun of, called names, or insulted (13.0%)

○    Pushed, shoved, tripped, or spit on (5.3%)

○    Leaving out/exclusion (5.2%)

○    Threatened with harm (3.9%)

○    Others tried to make them do things they did not want to do (1.9%)

○    Property was destroyed on purpose (1.4%)

OUTCOMES OF BULLYING

Kids Who are Bullied

Kids who are bullied can experience negative physical, social, emotional, academic, and mental health issues. Kids who are bullied are more likely to experience:

●    Depression and anxiety, increased feelings of sadness and loneliness, changes in sleep and eating patterns, and loss of interest in activities they used to enjoy. These issues may persist into adulthood.

●    Health complaints—aches and pains, headaches, stomach aches, anxiety and fear

●    Decreased academic achievement—GPA and standardized test scores—and school participation. They are more likely to miss, skip, or drop out of school.

A very small number of bullied children might retaliate through extremely violent measures. In 12 of 15 school shooting cases in the 1990s, the shooters had a history of being bullied.

Kids Who Bully Others

Kids who bully others can also engage in violent and other risky behaviors into adulthood. Kids who bully are more likely to:

●    Abuse alcohol and other drugs in adolescence and as adults

●    Get into fights, vandalize property, and drop out of school

●    Engage in early sexual activity

●    Have criminal convictions and traffic citations as adults

●    Be abusive toward their romantic partners, spouses, or children as adults

Bystanders

Kids who witness bullying are more likely to:

●    Have increased use of tobacco, alcohol, or other drugs

●    Have increased mental health problems, including depression and anxiety

●    Miss or skip school

WHAT CAN WE DO?

Parents and healthcare providers can help prevent “back to school means back to bullying” for children and teens.

Healthcare providers can be important allies in determining if a child is being bullied or why bullying behavior may have surfaced. Adding the question as part of a routine examination is an appropriate strategy to use. Healthcare providers – including pediatricians, nurses, and physician assistants – can also alert parents to signs that bullying may be continuing, that their child might be depressed, and if it is affecting health or other aspects of life. They can offer supportive referrals to address health and mental health concerns.

Parents are often the first to notice some of the subtle shifts that take place with children or adolescents who are affected by bullying. Their child may talk less. They may isolate themselves from friends. They may have trouble sleeping or struggle academically. They may not want to go to school, to avoid further torment by the child who is doing the bullying. Noticing behavior changes can open avenues for conversation – an important first step to intervene.

Steps parents can take include:

• Ask your child what he or she thinks should be done. What’s already been tried? What worked and what didn’t?
• Seek help from your child’s teacher or the school guidance counselor. Most bullying occurs on playgrounds, in lunchrooms, and bathrooms, on school buses or in unsupervised halls. Ask the school administrators to find out about programs other schools and communities have used to help combat bullying, such as peer mediation, conflict resolution, and anger management training, and increased adult supervision.
• Don’t encourage your child to fight back. Instead, suggest that he or she try walking away to avoid the bully, or that they seek help from a teacher, coach, or other adult.
• Help your child practice what to say to the bully so he or she will be prepared the next time.
• Help your child practice being assertive. The simple act of insisting that the bully leave him alone may have a surprising effect. Explain to your child that the bully’s true goal is to get a response.
• Encourage your child to be with friends when traveling back and forth from school, during shopping trips, or on other outings. Bullies are less likely to pick on a child in a group.

Resources:

American Academy of Adolescent and Child Psychiatry Bullying Resource Center https://www.aacap.org/AACAP/Families_and_Youth/Resource_Centers/Bullying_Resource_Center/Home.aspx

https://www.stopbullying.gov/resources/get-help-now

https://www.schoolsafety.gov/bullying-and-cyberbullying

https://www.pacer.org/bullying/info/sites-for-kids-and-teens.asp

CA Department of Education https://www.cde.ca.gov/ls/ss/se/bullyres.asp

https://www.cde.ca.gov/re/di/eo/complaint.asp

San Diego County Schools-How to Report Bullying

Alpine Union School District

Bonsall Unified School District

Borrego Springs Unified School District

Coronado Unified School District

Del Mar Union

Encinitas Union School District

Escondido Union School District

Grossmont Union High School-contact school counselor directly

Julian Union School District

Lakeside Union School District

La Mesa-Spring Valley Schools

Mountain Empire Unified Schools

Oceanside Unified School District

Poway Unified School District

Ramona Unified School District

Rancho Sante Fe

San Diego County Office of Education

San Diego Unified School District

San Dieguito Union School District

San Marcos Unified School District

San Pasqual Union School District

Santee School District

San Ysidro School District

Solana Beach School District

South Bay Union School District

Sweetwater Union High School District

Valley Center Unified School District

Vista Unified School District

Particularly for those more significantly affected, the issue of agitated and aggressive outbursts is often a major concern, though even in those with less significant symptom profiles, affectively charged outbursts may occur. Helping families and caregivers better understand both the causes of these incidents and the course of such outbursts can aid in reducing and preventing aggressive behaviors and may lead to helpful intervention strategies when they do occur.

Most aggressive and agitated episodes in the ASD population are best conceptualized as “meltdowns” which are a typically a reaction to either an overwhelming intense sensory experience or an unanticipated external frustration.   While sometimes compared to and described as “tantrums”, these meltdown outbursts are typically not goal-directed as most tantrums are in non-affected individuals.

For those with ASD, it is always important to consider what may be causing a meltdown—- parents and caregivers can and should be tasked with being “detectives” in figuring out possible causal factors. This can be a very powerful tool in addressing and reducing meltdowns over the long term.

Things to consider include:

• Is this a medical problem—is the individual in pain or other distress?
• Does the individual not have ability to communicate their wants or needs?
• Are cognitive or social demands too high or too low?
• Sensory dysregulation: Is there too much or too little stimulus?
• Has there been reinforcement of the behavior in the past?
• Is there a co-occurring mental health condition that might explain the problem(s)?
• Are there family/school dynamics such as bullying, moving to a new home/school, caregiver burnout?

Once (and if) a causal factor(s) for the meltdowns has been identified, it will often be feasible for parents and caretakers to intervene, either to address or to minimize their frequency and/or intensity.

An understanding of the concept of the “Rage Cycle” can also be a helpful framework for parents and caretakers in managing meltdown outbursts more effectively. The following graphic of the cycle of rage is very useful for understanding when and how a caretaker can intervene. Although referenced here in the context of individuals with ASD, the concepts can also be applied to other individuals with similar issues of reactivity, impulse control and affect management.

Most importantly, it is important to know that once the cycle of a meltdown has begun, ,,,this is NOT the time to attempt teaching what to do or introducing a new task or skill.

Early recognition of the precursors to a meltdown –when a person begins to “rumble”– can sometimes be helpful and if seen, early intervention may arrest the cycle from becoming a full meltdown. For example, rumbling may present with heightened physical activity such as jumping or pacing about, yelling, fidgeting, rapid movements or making noises. If the individual’s level of agitation is not too advanced, parents and caregivers can utilize simple strategies that may be used during the “rumbling phase” such as:

• Acknowledge the difficulty and coach simply and calmly
• Attempt gentle redirection or refocussing
• Intervene without challenging or raising the temperature
• Keep verbal input simple:   Just “walk”, don’t “talk”
• Move the individual away from the ‘offending’ environment, if feasible.
• Use proximity control– stay with the person, be present and calm
• Refer to a schedule and highlight positive future activities, if available
• Go to a predetermined “home base” or “calming place”

If the meltdown reaches the rage stage, aggressive behaviors are more likely occur and appropriate caution is important. In this phase, the profile may include disinhibition, impulsivity, emotional lability, explosive behavior, property destruction, self-injurious behavior, yelling, biting, hitting or crying. During this time, it is of utmost importance to keep the individual and those around them safe. Interventions during a meltdown may include:

• Protect the individual and others
• Disengage emotionally, this is not about you—getting agitated or loud won’t help.
• Use few words, remain calm and quiet.
• Be flexible—extra tolerance and a bit of slack may help defuse the rage state.
• Have a plan and follow it— e.g., siblings go to their rooms, only certain people will interact with individual, have pre-identified the safe places to go, etc.
• Attempt to move the individual to a “safe place” or “home base”
• Obtain assistance if needed.
• Do not discipline– this is not the “teachable phase” and retribution does no good.

Once the meltdown has begun to pass, the individual with ASD (or any other predisposing condition) will enter a “recovery” phase.   Keep in mind that they have just gone through an intense sensory and emotional overwhelm— often we will see someone needing to sleep, cry, withdraw or appear exhausted. During this time, allowing the person time to sleep, rest or engage in a preferred activity may be needed.

Again, this is not the time to teach a new skill or place demands on the person as they are in cool down mode, not learning mode.

Helping families and caregivers understand meltdowns and the rage cycle is rarely simple, but sustained efforts can provide effective, long term tools for addressing agitation and aggressive outbursts. Consultation with mental health providers and behavioral experts can be an important asset and should be part of the clinical team helping the ASD individual.

Some services provided by the San Diego Regional Center for families struggling with aggression include:

1. Consultation with a behavioral psychologist
2. Safety Alert, Inc. ( https://www.safetyalert.net/ )
3. START program  https://www.exodusrecovery.com/vista-start/.
4.  Fred Finch Specialized Wraparound https://www.fredfinch.org/specialized-wraparound
5. Advance CIRT (Crisis Intervention Response Team) Advance North (760) 294-1188 Advance San Diego (619) 756-4095

   All programs require a referral from the SDRC. Families may request these services through their Regional Center service coordinator.

   Reference:

Myles, B.S., and Southwick, J. (1999) Asperger Syndrome and Difficult Moments: Practical Solutions for Tantrums, Rage, and Meltdowns. Shawnee Mission, KS: Autism Asperger Publishing Company.

https://www.cdc.gov/ncbddd/autism/data.html