“Kids seldom come into your office and say, ‘I want to talk about bullying,’” explains REACH faculty member Ron Marino, DO/MPH. “Often, as clinicians, the only indication we have that a child is being bullied are changes in their behavior or new mental health symptoms. It’s our job to notice these changes and take appropriate action.”
The latest data show that 20% of U.S. children aged 12-18 experience bullying in a given year. As many as 58% of middle and high school students have experienced cyberbullying at some point in their lives. In addition to the trauma of bullying, children who have been or are being bullied are more likely to experience mental health disorders like anxiety and depression.
We asked Dr. Marino to share the basics of what primary care providers (PCPs) should know about spotting signs of bullying, best practices for responding, and the PCPs’ unique role in supporting patients who experience bullying.
Signs of Bullying: What to Watch For
As of this writing, there are currently no evidence-based tools to screen for bullying. Instead, Dr. Marino advises clinicians to be alert for changes in behavior. “The first signs of bullying may appear as symptoms of mental health disorders, such as a child being sullen, withdrawn, anxious, depressed, angry, or even aggressive.”
When noticing such changes, alongside using mental health screening tools, clinicians can ask open-ended questions about in-school, social, and online dynamics. Covering this full scope is important, as bullying today can take many different forms, including cyberbullying, social isolation, and what many consider “schoolyard bullying” that involves physical aggression and/or verbal abuse at school.
For example, a clinician might ask: “How are things going at school? Can you tell me about things you may not like at school? Can you tell me about your friends?” Clinicians can also add direct questions, such as: “Is bullying a problem for anyone at your school?”
To get at cyberbullying, clinicians can ask about patients’ use of social media, the types of websites they are visiting, and the types of interactions they are having online. For example, are people online being polite or are they being mean and rude?
When You Suspect Bullying: Actions to Take
If a child or adolescent shares that they are being bullied, clinicians should first and foremost reassure them that being bullied is not their fault. Dr. Marino tells patients: “You are entitled to be who you are, and be supported for who you are.”
Then, Dr. Marino advises several next steps:
Understand what has happened so far: Clinicians should find out what actions have been taken to resolve the bullying. Are parents aware? Has the school been notified or involved?
Connect with the child’s school: Most schools have bullying prevention programs, shares Dr. Marino, but “if the school doesn’t know about the bullying, they cannot address it.” Many states also have targeted laws regarding bullying that spell out a school’s role.
Thus, one of the most important actions a clinician can take is to ensure the child’s school is aware of the bullying. This may include reaching out to school administrators directly and, when appropriate, collaborating with the school to ensure the bullying has ceased and the child is receiving appropriate support for any additional mental health needs. REACH’s new course on Collaborating with Schools in Pediatric Primary Care provides further guidance and tools for working effectively with schools.
Document cyberbullying: With cyberbullying, documentation can be especially important. Comments and posts online can be deleted by those doing the bullying, but screenshots taken by clinicians can provide evidence for school administrators or, in extreme cases, law enforcement.
Screen for mental health issues: Bullying can trigger or exacerbate mental health disorders, compounding harm to children and adolescents. Clinicians should always screen for depression, anxiety, suicidality, and other mental health issues in patients who are experiencing bullying. Some young people may also develop school avoidance or school phobia. In the most extreme cases, a child may feel most comfortable changing schools.
The Clinician’s Ongoing Role
“A child who has been bullied needs a lot of empathy,” explains Dr. Marino. “They need family, friends, and even their doctor telling them, ‘I know this can be embarrassing, even humiliating. Know that you are a good person and worthy of respect and support.’”
In addition to treating identified mental health conditions, clinicians can help children build resilience through behavioral changes, such as getting enough sleep, eating healthy food, changing social media use, and building positive social supports. Clinicians can also encourage parents to model good coping mechanisms and problem-solving skills.
RESOURCES
- A wealth of useful resources for clinicians and parents can be found at the National Bullying Prevention Center and stopbullying.gov.
- Clinicians can learn about state laws related to bullying at https://www.stopbullying.gov/resources/laws.
- The National Child Traumatic Stress Network has also developed resources for understanding and managing bullying as a type of trauma.
