Episode Description:
Bullying is more than “I know it when I see it” behavior. According to stopbullying.gov, bullying is distinguished by certain specific elements: it is repetitive, aggressive, threatening behavior that involves a real or perceived power imbalance. From name-calling and teasing to hitting and spitting and beyond, the negative effects of bullying on our youth are well-documented.
Guest:
Daniel J. Flannery, PhD, Director, Begun Center for Violence Prevention, Case Western Reserve University
Host/producer: Carol Vassar
TRANSCRIPT
Announcer:
Welcome to Well Beyond Medicine, the world’s top-ranked children’s health podcast produced by Nemours Children’s Health. Subscribe on any platform at nemourswellbeyond.org or find us on YouTube.
Carol Vassar, podcast host/producer:
Each week we’re joined by innovators and experts from around the world, exploring anything and everything related to the 80% of child health impacts that occur outside the doctor’s office. I’m your host, Carol Vassar. And now that you are here, let’s go.
Dr. Daniel Flannery, Case Western Reserve University:
Bullying is not just a normal rite of passage that you should just blow off as being no big deal because we know it has these consequences short and long-term.
Carol Vassar, podcast host/producer:
That’s Dr. Daniel Flannery, Director of the Begun Center for Violence Prevention at Case Western Reserve University in Cleveland, pointing to the fact that bullying is today considered more than just a rite of passage as it had been for so many previous generations. It’s a serious and harmful issue for our kids today. So, what is bullying? More than just I know it when I see it behavior, StopBullying.gov says, “Bullying is distinguished by certain specific elements. It is repetitive, aggressive, threatening behavior that involves a real or perceived power imbalance. For kids, it can occur in and out of school and online. Bullying is verbal, teasing, name-calling, taunting, it’s social, purposely leaving someone out of a game or task, for example, spreading rumors about someone, embarrassing another in public, and it’s physical, spitting, hitting, tripping, pushing, even breaking or stealing another’s possessions.” Whatever form it takes, bullying is not something to be ignored by adults.
The consequences for kids who are bullied include the possibility of depression and anxiety, increased feelings of sadness and loneliness, changes in sleeping and eating patterns, and decreased academic performance. For those who perpetrate bullying, they’re more likely to engage in violent and other risky behaviors into adulthood. Dr. Flannery joined us at the Nemours Podcast booth at the 2024 American Academy of Pediatrics Experience National Conference in Orlando to talk about his research into bullying and how pediatricians, parents, and school officials can address it, both with children being bullied and with the perpetrators. We began our conversation by talking about the prevalence of bullying today, both in person and online. Here is Daniel Flannery.
Dr. Daniel Flannery, Case Western Reserve University:
So you started off with that, making a very important clarification, which is what we mostly know about bullying historically has been the face-to-face kind of bullying that occurs between kids, typically in a school setting. And when COVID hit and the influx of sort of social media and internet, we’ve seen a dramatic increase in cyberbullying or what the CDC sometimes calls electronic aggression. So, rates of in-person bullying remain pretty consistent. 30, 40% of kids report experiencing bullying pretty regularly and higher percentages, sometimes more sort of individual instances, but that’s a little bit of a misnomer too, because by definition, bullying is something that occurs repeatedly over time, and that’s the conundrum with online sort of social media where you could post something once, not even know who it is, not even know who the targeted victim is. And that instance of one time can go viral, and then that’s repeated.
So it’s part of a National Academy of Sciences panel study on bullying a few years ago, and this was actually a large part of our initial conversation, which is what does bullying consist of? And sometimes, people talk about peer victimization, for example, where you can be the victim of violence on a one-time incident, and that’s not the same thing as bullying. And there was at that time really no consideration of how to incorporate the idea of cyberbullying because of the definition of repeated and power imbalance and knowing the perpetrator, for example. I guess the other thing I would say is that we know a lot more about victims of bullying, and it’s only been in the last five or six years that we’ve really started to ask about who’s perpetrating the bullying. We just didn’t ask. Who’s going to admit to bullying somebody else or a caregiver isn’t going to say, “Yeah, my child’s a bully.” So we now know a bit more about the perpetrators and actually about people that are bullies and victims. So, victims are an increased likelihood of becoming bullies over time if we don’t intervene.
Carol Vassar, podcast host/producer:
We’re going to talk a little bit about who does the bullying, the perpetrators in a few minutes, but I want to ask, how does bullying affect the health and the well-being of children who are perhaps the victims, and I’m not sure I like the word victims, but those who receive the bullying, they’re on the receiving end of that short-term and long term.
Dr. Daniel Flannery, Case Western Reserve University:
Right. Well, this is the emerging evidence, right? Now, over time, we’ve actually had the opportunity to gather information over time, longitudinally. And there are some very clear, both mental health and behavioral health as well as physical health consequences short and long-term for young persons, it may manifest emotionally in things like anxiety or depression, school avoidance, somatic complaints that you need to be paying attention to. But we also know that now that we’ve followed kids into young adulthood, that there are actual consequences over the long term that can be quite serious. And, of course, in the extreme, there are instances where kids who have been the recipients of bullying commit self-harm or complete the act of suicide. So you need to take this seriously as one message when we come here and speak to pediatricians. Number one, bullying is not just a normal rite of passage that you should just blow off as being no big deal because we know it has these consequences short and long-term.
I think we want to recognize that while historically this has just been labeled as a part of normal growing up, it may be a thing that occurs regularly, but there’s not a lot that’s normal about it, and it’s something that we need to pay attention to, don’t necessarily need to overreact to every time someone says, like your daughter, when you say clean your room, and she says, “Quit bullying me,” not every instance needs to turn into a long screening and assessment and everything else, but this dynamic has changed pretty significantly even in the last five years with COVID, with the advent of social media. I’m a bit concerned about the sophisticated movement among AI, and we see it in other venues as well, politically and otherwise. How do you tell the difference between what’s real and what’s fake? And most young people can’t. So we are in a position where they can be both influenced and take advantage of that technology to do harm to others, and that’s going to be the next challenge.
We’ve moved beyond the bricks-and-mortar buildings of person-to-person bullying in its traditional sense. So that has implications in my mind for what we do about it or what we can do about it. It’s not just the 10-week program in a school to say, an anti-bullying program. It’s about climate and culture, kids feeling attached and accepted in their school environment, all of those things. And number two, here are the kinds of things you should look for in terms of identifying when there might be a problem. So those are two of the core things that we try to do.
Carol Vassar, podcast host/producer:
What should parents look for or pediatricians?
Dr. Daniel Flannery, Case Western Reserve University:
Parents and pediatricians. Right. So, number one, I mean, first of all, you don’t just ask a child, “Are you being bullied,” because they don’t really necessarily know what that is. My daughter, when she was younger, you would ask her to clean her room, and she would say, “Quit bullying me,” well, that’s just not the same thing. So there are other kinds of questions you might ask. Do you have friends at school? Do you sit with someone else at lunchtime? If you’re not going to school, tell me a little bit about why that is. So maybe a child’s getting picked on or harassed in some way. But again, what’s shifted is it’s not the traditional between two persons, the big bully beating up a smaller child and that power imbalance. So, you have to be a little more nuanced in terms of how you’re asking the question and trying to get to whether or not this is really what’s happening to a child in multiple settings, whether that’s on the bus or in the neighborhood walking to school or in the gymnasium or in the classroom.
So, the challenge that in terms of what we know is that we never ask the same question when we survey kids or caregivers or teachers or pediatricians. So, if you tried to use the very long formal definition that the Centers for Disease Control puts out, no 3rd or 5th or 7th grader’s going to read that and understand what you’re even asking them. But that’s very different from saying, “Were you bullied or are you bullying someone,” and getting that answer. So, when we look at the prevalence rates, that’s just a cautionary tale that you’re mostly still comparing apples and oranges. So, you sort of need to know what the question was and the age group of the children that we’re asking to have a little better understanding of what the data means. So, there’s a pretty broad range when you look at percentages of victimization or perpetration.
Carol Vassar, podcast host/producer:
When you’re talking about pediatricians and maybe the child is there for well care or another reason, what are some of the ways that pediatricians maybe can make that environment safe so they can open up about the possibility that they are being bullied?
Dr. Daniel Flannery, Case Western Reserve University:
Well, I think one very pragmatic thing is to maybe ask those questions without the caregiver present. When you have an opportunity to conduct your physical exam or your well-check and, just ask how they’re doing. How are things going at school? Your mom tells me you’re having stomach aches, or you wake up in the morning and you don’t really want to go to school. Tell me a little bit more about that. That’s certainly an issue around not blaming the child who’s being bullied. That’s not going to work. That’s not going to be very helpful. So, making sure that you’re not doing that as a caregiver or a provider is step number one. Step number two would be to take it seriously if they express some concerns and not to say, “Oh, no big deal.” Number three, there are a lot of things that you don’t want to be doing.
You don’t want to say, “Oh, well, why aren’t you standing up for yourself, and why aren’t you fighting back? And why don’t you take karate or boxing?” That’s not a good solution, either. Or calling the parents of the bully as the pediatrician or the parent. Not helpful. Bringing the two kids together and, say work it out, doesn’t work well either. So again, you want to be open to the possibility to a way that a child might bring those concerns to you and not be dismissive of them. And then B, I think you want to be the child’s best advocate with the caregiver, with the school. There are lots of resources out there, lots of information. There’s actually a really good website that the government keeps up. It’s called stopbullying.gov. It’s in Spanish as well. It’s a tremendous resource that’s kept well up to date when you have concerns about whether that’s a screening tool for assessing whether or not there’s a concern or what’s the literature on evidence-based programs that are being implemented to address bullying.
Carol Vassar, podcast host/producer:
I found it interesting that you mentioned in step one that the parents, maybe you’re out of the room when you ask about the bullying question. Why is that important?
Dr. Daniel Flannery, Case Western Reserve University:
I think a lot of kids who are victims of bullying are maybe… ashamed might not be the right word, but they’re certainly not all that interested in revealing that this is something going on, that someone is doing these things to them, or that it’s affecting them in a particularly significant way. So they don’t want to devolve certain things. And again, partly depending on the age of the child in terms of their comfort level to convey this to anybody, a parent or a pediatrician or a teacher. But that’s part of the larger strategy around making sure that a child feels attached to their school and to their teachers or coaches so that if something is going on, they do feel comfortable enough to say something.
Carol Vassar, podcast host/producer:
And at that point, I would presume that the pediatrician would have maybe a talk with the parents about what’s going on. Yes? No?
Dr. Daniel Flannery, Case Western Reserve University:
I think that’s the first step, right? A pediatrician calling the school on their own without working with or informing the parents again doesn’t work very well. So, you’d want to convey to the caregiver that with the child’s permission, can I share some of the things with your mom or dad and say, these are some things that are being conveyed to me? I think they’re of concern. I want you to be aware. And if these things continue or if these particular behavioral issues, emotional issues, physical issues get worse, please contact me. And even in the context of that, I would encourage pediatricians to schedule a follow-up visit if they don’t really have the time to get into it very much in the initial visit. But there’s some concern: follow up with the child and the caregiver a month or two later, “Hey, how’s it going? Were you able to take any steps?”
Mom and Dad, did you talk to the school? What did they say? Every school district now has some policy in place around bullying, some more comprehensive and thoughtful than others. Some states have legislatures that have become involved here, wanting to “criminalize” acts of bullying, which is a separate conversation as to whether that really helps in certainly extreme circumstances. There are issues there when bullying has been identified, brought to the school’s attention, and continues to occur, and then some tragic outcome happens. But schools are in a tough spot here with cyberbullying, much of which occurs outside of the school setting at home on someone’s phone. And the school will say, “I have no jurisdiction here until something happens within my building or on my computers,” or what have you. So, this is a tough position for schools right now to try to figure out where this is going to go.
Carol Vassar, podcast host/producer:
I want to turn to the perpetrators, the kids that are doing the bullying. What role do pediatricians play in kind of assessing the reasons they may be bullying and addressing it with the child and the family?
Dr. Daniel Flannery, Case Western Reserve University:
Well, yes, that’s a good point. We know less about the perpetrators and their motivations. And the National Academies Committee really pivoted into what we know about aggressive kids generally, right? And the interventions for aggressive kids, because they’re not really interventions that are just for children who perpetrate bullying. And so the typical things that you look for when a child is acting out in an aggressive way, when it’s inappropriate behavior at a very young age, when any teacher of 1st and 2nd-grade kids who says to me, “This child really stands out and this is why, and these are the behaviors that they’re engaging in, that are of concern to me when they’re aggressive,” sort of inappropriate social interactions and impulsive anger, kinds of acting out kinds of things, that stands out to me when a teacher has 25 or 30 children in a classroom for 10 or 15 years.
So it comes under that umbrella of inappropriate social interactions, poor problem solving and coping skills, and sort of a generally aggressive young person who other kids would identify as, “This is not the person I want to be hanging out with because they’re mean to everybody,” kind of thing. Those are the red flags that cause some concern where you really want to pay attention.
Carol Vassar, podcast host/producer:
Can pediatricians play a role in helping families with some of the underlying issues that may lead a child to be a perpetrator of bullying? For example, stress, trauma, lack of food, lack of transportation, peer pressure.
Dr. Daniel Flannery, Case Western Reserve University:
Sure. There’s even some emerging evidence that says some kids are engaging in bullying because it’s a way for them to maintain a certain stature and level of popularity among a certain group of their peers. So if you’re a behaviorist, as a pediatrician, you’re going to want to know what’s driving the behavior. Kids don’t necessarily wake up one day and become perpetrators of bullying. They have a lot of role models in their lives sometimes. And that gets into another sensitive area that when we have parents who operate on sort of the coercive parent-child interaction styles, and they’re very permissive, but themselves may be aggressive in their parenting and inconsistent, this is what the child picks up in terms of how do I interact with others and how do I problem solve conflict situations. So yes, I think pediatricians can be helpful, and again, sort of unpeeling some of the layers of this and bringing those things to the attention of the caregiver or a teacher or a vice principal and playing the role to as much as they’re able as another advocate for the child.
Carol Vassar, podcast host/producer:
It sounds like that relationship between the pediatrician, the family, the child, and the school is really important. They all kind of need to sing from the same hymn sheet, if you will.
Dr. Daniel Flannery, Case Western Reserve University:
Yeah, it’s like a lot of things, right? There’s no single solution to addressing this as an issue. There’s no medicine that you give to a victim or a perpetrator and say, this is going to make it better or do this one thing, and it’s going to make it better. And pediatricians are time-pressed. So you could say all you want that social skills sort of training when you can role play with a child in your office, when you can ask a number of questions, when you can screen for some of these things and ask the child in a brief five-minute screener some of these questions, you can at least play a role as an identifier and as a gatherer of information, and then provide resources like those that are available on stopbullying.gov. And then when other issues arise, be the connector to those other advocates for the child. But to say that the pediatrician is the sole source of the solution to this issue would be a disservice to pediatricians.
Carol Vassar, podcast host/producer:
What role can pediatricians play when it comes to helping children who have been bullied? How can they regain their self-confidence, their self-esteem?
Dr. Daniel Flannery, Case Western Reserve University:
Well, again, the first primary message is, “This isn’t your fault, and it’s not the things that you’re doing that sort of led to you being picked on or picked out in this space.” So, to be a listener and to say, “This is okay because it’s not your fault.” And I think that’s a message for kids that particularly experience bullying as a victim. That’s one of the first things they need to hear because it’s one of the reasons they don’t divulge what’s going on, either.
There’s some evidence that as many as seven out of 10 kids will say that they were bullying, and they never divulge that to anybody because of those concerns, because they’re embarrassed, because they don’t want people to overreact. Kids don’t want to be picked out, and especially in middle school, for example, they don’t want to be singled out for anything, including being bullied. But we know that the vulnerable kids that have physical ailments though, that are overweight, that are diabetic, or if a child stands out as different in any particular way, their gender identity, I mean, these are the kids that are most at risk for being singled out by their peers to become targets.
Carol Vassar, podcast host/producer:
What can pediatricians do for families, or how can they advise families who maybe have a child who’s been bullied to help them again regain that self-esteem, and that has to come as they progress and age?
Dr. Daniel Flannery, Case Western Reserve University:
Yeah, I think there are some simple strategies outside of go take karate and boxing and fight back. We want to inform caregivers about things that they shouldn’t do that aren’t going to be very helpful as much as the things that they should do. Taking a child’s phone away in a sort of zero-tolerance policy doesn’t seem to work very well either. They find ways around that. Telling parents what not to do in this space is one thing, but also, I think working with parents to say, “Hey, when these things occur, here’s some language you can coach with your child about how to respond and stand up for themselves verbally. Here’s what they can do with gaining support from their peers and bystanders.” That’s sort of a newer area of inquiry, which is how can we engage a peer group that see these things going on, they’re literally maybe standing by, how do we coach them and encourage them to be supporters or strategists and problem solvers?
Hey, let’s go over here. Let’s walk across the street. Let’s bring a buddy into the locker room. When are these things occurring? So, there are some simpler strategies that you want parents to then reinforce at home and to talk through scenarios with their child. Tell me what happens when so-and-so you say they’re harassing you or taking your lunch money. It’s the classic example. That’s number one. Number two, again, be the supporter for your child, right? Don’t minimize their concerns, and don’t dismiss them. And then thirdly, as I mentioned briefly before, understand that in a general sense as a caregiver, you’re a role model for your child. So how you respond and what you say when your child brings this to you and what you say about the parents of so-and-so who your child says is doing this and that, or the vice principal or the teachers, etc., you want to be as a caregiver, an advocate for your child.
Say, “Look, I’m going to call the school and let them know that you brought this to my concern,” but you’re going to need to work with your child, who will often say to you, “Don’t say anything to anybody. If so-and-so finds out that I said anything. Now I’m the snitch. Now I’m going to be targeted even worse.” And this leads us down the path sometimes where parents say, “If this is going on with my child, I’m pulling them out of school. They’re transferring schools, I’m going to home school them.” In the extreme circumstances, that may be a short-term strategy. It’s not the long-term solution when you have a child who’s may be socially awkward to begin with, which is why they’re more vulnerable. You want them to develop coping skills and social skills and problem-solving skills and removing them, isolating them, or just switching to another school may not be the long-term solution. There’s no school in this country that doesn’t have some issue around bullying. It really is about what are they doing to pay attention to it, or when it does occur, what’s their willingness to intervene?
Carol Vassar, podcast host/producer:
Real quick, I want to get into the online bullying a little bit. How much monitoring can and should parents be doing with regard to their child’s social media activity so that they can intervene when the time comes if they are bullied?
Dr. Daniel Flannery, Case Western Reserve University:
Yeah. There are apps out there now that will allow parents to load an on a child’s phone. It says you’re restricted to certain content. There are certainly apps that our children are much more savvy about than we are about what they access and how quickly it’s available to be viewed. When our kids were younger, we made them sign a contract instead of, “We’re paying for your phone that I get access to your phone at any time. I want to know your password, and at any random time I ask for your phone to see what you’ve been doing with it, you need to hand it over.” And again, they don’t like that, but if that’s a condition of them having a $1,000 computer that they’re running around within their pocket, that’s a reasonable strategy. It used to be saying things like, put the computer in the family room, the desktop computer so you can know when your child’s on it.
They take their phones with them 24/7 up into their rooms, so it’s hard to physically monitor their use. You can get information from the cell phone providers and the sites that they visited if you really want to do that. That’s an important conversation about what the guardrails are for your children. And again, you need to not be afraid to ask to know what their passwords are and to say, “You’re not permitted on these particular sites.” The clicking is a thing. The things that kids put on social media in order to get the clicks to be liked is kind of an emerging recognition that this is a motivator for sometimes inappropriate content or to post inappropriate or fake content to get those clicks. And that’s a double concern with the emergence of artificial intelligence. We’ve had several cases, even in the past few months, where kids have generated content with artificial intelligence, placing faces on naked bodies and things like that, and then distributing that material to a wide audience.
And in a couple of cases, school districts just didn’t have policies very specific to that kind of behavior, so there was no particular recourse to take yet. So, this is where that all comes together. And a school will tell you, “I’m limited in what I can do because they’re not using their phones to do this in my school or in the classroom or on my computer.” So, when parents say, “You need to do something about this,” the school is sort of stuck in a corner saying, “Well, I understand if this comes into the building, then I may have recourse, but I can’t stop your child from using a cell phone to post these materials. That’s on you and others in your circle.”
Carol Vassar, podcast host/producer:
Due diligence by the parents.
Dr. Daniel Flannery, Case Western Reserve University:
You have to be, and it’s an easy punt to say, “I just don’t get it. It’s all technology, apps. Who’s on what?” Every time I give a talk on bullying, I ask my young adult children, what’s the new apps that I don’t know about? Then, if you’re using Facebook, you’re passé, and they assume you’re over 30 and using Facebook, then you don’t know what’s going on. So, these apps are continuing to evolve in a more sophisticated way to post things that are “secure.” But kids also need to understand. You can find out. You can trace who’s posting what they think. It’s anonymous, so they think they can do these things and get away with it, and they’re not.
Carol Vassar, podcast host/producer:
There’s always a digital signature.
Dr. Daniel Flannery, Case Western Reserve University:
Yes. So, educating your child about what you post is your fingerprint, and it stays forever. It’s very hard to get rid of stuff on the internet and on social media.
Carol Vassar, podcast host/producer:
Dr. Daniel Flannery is the director of the Begun Center for Violence Prevention at Case Western Reserve University in Cleveland.
Thanks to Dr. Flannery for stopping by the Nemours Podcast booth at the 2024 American Academy of Pediatrics Experience National Conference in Orlando to share his insights on bullying prevention. And thanks to you for listening. More of our interviews with healthcare leaders from AAP on the way in the coming weeks, as well as interviews recorded at Health 2024 in Las Vegas. Recovering topics such as healthcare, collaboration, whole child health, obesity medication use in children, and the effects of dark design.
Don’t miss an episode. Visit nemourswellbeyond.org to subscribe to the podcast and leave a review. That’s nemourswellbeyond.org. Our production team for this episode includes Cheryl Munn, Susan Masucci, and Lauren Teta. I’m Carol Vassar. Join us next time as we talk artificial intelligence with the healthcare visionary leader, Dr. Robert Pearl. Until then, remember, we can change children’s health for good, well beyond medicine.
