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BHIPP Bulletin

Volume 2, Issue 6
December, 2016



In this final article in our school series, we will discuss the issue of bullying. Bullying consists of aggressive behavior, meant to cause distress or harm, involves a power imbalance, and happens repeatedly over time. This is not the same as teasing. Teasing is often playful and some use teasing as a way of fitting in, it’s not repetitive and does not target someone’s disabilities, ethnicity, faith or other characteristics.
Bullying may be verbal, physical, relational, or occur via technology. Cyberbullying may occur via texting, email, and social media or by creating. Cyberbullying has become increasingly common, particularly among adolescents. What makes cyberbullying unique is that the person being targeted may not know the identity of the bully or why they are being targeted. Additionally, unlike the victim or traditional bullying, the content used to harass the victim via technology can be quickly and easily disseminated to many people and may remain accessible well after it is initiated. Victims of cyberbullying may be exposed to bullying whenever they use technology, not just when the bully is in close proximity.

Boys tend to make physical threats or intimidate their peers, while bullying by girls is often verbal. Estimates show that up to half of children are bullied at some point during their school years, and 10% are bullied on a regular basis. There are a number of mental and behavioral health concerns associated with bullying:

  • Children who are bullied face numerous challenges – they are more likely to avoid school, drop out of school, perform lower academically, experience low self-esteem, and higher levels of anxiety and depression. They are more likely to attempt suicide, both as children and later in life.
  • Those who bully others display higher levels of aggression and impulsivity, are more likely to abuse alcohol and drugs, and have higher rates of criminal and delinquent behavior. 

While bullying can occur for a number of reasons, some children may be targeted based on their race, religion, sexual orientation, or disability. It is important to talk with children about their school environment and relationships with their peers, even if you do not suspect they are being bullied.  

The following tips may be helpful in order to help children who are victims of bullying to develop coping strategies:

  • Encourage children to stand tall, stay calm, and walk away from difficult situations. Do not encourage them to fight back.
  • Teach them phrases they can use to advocate for themselves such as: “I do not like when you talk to me like that” or “Please stop doing that.”
  • Encourage children to ask a trusted adult for help.
  • When possible, make sure children are with friends when traveling back and forth to school or during other outings.
  • Make school officials aware of the problem, and work with them to identify solutions.

If children who are being bullied become withdrawn, depressed, or reluctant to go to school, or if their academic performance begins to decline, further consultation or intervention may be necessary. Seeking help early on from a child and adolescent psychiatrist, or other mental health professional, may help reduce the risk of long-term emotional consequences.
If you are aware that a child is bullying others, it is important to intervene. Demonstrate to the child that he or she can get what they want without teasing, threatening, or hurting others. Help the child understand the impact of his or her behavior, and be a positive role model by demonstrating positive social interactions.

Additional Resources on Bullying
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Meet the BHIPP Team
Dr. Nicole Gloff is a clinical consultant with the BHIPP team and has worked with the program since 2014. She is an Assistant Professor of Child and Adolescent Psychiatry at the University of Maryland School of Medicine. Dr. Gloff received her B.A. in Chemistry from St. Mary’s College of Maryland. She then earned her medical degree at the University of Maryland School of Medicine. Dr. Gloff completed her general psychiatry residency training at the University of Maryland/Sheppard Pratt. Following residency, she completed a child and adolescent psychiatry fellowship at the University of Maryland where she served as Administrative Chief Resident.

Additional Resources

AAP Policy Statement: Addressing Early Childhood Emotional and Behavioral Problems
Emotional, behavioral, and relationship problems can develop in very young children, especially those living in high-risk families or communities. These early problems interfere with the normative activities of young children and their families and predict long-lasting problems across multiple domains. A growing evidence base demonstrates the efficacy of specific family-focused therapies in reducing the symptoms of emotional, behavioral, and relationship symptoms, with effects lasting years after the therapy has ended. Pediatricians are usually the primary health care providers for children with emotional or behavioral difficulties, and awareness of emerging research about evidence-based treatments will enhance this care. In most communities, access to these interventions is insufficient. Pediatricians can improve the care of young children with emotional, behavioral, and relationship problems by calling for the following: increased access to care; increased research identifying alternative approaches, including primary care delivery of treatments; adequate payment for pediatric providers who serve these young children; and improved education for pediatric providers about the principles of evidence-based interventions.
AAP Technical Report: Addressing Early Childhood Emotional and Behavioral Problems
More than 10% of young children experience clinically significant mental health problems, with rates of impairment and persistence comparable to those seen in older children. For many of these clinical disorders, effective treatments supported by rigorous data are available. On the other hand, rigorous support for psychopharmacologic interventions is limited to 2 large randomized controlled trials. Access to psychotherapeutic interventions is limited. The pediatrician has a critical role as the leader of the medical home to promote well-being that includes emotional, behavioral, and relationship health. To be effective in this role, pediatricians promote the use of safe and effective treatments and recognize the limitations of psychopharmacologic interventions. This technical report reviews the data supporting treatments for young children with emotional, behavioral, and relationship problems and supports the policy statement of the same name.

BHIPP Upcoming Event & Holiday Schedule

FREE WEBINAR:  Pediatricians Explain Why Screening, Brief Intervention, and Referral to Treatment (SBIRT) is Essential to Adolescent Health
Download Event Flyer

Earlier this year, the American Academy of Pediatrics (AAP) issued a policy statement that reaffirmed its recommendation to incorporate universal screening, brief intervention, and referral to treatment (SBIRT) practices for adolescent substance use in pediatric primary care. This webinar will discuss the rationale for the AAP's policy statement and current efforts to advance adolescent SBIRT in primary care settings.
Janet Williams, MD, FAAP, Coauthor of the AAP SBIRT statement
Robert Dudley, MD, FAAP, AAP Practice Improvement to Address Adolescent Substance Use project, Connecticut Physician Lead
Please note that the BHIPP consultation line will be closed on the following dates: 
Thursday, November 24, 2016
Friday, November 25, 2016
Monday, December 26, 2016
Monday, January 2, 2017

BHIPP Bulletin Newsletter Archive

November 2016: Learning Disorders and Intellectual Disability
October 2016: Educational Services: Know Your Rights and Resources
September 2016: Goodbye Summer, Hello School (Refusal)
August 2016: College Students and ADHD
July 2016: It's Summertime! ADHD and "Drug Holidays"
June 2016: Understanding Vyvanse
May 2016: Children's Mental Health Awareness Week, May 1-7, 2016
April 2016: "Universal" approaches for child mental health problems
March 2016: Pharmacological interventions for sleep concerns
February 2016: Behavioral interventions for sleep concerns
January 2016: Assessment of sleep disorders
November 2015: 5S's: Key questions for consultation
October 2015: Case discussion regarding school refusal
Copyright © 2016 Maryland Behavioral Health Integration in Pediatric Primary Care (BHIPP), All rights reserved.

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