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Autism and bullying: new developments in research and support

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Autism and bullying: new developments in research and support

Why are autistic students so frequently the victims of bullying? From our extensive clinical experience, the answer is that they are perceived as easy victims due to often being alone and not having a group of friends for protection, having the posture and body language of someone insecure and vulnerable, and having low self-esteem and social status, as well as being perceived as a relatively ‘soft target’, i.e., someone unlikely to be assertive or able to retaliate in a way that could cause discomfort to the ‘predator’.

Due to difficulties with social reasoning and Theory of Mind abilities, they may also lack the ability to determine if an action or suggestion was deliberate or accidental, whether teasing is friendly or malicious and the difference between humour and insult. Bullying can occur for autistic students of all ability levels, including children attending a special school (van Roekel, Scholte and Didden 2010). The study found that autistic adolescents who were frequently bullied sometimes misinterpreted non-bullying situations as bullying. They had become over-sensitised and quick to react without analysing intentions.

They may also lack conflict-resolution skills and be a source of entertainment when distressed. Recent research has added two more reasons: not being optimally tuned to social situations and resisting change (Forrest, Kroeger and Stroope (2020). The resistance to change means that the autistic student’s reaction and response are predictable, with difficulty acquiring more effective responses. Their intense emotional reaction also encourages the child who engages in bullying (Cappadocia et al, 2012).

The prevalence of being bullied

A study of over 1200 parents of autistic children explored the prevalence of their child being bullied over a one-month period. 38% of the children were bullied occasionally, with a further 28% being bullied frequently. Thus, most autistic children experienced some form of bullying over the month (Zablotsky et al., 2013). A study by Schroeder et al. (2014) confirmed high rates of bullying for autistic students, with 40% of their autistic research participants experiencing daily victimisation and a further 33% experiencing victimisation two to three times a week. A study by Fisher and Taylor (2016) of autistic adolescents found a prevalence of peer victimisation of 73%, with a prevalence of only 10% in non-autistic adolescents.

The signs of being bullied

The signs of being bullied can be very subtle, such as peer rejection, fewer birthday party invitations, or being picked last for team sports (Kloosterman et al., 2013; Schroeder et al., 2014) Other subtle expression of bullying are poking and having shoe laces tied together (Fisher & Taylor, 2016).

There may be physical evidence, such as lost or damaged possessions, or torn clothing, and medical evidence, such as bruising, injuries, stomachache, headaches and difficulty getting to sleep. Psychological evidence includes increased anxiety, especially before school, depression, school refusal and responding violently to bullying leading to suspension. There can also be signs of a lack of trust in peers, even paranoia, and a change in the special interest to a fascination with weapons and violent films with drawings of retribution and retaliation.

When parents ask about experiences of bullying at school, there may be a reluctance to disclose those experiences as disclosure means re-experiencing the emotions. There may also be aspects of alexithymia such that the autistic child or adolescent has considerable difficulty describing their thoughts and feelings about being bullied using conversational speech.

Assessment of being bullied

A new bullying experiences assessment instrument has been designed for autistic children and adolescents (Morton et al., 2022). The 22-item Assessment of Bullying Experiences (ABE) assesses verbal, physical, relational, and cyber victimisation using examples of bullying experiences that include:

  • Name-calling
  • Taunting
  • Teasing
  • Mocking or mimicking
  • Direct: hit, push, shove
  • Indirect: hit, push, shove
  • Damage possessions
  • Group exclusion
  • Ignored
  • Exclusion from an online group
  • Online impersonation
  • Social media insults
  • Spreading rumours
  • Held down or restraint
  • Physically take an object
  • Knock food/item from hands
  • Teased for joining a group
  • Provoked to have an outburst
  • Hurtful digital messages
  • Hurtful post online
  • Embarrassing photo/video

The assessment includes direct interpersonal bullying experiences at school and on social media. Home may not be a sanctuary from bullying in terms of cyberbullying and bullying from siblings.

We now have a new web-based touchscreen app to assess self-reported trauma exposure and symptoms in autistic children aged 8-14 (Hoover & Romero, 2019). The app has eight trauma exposure items, including bullying and teasing.

Disclosure of being bullied and support

A range of potential responses to bullying includes seeking help from teachers, friends, classmates, and parents and coping alone (Humphrey & Symes, 2010). When telling a teacher, the question can arise of which teacher or teacher assistant to tell and whether the teacher can or wants to rectify the situation. We have found that there can also be the issue of peer disapproval for disclosing bullying to teachers. Class peers may consider ‘dobbing’ a fellow student as a greater social ‘crime’ than reporting the bullying. Autistic students are more likely to confide in a friend if the friend is perceived as being able to do something about the situation or has some social influence over the bully.

Parents are often the last resort in terms of support, sometimes due to feeling uncomfortable having their parents involved in their school life and parents being perceived as unable to provide support during and immediately after being bullied. Research suggests that parenting stress also affects the likelihood of disclosing bullying to parents (Weis et al, 2015). When parents had low levels of stress, and there was open communication on problems at school, bullying could more easily be disclosed. In families that experienced high levels of stress, disclosure is less likely.

Coping alone often occurs with responses varying from ignoring the bullying and just walking away to acts of violence being seen as the only course of action to stop the bullying. Intervention strategies must include exploring and using a more comprehensive range of responses when violence has proved effective.

The effects of being bullied

As clinicians, we know the psychological effects of bullying are devastating, contributing to a range of mental health problems. It is a major cause of school refusal and suspension, often because the victim has become angry and reluctantly retaliated (Bitsika, Heyne and Sharpley 2021). It can contribute to developing an anxiety disorder due to constant fear of a bullying ‘attack’ or ambush each day and knowing there is no way to prevent such painful emotional experiences. The derogatory and provocative comments and actions may be internalised and believed by the victim, contributing to low self-esteem and clinical depression (Kim & Lecavalier, 2021; Ung et al., 2016) and suicidality (Halloran, Coey and Wilson, 2022). As so many interactions with peers are associated with being bullied, and so few positive social interactions are experienced, a sense of paranoia can develop based on the reality of their interactions with peers at school.

We increasingly recognise that one of the reasons for camouflaging or masking autism is to avoid being bullied (Cage & Troxell-Williams, 2019; Chapman et al., 2022). We also recognise a link between bullying and the development of Anorexia Nervosa (Brede et al., 2020) and gender dysphoria (Chang et al., 2021).

By being so sensitive to frequent bullying and having difficulty reading the intentions of others, an autistic child or adolescent may not be able to differentiate between friendly and unfriendly teasing, which can inhibit the development of a true friendship. Also, others may create a distance between themselves and the autistic student to avoid becoming targets themselves. This adds to a sense of loneliness and rejection. The autistic student may have few friends to provide protection and safety in numbers and have friends to calm the anguish and dissolve the despair, with no words or actions of support and compassion to create greater self-esteem and put the event in perspective. Thus, the effects of bullying go deeper and last longer for autistic students than non-autistic students.

Strategies to reduce experiences of being bullied

Research has confirmed our clinical experience that if peers intervene, over 50% of bullying episodes will stop (Cappadocia et al., 2012). Peers need to be educated about the effects of bullying on autistic students and actively encouraged to intervene. There will also be benefits in extending an autistic student’s social network to be less isolated and a more identifiable target and being able to call on the support of their friends (Hebron & Humphrey, 2014).

A study by Etherington (2007) evaluated the creation of a team of peer supporters for an autistic year eight student. The school chose six students, including two boys who were notorious for bullying the autistic student and two girls who had previously been socially supportive. A six-session training programme in support techniques and mentoring was held on a weekly basis during lesson time. A plan was agreed upon to provide support during break times. The team members recognised that sometimes the autistic student wanted to be alone during the breaks, and he could opt into or decline companionship. The peer supporters set up a rota to take turns to be ‘on call’ at each break. There was a significant reduction in the number of reported incidents with the following comments from the autistic student:

“Now I’ve got my peer supporters, I don’t feel alone anymore. I don’t keep thinking I’m going to get into trouble or do the wrong thing. I’m not frightened or anxious about coming to school anymore.

My peer supporters have really helped me. I can talk to them, and they will help me to know if what I am doing is appropriate. Sometimes I don’t know if people are trying to be unkind to me but I can ask one of my support group and they can tell me.

Once, this girl asked me to stand on a bench and sing a song. I did it, but I think she wanted to humiliate me. I asked one of my supporters. He said I shouldn’t do what people tell me to do if it makes me feel bad inside. I should just say no and walk away. I think he is right. I think I can trust him.”

Carol Gray (2010) has explored bullying using Social Stories on themes such as:

What is bullying?

Bullying: What to think, say and do

My team

Learning to respond to bullying

We have also found that her strategy of Comic Strip Conversations can help teachers and parents explore the autistic child’s perspective of events and explain the thoughts and motivations of those who engage in bullying. Parents and teachers can access literature and resources on bullying and autism, such as No Fishing Allowed: Reel in Bullying (Gray & Williams, 2006) and the books on bullying published by Jessica Kingsley publishers www.jkp.com

We now have social skills video games such as the Secret Agent Society specifically designed for autistic students, which includes components on managing bullying (Beaumont et al, 2021). We also have resources to improve online safety for autistic children and teenagers (Lonie, 2015).

Bullying can result in signs of trauma, and Eye Movement Desensitization and Reprocessing (EMDR) has been confirmed as an effective treatment for trauma in autistic adults (Lobregt-van Burren et al 2019).  The study found that 50% of participants had flashbacks of school bullying. EMDR could be considered for an autistic child or adolescent who has been traumatised by bullying.  

 

References

Beaumont et al. (2021). Journal of Autism and Developmental Disorders 51, 3637–3650.

Bitsika, H. & Sharpley (2021). Journal of Autism and Developmental Disorders 51, 1081–1092.

Brede et al. (2020). Journal of Autism and Developmental Disorders 50, 4280-4296

Cage & Troxell-Williams (2019). Journal of Autism and Developmental Disorders 49, 1899-1911

Cappadocia et al. (2012). Journal of Autism and Developmental Disorders 42.

Chang et al (2021) Autism 26 1-14.

Chapman et al (2022) Research in Autism Spectrum Disorders 99 102069

Etherington (2007) Good Autism Practice 8, 37-44.

Fisher and Taylor (2016) Autism 20, 402–411.

Forrest, Kroeger and Stroope (2020). Journal of Autism and Developmental Disorders 50, 560-571

Halloran, Coey and Wilson (2022) Clinical Psychology Review 93.

Hebron & Humphrey (2014). Autism 18.

Hoover & Romero (2019). Journal of Autism and Developmental Disorders 49, 1686-1692

Humphrey & Symes (2010). Journal of Research in Special Educational Needs 10, 82–90.

Kim and Lecavalier, (2021) Research in Autism Spectrum Disorders 88

Kloosterman et al (2013) Research in Autism Spectrum Disorder 7, 824-832

Lobregt-van Burren et al (2019). Journal of Autism and Developmental Disorders 49, 151–164.

Schroeder et al (2014) Journal of Autism and Developmental Disorders 44

Ung et al (2016) Research in Autism Spectrum Disorders 32, 70-79

van Roekel, Scholte and Didden (2010) Journal of Autism and Developmental Disorders 40, 63-73

Weis et al (2015) Autism Research 8, 727-737.

Zablotsky et al (2013). Journal of Developmental and Behavioral Pediatrics 34, 1-8

 

Resources

Gray C. and Williams (2006) No Fishing Allowed: Reel in Bullying Student workbook and teacher manual. Arlington, Future Horizons

Gray C. (2010) The New Social Story Book Arlington, Future Horizons

Lonie, N. (2015) Online Safety for Children and Teens on the Autism Spectrum: A Parent’s and Carer’s Guide London Jessica Kingsley Publishers

Secret Agent Society www.sst-institute.net

Autism and bullying

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Autism and bullying

Are the rates of bullying higher for autistic children?

Many of the autistic children and adolescents we see as clinicians have experienced frequent bullying by peers at school, and we are very concerned about the psychological consequences. Research has been conducted on the prevalence rates of bullying for autistic children and 40% experience daily bullying and a further 33% experience bullying two to three times a week (Schroeder et al 2014). This contrasts with the prevalence of being a target for bullying for typical children of only 10% (Olweus 1993).

Why are autistic children more likely to experience bullying?

In typical children, we recognise two types of targets, passive and proactive. A passive target is usually a child who is anxious, has low self-esteem, shy, engages in solitary pursuits and does not have an extensive network of friends. This could be a description of an autistic child who is an introvert. A proactive target wants to engage with peers but has poor social skills and is perceived as irritating by peers. This could be a description of an extrovert autistic child.

Other factors that may contribute to autistic children being bullied more than their peers is having low social status, such as, having few if any friends to come to their defence and not being good at character and intention judgements to identify and avoid children who engage in bullying.

Types of bullying

There are many expressions of bullying, and these include:

Verbal such as obscenities and sarcasm

Physical with actions that cause pain and discomfort

Emotional and psychological such as gossip, rumours, and derogatory comments, for example, “you’re so ugly/stupid or a loser” The term autistic can also be used as a derogatory comment

Practical jokes and humiliation

Sexual with inappropriate touching, gestures, and actions

Being set up and unaware of the implications of complying with the instructions

Cyberbullying

An example of cyberbullying and its consequences are illustrated in the following quotation.

My cyberbullies were relentless and would never leave me alone. I wanted to kill myself because I felt there was no way to get away from them, but I was scared I’d fail because I was such a pathetic loser. I never felt safe anywhere. So, I would cut myself in places that no one could see. The physical pain never matched the emotional pain I felt with what the bullies would say to me. (McKibbin 2016, page 61)

Where does bullying occur?

Those who engage in bullying do not want to be caught and reprimanded by a teacher, so most acts of bullying occur at locations where the incident is less likely to be detected. Bullying is most likely when there is no adult supervision such as hallways and on school transport and can also occur close to or in the home by children of neighbours, family friends and relatives. However, bullying attempts occur most frequently at school. Most bullying actions are covert with only 15% observed in the classroom by a teacher, and only 5% in the playground (Olweus 1993; Rigby 1996).

The autistic child’s signs of being bullied

There may be physical evidence such as lost or damaged possessions, torn clothing, and medical evidence such as bruising, injuries, stomach and head aches and difficulty getting to sleep. Psychological evidence and include increased anxiety, especially before school, depression and responding violently to bullying leading to school suspension. There can also be signs of lack of trust of peers and even paranoia, and a change in the special interest to weapons and violent films with drawings of retribution and retaliation.

The psychological effects of being bullied

Being bullied increases signs of anxiety, suicidal ideation, self-harm and depression (Ung et al 2016), as illustrated in this quotation:

Bullying for me was at its worst in secondary school. My bullies were merciless- they would make fun of me and tease me in the classroom- even in front of the teachers. And when I would look to the ‘trusted adult’ in the room for help, begging them to make it stop, I found them laughing with my bullies- making it worse and making my days even more intolerable. I tried to kill myself when I was 14 years old and ended up in hospital. It was only then that my parents finally agreed to let me do home-school. To this day, I swear it saved my life. (McKibbin 2016 page 67.)

The derogatory comments of those who engage in bullying create within an autistic child, a deepening negative self-belief due to being relentless and not contradicted by friends. The self-belief is that I am stupid, or psycho, or that no one will ever be my friend. Rates of anxiety and depression are lower in autistic children who are not the target of bullying (Schroeder et al 2014) and experiences of being bullied may need to be addressed in psychological treatment of anxiety and depression.

The autistic child may not understand why they are the target of bullying and why someone would intentionally cause distress. They subsequently ruminate on the acts of bullying, replaying the events in their mind, and especially when falling asleep, to try to determine the motivations of the person who engages in bullying and cannot forgive or forget until they have closure by understanding why and they are not at fault.

School can become a ‘war zone’ and incidents of bullying can lead to signs of Post-Traumatic Stress Disorder (PTSD). Bullying can also contribute to camouflaging autistic traits (Cage and Troxell-Whitman 2019) as in the following quotation from the research study with a participant explaining why she camouflaged her autism: To stop bullying and mocking as I’ve experienced when not masking.

Being bullied is also a contributory factor for developing an eating disorder (Brede et al 2020). The research found that autistic and typical adolescents that developed an eating disorder often talked about difficulties in friendship and experiencing loneliness, bullying and abuse which affected their eating.

Autistic children’s response to bullying

They may have a limited repertoire of responses to acts of bullying, with a propensity to respond with aggression and violence earlier than typical peers. If their experiences are not taken seriously, they make ‘take the law into their own hands’ which could lead to tragic consequences.

Strategies to decrease the frequency and type of bullying

There needs to be a whole school approach that includes the target, school administration, teachers, professionals, parents, other children, and the child who engages in bullying. This strategy will require an agreed code of conduct, staff education and consistency and the concept of justice and appropriate consequences based on the degree of responsibility. The following are brief explanations of ten strategies for autistic children.

The changes here are more about everyone changing, rather than the autistic child having to do all the work:

1: Create a map of safe and accessible places where the likelihood of being bullied is reduced and highlight vulnerable places, such as locations away from adult supervision.

2: Educate and inform students on the life-long consequences of someone who is the victim of bullying, but also who engages in bullying,  to ‘rescue’ both parties. Bystanders need to be assertive and intervene when acts of bullying occur.

3: Avoid vulnerable situations such as trying to hide in the toilets

4: Security is in numbers. That is being near other children or adults.

5: Prepare the child with an appropriate response which has been created together with adults and peers which has been rehearsed.

6: The autistic child will need an explanation why they were the target, but also the psychology of those who engage in acts of bullying.

7: Ensure that ALL students understand the consequences according to the relevant school rules and based on equitable social justice.

8: Support and provide guidance for all students in determining the difference between friendly and not friendly teasing.

9: Understanding the value of disclosure and who to disclose to and how.

10: Access literature and resources on bullying and autism such as No Fishing Allowed: Reel in Bullying by Carol Gray and Judy Williams and the books on bullying such as those published by Jessica Kingsley publishers www.jkp.com

Parents may consider how to communicate their concern with the school, recording incidents of bullying and the informing the school and psychologists of the child’s ability to cope with bullying and effect on mental health. They may also consider enrolling the child in a martial arts class, could you add something here about why you this could be beneficial, such as, increase self-confidence, rather than others implying that violence is the solution.  and changing school which may or may not contribute to reducing the frequency of bullying. Another option considered by parents and the child is home schooling.

References

Cage and Troxell-Whitman (2019) Journal of Autism and developmental Disorders 49, 1899-1911.

Gray, C. and Williams J. (2006) No Fishing Allowed: Reel in Bullying Arlington, Future Horizons

McKibben K. (2016) Life on the Autism Spectrum: A Guide for Girls and Women. Jessica Kingsley Publishers

Olweus, D. (1993) Bullying at school, Cambridge: Blackwell

Rigby, K. (1996) Bullying in schools. London, Jessica Kingsley Publishers

Schroeder et al (2014) Journal of Autism and Developmental Disorders 44

Ung et al (2016) Research in ASD 32, 70-79