Supporting kids with autism experiencing bullying

IN a recently published study we observed that children with a diagnosis of neurodevelopmental disorders (NDDs) such as autism spectrum disorder, attention deficit hyperactivity disorder, Tourette syndrome, and intellectual disability, are more likely to be bullied than their peers.

Specifically we found that among the NDDs, autism is the top risk factor.

There are also studies that have reported that autism is also a risk factor for perpetrating bullying including cyber bullying. However, it is to be noted that a key factor here may be the associated comorbid conditions, as there is evidence to suggest that, when comorbid psychopathology is accounted for along with other demographic factors, the increased risk for being a perpetrator or a victim-perpetrator was no longer present but the risk for being bullied persisted.

In this regard, there is report of significantly higher rates of worry about bullying and victimisation among those with comorbid internalizing symptoms such as anxiety and depression. While it is not clear which is the cause or the effect, and perhaps it is more a vicious cycle of interactive effect, it is critical that we identify and support those who might be at disproportionately higher risk for both bullying and for associated mental health impact through integrated health, educational and community support and interventions.

It is difficult to disentangle the reasons for a higher risk of being bullied but it is possible that the differences in social interactions, communications and specific interests or repetitive behaviours might draw attention to the person and this in turn may lead to being an easy target. It is often the case that it is the difference and not why they are different that is the issue.

This risk continues into young adulthood and beyond, and hence understanding the associated characteristics including comorbid conditions is critical in providing the right supports early. For example, an Australian study on autism and bullying found that those with comorbid anxiety disorders experienced more face‐to‐face bullying while those with depression experienced more cyber bullying.

It is possible to hypothesise that having anxiety, especially social anxiety, might attract more difficulties in face-to-face interactions and consequent bullying experience while comorbid depression might lead to more social withdrawal and more online interactions that might trigger cyber experience of exclusion or victimisation. The study also found that parental concerns typically included the impact of bullying on school attendance, participation and academic performance, self-esteem and confidence as well as adverse effects on mental health and behaviour. The latter is particularly important as being bullied can be associated with a fourfold increase in the risk of self-harm and/or suicidal thoughts.

What role can GPs play in supporting children with NDDs experiencing bullying?

Tania is a 15-year-old autistic girl. At primary school she was teased a lot but there were a couple of kids who were kind to her and one was a family friend and she used to sit with her at recess and lunch time which helped. But they went to a different high school and Tania didn’t know anyone in her new school. She was told by her family to try to initiate interaction, but this was perceived as inappropriate by her peers and they laughed at her. She is now so scared and wary of her peers that she has started to refuse to go to school on certain days when there is more free time. She was seen by the school counsellor and Tania reported that she wanted to make friends but did not know how to do it. Within her class, there were some who wanted to include Tania but were not sure how to do this, while others found that they could evoke a reaction in Tania by calling her names and making noises when she passed by. This led Tania to scream or shout and they found this reaction to be entertaining, leading to a vicious cycle.

Tania’s GP was the first point of contact in getting her the support she needed.

Tania was assessed by her GP, who identified that Tania was having significant anxiety and that she was worried about being bullied, which was causing the school refusal. The GP then organised a referral to a psychologist and communicated with the school about the need for putting in additional supports for Tania. The GP also made an appointment to review progress.

Tania undertook training on how to identify bullying and what to do if she was not sure. This included social stories, role plays and video examples to give her different options on how she might respond or react or engage. The aim was to provide her social choices rather than to imply that her differences were the problem and that it is her right to expect adaptations.

The school offered her an option to go to an identified teacher if there were any issues. She knew that this teacher would welcome her at any time, and that she would be supported by this teacher going over the incident with her to identify what was the issue that had upset her. Subsequently any issues including bullying would be investigated and dealt with such as by increasing staff supervision and pairing her with a buddy during lunch/recess etc.

Also, Tania was provided an opportunity to go to a “safe place” in the corner of the library if she was feeling stressed, where she could spend some time quietly or read, listen to music or go on the computer.

The school organised a peer awareness lesson about neurodiversity and in particular autism and how to be inclusive.

Some of the peers who had expressed an interest in including Tania were identified as “buddies” who would provide company during recess and lunch and check in with her to make sure she was okay.

Our findings also indicated that although those who have higher level of functioning especially in high school might look like they are okay, they may be at higher risk of bullying as well as those from disadvantaged background.

In light of this, there is merit in increasing awareness and understanding of neurodiversity alongside promoting inclusiveness as part of antibullying programs, such as Bully Zero and Bullying No Way. Further, identifying comorbid conditions and addressing these early would be critical. At school, organising a “safe place” and an “identified staff” to talk to plus linking up with “buddies” for support during recess and lunch can all help.

Professor Valsamma Eapen is the Chair of Infant, Child and Adolescent Psychiatry at UNSW Sydney, and Head of the Academic Unit of Child Psychiatry and Clinical Academic at the South West Sydney Local Health District.

The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.

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