Summary

Bullying has long been tolerated by many as a rite of passage among children and adolescents. There is an implication that individuals who are bullied must have “asked for” this type of treatment, or deserved it. Sometimes, even the child who is bullied begins to internalize this idea. For many years, there has been a general acceptance when it comes to a child or adolescent with greater social capital or power pushing around a child perceived as subordinate—such that you can almost hear the justification: “kids will be kids.” The schoolyard bully trope crosses race, gender, class, ethnicity, culture, and generations, appearing in popular media ranging from Harry Potter to Glee, and Mean Girls to Calvin and Hobbes cartoons. Its prevalence perpetuates its normalization. But bullying is not a normal part of childhood and is now appropriately considered to be a serious public health problem.

Although bullying behavior endures through generations, the milieu is changing. Historically, bullying has occurred at school—the physical setting in which most of childhood is centered and the primary source for peer group formation—or really anywhere that children played or congregated. In recent years, however, the physical setting is not the only place bullying is occurring. Technology allows for a new type of digital electronic aggres-

sion, cyberbullying, which takes place through chat rooms, instant messaging, social media, and other forms of digital electronic communication.

Simultaneously, the demographics of cities and towns in the United States are in flux, with resulting major changes in the ethnic and racial composition of schools across the country. Numerical-minority ethnic groups appear to be at greater risk for being targets of bullying because they have fewer same-ethnicity peers to help ward off potential bullies. Ethnically diverse schools may reduce actual rates of bullying because the numerical balance of power is shared among many groups.

Composition of peer groups, shifting demographics, changing societal norms, and modern technology are contextual factors that must be considered to understand and effectively react to bullying in the United States. Youth are embedded in multiple contexts, and each of these contexts interacts with individual characteristics of youth in ways that either exacerbate or attenuate the association between these individual characteristics and being a target or perpetrator of bullying. Even the definition of bullying is being questioned, since cyberbullying is bullying but may not involve repetition—a key component in previous definitions of bullying—because a single perpetrating act on the Internet can be shared or viewed multiple times.

Although the public health community agrees that bullying is a problem, it has been difficult for researchers to determine the extent of bullying in the United States. However, the prevalence data that are available indicate that school-based bullying likely affects between 18 and 31 percent of children and youth, and the prevalence of cyber victimization ranges from 7 to 15 percent of youth. These estimates are even higher for some subgroups of youth who are particularly vulnerable to being bullied (e.g., youth who are lesbian, gay, bisexual, and transgender [LGBT]; youth with disabilities). Although these are ranges, they show bullying behavior is a real problem that affects a large number of youth.

STUDY CHARGE AND SCOPE

Recognizing that bullying behavior is a major public health problem that demands the concerted and coordinated time and attention of parents, educators and school administrators, health care providers, policy makers, families, and others concerned with the care of children, a group of federal agencies and private foundations asked the National Academies of Sciences, Engineering, and Medicine to undertake a study of what is known and what needs to be known to reduce bullying behavior and its consequences. The Committee on the Biological and Psychosocial Effects of Peer Victimization: Lessons for Bullying Prevention was created to carry out this task under the Academies’ Board on Children, Youth, and Families and the Committee on

Law and Justice. The committee was charged with producing a comprehensive report on the state of the science on the biological and psychosocial consequences of peer victimization and the risk and protective factors that either increase or decrease peer victimization behavior and consequences (see Chapter 1 for the committee’s detailed statement of task).

This report builds on a workshop held in April 2014 and summarized in a report from the Institute of Medicine and National Research Council, Building Capacity to Reduce Bullying and Its Impact on Youth Across the Lifecourse. The committee that authored the current report, several members of which participated in the initial workshop, began its work in October 2014. The committee members represent expertise in communication technology, criminology, developmental and clinical psychology, education, mental health, neurobiological development, pediatrics, public health, school administration, school district policy, and state law and policy.

The committee conducted an extensive review of the literature pertaining to peer victimization and bullying and, in some instances, drew upon the broader literature on aggression and violence. To supplement its review of the literature, the committee held two public information-gathering sessions and conducted a site visit to a northeastern city.¹

Given the varied use of the terms “bullying” and “peer victimization” in both the research-based and practice-based literature, the committee chose to use a current definition for bullying developed by the Centers for Disease Control and Prevention (CDC):

Not only does this definition provide detail on the common elements of bullying behavior but it also was developed with input from a panel of researchers and practitioners. The committee also followed the CDC in focusing primarily on individuals between the ages of 5 and 18. The committee recognizes that children’s development occurs on a continuum, and so while it relied primarily on the CDC definition, its work and this report acknowledge the importance of addressing bullying in both early childhood and emerging adulthood. The committee followed the CDC in not including sibling violence, dating violence, and bullying of youth by adults, as those subjects were outside the scope of the committee’s charge.

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¹ The location of the city is not identified in order to protect the privacy of the focus group participants.

THE SCOPE AND IMPACT OF THE PROBLEM

While exact estimates of bullying and cyberbullying may be difficult to ascertain, how their prevalence is measured can be improved. The committee concluded that definitional and measurement inconsistencies lead to a variation in estimates of bullying prevalence, especially across disparate samples of youth. Although there is a variation in numbers, the national surveys show bullying behavior is a real problem that affects a large number of youth (Conclusion 2.1). Chapter 2 describes the definitional, measurement, and sampling issues that make it difficult to generate precise, consistent, and representative estimates of bullying and cyberbullying rates. Moreover, the national datasets on the prevalence of bullying focus predominantly on the children who are bullied. Considerably less is known about perpetrators, and nothing is known about bystanders in that national data (Conclusion 2.2). Further, there is currently a lack of nationally representative data for certain groups that are at risk for bullying, such as LGBT youth and youth with disabilities.

Although perceptions and interpretations of communications may be different in digital communities, the committee decided to address cyberbullying within a shared bullying framework rather than as a separate entity from traditional bullying because there are shared risk factors, shared negative consequences, and interventions that work on both cyberbullying and traditional bullying. However, there are differences between these behaviors that have been noted in previous research, such as different power differentials, different perceptions of communication, and differences in how to best approach the issue of repetition in an online context. These differences suggest that the CDC definition of traditional bullying may not apply in a blanket fashion to cyberbullying but that these entities are not separate species. The committee concludes cyberbullying should be considered within the context of bullying rather than as a separate entity. The Centers for Disease Control and Prevention definition should be evaluated for its application to cyberbullying. Although cyberbullying may already be included, it is not perceived that way by the public or by the youth population (Conclusion 2.3).

The committee also concludes that different types of bullying behaviors—physical, relational, cyber—may emerge or be more salient at different stages of the developmental life course (Conclusion 2.4). In addition, the committee concludes that the online context where cyberbullying takes place is nearly universally accessed by adolescents. Social media sites are used by the majority of teens and are an influential and immersive medium in which cyberbullying occurs (Conclusion 2.5).

As described in Chapter 3, research to date on bullying has been largely descriptive. These descriptive data have provided essential insights into a

variety of important factors on the topic of bullying, including prevalence, individual and contextual correlates, and adverse consequences. At the same time, this descriptive approach has often produced inconsistencies due, in part, to a lack of attention to contextual factors that render individual characteristics, such as race/ethnicity, more or less likely to be related to bullying experiences. Youth are embedded in multiple contexts, ranging from peer and family to school, community, and macrosystem. Each of these contexts can affect individual characteristics of youth (e.g., race/ethnicity, sexual orientation) in ways that either exacerbate or attenuate the association between these individual characteristics and perpetrating and/or being the target of bullying behavior (Conclusion 3.1)

The committee also concludes that contextual factors operate differently across groups of youth, and therefore contexts that protect some youth against the negative effects of bullying are not generalizable to all youth. Consequently, research is needed to identify contextual factors that are protective for specific subgroups of youth that are most at risk of perpetrating or being targeted by bullying behavior (Conclusion 3.2).

Finally, the committee notes that stigma² plays an important role in bullying. In particular, the role of stigma is evident not only in the groups of youth that are expressly targeted for bullying (e.g., LGBT youth, youth with disabilities, overweight/obese youth) but also in the specific types of bullying that some youth face (i.e., bias-based bullying). Despite this evidence, the role of stigma and its deleterious consequences is more often discussed in research on discrimination than on bullying. In the committee’s view, studying experiences of being bullied in particular vulnerable subgroups (e.g., those based on race/ethnicity or sexual orientation) cannot be completely disentangled from the study of discrimination or of unfair treatment based on a stigmatized identity. These are separate empirical literatures (school-based discrimination versus school-based bullying) although often they are studying the same phenomena. There should be much more cross-fertilization between the empirical literatures on school bullying and discrimination due to social stigma (Conclusion 3.5).

Bullying is often viewed as just a normal part of growing up, but it has long-lasting consequences and cannot simply be ignored or discounted as not important. It has been shown to have long-term effects not only on the child who is bullied but also on the child who bullies and on bystanders. While there is limited information about the physical effects of bullying,

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² As noted in a 2016 report Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence for Stigma Change from the National Academies of Sciences, Engineering, and Medicine, some stakeholder groups are targeting the word “stigma” itself and the Substance Abuse and Mental Health Services Administration is shifting away from the use of this term. The committee determined that the word stigma was currently widely accepted in the research community and uses this term in the report.

existing evidence suggests that children and youth who are bullied experience a range of somatic disturbances, including sleep disturbances, gastrointestinal concerns, and headaches. Emerging research suggests that bullying can result in biological changes. The committee concludes that although the effects of being bullied on the brain are not yet fully understood, there are changes in the stress response systems and in the brain that are associated with increased risk for mental health problems, cognitive function, self-regulation, and other physical health problems (Conclusion 4.3).

As described in Chapter 4, being bullied during childhood and adolescence has been linked to psychological effects, such as depression, anxiety, and alcohol and drug abuse into adulthood. The committee concludes that bullying has significant short- and long-term internalizing and externalizing psychological consequences for the children who are involved in bullying behavior (Conclusion 4.4). Studies suggest that individuals who bully and who are also bullied by others are especially at risk for suicidal behavior due to increased mental health problems. Individuals who are involved in bullying in any capacity (as perpetrators, targets, or both) are statistically significantly more likely to contemplate or attempt suicide, compared to children who are not involved in bullying. However, there is not enough evidence to date to conclude that bullying is a causal factor for youth suicides. Focusing solely on bullying as a causal factor would ignore the many other influences that contribute to youth suicides.

With regard to the linkages between bullying and school shootings, several characteristics of the research that has been conducted on school shootings bear mentioning. First, to date, research has not been able to establish a reliable profile or set of risk factors that predicts who will become a school shooter. Second, it is important to keep in mind that multiple-victim school shootings are low base rate events, and thus caution should be used in generalizing findings from these rare events to broad populations of students. There is also a lack of reliable evidence about school shootings that may have been successfully prevented or averted.

Given that school shootings are rare events, most of what is known about them comes from studies that aggregate events over many years. These studies mostly employ qualitative methods, including descriptive post-incident psychological autopsies of the shooters, analysis of media accounts, or in-depth interviews of a small subset of surviving shooters. Most investigations have concluded that bullying may play a role in many school shootings but not all. It is a factor, and perhaps an important one, but it does not appear to be the main influencing factor in a decision to carry out these violent acts. Further, there is not enough evidence to date (qualitative or quantitative) to conclude that bullying is a causal factor for multiple-homicide targeted school shootings nor is there clear evidence on how bullying or related mental health and behavior issues contribute to

school shootings. The committee concludes that the data are unclear on the role of bullying as one of or a precipitating cause of school shootings (Conclusion 4.5).

Although the research is limited, children and youth who do the bullying also are more likely to be depressed, engage in high-risk activities such as theft and vandalism, and have adverse outcomes later in life, compared to those who do not bully. However, whereas some individuals who bully others may in fact be maladjusted, others who are motivated by establishing their status within their peer group do not evidence negative outcomes. Thus, the research on outcomes for children who bully is mixed, with most research on the short- and long-term outcomes of bullying not taking into account the heterogeneity of children who bully. The committee concludes that individuals who both bully others and are themselves bullied appear to be at greatest risk for poor psychosocial outcomes, compared to those who only bully or are only bullied and to those who are not bullied (Conclusion 4.6).

Existing evidence suggests that both social-cognitive and emotion regulation processes may mediate the relation between being bullied and adverse mental health outcomes (Conclusion 4.8). Regardless of mechanism, being bullied seems to have an impact on mental health functioning during adulthood. Prior experiences, such as experiences with early abuse and trauma; a chronically activated stress system due to home, school, or neighborhood stress; the length of the bullying experience; and the child’s social support system, all interact to contribute to the neurobehavioral outcome of bullying.

A PIVOTAL TIME FOR PREVENTION: NEXT STEPS

This is a pivotal time for bullying prevention. Reducing the prevalence of bullying and minimizing the harm it imparts on children can have a dramatic impact on children’s well-being and development. Many programs and policies have been developed, but more needs to be known about what types of programs or investments will be most effective. The committee concludes that the vast majority of research on bullying prevention programming has focused on universal school-based programs; however, the effects of those programs within the United States appear to be relatively modest. Multicomponent schoolwide programs appear to be most effective at reducing bullying and should be the types of programs implemented and disseminated in the United States (Conclusion 5.1).

Universal prevention programs are aimed at reducing risks and strengthening skills for all youth within a defined community or school setting. Through universal programs, all members of the target population are exposed to the intervention regardless of risk for bullying. Examples

of universal preventive interventions include social–emotional lessons that are used in the classroom, behavioral expectations taught by teachers, counselors coming into the classroom to model strategies for responding to or reporting bullying, and holding classroom meetings among students and teachers to discuss emotionally relevant issues related to bullying or equity. They may also include guidelines for the use of digital media, such as youth’s use of social network sites.

Selective preventive interventions are directed either to youth who are at risk for engaging in bullying or to youth at risk of being a target of bullying. Such programs may include more intensive social–emotional skills training, coping skills, or de-escalation approaches for youth who are involved in bullying. Indicated preventive interventions are typically tailored to meet youth’s needs and are of greater intensity as compared to the universal or selective levels of intervention. Indicated interventions incorporate more intensive supports and activities for those who are already displaying bullying behavior or who have a history of being bullied and are showing early signs of behavioral, academic, or mental health consequences.

There is a growing emphasis on the use of multi-tiered approaches, which leverage universal, selective, and indicated prevention programs and activities. These combined programs often attempt to address at the universal level such factors as social skill development, social–emotional learning or self-regulation, which also tend to reduce the chances that youth would engage in bullying or reduce the risk of being bullied further. Multi-tiered approaches are vertical programs that increase in intensity, whereas multicomponent approaches could be lateral and include different elements, such as a classroom, parent, and individual components bundled together.

Research indicates that positive relationships with teachers, parents, and peers appear to be protective. The committee concludes that most of the school, family, and community-based prevention programs tested using randomized controlled trial designs have focused on youth violence, delinquency, social–emotional development, and academic outcomes, with limited consideration of the impacts on bullying specifically. However, it is likely that these programs also produce effects on bullying, which have largely been unmeasured and therefore data on bullying outcomes should be routinely collected in future research (Conclusion 5.2).

Families play a critical role in bullying prevention by providing emotional support to promote disclosure of bullying incidents and by fostering coping skills in their children. And some research points to an opportunity to better engage bystanders, who have the best opportunity to intervene and minimize the effects of bullying.

Chapter 5 offers a number of specific ways to improve the quality and efficacy of preventive interventions. As concluded by the committee, there has been limited research on selective and indicated models for bullying intervention programming, either inside or outside of schools. More at-

tention should be given to these interventions in future bullying research (Conclusion 5.3).

There remains a dearth of intervention research on programs related to cyberbullying and on programs targeted to vulnerable populations, such as LGBT youth, youth with chronic health problems such as obesity, or youth with developmental disabilities such as autism. Schools may consider implementing a multicomponent program that focuses on school climate, positive behavior support, social–emotional learning, or violence prevention more generally, rather than implementing a bullying-specific preventive intervention, as these more inclusive programs may reach a broader set of outcomes for students and the school environment.

Moreover, suspension and related exclusionary techniques are often the default response by school staff and administrators in bullying situations. However, these approaches do not appear to be effective and may actually result in increased academic and behavioral problems for youth. Caution is also warranted about the types of roles youth play in bullying prevention programs. The committee concludes that the role of peers in bullying prevention as bystanders and as intervention program leaders needs further clarification and empirical investigation in order to determine the extent to which peer-led programs are effective and robust against potentially iatrogenic effects (Conclusion 5.5).

As the consequences of bullying become clearer and more widely known, states are adopting new laws and schools are embracing new programs and policies to reduce the prevalence of bullying. As noted in Chapter 6, over the past 15 years all 50 states and the District of Columbia have adopted or revised laws to address bullying. Forty-nine states and the District of Columbia include electronic forms of bullying (cyberbullying) in their statutes. The committee concludes that law and policy have the potential to strengthen state and local efforts to prevent, identify, and respond to bullying (Conclusion 6.1). However, there are few studies that have examined the actual effect of existing laws and policies in reducing bullying. The committee concludes that the development of model anti-bullying laws or policies should be evidence based. Additional research is needed to determine the specific components of an anti-bullying law that are most effective in reducing bullying, in order to guide legislators who may amend existing laws or create new ones (Conclusion 6.2). Further, evidence-based research on the consequences of bullying can help inform litigation efforts at several stages, including case discovery and planning, pleadings, and trial (Conclusion 6.6).

Some policies and programs have been shown to be ineffective in preventing bullying. The committee concludes there is emerging research that some widely used approaches such as zero tolerance policies are not effective at reducing bullying and thus should be discontinued, with the resources redirected to evidence-based policies and programs (Conclusion 6.7).

In Chapter 7, the committee makes seven recommendations. The first three recommendations are directed to the cognizant federal agencies and their partners in state and local governments and the private sector, for improving surveillance and monitoring activities in ways that will address the gaps in what is known about the prevalence of bullying behavior, what is known about children and youth who are at increased risk for being bullied, and what is known about the effectiveness of existing policies and programs. Another four recommendations are either directed at fostering the development, implementation, and evaluation of evidence-based preventive intervention programs and training or directed to social media companies and federal partners to adopt, implement, and evaluate policies and programs for preventing, identifying, and responding to bullying on their platforms. The committee’s recommendations are provided below:

In addition, the committee identified a set of current research gaps and recognized the value of future research in addressing issues raised in the report and important for a more comprehensive understanding of bullying behavior, its consequences, and factors that can ameliorate the harmful effects of bullying and foster resilience. These research needs are listed in Table 7-1 and are connected to general topics addressed in the report such as “Law and Policy,” “Prevalence of Bullying,” and “Protective Factors and Contexts.”

The study of bullying behavior is a relatively recent field, and it is in transition. Over the past few decades, research has significantly improved understanding of what bullying behavior is, how it can be measured, and the critical contextual factors that are involved. While there is not a quick fix or one-size-fits-all solution, the evidence clearly supports preventive and interventional policy and practice. Tackling this complex and serious public health problem will require a commitment to research, analysis, trial, and refinement, but doing so can make a tangible difference in the lives of many children.

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