Wednesday, 10 October 2012

I am not condoning violence...

Mr Bruce Lee @ Wikipedia 
Name calling, spreading rumours, excluding from social groups, hitting, kicking and taking belongings. Bullying (definition courtesy of the UK National Autistic Society) covers quite a lot of ground.

I don't actually know if I had a bully or not at school. I mean, there was this one kid at school who always seemed to have it in for me until that is, one day I snapped (yes, we English are not all watercress sandwiches and afternoon tea) after which the kid in question didn't tend to come near me again. I never actually thought however that this kid was a bully per se; just someone who I didn't seem to get along with.

That was then. Nowadays the media is awash with news about cyber-bullying and the various new fangled ways that some kids use / have used to cause misery to other kids (albeit with questions about prevalence). I have to say that I'm kinda glad that I'm not a teenager in the Internet or cameraphone age after reading all this.

In this post I want to talk about the paper by Paul Sterzing and colleagues* reporting on the experiences of school year bullying (and bullying perpetration) in teens with an autism spectrum disorder (ASD). On purpose I've left it a while before I get to this paper in order to let the dust settle around this quite emotive topic before I stuck my oar in with this quite long post.

Needless to say that this study has from the initial press release and author profile created quite a few column inches as per headlines like this one: School bullies prey on children with autism and this one: Why autistic kids make easy targets for school bullies no doubt alongside hitting some really raw nerves for many people. I tread carefully.

A quick summary first:

  • This was a survey study which asked parents (N=920) (and teachers) of teens with an autism spectrum disorder about the bullying (both victim and perpetrator) experiences of their children.
  • Coming up to almost half of all teens with autism were reported to be the victims of bullying (46%) whilst 15% were perpetrators of bullying and about 10% combined bullying victims and perpetrators.
  • Various factors correlated with bullying victim status including lower social skills, some level of conversational ability and a comorbid ADHD diagnosis. Being in mainstream education was also mentioned as a correlate.
  • On the other hand, the presence of ADHD was also associated with being a bullying perpetrator alongside having some kind of friendship base.

This is not the first time that bullying has been studied with autism in mind. This paper from van Roekel and colleagues** (open-access) looked at bullying specifically within the special education school system, again reporting a figure of 46% on the prevalence of bullying and victimisation. Indeed not dissimilar from the findings from a recent UK report on the school experience and autism (see here).

I was also interested in the findings reported by Montes & Halterman*** on the influence of ADHD comorbidity, where dual presentation (autism & ADHD) seemed to confer the greatest risk for bullying behaviours. Not a million miles away from the Sterzing conclusions. As an aside, I do also wonder whether the paper by Susan Dickerson Mayes and colleagues**** on suicide ideation and attempts in cases of autism might also reflect a potential effect from bullying in some extreme cases.

I'm not an expert on bullying but I might add a few points potentially tied into these findings. Stick with me on this one.

Although there are probably lots of reason for bullying behaviour, I've always believed that, from the bully's point of view, it all eventually comes down to exerting power over another person/s. It's a two-stage process so please hear me out: (i) a bully, whether because of issues in their own life, at home, at school, at anywhere, either has lost some degree of 'power' over their own life and wants to recoup it over others perceived as less powerful, or in some cases, has an insatiable desire for power not readily satisfied by their current life. That's how (I think) it starts, accepting that other factors such as prejudice, jealousy, socio-economic status (see here) and popularity among peers also might carry influence. The second stage (ii) is all about maintaining a bullying control over someone; something where the more social side of things comes into play. Peer groups based on that bullying power, some degree of showing off to those peers and the notion of 'getting away with it' all contribute to keeping the cycle of bullying going.

Then there is the 'victim' perspective. As per the discussion above, victims generally have to be perceived by bullies as someone who is less powerful than them. This could take the form of being less physically powerful than the bully as per this study by Bejerot and colleagues***** on how poor performance in physical education classes might be a risk factor for being bullied or this study by Wildhaber and colleagues****** discussing asthma-related bullying. It could also be someone who 'stands out' from the crowd as discussed in this study by Kukaswadia and colleagues******* on obesity being a determinant of bullying. As per this editorial, "the symptoms of the disorder are the exact reasons that make young people with autism vulnerable". With that in mind, have a think about the suggestion of hyper vs. hypo-theory of mind (see here) with bullying and autism in mind.

Without trying to cherry-pick the evidence, other research on some of the hows and whys of bullying, victims and their behaviour (as per studies like this one and this one and this one) to some degree correlate with my view including this very interesting piece from the American Psychological Association.

I know some people might read all this psycho-babble and ask questions like 'why can't society be kinder?' and 'who would pick on a child with autism?'. I too ask those questions. The simple fact however is that children, like adults, whether with or without autism or other labels, are complicated and the way society like schools are set-up combined with that human nature means that bullying is probably always going to be present to some degree. Where there is social structure, there's always going to be people who want to be top dog. Where there are differences, there will probably always be some degree of prejudice. These aren't nice thoughts, but unfortunately it is current reality.

But that's not to say that something can't be done to moderate those bully and victim characteristics. Quite a few people seem to be talking about bullying prevention and interference strategies and I believe that when they work, they can work very well. So little things like bullying victims being able to tell someone about their experiences, through to proactive processes and policies at a school and even at a societal level designed to educate and stop would-be bullies from starting their 'give me your dinner money' ways. There are some obvious issues with some of these suggestions when applied to some cases of autism and the characteristic presentation of the condition but I don't really have the space in this post to go into specifics now.

If you're still reading this, I would perhaps also offer another tool in the anti-bullying arsenal: self-defence skills. As per the title of this post, I am not condoning violence in any way, shape or form by saying this and realise that bullying covers so much more than just physical action. But let's face it, with all the will in the world and support from parents, schools, whoever, there are always going to be situations where a child is on their own and potentially faced with a bully or bullies. Particularly when bullying turns from words and phrases to 'sticks and stones' is where perhaps some degree of self-defence might come in handy. Note the stress on defence before any charges of incitement to violence are levelled at me. And I'm not the only one suggesting this by the way.

Searching the literature on the use of martial arts / self-defence for people with autism, there are some interesting pieces of research to note. This poster presentation by Palermo and colleagues******** talks about how karate is not only a skill that can be taught to children with autism, but also a skill which might (in some cases) actually have some value-added benefits outside of just being able to 'take care of yourself'. Indeed other studies, whilst limited in quantity, have indicated similar potential gains from taking up martial arts as per this study by Bahrami and colleagues*********. If one takes the martial arts path to its natural progression in terms of the mental and physical discipline required and related concepts like mindfulness, you can perhaps see other potential benefits which might also accompany the various moves outside of just increasing self-confidence and physical empowerment.

I'll reiterate that I'm not suggesting that every child with autism trains up to be some kind of Keanu Reeves "I know Kung-Fu" warrior. And once again I am totally understanding of the voices of 'why would someone bully a kid with autism?' sentiments and the need to try and alter attitudes whether through education or indeed legislation. The trouble is that we live in a world where kids, some kids, can be very cruel and whether through ignorance or other factors, bullying is pretty much always going to be on the periphery of growing up just as it can, and often does, carry forward to the adult workplace. Having autism it seems, does not confer immunity to that premise. With all that in mind, does taking a wide ranging approach to managing bullying including an element of teaching self-defence really sound so un-PC?


* Sterzing PR. et al. Bullying involvement and autism spectrum disorders: prevalence and correlates of bullying involvement among adolescents with an autism spectrum disorder. Archives of Pediatrics & Adolescent Medicine. September 2012.

** van Roekel E. et al. Bullying among adolescents with autism spectrum disorders: prevalence and perception. JADD. 2010; 40: 63-73.

*** Montes G. & Halterman JS. Bullying among children with autism and the influence of comorbidity with ADHD: a population-based study. Ambulatory Pediatrics. 2007; 7: 253-257.

**** Dickerson Mayes S. et al. Suicide ideation and attempts in children with autism. Research in Autism Spectrum Disorders. 2013; 7: 109-119.

***** Bejerot S. et al. Poor performance in physical education - a risk factor for bully victimization. A case-control study. Acta Paediatrica. 2011; 100: 413-419.

****** Wildhaber J. et al. Global impact of asthma on children and adolescents' daily lives: the room to breathe survey. Pediatric Pulmonology. 2012; 47: 346-357.

******* Kukaswadia A. et al. Obesity as a determinant of two forms of bullying in Ontario youth: a short report. Obesity Facts. 2011; 4: 469-472.

******** Palermo MT. et al. Karate and autism spectrum disorders: sports as treatment for social cognition deficits. Archives of Disease in Childhood. 2008; 93: ps540.

********* Bahrami F. et al. Kata techniques training consistently decreases stereotypy in children with autism spectrum disorder. Research in Developmental Disabilities. 2012; 33: 1183-1193.

---------- Sterzing PR, Shattuck PT, Narendorf SC, Wagner M, & Cooper BP (2012). Bullying Involvement and Autism Spectrum Disorders: Prevalence and Correlates of Bullying Involvement Among Adolescents With an Autism Spectrum Disorder. Archives of pediatrics & adolescent medicine, 1-7 PMID: 22945284