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Autism Therapy

What types of bullying do ASD adolescents in inclusive schooling experience and what is the impact on their lives?

Jennifer Althaus
June 2023

Introduction

Autism Spectrum Disorder (ASD) is a neurological disorder characterised by deficits in social communication and interaction and restricted and repetitive behaviours. ASD adolescents experience more frequent bullying than their neurotypical peers (Ashburner et al, 2019; Fink et al, 2017; Cappadocia et al, 2012). Whilst inclusion in education is important, research has found that autistic school-aged youth with ASD are observed to be at greater risk of bullying than their non-ASD peers (Forrest et al, 2020).

Volkmar and Pete (2012) define bullying as a person (or group of persons) who use power, strength, or some kind of dominant position to intimidate a person or persons who are perceived to be more vulnerable or weak. Hwang et al (2017) define bullying as a perpetrating behaviour by children and adolescents who hold and/or try to maintain dominant position over others; bullying requires clear intent to cause mental and/or physical suffering to another; it is a dynamic and complex social interaction. Forrest et al (2020), using a social ecological perspective to understand bullying, states bullying victimisation to consist of complex interactions between peers and their broader social environment. Hodgins et al (2020) states bullying of autistic adolescents to be of interest given that it is a familiar life
experience for these adolescents. Hsiao et al (2021), in their study, found a sevenfold increased risk of bullying involvement among autistic youths compared to their neurotypical peers.

All referenced articles agree that the definition of bullying is the power of an individual or group over another. Advantages by the bully/ies are obtained through advantage in social status, physical size/strength, intellectual ability, or membership of the dominant group. This definition is used for the purpose of this paper.

For this paper, the referenced articles were compiled into Table 1(below), breaking them into the types of bullying, contributing factors to bullying of autistic adolescents and the impact on bullying on autistic adolescents. Articles were sourced using Griffith University
Online Library, Google Scholar, Proquest Education and EBSCOhost. Articles were sourced from the areas of education and criminal justice.

This paper focuses on the traditional bullying models of physical, verbal, and social victimisation. Although researched articles have included cyberbullying this is a complex area that presents with different social understandings and implication so has not been included in this paper.

Table 1: Overview of research papers.

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Physical Bullying

 

Physical bullying is the use of physical force or violence such as hitting, kicking, punching, shoving, pushing, or tripping to intimidate, harm or control another person. This may leave physical injuries, along with psychological and emotional trauma.

 

Research shows that peer friendship acts as a protective barrier to physical bullying. The forming of positive peer relationships relies on the understanding of social cues, shared social understandings, verbal and nonverbal communication and empathy (Forrester et al, 2020). Most, if not all, of these are found to be deficit in autistic youth, although on varying levels.

 

The use of aggressive behaviour as a tool to fight back against bullies or as a coping mechanism can impact the reaction by bullies and in turn have them labelled as perpetrators and seen unfavourably by their peers. Aggressive behaviours associated with Attention Deficit Hyperactivity Disorder, Oppositional Defiant Disorder or Conduct Disorder are more likely observed in individuals with ASD (Hsiao et al, 2022). Hsiao et al (2020) makes a point in stating that this behaviour, when seen as perpetrator behaviour, is different from that of bully behaviour where the aggression is pro-active and goal-directed to control others and gain social power.

Verbal Bullying

 

Verbal bullying is the use of words toward another with the goal of intimidating or harming them. This may involve the use of derogatory words to belittle or demean the person, ridiculing or teasing them, using words to threaten them or the spreading or rumours or gossip about them.

 

Assertive and healthy communication in face-to-face interactions with your peers is important during the adolescent years. From the age of 11 years conversation skills become more important than play skills (Coppadocia et al, 2012). Communication impairments (speech and understanding) place autistic youth at an increased risk of victimisation by their peers (Cappadocia et al, 2012).  As children age and develop they come to understand that verbal bullying is equally, if not more effective, in hurting their victim (Cappadocia et al, 2012). This form of bullying is less likely to be detected by adults and able to be carried out in a wide variety of situations.

 

Social Bullying

 

Social bullying is the damaging of a person’s social relationships, status, reputation, or sense of belonging. Like verbal bullying the bully may spread rumours or gossip, sharing false information that tarnishes the victim’s social reputation. The bully may influence others, taking control of the victim’s friendships and relationships.

 

Deficits in social and communication skills make it difficult for autistic youth to initiate and sustain peer interaction.  This corelates to difficulties forming and maintaining friendships placing them in a position of poor peer relationships (Cappadocia et al, 2012; Hwang et al, 2017).

 

Discussion

 

Adams et al (2016) talk of the importance inclusive education plays in the exposure of autistic adolescents to typically developing peers, ensuring adequate education and normative social experiences. The downfall to this is that for autistic adolescents bullying is at its highest at a time when the approval and inclusion of peers is at its highest.

 

Analysis of research shows autistic youth are more likely to bring bullying with them from primary school, and take it into adulthood, than their neurotypical peers. Volkmar and Pete (2021) found bullying to peak in middle childhood and adolescents – persisting into adulthood. An earlier study by Fink et al, (2017) found bullying to decrease with age but still be at its highest at the beginning of secondary school. Hwang et al (2017) found studies in US, Canada, UK and Netherlands to report bullying prevalence to be as high as 75% for autistic individuals as victims and 46% for autistic individuals as perpetrators. Whilst Fink et al, (20170 found both girls and boys as equally likely to be victimised, Volkmar & Pete (2021), when speaking of perpetrators, found boys to be more likely to engage in physical aggressive bullying whereas girls more the social aggression of gossip and rumours.

 

ASD presents complex and varied characteristics in the domains of social and communication and repetitive and restrictive behaviours. Individuals with ASD often carry an array of comorbid conditions that may go undetected.  Theory of Mind, the ability to understand that others have their own unique thoughts, perspectives and mental experiences that differ from yours, also plays a role in contributing factors. A deficit in Theory of Mind makes it difficult for autistic youth to predict and interpret the actions and behaviours of others, playing a role in social interactions, empathy, building friendships and relationships and communication. This makes autistic individuals more trusting, or gullible, and less likely to recognise bullying.

 

Children with poor social skills and few friends are marginalised and unprotected within the social group and are vulnerable to the abuse of power by peers (Cappadocia et al, 2012). Volkmar and Pete (2021) found victims to be less likely to have friends and be less actively involved with peers in the classroom setting. Having a close friendship and positive relationships is an established protector factor against peer victimisation - this protective factor is often absent in individuals with autism (Hwang et al, 2017). Adolescents who present with a lower level of social impairment may be aware of victimisation and be more likely to report it, but these students may also be more involved with peers so more victimised (Ashburner et al, 2019).

 

Hsiao et al (2022) mentions autistic individuals as being targets for bullying due to their pervasive difficulties in social communication and interactions adding that the ASD diagnosis may keep youths from asserting themselves against being perpetrated by others. Hsiao et al (2022) did not find any results confirming that the autistic severity plays any role in effecting the pathway to victimisation whereas Rodriguez et al (2021) found evidence severity played a role in victimisation (ages 5-21 years), with the more severely autistic experiencing more victimisation.

 

Social bullying was the focus of most of the research articles over that of physical and verbal bullying. This is a reflection on the social deficit characteristics of ASD and the restrictive and repetitive behaviours that are outside the social norm of neurotypical peers. The school years are the years of social importance with lifelong social skills being developed in the education setting.  As well as being more vulnerable to bullying, the lack of social skills places ASD students at higher risk of being ignored by their peers and purposely excluded (Adams et al., 2016). Autism-related social deficits may make it difficult for youth with ASD to determine whether the behaviour of others is ill intention (Fisher& Taylor, 2016).

 

Socio-environment factors come into play as contributing factors to bullying. Brewer and Young (2018, p.76-77) talk of extended ostracism and social rejection leading to eventually feeling worthless and angry and aggressive towards others. They go as far as linking extended exclusion and social rejection to leading to behaviours that have the potential to lead to criminal activity.

 

Relationships with proximal social contexts such as family and peer group may contribute to victimisation experiences. Parents represent primary social agents and play a critical role in social development and understanding (Cappadocia et al, 2012). An individual’s relationship with their parents, teachers and community may contribute to the experiences of victimisation. Having a strong adult connection provides a social community of trust and protection that is cohesive to the reporting of bullying. 

 

Bullying literature on typical developing youth indicates that peer victimisation experiences are related to poor parent-child relationships (Cappadocia et al, 2012). Research shows that children who are bullied are three times more likely to have a parent with greater mental health problems (Cappadocia et al, 2012). These parents are less able to create a social environment that supports their child and changes the dynamics of the bullying situation (Cappadocia et al, 2012). Children who have been maltreated within their family were found by Volkmar and Pete (2021) to be significantly more likely to be bullied. The impact on low self-esteem and self-worth due to maltreatment may play a role in their attraction to the bully, with bullying victimisation further escalating their low self-esteem and self-worth. Volkmar and Pete (2021) mention the risk of bullying to youth who identify as LGBTQ, there sexual preference creating a further wedge in the social peer circle.

 

The impact of bullying on autistic adolescents presents serious and lifelong negative outcomes. Table 1 gives an insight into the extent of the impact of bullying and the negative outcomes it may have on social and communication, self-esteem, and emotional regulation, areas that already present with deficits in those with ASD. Victims are at risk of negative short- and long-term consequences such as depression, anxiety, low self-esteem, and delinquency (Volkmar & Pete, 2021). Parents and teachers may initially see a drop in school attendance, poor grades, truancy, and social withdrawal. Adams et al (2016) found students with ASD to receive less support from their classmates, spend more time in solitary activities and spend less time in cooperative interactions with classmates. The immediate effects of physical bullying that may be noticeable are physical injuries, missing money or electronic devices and school avoidance or refusal, with less obvious effects being increased anxiety or depression or suicidal ideation (Volkmar & Pete, 2021). Ashburner et al, (2019), in relation to impact at home, speak of parents stating the child would hold it together at school, becoming angry and upset when they came home. In relation to impact on a student’s self-esteem and mental health Ashburner et al (2019) records reports from parents who speak of the victims symptoms of depression and ‘ spirals going downward.’

 

Effects that go unnoticed and are of high concern are those that are internalised. Lu et al, (2020) reports there is strong evidence to support the association between bullying and the onset of mental health conditions in students with ASD. Cappadocia et al (2012) found children who experience internalising mental health problems tended to exhibit less assertiveness and self-confidence than their peers. Internalised impacts may also present externally as problems in conduct, aggression, and predatory behaviour. Parents of children who were interviewed by Cappadocia et al, (2012), and who’s children were rated as experiencing high levels of victimisation (one or more a week), found their children to have higher levels of anxiety, hyperactivity, self-injurious and stereotypic behaviour, and over sensitivity than children who experience no victimisation or low levels of victimisation. 

 

Forrest et al, (2020), Brewer and Young, (2018) and Cappadocia et al, (2012) bring attention to current and future delinquent and criminal behaviour as an impact of bullying. Brewer and Young (p. 77, 2018) state it seems likely that extended exclusion or social rejection may in some cases lead to behaviours that have the potential to culminate in criminal activity but also state, ‘Being bullied does not, by itself, translate into criminal offending by individuals with ASD, otherwise prevalence estimates would be much higher.’ (p.76). Forrest et al, (2019) speak of the far-reaching consequences of anti-social behaviour and future criminal behaviour on individuals and schools. This behaviour has far reached community and governmental consequences. Research shows that youth who are bullied are more likely to exhibit psychosomatic symptoms, poor social and emotional adjustment and significant social problems that include delinquent behaviours such as substance abuse, carrying weapons and physical fighting (Cappadocia et al, 2012). On substance abuse Brewer and Young (2018) report statistic by the Australian Institute of Criminology that show around two-thirds of samples collected from autistic individuals who were engaged in crime tested positive for at least one drug other than alcohol. Although Brewer and Young (2018) mention no link to substance abuse and bullying they link it to psychiatric disorders of which they state as co-existing with ASD and being a contributing factor to bullying and social rejection.

 

Conclusion

 

Accumulating research shows that bullying is more prevalent in autistic youth than their neurotypical peers. ASD presents with deficits in social and communication and repetitive and restricted behaviours which are cohesive to the poor social interactions that lead to physical, verbal, and social bullying. Deficits in Theory of Mind add increased risk of bullying of autistic youth as they are more trusting and gullible and more likely to misinterpret negative peer behaviour as positive behaviour.  

 

Understanding the risk factors for bullying and the impact they have on lives helps guide intervention programs that prevent new and further bullying within the education setting. There is researched evidence that concludes that the impact of bullying leads to negative social and emotional adjustment, anxiety, and delinquent behaviour. Existing comorbid conditions play a role in the likely hood or extent of bullying happening along with external environmental factors. The association between bullying victimisation and the school environment comprises of multiple factors, including parental engagement in school affairs, positive interpersonal interactions, peer social support and the quality of friendships (Lu et al, 2020).

 

Volkmar and Pete (2021) found bullying to peak in middle childhood and adolescents – persisting into adulthood. Analysis of research showed autistic youth to be more likely to bring bullying with them from primary school and take it into adulthood than their neurotypical peers. Bullying programs should be part of all education curriculums from the start of the schooling years through to the final secondary years. Successful positive bullying programs would lead to less hostility and disobedience in the classroom, less truancy, higher school engagement and higher academic achievement by students.

 

Peers play on important role in the dissolution of bullying. School bullying programs should include an understanding of the deficits of neurological disabilities, creating an acceptance of difference and a protective barrier to negative mental well-being, whilst promoting positive social relationships. Social capital that includes a supportive school environment, a sense of community and positive interpersonal and intergroup relationships is important to the prevention of youth bullying in the education setting and the wider adult community.

 

The education environment plays an important role in the protection of youth with ASD from bullying. Youth spend a large majority of their day within the social realms of the education environment, including the higher education of TAFE and university.  It is within this environment that they develop continued social interactions. Research shows that students with ASD who experience high social cohesion, harmony and assistance within the education environment have lower risks of insults, teasing and social exclusion (Lu et al, 2022).

 

Forrest et al, (2020), Brewer and Young, (2018) and Cappadocia et al, (2012) bring attention to current and future delinquent and criminal behaviour as an impact of bullying. Further research on the impact of bullying and its relationship to the high rate of youth crime, that is currently creating a division between youth and communities, needs to be undertaken. The key to lessening youth crime may lie in the prevention of bullying within the education system that impacts the social behaviours within the wider community of youth with ASD.

References

 

Adams, R., Taylor, J., Duncan, A., & Bishop, S. (2016). Peer Victimization and Educational Outcomes in Mainstreamed Adolescents with Autism Spectrum Disorder (ASD). Journal of Autism and Developmental Disorders, 46(11), 3557-3566. https://doi.org/https://doi.org/10.1007/s10803-016-2893-3

Ashburner, J., Saggers, B., Campbell, M. A., Julie, A. D. W., Yoon‐Suk, H., Carrington, S., & Bobir, N. (2019). How are students on the autism spectrum affected by bullying? Perspectives of students and parents. Journal of Research in Special Educational Needs, 19(1), 27-44. https://doi.org/https://doi.org/10.1111/1471-3802.12421

 

Brewer Neil, Young, Robin (2018). Crime and autism spectrum disorder: myths and mechanisms. Jessica Kingsley Publishers.

 

Cappadocia, M. C., Weiss, J. A., & Pepler, D. (2012). Bullying Experiences Among Children and Youth with Autism Spectrum Disorders. Journal of Autism and Developmental Disorders, 42(2), 266-277. https://doi.org/10.1007/s10803-011-1241-x

Fink, E., Olthof, T., Goossens, F., van der Meijden, S., & Begeer, S. (2018). Bullying-Related Behaviour in Adolescents with Autism: Links with Autism Severity and Emotional and Behavioural Problems. Autism: The International Journal of Research and Practice, 22(6), 684-692. https://doi.org/https://doi.org/10.1177/1362361316686760

 

Fisher, M. H., & Taylor, J. L. (2016). Let's Talk about It: Peer Victimization Experiences as Reported by Adolescents with Autism Spectrum Disorder. Autism: The International Journal of Research and Practice, 20(4), 402-411. https://doi.org/https://doi.org/10.1177/1362361315585948

 

Forrest, D. L., Kroeger, R. A., & Stroope, S. (2020). Autism Spectrum Disorder Symptoms and Bullying Victimization Among Children with Autism in the United States. Journal of Autism and Developmental Disorders, 50(2), 560-571. https://doi.org/https://doi.org/10.1007/s10803-019-04282-9

 

Hodgins, Z., Kelley, E., Kloosterman, P. et al. Brief Report: Do You See What I See? The Perception of Bullying in Male Adolescents with Autism Spectrum Disorder. J Autism Dev Disord 50, 1822–1826 (2020). https://doi.org/10.1007/s10803-018-3739-y

Hsiao, Mei-Ni, Tai, Yueh-Ming,Wu, Yu-Yu, Tsai, Wen-Che, Chiu, Yen-Nan,  Shur-Fen Gau, Susan, (2022) Psychopathologies mediate the link between autism spectrum disorder and bullying involvement: A follow-up study, Journal of the Formosan Medical Association,Volume 121, Issue 9,Pages 1739-1747,

https://doi.org/10.1016/j.jfma.2021.12.030.

 

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Hwang, S., Kim, Y. S., Koh, Y.-J., & Leventhal, B. L.. (2018). Autism Spectrum Disorder and School Bullying: Who is the Victim? Who is the

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Lu, H.-H., Chen, D.-R., & Chou, A.-K. (2022). The school environment and bullying victimization among seventh graders with autism spectrum disorder: a cohort study. Child and Adolescent Psychiatry and Mental Health, 16(1). https://doi.org/10.1186/s13034-022-00456-z

Rodríguez, G., Drastal, K., & Hartley, S. L. (2021). Cross-lagged model of bullying victimization and mental health problems in children with autism in middle to older childhood. Autism : the international journal of research and practice, 25(1), 90-101. https://doi.org/10.1177/1362361320947513

 

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