Cyberbullying is defined as “the use of technology to harass, threaten, embarrass or target another person.” According to 2016 data, approximately 34 percent of children have been bullied online or through mobile digital devices such as smartphones. Given the number of children and adolescents affected by cyberbullying, as well as the negative short- and long-term health effects on its victims, today’s clinicians must learn the signs of cyberbullying, how it affects their patients, and how to prevent and treat associated health outcomes.
Cyberbullying and traditional bullying
Bullying is the systematic exploitation of a perceived power differential in which the more powerful repeatedly, often increasingly, harm the less powerful. Traditional bullying, such as name calling, slander, social ostracism, and physical threats and abuse, is often linked to cyberbullying. Those who experience traditional bullying at school or on the playground often experience it online, and those who bully others often do so both IRL (in the “real world”) and online. While physical abuse cannot occur online, other forms of traditional bullying can, and because the power differential is less clear in the digital domain, cyberbullying allows a greater proportion of “bully-victims” — those who are victimized online then turn around and victimize others.
Traditional boy bullying is often physical in nature, with larger or stronger males inflicting harm against their weaker peers. Female bullying is typically more psychological, preying on victims’ vulnerabilities, insecurities or social status. As a result, adolescent girls are far more likely to experience cyberbullying than adolescent males.
A recent study making headlines found that children who own smartphones are more likely to be cyberbullied than those who do not. While a seemingly easy fix would be to advise our patients and their parents to ban all internet-connected devices, this would not address the underlying issues of children’s development of healthy human relations, misdirecting blame on powerful, but passive, digital tools for cyberbullying behaviors.
We have to remember that bullying is opportunistic. Smartphones give children the opportunity to do all kinds of things, from learning about and seeing distant places and entertaining themselves with funny videos to interacting with others nearby and around the world. What the researchers found isn’t necessarily surprising — when given access to smartphones, children are more likely to get involved in cyberbullying (as well as a host of other desirable and undesirable activities) because of the opportunity owning a digital device presents.
Children, tweens and teens are still developing impulse control, empathy, effective interpersonal communication, and how to make oneself feel good and be respectful to oneself and to others. What we’re seeing is not that smartphones have changed our children into bullies, but that they are behaving, as children always have, without fully-developed executive functions. Because mobile interactive media can spread their behaviors farther and faster than ever, they need to be taught to use these powerful tools effectively, mindfully and respectfully.
What clinicians can do
Given that children are spending more and more of their waking time on screens, we have to feel comfortable with and take responsibility for addressing their digital lives as part of caring for their health and well-being. The digital domain is a large part of their world and we need to be able to help them live there in healthy, safe, developmentally optimal ways. As such, issues of cyberbullying must be addressed in all well-child visits, both with the patient and their parents (when possible), beginning with the questions below:
- What internet-capable devices does your child have? Smartphone, tablet, laptop?
- Define social media. Many parents and children think it is only apps such as Facebook and Snapchat. However, there are many, many forms such as YouTube, texting, etc. It is also important to ask what social media their child is using. Mention the Children’s Online Privacy Protection Act (COPPA). Many parents are unaware or don’t mind their under-13-year-old child violating this federal law designed to protect underage children from being exploited by marketers.
- Ask parents if they have any concerns about their child’s online behaviors.
- Ask parents if they have noticed any difference in their child’s behaviors, especially connected with their social media use/device use.
- Ask about what rules are in place for their child’s social media use, and offer constructive guidelines. Consider using the American Academy of Pediatrics’ Family Media plan.
When the child’s parent is not present, ask your patient directly if they or any of their friends are being cyberbullied. Reassure your patient that this is not an attempt to get them off their devices or to take them away, but to help them master them. Asking broad questions, such as “Have you come across anything online that makes you feel uncomfortable?” can open the door.
Reaching out to the BACPAC program
Boston Children’s Bullying and Cyberbullying Prevention and Advocacy Collaborative (BACPAC) team is available when your patient needs us. The anti-bullying program consists of pediatric experts including neurologist and BACPAC Program Director Peter Raffalli, MD, FAAP, a social worker and an education resource specialist. The program was founded in 2009 and is the first of its kind in the United States.
During a patient appointment, our team listens to the child and offers strategies to combat bullying. These strategies include:
- educating the family about the child’s rights under federal and state laws
- providing strategies to help end bullying situations and bullying-prevention advice for the future
- offering empowerment strategies on how to develop a network of adult staff at school that could be available to the child and who could advocate for the child at the level of the principal’s office when reporting bullying
- offering ways to improve friendship groups as a strong friendship group (this has been shown to be an insulating factor against bullying)
- providing a list of various state agencies that could be called upon if the family feels the school is not adequately troubleshooting the situation
- reports/documentation and recommendations to share with the school in the hopes that the suggestions could be used by the school to protect the child/victim
Clinicians must be as alert to the signs and symptoms of victimization as they are to physical or sexual abuse. Cyberbullying, if left unaddressed, can cause children and adolescents to feel vulnerable, isolated and scared, believing that no one understands what they are going through. In part, it is because they do not tell anyone, for fear of both retaliation by the bully and the parental or school “solution” of taking their device. Clinicians must be as alert to the signs and symptoms of victimization as they are to physical or sexual abuse. Understanding that the child may be fearful that their phone will be confiscated, clinicians must ask about cyberbullying, opening the door to disclosure in a non-judgmental way. If the patient is victimized, ask your patient if he or she has ever sent hurtful images or messages themselves.
Taking away the device is not the solution, not only because kids will work around it by using other devices, but because it blames the technology rather than solving the human behavior. It is the behavior of not just one child, but their social group; it is the culture of their school or community that must be addressed.
Cyberbullying is a social illness that can be healed by building a culture among youth of mutual respect and self-respect, one in which differences are valued, and one in which hurting another, online or in person, is not acceptable to anyone.
Additional clinician resources:
- Center on Media and Child Health: Cyberbullying
- The Center on Media and Child Health: Clinician Toolkit
- Bullying and Cyberbullying Prevention and Advocacy Collaborative (BACPAC)
- Samantha’s story: Partnering with BACPAC program to end bullying
Learn more about Boston Children’s Center on Media and Child Health and the Bullying and Cyberbullying Prevention and Advocacy Collaborative (BACPAC).
About the author: Michael Rich, MD, MPH, FAAP, FSAHM, is the founder and director of the Center on Media and Child Health at Boston Children’s Hospital and associate professor at Harvard Medical School and Harvard School of Public Health. He is the recipient of the AAP’s Holroyd-Sherry Award and the SAHM New Investigator Award, has developed media-based research methodologies and authored numerous papers and AAP policy statements, testified to the United States Congress and makes regular national press appearances.