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Melanie Cole (Host): There's no handbook for your child's health, but we do have a podcast featuring world-class clinical and research physicians covering everything from your child's allergies to zinc levels.

Welcome to Kids Health Cast by Weill Cornell Medicine. I'm Melanie Cole. And today, we're talking with Dr. Hannah Simon. She's a child and adolescent psychiatrist at New York Presbyterian Weill Cornell Medical Center, and she's here to talk about bullying prevention.

Dr. Simon, it's a pleasure to have you with us. Before we get into this topic, such a good topic too, I'd like you to tell us a little bit about yourself. What does a child and adolescent psychiatrist really do?

Dr Hannah Simon: Thank you so much for having me, Melanie. It's such an honor to be here today. I'm really excited to talk about this very important and very timely topic. So as a child and adolescent psychiatrist, I am a physician by training. So, I'm a medical doctor. I specialize in diagnosing and treating mental health conditions that can affect thinking, feeling or behavior. And I treat children, adolescents. I also do work with adults and families as well.

Melanie Cole (Host): Well, thank you for that. So, what an important job you have, especially right now with the mental health epidemic that we've been seeing as a result of COVID and everything, my goodness. But we're talking today about bullying. I'd like you to tell us about the impact of bullying on kids and families. What's really considered bullying? Because I think there are different types and our whole view of this has changed a lot recently as well.

Dr Hannah Simon: Yes, absolutely. So just kind of starting off with an understanding and definition bullying, bullying is any repeated use of force of hurtful teasing or threat to deliberately cause harm to another person. Getting bullied can be a really traumatic experience for anyone and especially for a child. The act of getting bullied can cause children to have reduced self-esteem. It can make kids feel more depressed or anxious. They may not want to go to school. They may avoid scenarios that bullying can occur in. In some cases, bullying can have long-lasting effects on children's psychological wellbeing.

And bullying, it can present in a number of different ways and is really evolving as our technology moves at rapid paces. So, bullying can be physical, so pushing or shoving, that's kind of what we traditionally think of as bullying. It can also be verbal, using derogatory names, threatening. Bullying can exist as a psychological attack, which can include socially excluding or targeting individuals. Increasingly throughout the pandemic, bullying is occurring in the digital realm through cyberbullying. So, this can be any sort of attack on another that occurs on social media, through texting, on the internet, and it can be happening a lot more often in secret, where it's out of plain sight.

Melanie Cole (Host): Well then, Dr. Simon, what do we know about why kids bully? Is it loss of self-esteem? Are they mirroring something that was done to them? Are they subject to abuse at home or depression, anxiety? Do we know why kids bully?

Dr Hannah Simon: There really is a lot of research into the etiology of bullying, and the truth is that we really don't know definitively why kids bully. Oftentimes, kids that engage in bullying are not inherently "bad kids." They don't have antisocial traits. They do not go on to become criminals in the majority of cases.

More often, kids that engage in bullying are experiencing depression. They could be having difficulty making friends or regulating their emotions. They're hurting in some way, and they're expressing that hurt in the only way that they know how. In a lot of cases, kids who bully, they might be experiencing bullying at home or in other settings. And they have learned that bullying is how conflict is resolved. They don't know other ways of navigating, you know, social interactions. Some research suggests that kids who engage in bullying may have low self-esteem and they may actually feel better about themselves by putting others down. And some children may be seeking attention in a way they know how. They may not even fully realize the impact of their actions.

And then in other cases, bullying can exist in more subtle forms, psychological or cyberbullying. And in these cases, it may be that kids and adults can use bullying as a way to kind of strengthen or fortify their social position or advance themselves within a social hierarchy.

So, there's really a whole myriad of different reasons why kids bully. But I think the important thing to take away from this is that just because a kid may engage in bullying, it does not necessarily mean that they are a bad kid, right? They made a mistake and there's lots of opportunities to remedy that and lots of interventions that can really mitigate the amount and the impact and the severity of bullying.

Melanie Cole (Host): Yeah, I think it's sad situation for both the victim and the person doing the bullying. As you said, and such good points that you made, it could be depression. It could be abusive homes. So many things could be the cause of that. Let's talk about what happens to the victim, because, gosh, we've heard of some horrific impacts that bullying has had. Whether a child is, you know, been outed or they're different or something, we hear about horrible things that happened to children that have been bullied.

Dr Hannah Simon: Yeah. And it really is a huge problem, especially as we're talking about the mental health epidemic here in the US with children and adolescents, because there is absolutely an association between bullying and the victims experiencing some form of psychological trauma. Research shows that individuals persistently subjected to bullying, and this can include cyberbullying as well as physical or verbal bullying, have higher rates of depression, anxiety; in some cases, higher rates of body dysmorphia, so feeling really insecure about their body; having higher rates of loneliness, and they are more likely to have suicidal thoughts.

It's important also to recognize that bullying alone does not cause suicide, though it may increase one's risk, which is why it's so important to intervene early when you hear about someone, a kid, your child, a patient, someone being bullied, in order to help increase that individual's access to mental health resources, to make sure they have good social supports on board or, in some cases, to notify the appropriate authority, whether that's a child's parents, the teachers, in some cases, even law enforcement just because we know that the bullying can have such a devastating impact on kids mental health. And there are ways that we can intervene to really reduce that impact and help kids who are victims of bullying gain increased resilience and to have more positive coping skills.

Melanie Cole (Host): So, I think one of most important things we as parents can find out from you, Dr. Simon, is warning signs, red flags, that our child might be being bullied. How do we identify it? When it comes to our kids, what are we looking for?

Dr Hannah Simon: There's actually a great resource. It's called stopbullying.gov that outlines potential warning signs to look for when a child is being bullied. On the website, they outline some of these signs. They include unexplained injuries, lost or destroyed valuables, school avoidance, frequent school absences. Children may present with lots of headaches or stomachaches. These kind of non-specific physical symptoms, sudden avoidance of different situations. Maybe a child no longer wants to go to a sports practice or the swimming pool when they previously really enjoyed those activities. They can also have decline in grades, so you can see that kids may have frequently missed assignments or maybe zoning out in class. They can even have nightmares and sleep disturbances.

But as you can see, these signs are really non-specific, which makes it so incredibly difficult for teachers and parents to identify when a child is being bullied. This is why it's so important to ask children upfront if there's any suspicion that they may be being bullied at school. And a lot of times, kids may not even recognize that certain behaviors from peers are bullying. So, asking them in really clear, straightforward terms and maybe not even asking the child, are you being bullied, but asking them about peer interactions. Are there children that may be targeting you or said things to you repeatedly that made you feel uncomfortable, that pointed things out about you, about your physical appearance, that made you really upset?

Kids may not speak up about being bullied and for a number of reasons. They can feel embarrassed. They can feel deeply ashamed. There's also often a fear of retribution from the bully if they disclose their actions, they worry that they get the bully in trouble, there may be worse consequences for them. And in some cases, kids may just feel powerless against a bully and believe that their circumstances will not get better, even if they do report that they're being bullied.

Melanie Cole (Host): Yeah, it's a pretty complex problem, Dr. Simon. And those were all great points if we communicate, which obviously has been such an important aspect of finding out what your child is going through, whether it's depression or school avoidance or going into their room or sleeping more, any of these different kinds of things. What do we do next? What do if we find this out? Do we call the school? Do we call the parents of the bully? Do we call the police? What do we do?

Dr Hannah Simon: So, it's a really scary thing for a parent to find out that their child is being bullied. And I think, again, speaking as both a child psychiatrist, but also a parent, I think our instinct is we want to intervene right away, right? We want to march up to that kid and say, "How dare you insult my baby?" But the reality is that there are steps that can be more effective and ways that we can really better arm our children against bullying.

One of these things I recommend parents early on if there are concerns about bullying, to be an advocate, to talk to the school. Because bullying education through the school, if it's made in a developmentally appropriate way, can really be a strong weapon against future bullying.

If your child is being stalked or threatened with violence, of course, in those cases, you really should contact the police as well as the school. Because in extreme cases, bullying can be a criminal matter. But in the cases of most types of bullying that occured on the playground or on social media, really liaisoning with the school early on to make sure that they're aware of the situation.

And then, as far as talking to your child, I think there's a lot of ways that you can help them feel more confident and sort of cope ahead, prepare for those situations when they fear that they may be bullied. So, practicing role playing is something that I do with a lot of my patients, talking about ways to navigate these situations and really practicing for the child, if they are bullied, how can they approach an adult? How can they make sure that the school is aware and that someone is there to intervene? Because oftentimes that's really the barrier to kids getting the support they need, is they're just so afraid to speak up to an adult.

Melanie Cole (Host): Yeah. That's so interesting and true as well. What do you do if your child's the bully? What do when you find that out? If some parent comes to you or if the school calls you and tells you about your child's misbehavior and bullying attitude, what do you do then as a parent?

Dr Hannah Simon: So again, I think it's important to reiterate that a lot of kids do engage in bullying behaviors at various times. And sometimes this is kind of developmentally normal or appropriate, or this is how they're sort of learning how to navigate social situations. Just because a child bullies, it does not mean that they are inherently a bad kid and that there really are corrective actions to help them learn that their behaviors are harming others and to help them grow in a more mature and appropriate manner.

So, I would start by really talking through the situation with your child. Kind of sit them down and say, "Listen, there's some concerns at school," in a judgment-free way, in an open, honest manner. Allow your child to explain what was going on, what was the reason for the bullying behaviors. It's important to explain that these actions are hurtful and have the child engage in perspective taking, meaning asking your child "I heard that you called Sally this name. How do you think that felt to Sally?" Or "I heard you posted something really mean on Veronica's social media site, on her Instagram. What do you think that felt like for Veronica, knowing other people are reading that comment?" So, making sure that they can really understand the victim's point-of-view and better relate to their experience.

And then with your child, this is another opportunity to help cope ahead and help them prepare for future social interactions. So, knowing healthier ways, more productive ways, more pro-social ways that they can manage these types of interactions. So, if it seems like the child tends to bully one kid or has made comments directed at one individual and they might say, "Well, you know, Sally was really mean to me and she posted a really unflattering photo" and then, have them practice better ways for, "Okay, let's say Sally posts another photo. What can we do instead of retaliating or instead of trying to mock her or troll her on social media? What are some other ways that we can manage the situation?"

And then, I think it's also important to kind of look inward, because there are instances where kids that bully might be mirroring certain behaviors that they experience, interactions they see at home or in other environments. In some cases, as we had talked about earlier, it could be in response to their own depression or anxiety or problems regulating and expressing their emotions. So, thinking about the environment that you're creating for this child at home and whether this an environment that's nurturing their psychological wellbeing?

And then, of course, there should be meaningful consequences. So after you've gone through all these steps, and if your child continues to bully, it's really important that you show that this is not acceptable and that there are consequences that will be enforced. So, let's say your child, going back to the social media, that posting and the cyberbullying, a consequence maybe we'll take your phone away or we'll delete your Instagram account if you're going to be posting things that are derogatory in nature or offensive to other kids. And so, I think that taking a hard stance and showing your kids that this behavior is not acceptable and that there are real consequences, if it does continue.

Melanie Cole (Host): Dr. Simon, this is all such important information from all the sides of this fence. So as we wrap up, I'd like you to answer a few questions. First, for parents, I'd like you to summarize the importance of that communication with our pediatrician, our medical home, our school system; if need be, a specialist, an expert in mental health to help our children with this mental health epidemic, bullying, all the things, which bullying now takes such a different picture. And as we're communicating with our children, if our children do see something like this on the playground at the mall or cyberbullying, they see this happening, do you have some suggestions about to whom they should turn and what they should do?

Dr Hannah Simon: Again, bullying, this is an issue that comes up a lot as a child psychiatrist. I've seen both kids presenting who have been bullied and are feeling more anxious or depressed. I've also seen parents express concerns, "I think that my child might be bullying another. What do I do?" And I think just having that communication with me as a child psychiatrist, the school, the pediatrician in a lot of cases and the family is so important. So, having open dialogue, recognizing that this is an issue that really is multifactorial that affects all different realms medically, psychologically, academically, and that in order to target bullying, it really needs to be all hands on deck sort of approach.

As far as what to tell kids when they do see bullying happening at school, the phrase at this point, especially in New York, on the subway, we hear it all the time, "See something, say something." But it really is so important because with bullying, as we know with just the amount of peer pressure and social coercion, a lot of times bystanders are too afraid to speak up or do anything, and that just enables bullying behavior to continue. So, even if you're not the victim or you're not the "bully", if you're witnessing this happening either at school, on the internet, at home, it's so important to speak up to an adult. So, go to a teacher, a guidance counselor. If they're not available, go to a parent and you can always speak with your pediatrician or your mental health provider. But it's so important that this is something that's handled by authority. Because when kids try to navigate conflict resolution with bullying, it often does not end well and it can really escalate. So, I think just getting adults involved early is really important in attacking this issue.

Melanie Cole (Host): I think so too, and it's a complex issue and certainly getting more complex, which as you mentioned about cyberbullying and this whole new realm and the new way kids can bully each other and hurt each other's feelings, but such great information. Dr. Simon, thank you so much for joining us.

And Well Cornell Medicine continues to see our patients in person as well as through video visits, and you can be confident of the safety of your appointments at Well Cornell Medicine. That concludes today's episode of Kids Health Cast. We'd like to invite our to download, subscribe, rate, and review Kids Health Cast on Apple Podcast, Spotify, and Google Podcast. And for more health tips, please visit weillcornell.org and search podcasts. And don't forget to check out Back to Health. I'm Melanie Cole.

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