PEDIATRICS Vol. 120 No. 5 November 2007, pp. 1226-1227 (doi:10.1542/peds.2007-2187)
LETTER TO THE EDITOR |
Relevance of Motor Skill Problems in Victims of Bullying
Susanne Bejerot, MDDepartment of Clinical Neuroscience
Section Psychiatry St Göran
Karolinska Institute
SE-112 81 Stockholm, Sweden
Mats Humble, MD
Department of Clinical Sciences
Lund University
SE-205 02 Malmö, Sweden
Biological Psychiatry Research Group
Universitetssjukhuset MAS
SE-205 02 Malmö, Sweden
To the Editor.—
We were pleased to see that bullying again was discussed in the July issue of Pediatrics.1 The authors showed that bully victimization is associated with the prevalence of headache, stomachache, sleeping problems, nervousness, and more frequent use of medication. Previous longitudinal studies have confirmed that bullying leads to increased risk of physical symptoms, whereas the direction of causality for psychological factors remains uncertain. Unfortunately, the results from this study shed no additional light on this complex issue. Although the directionality of bullying and emotional problems is complicated, it is, according to our view, essential to prevent bullying. As adult psychiatrists we know that exposure to severe bullying in childhood will continue to influence the person's self-image and trust in others in adulthood. Also, those who have only been afflicted by milder forms of bullying will probably remember this humiliation all through their lives.
A relationship between bully victimization and having poor social skills has been shown,2,3 but to determine if poor social skills are the result of being bullied or are the cause requires not only large prospective longitudinal studies but also time-consuming assessments. Other ways to disentangle this complex matter could be to study conditions related to the target issue, but where the direction of causality is less disputed. Children with autism spectrum disorder (ASD) run a high risk for becoming severely bullied, as testified to in numerous autobiographies. Indisputably, it is more likely that the subjects' poor social skills, defined in the diagnostic criteria for ASD, give rise to the bullying than that bullying causes their ASD.
According to Rutter,4 autism might be based on a continuously distributed dimension rather than a distinct category. A broader phenotype of milder varieties of ASD is probably common in the general population. If poor social skills frequently result in being bullied, subjects with the ASD phenotype would be overrepresented in the bully-victim population. One way of identifying this phenotype could be to study motor skills. Motor impairment is strikingly common in ASD.5–7 We assume that children with motor impairment would perform poorly in physical education. On the basis of these assumptions, we hypothesized that bullying victimization would be more common for children with poor performance in physical education compared with those with superior performance.
To challenge our hypothesis we conducted a somewhat unorthodox study on the audiences, all professionals, attending a series of day conferences on psychiatric disorders in adults during 2006–2007 (N = 1043; 85% female; mean ± SD age: 44 ± 11 years; range: 19–71 years). The conferences were held in 7 different Swedish cities on 9 occasions. During the course of the day the participants were asked to respond anonymously to a few questions, presented 1 at a time, in a slide show. They were asked if they had been bullied in school (not at all, a little, or severely) and to estimate their own performance in physical education. We supplemented our investigation on the 3 last conferences by adding an additional question on their academic performance in school (above average, average, or below average). Bullying was not otherwise mentioned in the conference lectures until after this assignment was accomplished.
Exposure to bullying was equally common at all locations and in both genders. Thirty percent reported that they were bullied in school at least to some degree. More men than women reported superior performance in physical education (
2 = 10.1; degrees of freedom [df] = 2; P = .006). Academic performance, however, did not differ between genders. Those participants who acknowledged being poor performers in physical education (27% [n = 263]) were exposed more often to bullying than those who reported superior performance (2 = 28; df = 2; P = .000001), whereas the relationship between reported academic achievement and exposure to bullying was nonsignificant (n = 316; 2 = 5.2; df = 2; P = .08).
In our view, being a target of bullying per se does not determine a poor psychosocial outcome. We propose that a poor psychosocial outcome in bullied subjects mostly reflects a previous low social capacity that may generate aversive feelings in peers who instinctively respond by bullying. This is likely to result in a vicious cycle with increased anxiety and maladjustment, which possibly explains more frequent use of medication. However, one should keep in mind that having an ASD phenotype, per se, may increase the risk for several physical and mental symptoms.
To prevent bullying it is crucial to understand why certain children are at risk for becoming victims and to enhance other children's understanding and acceptance for those with poor social skills. To accomplish this is a true challenge, but without adequate guidance it is difficult for any child to suppress instinctive behaviors, and there is a high cost for those who become their targets. Political correctness says that being a victim of severe bullying is likely to be a random event. Everyone who has gone through school knows that this is not true, which should be kept in mind when planning intervention and prevention programs against bullying.
REFERENCES
- Due P, Hansen EH, Merlo J, Andersen A, Holstein BE. Is victimization from bullying associated with medicine use among adolescents? A nationally representative cross-sectional survey in Denmark.
Pediatrics. 2007;120
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[Abstract/Free Full Text] - Kaukiainen A, Salmivalli C, Lagerspetz K, et al. Learning difficulties, social intelligence, and self-concept: connections to bully-victim problems. Scand J Psychol. 2002;43 :269 –278[CrossRef][Web of Science][Medline]
- Fox CL, Boulton MJ. The social skills problems of victims of bullying: self, peer and teacher perceptions. Br J Educ Psychol. 2005;75 :313 –328[CrossRef][Web of Science][Medline]
- Rutter M. Autism research: lessons from the past and prospects for the future. J Autism Dev Disord. 2005;35 :241 –257[CrossRef][Web of Science][Medline]
- Ghaziuddin M, Butler E. Clumsiness in autism and Asperger syndrome: a further report. J Intellect Disabil Res. 1998;42 :43 –48[CrossRef][Web of Science][Medline]
- Freitag CM, Kleser C, Schneider M, von Gontard A. Quantitative assessment of neuromotor function in adolescents with high functioning autism and Asperger syndrome. J Autism Dev Disord. 2007;37 :948 –959[CrossRef][Web of Science][Medline]
- Sahlander C, Mattsson M, Bejerot S. Motor function in adults with Asperger's disorder: a comparative study. Physiother Theory Pract. 2007; In press
PEDIATRICS (ISSN 1098-4275). ©2007 by the American Academy of Pediatrics
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