Amy Seery MD Via Christi Medical Center Family Medicine Residency September 2013

Is avoiding technology the answer? Is this really affecting my child? How does cyberbullying occur? Is cyberbullying really that harmful for anyone? What if my child is the victim? Or the bully?

Cultural Inertia

ClassSchoolCityStateNation Worldwide

Overt Physical (hitting, kicking, gym aggression, having personal items stolen) Verbal (name calling, mocking, teasing) Relational Social exclusion, spreading rumors Cyberbullying

"Cyberbullying" is when a child, preteen or teen is tormented, threatened, harassed, humiliated, embarrassed or otherwise targeted by another child, preteen or teen using the Internet, interactive and digital technologies or mobile phones. Adult involvement is cyber-harassment or cyber-stalking Stopcyberbullying.org

Cyberbullying is different from traditional face-to-face aggression because of the anonymity of the mediums used. The distance between the perpetrator and the victim prevents the perpetrator from seeing the harmful consequences of their actions or to experience any sympathy/empathy for their victim.

Mean 24.4

VictimsBullies

October 2003 He was repeatedly sent instant messages from middle school classmates accusing him of being gay, and was "threatened, taunted and insulted incessantly" Bullying on the internet "amplified and accelerated the hurt and pain he was trying to deal with, that started in the real world". Growing Up Online (Chapter 6: "Cyberbullying")Growing Up Online (Chapter 6: "Cyberbullying"). [Television production]. Boston: PBS. January 22, 2008. Event occurs at 0:08:160:08:30. http://www.pbs.org/frontline/video/share.html?s=frol02n3b7q4e. Retrieved 2010-10-27.PBShttp://www.pbs.org/frontline/video/share.html?s=frol02n3b7q4e

October 2006 Witnesses testified that the women intended to use Meiers e-mails with "Josh" to get information about her and later humiliate her, in retribution for her allegedly spreading gossip about Drew's daughter Steinhauer, Jennifer (November 26, 2008). "Verdict in MySpace Suicide Case". New York Times. http://www.nytimes.com/2008/11/27/us/27myspace.html?_r=1&hp. Retrieved 2010-10-27."Verdict in MySpace Suicide Case"New York Times http://www.nytimes.com/2008/11/27/us/27myspace.html?_r=1&hp

July 2008 She had sent nude pictures of herself to a boyfriend. When they broke up, he sent them to other high school girls. The girls were harassing her, calling her a slut and a whore. She was miserable and depressed, afraid even to go to school. Celizic, Mike (March 6, 2009). Her teen committed suicide over sexing". Today Parenting- MSNBC. http://today.msnbc.msn.com/id/29546030. Retrieved 2010-10-27.Her teen committed suicide over sexing"

April 2009 "There is name-calling, there is teasing, but I will tell you that it is almost always done outside the presence of adults. There is a code of silence among the students." Time Magazine. Bullying: Suicides Highlight a Schoolyard Problem By Paige Bowers Wednesday, May. 20, 2009Paige Bowers

September 2010 The bullying took every form. "It was eye to eye, over the telephone, personal, over the Internet. He spent a lot of his life frightened." Time Magazine. The Bullying of Seth Walsh: Requiem for a Small-Town Boy By Bryan Alexander / Tehachapi Saturday, Oct. 02, 2010Bryan Alexander / Tehachapi

September 2010 His roommate had secretly recorded a video of Clementi kissing a guy; the video went up on YouTube. On Facebook, Clementi offered a final status update: "jumping off gw bridge sorry." Jonathan Lemire, Michael J. Feeney And Larry Mcshane (1 October 2010). "He Wanted Roomie Out Rutgers Suicide Complained Of Video Voyeur Before Fatal Fall". Daily News (New York): p. 2. Retrieved 2010-10-27."He Wanted Roomie Out Rutgers Suicide Complained Of Video Voyeur Before Fatal Fall"

September 21 st 2011- Freshman at NE High "We never even thought in a million years this would happen. It was a complete shock," Morawitz said. "We knew she was being bullied and that some crap was going on at school.... We tried to make the school aware of it. They knew what was going on, but they didn't do anything about it."

A continuum of cyberbullying: Ignored Disrespected Spreading Rumors Stalking Physical Threats

Minors involved = illegal Taken without consent = illegal Taken by the subject and handed over freely illegal

(aka: cyberbullying-by-proxy)

Abuse alcohol and other drugs in adolescence and as adults. Get into fights, vandalize property, and drop out of school. Engage in early sexual activity. Have criminal convictions and traffic citations as adults. In one study, 60% of boys who bullied others in middle school had a criminal conviction by age 24. Be abusive toward their romantic partners, spouses or children as adults. Are more likely to-

Have increased use of tobacco, alcohol or other drugs. Have increased mental health problems, including depression and anxiety. Are more likely to miss or skip school.

Mishna F, et al. Cyber Bullying Behaviors Among Middle and High School Students. American Journal of Orthopsychiatry. 2010. Vol 8, No 3, 362-374

Anger, revenge, frustration, jealousy Vengeance for the wronged friend Entertainment Boredom Ego booster Readily accessible Revenge of the Nerd- victim becomes the bully Impersonal nature of a screen

58% have not told their parents or an adult about something mean or hurtful that happened to them online. Cyberbullying is rarely reported Fear of retaliation or worsening of the bullying A major barrier is fear of losing internet or phone privileges. Kowalski R, et al. Electronic bullying among middle school students. Journal of Adolescent Health, 41, S22-S30. 2007. isafe.org

One of the most damaging effects is that a victim begins to avoid friends and activities, often the very intention of the cyberbully.

In general, peer harassment leads to: Hinduja S, et al. Bullying, Cyberbullying, and Suicide. Archives of Suicide Research. 14:206-221, 2010. Depression Decreased self- worth Hopelessness Loneliness Lower GPA / Grad rates Poor sleep patterns Emotionally labile Withdrawal Avoidance of media Lying Poor health (up to 3 yr) Use of violence in confrontations

CDC: suicide was the 2 nd leading cause of death among 10-24 year olds in 2010. Even though suicide rates have decreased between 1990- 2000 among young people, there has been an upward trend in 10- to 20-year olds from 2000-2010. Baldry A, et al. Direct and vicarious victimization at school and at home as risk factors for suicidal cognition among Italian adolescents. Journal of Adolescence. 26(6). 703-716. 2003. Centers for Disease Control and Prevention. 2007. Morbidity and Mortality Weekly Report, 56(35), 905-908.

Youth who are bullied are at an elevated risk for suicidal ideation, attempts, and completion of suicides. Among boys who were frequently bullied (at least once per week) 4% had severe suicidal ideation versus 1% in boys not bullied. In girls, of those bullied 8% had severe SI versus 1% in those not. Of those who bullied others at least once per week both boys and girls showed 8% increase of severe SI. Kaltiala-Heino R, et al. Bullying, depression, and suicidal ideation in Finnish adolescents: School Survey. British Medical Journal. 319(7206). 348-351. 1999.

Youth who experienced traditional bullying or cyberbullying, as either offender or victim, scored higher on suicidal ideation scales. Cyberbullying victimization was a stronger predictor of suicidal ideation than bullying or cyberbullying offending. Hinduja S, et al. Bullying, Cyberbullying, and Suicide. Archives of Suicide Research. 14:206-221, 2010.

Recognize the importance of online relationships for children and adolescents Counsel and demonstrate internet safety and responsibility Encourage efforts by schools and lawmakers Ask about your childs screen time (cell, tv, games, computer, etc.) Talk about your childs online life Talk about suicide with your child Encourage open communication between your child and their teachers, physician, and other trusted adults

Is it okay to snoop? Play-date analogy Use parental monitoring software and site filters Do NOT rely on these methods only An opportunity to reward good behavior Keep passwords for emergencies Check your childs internet History

Talk about allowable and unallowable sites BAN Ask.fm and sites that promote negativity Set a time limit for use Consistently apply firm consequences for inappropriate on-line behavior

Sexual Orientation Race Disability Mental health Poverty DepressionVictim

Use the right words (Avoid me & you) NO- I dont like what you posted about me. YES- That post doesnt belong on Facebook Using assertive language is most effective!

Facebook is making changes. Links provided allow children to respond to posts or images that they dont like in a constructive manner

Keep evidence of cyberbullying. Record the dates, times, and descriptions of instances when cyber bullying has occurred. Save and print screenshots, emails, and text messages. Use this evidence to report cyberbullying to web and cell phone service providers. Block the person who is cyberbullying. Report the cyberbullying to social media sites and internet service providers Cyberbullying behavior usually violates the terms of service

Cyber activities that include the following are crimes and should be reported to police: Threats of violence or extortion Child pornography or sending sexually explicit messages or photos Taking a photo or video of someone in a place where he or she would expect privacy Stalking and hate crimes

K.S.A. 72-8256 Introduced 2007 Amended in 2008 to include Cyberbullying March 2011- first week of Oct is Bullying Awareness Week Additional amendments to strengthen this law died in committee June 2012 USD 259 P1464 PUPIL BEHAVIOR REGULATIONS Bullying occurs in all forms including, but not limited to, appearance, status with a peer group (social power), intellectual, socio-economic, gender, race, sexual orientation, ethnicity, etc. Bullying in any form is prohibited on school property, in a school vehicle, or at a school-sponsored activity or event. In addition, bullying is prohibited while utilizing school property. Bullying includes Cyberbullying.

What doesnt work: Zero-tolerance policies Conflict resolution with peer mediation Group treatment for student who bully Simple, short-term solutions What does work: Role playing, practice scenarios as part of year-long curriculum Acknowledging bullying outside of school affects school performance and attendance Protecting students that report cyber bullying Strict monitoring of digital media use Helping to educate parents

School Violence Hotline 1-877-626-8203 If a child is bullied because of their race, ethnicity, or disability and local help is not working to solve the problem- Contact the U.S. Department of Educations Office on Civil Rights

No federal laws currently against bullying Only Harassment / Discrimination protection Qualifiers for Federal protection: Severe, Persistent, Pervasive Hostile environment (Students participation is limited) Race/EthnicColorSexDisability*Religion

D.D. v. R.R. In this cyberbullying case, D.C., a 15 year old student, and his parents brought a hate crime, defamation, and other claims against another student, R.R., and his parents concerning the posting of threatening and derogatory comments on the student, D.C.'s, web page. One comment referred to R.R.'s desire to "pound your head in with an ice pick". The court denied the special motion to strike under California Code of Civil Procedure 425.16. The Court of Appeal found that the defendants statements were true threats and were not protected speech and not a public issue. This case demonstrates that some instances of cyber bullying may not necessarily be protected under Freedom of Speech. D.C. v. R.R., 182 Cal. App. 4th 1190 (2010)

www.stopbullying.com www.stopbullying.com www.stopcyberbullying.org www.stopcyberbullying.org www.ncpc.org provides information about stopping cyber bullying before it starts. www.ncpc.org www.wiredsafety.com www.wiredsafety.com Growing Up Online Frontline- PBS, purchase DVD or view on-line at: www.pbs.org/wgbh/pages/frontline/kidsonline/view/ www.pbs.org/wgbh/pages/frontline/kidsonline/view/ www.commonsense.org

http://www.youtube.com/watch?v=ej7afkypUsc October 10 th, 2012

Baldry A, et al. Direct and vicarious victimization at school and at home as risk factors for suicidal cognition among Italian adolescents. Journal of Adolescence. 26(6). 703-716. 2003. Bandura A. 2002. Selective moral disengagement in the exercise of moral agency. J Moral Edu 31:101-119. Celizic, Mike (March 6, 2009). Her teen committed suicide over sexing". Today Parenting- MSNBC. http://today.msnbc.msn.com/id/29546030. Retrieved 2010-10-27.Her teen committed suicide over sexing" Centers for Disease Control and Prevention. 2007. Morbidity and Mortality Weekly Report, 56(35), 905-908. Centers for Disease Control and Prevention. Injury Prevention: Youth Violence: National Statistics. http://www.cdc.gov/violenceprevention/youthviolence/stats_at-a_glance/national_stats.html. Retrieved 2013- 09-09. http://www.cdc.gov/violenceprevention/youthviolence/stats_at-a_glance/national_stats.html. Common Sense media agreement for parents and kids (teens). www.commonsense.org. Retrieved 2013-09- 09.www.commonsense.org Growing Up Online (Chapter 6: "Cyberbullying")Growing Up Online (Chapter 6: "Cyberbullying"). [Television production]. Boston: PBS. January 22, 2008. Event occurs at 0:08:160:08:30. http://www.pbs.org/frontline/video/share.html?s=frol02n3b7q4e. Retrieved 2010-10- 27.PBShttp://www.pbs.org/frontline/video/share.html?s=frol02n3b7q4e Hinduja S, et al. Bullying, Cyberbullying, and Suicide. Archives of Suicide Research. 14:206-221, 2010. KSDE Bullying Prevention. Statement from the Kansas State Board of Education. Access from http://www.ksde.org/LinkClick.aspx?fileticket=KGbmh5hB-fY%3D&tabid=4732 on December 5 th, 2012. http://www.ksde.org/LinkClick.aspx?fileticket=KGbmh5hB-fY%3D&tabid=4732 Kaltiala-Heino R, et al. Bullying, depression, and suicidal ideation in Finnish adolescents: School Survey. British Medical Journal. 319(7206). 348-351. 1999. Kowalski R, et al. Electronic bullying among middle school students. Journal of Adolescent Health, 41, S22- S30. 2007. Kowalski R, et al. 2008. Cyber Bullying. Malden, MA: Blackwell. References

Jonathan Lemire, Michael J. Feeney And Larry Mcshane (1 October 2010). "He Wanted Roomie Out Rutgers Suicide Complained Of Video Voyeur Before Fatal Fall". Daily News (New York): p. 2. Retrieved 2010-10-27."He Wanted Roomie Out Rutgers Suicide Complained Of Video Voyeur Before Fatal Fall" Mishna F, et al. Cyber Bullying Behaviors Among Middle and High School Students. American Journal of Orthopsychiatry. 2010. Vol 8, No 3, 362-374. Pornari CD, et al. Peer and Cyber Aggression in Secondary School Students: The Role of Moral Disengagement, Hostile Attribution Bias, and Outcome Expectancies. Aggressive Behavior. Vol 36, pg 81-94. (2010) Steinhauer, Jennifer (November 26, 2008). "Verdict in MySpace Suicide Case". New York Times. http://www.nytimes.com/2008/11/27/us/27myspace.html?_r=1&hp. Retrieved 2010-10-27."Verdict in MySpace Suicide Case"New York Times http://www.nytimes.com/2008/11/27/us/27myspace.html?_r=1&hp Young, R. (Writer), & Ashlock, A. (Director). (2013). Facebook Debuts New Bullying Reporting Messages [Radio series episode]. In K. McKenna (Producer), Here and Now. Boston: NPR, WBUR.

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Amy Seery MD Via Christi Medical Center Family Medicine Residency September 2013