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Bullying Among Adolescents With Autism Spectrum Disorders: Prevalence and Perception

Bullying Among Adolescents With Autism Spectrum Disorders: Prevalence and Perception J Autism Dev Disord (2010) 40:63–73 DOI 10.1007/s10803-009-0832-2 OR IGINAL PAPER Bullying Among Adolescents With Autism Spectrum Disorders: Prevalence and Perception Eeske van Roekel Æ Ron H. J. Scholte Æ Robert Didden Published online: 8 August 2009 The Author(s) 2009. This article is published with open access at Springerlink.com Abstract This study examined: (a) the prevalence of time, to negative actions on the part of one or more other bullying and victimization among adolescents with ASD, students (Olweus 1993). Bullying can have serious con- (b) whether they correctly perceived bullying and victim- sequences and is related to later behavioral and emotional ization, and (c) whether Theory of Mind (ToM) and bul- problems in bullies as well as in victims (Scholte et al. lying involvement were related to this perception. Data 2007). Until now, research on bullying in adolescence has were collected among 230 adolescents with ASD attending focused predominantly on adolescents attending general special education schools. We found prevalence rates of education settings, while surprisingly little attention has bullying and victimization between 6 and 46%, with been given to special needs adolescents such as those teachers reporting significantly higher rates than peers. with autism spectrum disorders (ASD). In special needs Furthermore, adolescents who scored high on teacher- and children and adolescents, peer victimization has been self-reported victimization were more likely to misinterpret found to be more prevalent in children with special health non-bullying situations as bullying. The more often ado- care needs (Van Cleave and Davis 2006), Specific Lan- lescents bullied, according to teachers and peers, and the guage Impairment (Conti-Ramsden and Botting 2004), less developed their ToM, the more they misinterpreted chronic disease (Nordhagen et al. 2005), internalizing bullying situations as non-bullying. Implications for clini- problems and psychosomatic symptoms (Kumpulainen cal practice are discussed. et al. 1998), learning disabilities and co-morbid psychi- atric problems (Baumeister et al. 2008), and in children Keywords Bullying  Perception  Autism  Adolescents  who were more likely to have had contact with mental Prevalence  Theory of Mind health services in the past 3 months (Kumpulainen et al. 2001). Furthermore, bullying was more prevalent among children with behavioral, emotional or developmental problems (Van Cleave and Davis 2006), attention deficit Introduction disorder, depression and oppositional/conduct disorder Bullying in school is a common problem worldwide (Kumpulainen et al. 2001), and psychiatric problems (Smith et al. 1999). The estimated rates of bullying and (Nordhagen et al. 2005). None of these studies have victimization worldwide vary from 5 to 38% for girls, and examined bullying and victimization among adolescents from 6 to 41% for boys (Due et al. 2005). Bullying is a with ASD, who may be especially at risk for bullying and subtype of aggression that may be defined as a systematic victimization. There are at least two reasons why special abuse of power (Smith and Sharp 1994), in which a needs children and adolescents are at higher risk for person (i.e., the victim) is exposed, repeatedly and over bullying and victimization: they are less socially compe- tent (Whitney et al. 1992) and have fewer friendships (Martlew and Hodson 1991). These reasons may also E. van Roekel (&)  R. H. J. Scholte  R. Didden explain why adolescents with ASD may be at higher risk Behavioural Science Institute, Radboud University Nijmegen, for bullying and victimization, but none of the studies P.O. Box 9104, 6500 HE Nijmegen, The Netherlands on adolescents with special needs have examined this. e-mail: [email protected] 123 64 J Autism Dev Disord (2010) 40:63–73 Therefore, the purpose of this study is to examine bul- Empirical data on the association between ASD and bul- lying and victimization among adolescents with ASD. lying involvement in special education are still lacking. Therefore, the focus of the present study is on examining Prevalence of Bullying and Victimization Among bullying and victimization among adolescents with ASD in Adolescents With ASD special education. One reason why adolescents with ASD may be at higher Perceptions of Bullying risk for victimization is that they have deficits in devel- oping normal social interactions and relationships as well The perception of bullying and victimization consists of as deficits in understanding the behavior of others (Frith two main parts: first, one has to perceive that the action and Hill 2004). In general education settings, adolescents is aggressive in nature, and second, one has to perceive with ASD may be at higher risk for victimization because that this aggression is directed towards a person who is of characteristics related to ASD, such as their deficits in relatively weaker than the aggressor(s), which refers to an communication and their stereotyped behavior and inter- imbalance of power. A7lthough it can be expected that ests (Haq and Le Couteur 2004). Furthermore, they may bullying and victimization are related to ASD, an also be at higher risk for victimization because of their important question is whether adolescents with ASD can problems with developing friendships (Bauminger and actually perceive bullying or victimization when it Kasari 2000; Chamberlain et al. 2007), which is a risk occurs. Individuals with ASD have deficits in Theory of factor for victimization (Hodges et al. 1999). To our Mind (ToM) skills, which is the ability of individuals to knowledge, only two studies have examined peer victim- attribute mental states to themselves and to others in ization among children and adolescents with Asperger order to explain and predict behavior (Baron-Cohen syndrome in general education settings (Little 2001, 2002). 2000). Mental states include beliefs, desires, intentions, Results of these studies showed that, compared to the perceptions, imagination, and emotions (Repacholi and nondisabled population, victimization rates were four Slaughter 2003). People with ASD are supposed to have times higher in this sample, with up to 75% of adolescents a deficit in the understanding of minds and mental states with Asperger being victimized (Little 2001). Furthermore, of other people (Frith and Hill 2004), and consequently Little (2002) found that 94% of the children with either also in understanding the intentions of others. In high- Asperger Syndrome or Nonverbal Learning Disability functioning autism, ToM abilities are more developed, were victimized in the past year, as reported by their but the adolescents still score significantly lower than mothers. non-disabled peers (Baron-Cohen et al. 1997; Happe ´ 1994). Because of these deficits in social insight, ado- There may also be several reasons why adolescents with ASD are at higher risk for bullying others, both in general lescents with ASD may be less able to recognize bullying and in special education settings. First, adolescents with than adolescents without ASD. Unlike adolescents with ASD are often found to show increased levels of aggressive ASD, we expect typically developing adolescents to be behaviors (Matson and Nebel-Schwalm 2007; McClintock able to recognize bullying as they are likely to possess et al. 2003). Since bullying can be considered a specific the social skills and social insight to perceive bullying kind of aggression, adolescents with ASD might also be behavior correctly. more at higher risk for bullying others. Second, because A small number of studies have revealed that ado- adolescents with ASD have limited insight in social pro- lescents with autism are not able to interpret social sit- cesses (Frith and Hill 2004), they may not be aware of the uations correctly, possibly as a result of their less well consequences of their own behavior, and may thus bully, developed social insight. For example, Pierce et al. without being aware of it. Previous research on the asso- (1997) examined social perception in children with aut- ciation between ASD and perpetrating of bullying among ism by showing videotaped vignettes of both positive and adolescents has to some extent supported these hypotheses. negative social interactions with varying numbers of In general education settings, it has been found that mostly, social cues (e.g., verbal content, tone, nonverbal behavior adolescents with ASD were as likely to bully as typically with object, and nonverbal behavior without object). developing adolescents. However, when adolescents with They found that children with autism scored significantly ASD had co morbid Attention-Deficit/Hyperactivity Dis- lower on interpreting social situations than the compari- order, they turned out to be five times more likely to bully son groups when the social perception stories contained than neurotypical adolescents (Montes and Halterman more than one cue. Loveland et al. (2001) found that the 2007). group with ASD had significantly more problems in Until now, studies on ASD and bullying involvement detecting inappropriate behaviors in video fragments than have been conducted in general education settings. the non-ASD group, but only for scenes that included 123 J Autism Dev Disord (2010) 40:63–73 65 verbal behavior. These results imply that children with Methods ASD can understand and recognize simple (one-cued) social situations, but fail to correctly understand more Participants complex social situations. It can thus be expected that adolescents with ASD will have difficulties with recog- The sample for this study consisted of adolescents with nizing bullying behavior. ASD who attended schools for special secondary education However, not all adolescents with ASD will be equally in the Netherlands. The participants were derived from disabled in recognizing bullying behavior, because differ- three special education schools, all located in the eastern part of The Netherlands. These schools were primarily ences in this group exist in several relevant characteristics that are important in the perception of bullying. The first focused on educating adolescents with ASD, thus all stu- relevant characteristic is ToM. It may be expected that dents from these schools had a diagnosis of a disorder in adolescents with a higher developed ToM are better in the the autistic spectrum. The diagnoses in this sample were perception of bullying than adolescents with a lower the following: Autism Spectrum Disorder (ASD; n = 35), developed ToM. The second characteristic that may be Pervasive Developmental Disorders Not Otherwise Speci- important in the perception of bullying is the level of fied (PDD-NOS, n = 123), and Asperger Syndrome victimization. Adolescents who report to be frequently (AS; n = 29). Several adolescents had an additional victimized have experienced many negative interactions diagnosis of Attentional Deficit/Hyperactivity Disorder and situations, and thus may be biased in their perception (ADHD; n = 31). These diagnoses were set by qualified of social situations. The final relevant characteristic is the psychiatrists or psychologists, based on DSM-IV criteria. level of bullying. Results from studies on social perception Participants were 230 adolescents with ASD, of whom 208 in aggressive children and adolescents reveal that they have were boys. They were 12–19-years-old (M = 14.97, deficits in their perception. Aggressive children and ado- SD = 1.45), and the level of education varied from voca- lescents perceive, interpret, and make decisions about tional to pre-university education. Their mean total IQ was social stimuli in ways that increase the likelihood that they 97.07 (SD = 14.64). will engage in aggressive acts (Crick and Dodge 1996). Furthermore, a control group was selected to check Aggressive children attribute hostile intentions to ambig- whether the perceptions of adolescents with ASD differed uous provocation situations more often than other children, from the perceptions of adolescents without ASD. This and they expect positive outcomes from aggressive acts control group consisted of 24 adolescents (22 boys, 2 girls) who followed secondary education. These adolescents and perceive aggression as a useful means for obtaining desired goals (Crick and Dodge 1996). Furthermore, sev- were group matched with the group of adolescents with ASD on educational level, age (M = 15.5), and sex. As eral studies have found that stronger anger attribution bias (perceiving anger from non-anger cues) predicted higher was the case with the ASD adolescents, passive informed levels of aggression (Fine et al. 2004; Schultz et al. 2000). consent from these adolescents and their parents was Since bullying is a subtype of aggression, it may be obtained. Before starting the study, a pilot study was expected that especially bullies show deficits in their per- conducted on a small sample of adolescents to pilot test the ception of bullying. video clips (see ‘‘Measures’’). This pilot sample contained 26 adolescents (11 boys, 15 girls), aged between 12 and The Present Study 14 years, with an educational level comparable to the educational level of the ASD adolescents and control group The main hypothesis of this study is that adolescents with adolescents. Both the control sample and the pilot sample ASD have difficulties in recognizing bullying behavior. were recruited by contacting schools and parents by letters The specific aims of the present study were: (a) to examine and asking for parental consent. the prevalence of bullying and victimization among ado- lescents with ASD, and (b) to examine whether adolescents Procedure with ASD are able to perceive bullying and victimization and which factors are related to this perception. The data The special secondary education schools were recruited by were collected among adolescents with ASD attending contacting the principals by telephone. After the schools three special education schools by administering ques- consented to participate, parents of 242 adolescents were tionnaires among these adolescents and their teachers, and sent a letter in which they were informed about the aims of by examining their evaluation of videotaped fragments of the study and they were asked to give their consent. Parents social interactions. In this study, we will focus on adoles- of twelve students refused to give their consent, because cents with ASD, we will not distinguish between the dif- the research would be too intrusive for their children, or ferent subtypes of ASD. because their children were already involved in other 123 66 J Autism Dev Disord (2010) 40:63–73 studies or clinical research. Therefore, our final sample This final score indicates how often that participant bullies consisted of 230 adolescents with ASD. or is bullied (varying from never to several times a week). Data were collected during classroom visits by the first The scores on all ratings (peer-, teacher- and self-) could author. The questionnaires were administered group wise. vary between 1 and 5. To maximize the probability that all adolescents had the Teacher-ratings on bullying and victimization. The same definition of bullying in mind, the definition of bul- teachers filled in a questionnaire which included the same lying was printed on a questionnaire, and the experimenter questions as in the peer ratings. They had to rate every read the definition out loud in the class to make sure the child in their class on the two questions mentioned above. participants understood the concept of bullying. Subse- The teachers were the class tutors. The number of hours a quently, the participants were asked whether they under- teacher was in the classroom varied from 3 to 7 h a day stood the definition and they were instructed to ask for on average. These teachers knew their students well and clarification if they had any questions. The video fragments were also present during lunch breaks and on the were shown to participants in their classroom. After each playground. fragment, the video was paused, and the participants were Self-ratings on bullying and victimization. All partici- asked to write down on the questionnaire whether or not pants also rated themselves on the two bullying related that fragment contained bullying (yes or no). The ques- questions, thus indicating how often they thought they tionnaire and the video fragments were administered within bullied or were bullied. 45 min. Participants were allowed to take a 5 min break Perceptions of bullying. To measure the ability to rec- between the administration of the questionnaire and the ognize bullying, video fragments which represented social video fragments. situations were shown to and evaluated by participants. The ToM task was computerized, and was individually These video fragments were selected from a Dutch tele- administered on computers with an internet connection. vision show and two Dutch movies, which were all suitable The instructions for the ToM task were given on screen. for adolescents. The selected 14 video fragments contained This task did not need any additional instruction or bullying situations and positive social interaction situa- supervision from the investigator or the teacher. The tions. To check whether this categorization was unambig- duration of this task was 15 min. uous, the fragments were first evaluated by four independent researchers. The agreement between the Measures researchers on which fragments contained bullying and which did not was 95%. To examine whether non-disabled Peer-ratings on bullying and victimization. To measure adolescents would perceive the bullying, a pilot study was conducted on 26 adolescents in a general education setting, peer-reported levels of bullying and victimization, partici- pants had to rate on a 5-point Likert scale how well each of who were matched with the group of adolescents with ASD their class members fitted two behavioral descriptions on age and educational level. The video fragments were related to bullying and victimization. The item for bullying shown to them in their classroom. They had to score was ‘bullies other children’, and the item for victimization individually whether or not each fragment contained any was ‘is victimized’. The answer categories were: (1) bullying (yes/no format). The results of this pilot were in ‘never’, (2) ‘a few times a year’, (3) ‘once a month’, (4) concordance with the categorization made by the ‘once a week’, and (5) ‘several times a week’. The par- researchers. The average agreement between the adoles- ticipants were provided with a list of names of their class cents was 93%. In total, all 14 fragments were selected, of members, and had to rate how often each class member which eight contained bullying and six contained positive displayed the behavior described. The following descrip- social situations (i.e., no bullying). The average length of tion of bullying was given: ‘Bullying is when a child or a the fragments was 33 s, ranging between 12 and 51 s. The group children regularly say unpleasant or mean things to fragments contained the three different types of bullying another child, or laugh at another child, who can not that have been distinguished in previous studies (Bjo ¨ rkqvist defend himself/herself. It is also bullying when a child is et al. 1992): physical bullying, verbal bullying, and rela- regularly hit, kicked, threatened, locked up, or when his or tional bullying. An example of a fragment that contained her belongings are taken or destroyed. It is also bullying bullying is a clip in which a group of boys and girls are when a child is regularly shut out, or when other children laughing at one of their classmates and making funny faces spread rumors or lies about him/her. It is not bullying when towards her. An example of a positive situation is a clip in two children of the same strength argue or fight’ (Olweus which a group of boys and girls are planning a surprise 1991; Whitney and Smith 1993). The scores were summed party for one of their friends. The 14 fragments were pre- for every participant, and then divided by the number of sented to the adolescents in four random orders, to avoid raters in that class to account for differences in class size. order effects. To be able to examine whether the 123 J Autism Dev Disord (2010) 40:63–73 67 adolescents with ASD would perceive and report bullying were combined to create one measure for ToM. We also in the video fragments differently from adolescents from examined the results for all the ToM tests separately, but the general population, we also showed the video frag- these results did not differ from the combined ToM test. The ments to the control group of 24 adolescents without ASD, total score of the ToM task could vary between 0 and 22. The and compared the results of this group with the results from reliability of all ToM tasks combined was a = .803. the adolescents with ASD. We decided to examine the type of mistakes that were made by participants, in stead of a total perception score. Results Two types of mistakes could be made. First, the partici- pants could misinterpret non-bullying situations, rating First, we calculated the intercorrelations for all variables. them as if bullying occurred in the video fragments (i.e., As can be seen in Table 1, the three different ratings of false positives), or secondly, they could misinterpret bul- bullying (i.e., teacher-, peer-, and self-report) were signif- lying situations, rating them as if no bullying occurred in icantly related to each other, as were the ratings for the video fragments (i.e., false negatives). These two victimization. variables were computed by summing the mistakes that Subsequently, the means and standard deviations were were made by each participant, and by categorizing them examined for the bullying and victimization measures and into false positives and false negatives. The scores on false the ToM task. For bullying, the means varied between 1.67 positives could vary between 0 and 6, the score on false for peer- and self-reports (SD = 0.82 and 1.13, respec- negatives could vary between 0 and 8. tively) and 2.49 for teacher-reports (SD = 1.47). For vic- Theory of Mind-Task. For assessing ToM-skills, several timization, the means were 2.12 for teacher-reports tests were used. First, first-order false belief was assessed (SD = 1.25), 1.50 for peer-reports (SD = 0.78), and 1.63 by administering the Sally and Ann task (Baron-Cohen for self-reports (SD = 1.15). The average ToM scores was et al. 1985), and second-order false belief by administering 14.60 (SD = 4.41). These results show that the mean level the Ice-Cream Story (Bauminger and Kasari 1999; Perner of bullying and victimization reported by teachers is higher and Wimmer 1985). In addition, an advanced test of ToM than the mean level of bullying and victimization reported was included to further discriminate between the partici- by the adolescents themselves (peer- and self-reported). ´ ´ pants (Happe 1994). Happe (1994) developed the Strange Stories test, which consists of a set of stories about Prevalence of Bullying everyday situations where people say things they do not literally mean. Ten story types were included, which rep- To examine the prevalence of bullying and victimization in our sample, we calculated the percentages of adolescents resent different aspects of ToM (such as white lie, pretend, double bluff, and sarcasm). The participants were presented involved in bullying and victimization. There are several with a story, and subsequently had to answer two questions: criteria to allocate adolescents into the ‘bully’- or ‘victim’ a comprehension question (‘was it true, what X said?’) and category. According to Solberg and Olweus (2003), the a justification question (‘why did X say that?’). The most valid cutoff point for classifying adolescents as vic- answers on the justification questions were rated on a tims and/or bullies is more than ‘two times a month’. 3-point scale: incorrect (0 points), partly correct (1 point), However, for distinguishing the most extreme bullies and and completely correct (2 points). The different ToM tests victims, more than ‘once a week’ is the most useful cutoff Table 1 Intercorrelations for all variables 123 45 6 7 8 9 1. Bullying (teacher) – 2. Bullying (peer) 0.59** – 3. Bullying (self) 0.44** 0.38** – 4. Victimization (teacher) 0.23** 0.14** 0.09 – 5. Victimization (peer) 0.16* 0.15* 0.11 0.51** – 6. Victimization (self) 0.10 0.01 0.21** 0.38** 0.47** – 7. Theory of Mind -0.14 -0.44 0.09 -0.16* 0.03 0.05 – 8. False positives -0.06 -0.04 0.14 0.15* 0.11 0.15* -0.14 – 9. False negatives 0.17* 0.17* 0.12 0.04 0.02 0.04 -0.18** -0.05 – * p \ .05, ** p \ .01 123 68 J Autism Dev Disord (2010) 40:63–73 point. To calculate the prevalence of bullying and victim- standardized residuals of the peer report indicated that they ization, we used these two criteria for including adolescents reported significantly less bullying and victimization than in the ‘involved’ or ‘non-involved’ category. The more expected (r =-4.8, -4.0, -4.4, and -4.4, respectively). severe criterion was that adolescents had to have a score of An interesting finding concerning the prevalence of bul- four or higher on the bully or victim variables, which lying and victimization reported by teachers is that they corresponds with bullying or being bullied more than once significantly reported far more bullying and victimization a week. The adolescents included in these categories were than the adolescents reported about their peers and about the extreme bullies or victims. The less severe criterion themselves. Furthermore, peers reported significantly less was that adolescents had to have a score of three or higher bullying and victimization than expected. These results on the bully or victim variables, which corresponds with may seem to be in contradiction with the descriptive results bullying or being bullied more than once a month. The presented earlier, because the means for the peer- and self- adolescents in these categories were the moderate to reports on bullying were equal. However, although the extreme bullies or victims. To examine the prevalence of means are equal, the distribution of the scores is different, bullying and victimization, we calculated the percentages which explains the different prevalence rates. of adolescents involved in bullying and victimization, categorized into the moderate to extreme group and the Perceptions of Bullying extreme group. These prevalence rates can be found in Table 2. First, we examined the self-reported perception of bullying As can be seen in Table 2, teachers report more bullying in our sample. The mean score on all video fragments was than peers and the adolescents themselves. To test whether 12.77 (SD = 1.14, range 0–14) and the average number the differences between the teacher- and the peer- and self- of false positive and false negative mistakes was .69 ratings were significant, chi squares were calculated for the (SD = 1.04) and .65 (SD = .83), respectively. Further- four sub tables. The percentages of adolescents involved in more, to examine whether the ASD adolescents’ scores on bullying and victimization significantly differed by raters, the video fragments were significantly different from a for moderate to extreme bullies, v (2, N = 658) = 89.23, distribution based on chance, we conducted binomial tests p \ .05; extreme bullies, v (2, N = 655) = 43.47, p \ .05; on the 14 video fragments. The results from these tests moderate to extreme victims, v (2, N = 658) = 55.00, were significant for all 14 items (p \ .001), indicating that p \ .05; and extreme victims, v (2, N = 655) = 41.91, the ASD adolescents scored significantly better than could p \ .05. Subsequently, the standardized residuals were be expected by chance. We also compared the results examined to determine which cells contributed most in of the ASD adolescents with results of the control group creating these differences (Haberman 1973). The stan- of adolescents without ASD. Results from a one-way dardized residuals are calculated by subtracting the ANOVA showed that the ASD group did not significantly expected frequencies from the observed frequencies, and differ from the control group in the scores on the video dividing this by the square root of the expected frequen- fragments (F[1] = .589, p = .443). All of these findings cies. For all four sub tables, the standardized residuals indicate that the ASD adolescents made very few false of the teacher report indicated that they reported signifi- positive and false negative mistakes, and were as able cantly more bullying and victimization than expected as adolescents without ASD to perceive and report on (r = 6.4, 4.4, 5.3, and 4.3, respectively). Furthermore, the bullying. Table 2 Percentages of More than once a month More than once a week adolescents with ASD who are (moderate to extreme group) (extreme group) Involved and non-involved in bullying and victimization Involved (%) Non-involved (%) Involved (%) Non-involved (%) Bullies Teacher-report 46 54 27 73 Peer-report 15 85 4 96 Self-report 19 81 12 88 Victims Teacher-report 30 70 18 82 Peer-report 7 93 0.4 99.6 Self-report 17 83 10 90 123 J Autism Dev Disord (2010) 40:63–73 69 Table 3 Linear regression analyses of Theory of Mind, bullying, and Table 4 Linear regression analyses of Theory of Mind, bullying, and victimization on false positives based on teacher- and self-reported victimization on false negatives based on teacher- and peer-reported bullying and victimization bullying and victimization False positives False negatives Teacher report Self report Teacher report Peer report B SE(B) b B SE(B) b B SE(B) b B SE(B) b ToM -0.02 0.01 -0.11 -0.30 0.01 -0.16 ToM -0.04* 0.02 -0.18* -0.04* 0.02 -0.18* Bullying -0.05 0.04 -0.09 -0.01 0.05 -0.01 Bullying 0.13* 0.05 0.18* 0.22* 0.09 0.18* Victimization 0.10* 0.05 0.15* 0.12* 0.06 0.16* Victimization -0.00 0.06 -0.01 0.02 0.09 0.02 Note: ToM = Theory of Mind Note: ToM = Theory of Mind * p \ .05 * p \ .05 Our main research question concerned the self-reported F(3,189) = 4.48, p = .005. This means that the higher the perception of bullying (categorized in false positive and level of ToM, the less false negative mistakes the adoles- false negative mistakes) and its relation with ToM, the cents made and the higher the level of bullying, as reported level of bullying and the level of victimization. Three by teachers, the more they misinterpreted bullying situa- tions as non-bullying. The proportion of variance explained multiple linear regression analyses were performed to explore the associations between ToM, bullying, victim- by all variables in the analysis was 7%. In the analysis with ization and the type of mistakes. The results were exam- peer reported bullying and victimization, ToM and peer ined separately for teacher-, peer-, and self-reported reported bullying were significant predictors of the number bullying. In all three analyses, ToM and the level of bul- of false negative mistakes made, F(3,191) = 4.56, lying and victimization were the independent variables, p = .004. This indicates that the higher the level of peer- and the number of false positive mistakes was the depen- reported bullying, the more adolescents misinterpreted dent variable. For peer reported bullying and victimization, bullying situations as non-bullying. This model explained the results were not significant. The results of the analyses 7% of the variance in false negative mistakes, when all with teacher- and self-reported bullying and victimization variables are taken account of. can be found in Table 3. As can be seen in Table 3, both teacher- and self- reported victimization were significantly related to the Discussion number of false positive mistakes, F(3,189) = 2.83, p = .005, and F(3,191) = 3.08, p = .004, respectively. The aims of the present study were: (a) to examine the This indicates that the more adolescents were bullied, as prevalence of bullying and victimization among adoles- reported by teachers and themselves, the more they mis- cents with ASD, and (b) to examine whether adolescents interpreted non-bullying situations as bullying. The pro- with ASD are able to perceive bullying and victimization portion of variance explained by all variables included in and which factors are related to this perception. the analyses was 4.3% for teacher reported victimization and 5% for peer reported victimization. Prevalence of Bullying and Victimization Second, we conducted three multiple linear regression analysis on ToM, bullying, victimization, and false nega- It may be concluded that bullying is prevalent among tives, one on teacher reported bullying and victimization, adolescents with ASD in special education schools. An one on peer reported bullying and victimization, and one important finding is that a large discrepancy exists between on self-reported bullying and victimization. In all three the level of bullying reported by teachers on the one hand, analyses, ToM and the level of bullying and victimization and by peers and adolescents themselves on the other hand, were the independent variables, and the number of false with teachers reporting higher levels of bullying than peers negative mistakes made was the dependent variable. The and adolescents. The prevalence rates based on peer- and results from the analysis with self-reported bullying and self-reports are in line with prevalence rates in children in victimization were not significant. The results from tea- general education settings found in other studies (Eslea cher- and peer-reported bullying and victimization can be et al. 2004), in which prevalence rates of 2 to 17% were found in Table 4. found, based on self-reports. The prevalence of bullying in As can be seen in Table 4, ToM and teacher reported our sample according to teachers is much higher than in bullying were significant predictors in the first analysis, children in general education settings. This is in contrast to 123 70 J Autism Dev Disord (2010) 40:63–73 results on studies on bullying and victimization in children victimization does not completely disappear, making the in general education settings, showing that teachers gen- transition from general to special education settings does erally tend to report lower levels of bullying than the seem to decrease the prevalence rates of victimization. An adolescents themselves (Beaty and Alexeyev 2008; Salm- explanation for this difference in victimization may be that ivalli 2002). In typically developing children, the main all adolescents attending these special education schools explanation for this lower level of bullying reported by have ASD. Therefore, the specific characteristics which teachers is that bullying often occurs outside the classroom makes special needs children and adolescents obvious (in toilets, lunchrooms, playgrounds, etc.), situations in targets in general education settings, such as their low which teachers are not always present. In our sample, social competence and the low number of friendships adolescents with ASD attend special education schools, in (Martlew and Hodson 1991; Whitney et al. 1992) are not which each class has their own teacher during most of the exceptional anymore, which may reduce the victimization day. During breaks, the students are under continuous rates. Furthermore, the structure and routine organization supervision of several teachers, in lunchrooms as well as on in special education schools seems to be higher than in the playground. Therefore, the teachers in our sample are general education settings, which might reduce the dis- probably able to report most of the bullying behavior that ruptive behavior of adolescents with ASD. occurs, and this may explain the higher percentages of both It is important to note that no conclusions can be drawn bullying and victimization in the current study compared to about who the best reporter of bullying and victimization outcomes of other studies in this area. The level of bullying is. Teacher reports may be valuable because they contain and victimization reported by peers in the present study information gained by adults who are relative outsiders of was significantly lower than the amount of bullying and the adolescent peer group. However, what teachers report victimization reported by teachers and by the adolescents differs from what the adolescents perceive about their own themselves. This is in line with results from previous situation and about their peer group. They may all have studies in children in general education settings, in which different interpretations of the bullying that occurs in their the level of bullying and victimization reported by peers is class. Hence the different reports may represent different generally lower than the level of bullying and victimization aspects of bullying. reported by adolescents themselves (Salmivalli 2002; Stassen Berger 2007). Perceptions of Bullying The prevalence rates of bullying of adolescents with ASD in our sample, as reported by peers, is in agreement Our findings provide several indications that the percep- with the prevalence rates found in adolescents with ASD in tions of adolescents with ASD on bullying were likely to be accurate. The ASD adolescents made very few mistakes on general education settings. In a study by Montes and Hal- terman (2007), 26% of the adolescents with ASD were the video fragments and performed much better than could classified as bullies. have been expected by change, as indicated by the results The prevalence rates for victimization (moderate to from the binominal tests. In addition, their perceptions on severe victims) varied from 7 to 30%, with peers reporting bullying did not differ significantly from the perceptions the least victimization and teachers reporting the most of adolescents from the general population. These are victimization. These rates indicate that victimization is also important findings, because adolescents with ASD are a prevalent problem in adolescents with ASD attending found to have deficits in their social perception. However, special education. As in bullying, the most striking result because the current study is among the first to examine was that teachers reported far more victimization than the peer-, and self-reported bullying among adolescents with adolescents themselves. This difference may be explained ASD, further research is warranted to replicate our by the same reasons given above concerning bullying. findings. The prevalence rates in the present study are in line with Another important finding of the present study was that prevalence rates of victimization in children in general the more often adolescents were bullied, as rated by education settings in 28 countries (Due et al. 2005). teachers and the adolescents themselves, the more they However, the rates found in the present study are much misinterpreted non-bullying situations as bullying (i.e., had lower than those found by Little (2001), who found a higher levels of false positive mistakes), even though the prevalence rate of victimization of 75% in children and effect sizes of these findings were relatively small. Ado- adolescents with Asperger syndrome attending general lescents who are bullied a lot may experience many neg- education settings. The level of victimization in adoles- ative interactions and situations, and as a consequence may cents with ASD in special education is thus much lower be biased in their perception and interpret neutral or posi- than the level of victimization in adolescents with Asperger tive situations more negatively. That only teacher- and self- syndrome in general education settings. Although the reported victimization were related to the number of false 123 J Autism Dev Disord (2010) 40:63–73 71 positives is not surprising. The adolescents who rate bullying and victimization were used. Third, we examined themselves as being victims (whether it is true or not) will the perception of bullying through video fragments, which, have experienced negative situations and thus may have a to our knowledge, has never been done in previous research bias in their perception. on bullying. Furthermore, the teacher probably rated the adolescents The present study also has some shortcomings. First, we who were actually bullied, or at least had experienced found that the level of bullying and victimization were negative situations, as victim, because they were in the significant predictors of the number of false negative and position to observe most bullying and victimization. Peers, false positive mistakes, respectively. However, because the on the other hand, probably do not perceive all victimiza- current study was correlational, no conclusions could be tion that occurs, because of their limited insight in social drawn about causal influences. It could be that adolescents processes. Victimization of their class members could with high levels of bullying and victimization develop a especially be hard to observe for them, because it does not distorted perception as a result of these high levels of directly involve themselves. The level of bullying was not bullying and victimization. On the other hand, it may also significant in predicting the number of false positives. And, be possible that a distorted perception in adolescents results surprisingly, ToM was not related to the number of false in a high involvement in bullying and victimization. positives. Second, in bullying research in general education set- Another striking result in the current study concerns the tings, the results are often examined for boys and girls false negative mistakes. We found that the more often separately. Boys usually bully more than girls (Haynie adolescents bullied, as rated by teachers and peers, the et al. 2001) and use more direct, physical types of bul- more they misinterpreted bullying situations as non-bully- lying, while girls are more involved in indirect, relational ing. As was the case with the false positive mistakes, the bullying (Rivers and Smith 1994). In the present study, effect sizes for these findings were also relatively small. we could not examine the results for boys and girls, The relationship between the level of bullying and false because the sample size of girls was too small. This was negative mistakes could be explained in two ways. First, it not surprising, because ASD is more prevalent in boys is possible that adolescents who bully a lot make mistakes than in girls. However, in future research this could be an in processing social information, as was found in aggres- important topic, because results from past research have sive adolescents (Crick and Dodge 1996). Second, this shown that the amount and type of bullying differs for deficit in perception could be a form of cognitive disso- boys and girls. nance. These adolescents may know that their own bullying Third, differences in prevalence of bullying and vic- behavior is not permitted, and as a consequence they rate timization and in the perception of bullying may exist between the different subtypes of ASD. However, in the bullying situations as non-bullying, because by denying certain behavior as bullying they may try to condone their present study we could not distinguish between these types own bullying behavior. This may also explain why only of ASD because the sample sizes of these groups were too teacher- and peer-rated bullying were significant predictors small. for the number of false negative mistakes made, the ado- Next to these strengths and limitations, an implication lescents who report their own bullying behavior are less for practice can be derived from the current study. We likely to make more false negative mistakes than adoles- found that the more adolescents bullied themselves or were cents who deny their own bullying. Furthermore, ToM was bullied by others, the more mistakes they made in their negatively related to the number of false negatives, perception of bullying. This is important in designing implying that the better a participants’ ToM abilities are, interventions, because these results imply that interventions the fewer false negative mistakes he/she made. This rela- should focus on improving the perception of bullying and tionship could be expected based on common sense; the victimization. Up to now, most interventions focus on better understanding adolescents’ have of mental states of psycho education, behavior modification, teacher training, others, the better they can perceive and interpret social or the development of anti-bullying policies (Smith et al. situations. 2003; Vreeman and Carroll 2007). 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Bullying Among Adolescents With Autism Spectrum Disorders: Prevalence and Perception

van Roekel, Eeske; Scholte, Ron H. J.; Didden, Robert
Journal of Autism and Developmental Disorders , Volume 40 (1) – Aug 8, 2009
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© The Author(s) 2009
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0162-3257
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1573-3432
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10.1007/s10803-009-0832-2
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J Autism Dev Disord (2010) 40:63–73 DOI 10.1007/s10803-009-0832-2 OR IGINAL PAPER Bullying Among Adolescents With Autism Spectrum Disorders: Prevalence and Perception Eeske van Roekel Æ Ron H. J. Scholte Æ Robert Didden Published online: 8 August 2009 The Author(s) 2009. This article is published with open access at Springerlink.com Abstract This study examined: (a) the prevalence of time, to negative actions on the part of one or more other bullying and victimization among adolescents with ASD, students (Olweus 1993). Bullying can have serious con- (b) whether they correctly perceived bullying and victim- sequences and is related to later behavioral and emotional ization, and (c) whether Theory of Mind (ToM) and bul- problems in bullies as well as in victims (Scholte et al. lying involvement were related to this perception. Data 2007). Until now, research on bullying in adolescence has were collected among 230 adolescents with ASD attending focused predominantly on adolescents attending general special education schools. We found prevalence rates of education settings, while surprisingly little attention has bullying and victimization between 6 and 46%, with been given to special needs adolescents such as those teachers reporting significantly higher rates than peers. with autism spectrum disorders (ASD). In special needs Furthermore, adolescents who scored high on teacher- and children and adolescents, peer victimization has been self-reported victimization were more likely to misinterpret found to be more prevalent in children with special health non-bullying situations as bullying. The more often ado- care needs (Van Cleave and Davis 2006), Specific Lan- lescents bullied, according to teachers and peers, and the guage Impairment (Conti-Ramsden and Botting 2004), less developed their ToM, the more they misinterpreted chronic disease (Nordhagen et al. 2005), internalizing bullying situations as non-bullying. Implications for clini- problems and psychosomatic symptoms (Kumpulainen cal practice are discussed. et al. 1998), learning disabilities and co-morbid psychi- atric problems (Baumeister et al. 2008), and in children Keywords Bullying  Perception  Autism  Adolescents  who were more likely to have had contact with mental Prevalence  Theory of Mind health services in the past 3 months (Kumpulainen et al. 2001). Furthermore, bullying was more prevalent among children with behavioral, emotional or developmental problems (Van Cleave and Davis 2006), attention deficit Introduction disorder, depression and oppositional/conduct disorder Bullying in school is a common problem worldwide (Kumpulainen et al. 2001), and psychiatric problems (Smith et al. 1999). The estimated rates of bullying and (Nordhagen et al. 2005). None of these studies have victimization worldwide vary from 5 to 38% for girls, and examined bullying and victimization among adolescents from 6 to 41% for boys (Due et al. 2005). Bullying is a with ASD, who may be especially at risk for bullying and subtype of aggression that may be defined as a systematic victimization. There are at least two reasons why special abuse of power (Smith and Sharp 1994), in which a needs children and adolescents are at higher risk for person (i.e., the victim) is exposed, repeatedly and over bullying and victimization: they are less socially compe- tent (Whitney et al. 1992) and have fewer friendships (Martlew and Hodson 1991). These reasons may also E. van Roekel (&)  R. H. J. Scholte  R. Didden explain why adolescents with ASD may be at higher risk Behavioural Science Institute, Radboud University Nijmegen, for bullying and victimization, but none of the studies P.O. Box 9104, 6500 HE Nijmegen, The Netherlands on adolescents with special needs have examined this. e-mail: [email protected] 123 64 J Autism Dev Disord (2010) 40:63–73 Therefore, the purpose of this study is to examine bul- Empirical data on the association between ASD and bul- lying and victimization among adolescents with ASD. lying involvement in special education are still lacking. Therefore, the focus of the present study is on examining Prevalence of Bullying and Victimization Among bullying and victimization among adolescents with ASD in Adolescents With ASD special education. One reason why adolescents with ASD may be at higher Perceptions of Bullying risk for victimization is that they have deficits in devel- oping normal social interactions and relationships as well The perception of bullying and victimization consists of as deficits in understanding the behavior of others (Frith two main parts: first, one has to perceive that the action and Hill 2004). In general education settings, adolescents is aggressive in nature, and second, one has to perceive with ASD may be at higher risk for victimization because that this aggression is directed towards a person who is of characteristics related to ASD, such as their deficits in relatively weaker than the aggressor(s), which refers to an communication and their stereotyped behavior and inter- imbalance of power. A7lthough it can be expected that ests (Haq and Le Couteur 2004). Furthermore, they may bullying and victimization are related to ASD, an also be at higher risk for victimization because of their important question is whether adolescents with ASD can problems with developing friendships (Bauminger and actually perceive bullying or victimization when it Kasari 2000; Chamberlain et al. 2007), which is a risk occurs. Individuals with ASD have deficits in Theory of factor for victimization (Hodges et al. 1999). To our Mind (ToM) skills, which is the ability of individuals to knowledge, only two studies have examined peer victim- attribute mental states to themselves and to others in ization among children and adolescents with Asperger order to explain and predict behavior (Baron-Cohen syndrome in general education settings (Little 2001, 2002). 2000). Mental states include beliefs, desires, intentions, Results of these studies showed that, compared to the perceptions, imagination, and emotions (Repacholi and nondisabled population, victimization rates were four Slaughter 2003). People with ASD are supposed to have times higher in this sample, with up to 75% of adolescents a deficit in the understanding of minds and mental states with Asperger being victimized (Little 2001). Furthermore, of other people (Frith and Hill 2004), and consequently Little (2002) found that 94% of the children with either also in understanding the intentions of others. In high- Asperger Syndrome or Nonverbal Learning Disability functioning autism, ToM abilities are more developed, were victimized in the past year, as reported by their but the adolescents still score significantly lower than mothers. non-disabled peers (Baron-Cohen et al. 1997; Happe ´ 1994). Because of these deficits in social insight, ado- There may also be several reasons why adolescents with ASD are at higher risk for bullying others, both in general lescents with ASD may be less able to recognize bullying and in special education settings. First, adolescents with than adolescents without ASD. Unlike adolescents with ASD are often found to show increased levels of aggressive ASD, we expect typically developing adolescents to be behaviors (Matson and Nebel-Schwalm 2007; McClintock able to recognize bullying as they are likely to possess et al. 2003). Since bullying can be considered a specific the social skills and social insight to perceive bullying kind of aggression, adolescents with ASD might also be behavior correctly. more at higher risk for bullying others. Second, because A small number of studies have revealed that ado- adolescents with ASD have limited insight in social pro- lescents with autism are not able to interpret social sit- cesses (Frith and Hill 2004), they may not be aware of the uations correctly, possibly as a result of their less well consequences of their own behavior, and may thus bully, developed social insight. For example, Pierce et al. without being aware of it. Previous research on the asso- (1997) examined social perception in children with aut- ciation between ASD and perpetrating of bullying among ism by showing videotaped vignettes of both positive and adolescents has to some extent supported these hypotheses. negative social interactions with varying numbers of In general education settings, it has been found that mostly, social cues (e.g., verbal content, tone, nonverbal behavior adolescents with ASD were as likely to bully as typically with object, and nonverbal behavior without object). developing adolescents. However, when adolescents with They found that children with autism scored significantly ASD had co morbid Attention-Deficit/Hyperactivity Dis- lower on interpreting social situations than the compari- order, they turned out to be five times more likely to bully son groups when the social perception stories contained than neurotypical adolescents (Montes and Halterman more than one cue. Loveland et al. (2001) found that the 2007). group with ASD had significantly more problems in Until now, studies on ASD and bullying involvement detecting inappropriate behaviors in video fragments than have been conducted in general education settings. the non-ASD group, but only for scenes that included 123 J Autism Dev Disord (2010) 40:63–73 65 verbal behavior. These results imply that children with Methods ASD can understand and recognize simple (one-cued) social situations, but fail to correctly understand more Participants complex social situations. It can thus be expected that adolescents with ASD will have difficulties with recog- The sample for this study consisted of adolescents with nizing bullying behavior. ASD who attended schools for special secondary education However, not all adolescents with ASD will be equally in the Netherlands. The participants were derived from disabled in recognizing bullying behavior, because differ- three special education schools, all located in the eastern part of The Netherlands. These schools were primarily ences in this group exist in several relevant characteristics that are important in the perception of bullying. The first focused on educating adolescents with ASD, thus all stu- relevant characteristic is ToM. It may be expected that dents from these schools had a diagnosis of a disorder in adolescents with a higher developed ToM are better in the the autistic spectrum. The diagnoses in this sample were perception of bullying than adolescents with a lower the following: Autism Spectrum Disorder (ASD; n = 35), developed ToM. The second characteristic that may be Pervasive Developmental Disorders Not Otherwise Speci- important in the perception of bullying is the level of fied (PDD-NOS, n = 123), and Asperger Syndrome victimization. Adolescents who report to be frequently (AS; n = 29). Several adolescents had an additional victimized have experienced many negative interactions diagnosis of Attentional Deficit/Hyperactivity Disorder and situations, and thus may be biased in their perception (ADHD; n = 31). These diagnoses were set by qualified of social situations. The final relevant characteristic is the psychiatrists or psychologists, based on DSM-IV criteria. level of bullying. Results from studies on social perception Participants were 230 adolescents with ASD, of whom 208 in aggressive children and adolescents reveal that they have were boys. They were 12–19-years-old (M = 14.97, deficits in their perception. Aggressive children and ado- SD = 1.45), and the level of education varied from voca- lescents perceive, interpret, and make decisions about tional to pre-university education. Their mean total IQ was social stimuli in ways that increase the likelihood that they 97.07 (SD = 14.64). will engage in aggressive acts (Crick and Dodge 1996). Furthermore, a control group was selected to check Aggressive children attribute hostile intentions to ambig- whether the perceptions of adolescents with ASD differed uous provocation situations more often than other children, from the perceptions of adolescents without ASD. This and they expect positive outcomes from aggressive acts control group consisted of 24 adolescents (22 boys, 2 girls) who followed secondary education. These adolescents and perceive aggression as a useful means for obtaining desired goals (Crick and Dodge 1996). Furthermore, sev- were group matched with the group of adolescents with ASD on educational level, age (M = 15.5), and sex. As eral studies have found that stronger anger attribution bias (perceiving anger from non-anger cues) predicted higher was the case with the ASD adolescents, passive informed levels of aggression (Fine et al. 2004; Schultz et al. 2000). consent from these adolescents and their parents was Since bullying is a subtype of aggression, it may be obtained. Before starting the study, a pilot study was expected that especially bullies show deficits in their per- conducted on a small sample of adolescents to pilot test the ception of bullying. video clips (see ‘‘Measures’’). This pilot sample contained 26 adolescents (11 boys, 15 girls), aged between 12 and The Present Study 14 years, with an educational level comparable to the educational level of the ASD adolescents and control group The main hypothesis of this study is that adolescents with adolescents. Both the control sample and the pilot sample ASD have difficulties in recognizing bullying behavior. were recruited by contacting schools and parents by letters The specific aims of the present study were: (a) to examine and asking for parental consent. the prevalence of bullying and victimization among ado- lescents with ASD, and (b) to examine whether adolescents Procedure with ASD are able to perceive bullying and victimization and which factors are related to this perception. The data The special secondary education schools were recruited by were collected among adolescents with ASD attending contacting the principals by telephone. After the schools three special education schools by administering ques- consented to participate, parents of 242 adolescents were tionnaires among these adolescents and their teachers, and sent a letter in which they were informed about the aims of by examining their evaluation of videotaped fragments of the study and they were asked to give their consent. Parents social interactions. In this study, we will focus on adoles- of twelve students refused to give their consent, because cents with ASD, we will not distinguish between the dif- the research would be too intrusive for their children, or ferent subtypes of ASD. because their children were already involved in other 123 66 J Autism Dev Disord (2010) 40:63–73 studies or clinical research. Therefore, our final sample This final score indicates how often that participant bullies consisted of 230 adolescents with ASD. or is bullied (varying from never to several times a week). Data were collected during classroom visits by the first The scores on all ratings (peer-, teacher- and self-) could author. The questionnaires were administered group wise. vary between 1 and 5. To maximize the probability that all adolescents had the Teacher-ratings on bullying and victimization. The same definition of bullying in mind, the definition of bul- teachers filled in a questionnaire which included the same lying was printed on a questionnaire, and the experimenter questions as in the peer ratings. They had to rate every read the definition out loud in the class to make sure the child in their class on the two questions mentioned above. participants understood the concept of bullying. Subse- The teachers were the class tutors. The number of hours a quently, the participants were asked whether they under- teacher was in the classroom varied from 3 to 7 h a day stood the definition and they were instructed to ask for on average. These teachers knew their students well and clarification if they had any questions. The video fragments were also present during lunch breaks and on the were shown to participants in their classroom. After each playground. fragment, the video was paused, and the participants were Self-ratings on bullying and victimization. All partici- asked to write down on the questionnaire whether or not pants also rated themselves on the two bullying related that fragment contained bullying (yes or no). The ques- questions, thus indicating how often they thought they tionnaire and the video fragments were administered within bullied or were bullied. 45 min. Participants were allowed to take a 5 min break Perceptions of bullying. To measure the ability to rec- between the administration of the questionnaire and the ognize bullying, video fragments which represented social video fragments. situations were shown to and evaluated by participants. The ToM task was computerized, and was individually These video fragments were selected from a Dutch tele- administered on computers with an internet connection. vision show and two Dutch movies, which were all suitable The instructions for the ToM task were given on screen. for adolescents. The selected 14 video fragments contained This task did not need any additional instruction or bullying situations and positive social interaction situa- supervision from the investigator or the teacher. The tions. To check whether this categorization was unambig- duration of this task was 15 min. uous, the fragments were first evaluated by four independent researchers. The agreement between the Measures researchers on which fragments contained bullying and which did not was 95%. To examine whether non-disabled Peer-ratings on bullying and victimization. To measure adolescents would perceive the bullying, a pilot study was conducted on 26 adolescents in a general education setting, peer-reported levels of bullying and victimization, partici- pants had to rate on a 5-point Likert scale how well each of who were matched with the group of adolescents with ASD their class members fitted two behavioral descriptions on age and educational level. The video fragments were related to bullying and victimization. The item for bullying shown to them in their classroom. They had to score was ‘bullies other children’, and the item for victimization individually whether or not each fragment contained any was ‘is victimized’. The answer categories were: (1) bullying (yes/no format). The results of this pilot were in ‘never’, (2) ‘a few times a year’, (3) ‘once a month’, (4) concordance with the categorization made by the ‘once a week’, and (5) ‘several times a week’. The par- researchers. The average agreement between the adoles- ticipants were provided with a list of names of their class cents was 93%. In total, all 14 fragments were selected, of members, and had to rate how often each class member which eight contained bullying and six contained positive displayed the behavior described. The following descrip- social situations (i.e., no bullying). The average length of tion of bullying was given: ‘Bullying is when a child or a the fragments was 33 s, ranging between 12 and 51 s. The group children regularly say unpleasant or mean things to fragments contained the three different types of bullying another child, or laugh at another child, who can not that have been distinguished in previous studies (Bjo ¨ rkqvist defend himself/herself. It is also bullying when a child is et al. 1992): physical bullying, verbal bullying, and rela- regularly hit, kicked, threatened, locked up, or when his or tional bullying. An example of a fragment that contained her belongings are taken or destroyed. It is also bullying bullying is a clip in which a group of boys and girls are when a child is regularly shut out, or when other children laughing at one of their classmates and making funny faces spread rumors or lies about him/her. It is not bullying when towards her. An example of a positive situation is a clip in two children of the same strength argue or fight’ (Olweus which a group of boys and girls are planning a surprise 1991; Whitney and Smith 1993). The scores were summed party for one of their friends. The 14 fragments were pre- for every participant, and then divided by the number of sented to the adolescents in four random orders, to avoid raters in that class to account for differences in class size. order effects. To be able to examine whether the 123 J Autism Dev Disord (2010) 40:63–73 67 adolescents with ASD would perceive and report bullying were combined to create one measure for ToM. We also in the video fragments differently from adolescents from examined the results for all the ToM tests separately, but the general population, we also showed the video frag- these results did not differ from the combined ToM test. The ments to the control group of 24 adolescents without ASD, total score of the ToM task could vary between 0 and 22. The and compared the results of this group with the results from reliability of all ToM tasks combined was a = .803. the adolescents with ASD. We decided to examine the type of mistakes that were made by participants, in stead of a total perception score. Results Two types of mistakes could be made. First, the partici- pants could misinterpret non-bullying situations, rating First, we calculated the intercorrelations for all variables. them as if bullying occurred in the video fragments (i.e., As can be seen in Table 1, the three different ratings of false positives), or secondly, they could misinterpret bul- bullying (i.e., teacher-, peer-, and self-report) were signif- lying situations, rating them as if no bullying occurred in icantly related to each other, as were the ratings for the video fragments (i.e., false negatives). These two victimization. variables were computed by summing the mistakes that Subsequently, the means and standard deviations were were made by each participant, and by categorizing them examined for the bullying and victimization measures and into false positives and false negatives. The scores on false the ToM task. For bullying, the means varied between 1.67 positives could vary between 0 and 6, the score on false for peer- and self-reports (SD = 0.82 and 1.13, respec- negatives could vary between 0 and 8. tively) and 2.49 for teacher-reports (SD = 1.47). For vic- Theory of Mind-Task. For assessing ToM-skills, several timization, the means were 2.12 for teacher-reports tests were used. First, first-order false belief was assessed (SD = 1.25), 1.50 for peer-reports (SD = 0.78), and 1.63 by administering the Sally and Ann task (Baron-Cohen for self-reports (SD = 1.15). The average ToM scores was et al. 1985), and second-order false belief by administering 14.60 (SD = 4.41). These results show that the mean level the Ice-Cream Story (Bauminger and Kasari 1999; Perner of bullying and victimization reported by teachers is higher and Wimmer 1985). In addition, an advanced test of ToM than the mean level of bullying and victimization reported was included to further discriminate between the partici- by the adolescents themselves (peer- and self-reported). ´ ´ pants (Happe 1994). Happe (1994) developed the Strange Stories test, which consists of a set of stories about Prevalence of Bullying everyday situations where people say things they do not literally mean. Ten story types were included, which rep- To examine the prevalence of bullying and victimization in our sample, we calculated the percentages of adolescents resent different aspects of ToM (such as white lie, pretend, double bluff, and sarcasm). The participants were presented involved in bullying and victimization. There are several with a story, and subsequently had to answer two questions: criteria to allocate adolescents into the ‘bully’- or ‘victim’ a comprehension question (‘was it true, what X said?’) and category. According to Solberg and Olweus (2003), the a justification question (‘why did X say that?’). The most valid cutoff point for classifying adolescents as vic- answers on the justification questions were rated on a tims and/or bullies is more than ‘two times a month’. 3-point scale: incorrect (0 points), partly correct (1 point), However, for distinguishing the most extreme bullies and and completely correct (2 points). The different ToM tests victims, more than ‘once a week’ is the most useful cutoff Table 1 Intercorrelations for all variables 123 45 6 7 8 9 1. Bullying (teacher) – 2. Bullying (peer) 0.59** – 3. Bullying (self) 0.44** 0.38** – 4. Victimization (teacher) 0.23** 0.14** 0.09 – 5. Victimization (peer) 0.16* 0.15* 0.11 0.51** – 6. Victimization (self) 0.10 0.01 0.21** 0.38** 0.47** – 7. Theory of Mind -0.14 -0.44 0.09 -0.16* 0.03 0.05 – 8. False positives -0.06 -0.04 0.14 0.15* 0.11 0.15* -0.14 – 9. False negatives 0.17* 0.17* 0.12 0.04 0.02 0.04 -0.18** -0.05 – * p \ .05, ** p \ .01 123 68 J Autism Dev Disord (2010) 40:63–73 point. To calculate the prevalence of bullying and victim- standardized residuals of the peer report indicated that they ization, we used these two criteria for including adolescents reported significantly less bullying and victimization than in the ‘involved’ or ‘non-involved’ category. The more expected (r =-4.8, -4.0, -4.4, and -4.4, respectively). severe criterion was that adolescents had to have a score of An interesting finding concerning the prevalence of bul- four or higher on the bully or victim variables, which lying and victimization reported by teachers is that they corresponds with bullying or being bullied more than once significantly reported far more bullying and victimization a week. The adolescents included in these categories were than the adolescents reported about their peers and about the extreme bullies or victims. The less severe criterion themselves. Furthermore, peers reported significantly less was that adolescents had to have a score of three or higher bullying and victimization than expected. These results on the bully or victim variables, which corresponds with may seem to be in contradiction with the descriptive results bullying or being bullied more than once a month. The presented earlier, because the means for the peer- and self- adolescents in these categories were the moderate to reports on bullying were equal. However, although the extreme bullies or victims. To examine the prevalence of means are equal, the distribution of the scores is different, bullying and victimization, we calculated the percentages which explains the different prevalence rates. of adolescents involved in bullying and victimization, categorized into the moderate to extreme group and the Perceptions of Bullying extreme group. These prevalence rates can be found in Table 2. First, we examined the self-reported perception of bullying As can be seen in Table 2, teachers report more bullying in our sample. The mean score on all video fragments was than peers and the adolescents themselves. To test whether 12.77 (SD = 1.14, range 0–14) and the average number the differences between the teacher- and the peer- and self- of false positive and false negative mistakes was .69 ratings were significant, chi squares were calculated for the (SD = 1.04) and .65 (SD = .83), respectively. Further- four sub tables. The percentages of adolescents involved in more, to examine whether the ASD adolescents’ scores on bullying and victimization significantly differed by raters, the video fragments were significantly different from a for moderate to extreme bullies, v (2, N = 658) = 89.23, distribution based on chance, we conducted binomial tests p \ .05; extreme bullies, v (2, N = 655) = 43.47, p \ .05; on the 14 video fragments. The results from these tests moderate to extreme victims, v (2, N = 658) = 55.00, were significant for all 14 items (p \ .001), indicating that p \ .05; and extreme victims, v (2, N = 655) = 41.91, the ASD adolescents scored significantly better than could p \ .05. Subsequently, the standardized residuals were be expected by chance. We also compared the results examined to determine which cells contributed most in of the ASD adolescents with results of the control group creating these differences (Haberman 1973). The stan- of adolescents without ASD. Results from a one-way dardized residuals are calculated by subtracting the ANOVA showed that the ASD group did not significantly expected frequencies from the observed frequencies, and differ from the control group in the scores on the video dividing this by the square root of the expected frequen- fragments (F[1] = .589, p = .443). All of these findings cies. For all four sub tables, the standardized residuals indicate that the ASD adolescents made very few false of the teacher report indicated that they reported signifi- positive and false negative mistakes, and were as able cantly more bullying and victimization than expected as adolescents without ASD to perceive and report on (r = 6.4, 4.4, 5.3, and 4.3, respectively). Furthermore, the bullying. Table 2 Percentages of More than once a month More than once a week adolescents with ASD who are (moderate to extreme group) (extreme group) Involved and non-involved in bullying and victimization Involved (%) Non-involved (%) Involved (%) Non-involved (%) Bullies Teacher-report 46 54 27 73 Peer-report 15 85 4 96 Self-report 19 81 12 88 Victims Teacher-report 30 70 18 82 Peer-report 7 93 0.4 99.6 Self-report 17 83 10 90 123 J Autism Dev Disord (2010) 40:63–73 69 Table 3 Linear regression analyses of Theory of Mind, bullying, and Table 4 Linear regression analyses of Theory of Mind, bullying, and victimization on false positives based on teacher- and self-reported victimization on false negatives based on teacher- and peer-reported bullying and victimization bullying and victimization False positives False negatives Teacher report Self report Teacher report Peer report B SE(B) b B SE(B) b B SE(B) b B SE(B) b ToM -0.02 0.01 -0.11 -0.30 0.01 -0.16 ToM -0.04* 0.02 -0.18* -0.04* 0.02 -0.18* Bullying -0.05 0.04 -0.09 -0.01 0.05 -0.01 Bullying 0.13* 0.05 0.18* 0.22* 0.09 0.18* Victimization 0.10* 0.05 0.15* 0.12* 0.06 0.16* Victimization -0.00 0.06 -0.01 0.02 0.09 0.02 Note: ToM = Theory of Mind Note: ToM = Theory of Mind * p \ .05 * p \ .05 Our main research question concerned the self-reported F(3,189) = 4.48, p = .005. This means that the higher the perception of bullying (categorized in false positive and level of ToM, the less false negative mistakes the adoles- false negative mistakes) and its relation with ToM, the cents made and the higher the level of bullying, as reported level of bullying and the level of victimization. Three by teachers, the more they misinterpreted bullying situa- tions as non-bullying. The proportion of variance explained multiple linear regression analyses were performed to explore the associations between ToM, bullying, victim- by all variables in the analysis was 7%. In the analysis with ization and the type of mistakes. The results were exam- peer reported bullying and victimization, ToM and peer ined separately for teacher-, peer-, and self-reported reported bullying were significant predictors of the number bullying. In all three analyses, ToM and the level of bul- of false negative mistakes made, F(3,191) = 4.56, lying and victimization were the independent variables, p = .004. This indicates that the higher the level of peer- and the number of false positive mistakes was the depen- reported bullying, the more adolescents misinterpreted dent variable. For peer reported bullying and victimization, bullying situations as non-bullying. This model explained the results were not significant. The results of the analyses 7% of the variance in false negative mistakes, when all with teacher- and self-reported bullying and victimization variables are taken account of. can be found in Table 3. As can be seen in Table 3, both teacher- and self- reported victimization were significantly related to the Discussion number of false positive mistakes, F(3,189) = 2.83, p = .005, and F(3,191) = 3.08, p = .004, respectively. The aims of the present study were: (a) to examine the This indicates that the more adolescents were bullied, as prevalence of bullying and victimization among adoles- reported by teachers and themselves, the more they mis- cents with ASD, and (b) to examine whether adolescents interpreted non-bullying situations as bullying. The pro- with ASD are able to perceive bullying and victimization portion of variance explained by all variables included in and which factors are related to this perception. the analyses was 4.3% for teacher reported victimization and 5% for peer reported victimization. Prevalence of Bullying and Victimization Second, we conducted three multiple linear regression analysis on ToM, bullying, victimization, and false nega- It may be concluded that bullying is prevalent among tives, one on teacher reported bullying and victimization, adolescents with ASD in special education schools. An one on peer reported bullying and victimization, and one important finding is that a large discrepancy exists between on self-reported bullying and victimization. In all three the level of bullying reported by teachers on the one hand, analyses, ToM and the level of bullying and victimization and by peers and adolescents themselves on the other hand, were the independent variables, and the number of false with teachers reporting higher levels of bullying than peers negative mistakes made was the dependent variable. The and adolescents. The prevalence rates based on peer- and results from the analysis with self-reported bullying and self-reports are in line with prevalence rates in children in victimization were not significant. The results from tea- general education settings found in other studies (Eslea cher- and peer-reported bullying and victimization can be et al. 2004), in which prevalence rates of 2 to 17% were found in Table 4. found, based on self-reports. The prevalence of bullying in As can be seen in Table 4, ToM and teacher reported our sample according to teachers is much higher than in bullying were significant predictors in the first analysis, children in general education settings. This is in contrast to 123 70 J Autism Dev Disord (2010) 40:63–73 results on studies on bullying and victimization in children victimization does not completely disappear, making the in general education settings, showing that teachers gen- transition from general to special education settings does erally tend to report lower levels of bullying than the seem to decrease the prevalence rates of victimization. An adolescents themselves (Beaty and Alexeyev 2008; Salm- explanation for this difference in victimization may be that ivalli 2002). In typically developing children, the main all adolescents attending these special education schools explanation for this lower level of bullying reported by have ASD. Therefore, the specific characteristics which teachers is that bullying often occurs outside the classroom makes special needs children and adolescents obvious (in toilets, lunchrooms, playgrounds, etc.), situations in targets in general education settings, such as their low which teachers are not always present. In our sample, social competence and the low number of friendships adolescents with ASD attend special education schools, in (Martlew and Hodson 1991; Whitney et al. 1992) are not which each class has their own teacher during most of the exceptional anymore, which may reduce the victimization day. During breaks, the students are under continuous rates. Furthermore, the structure and routine organization supervision of several teachers, in lunchrooms as well as on in special education schools seems to be higher than in the playground. Therefore, the teachers in our sample are general education settings, which might reduce the dis- probably able to report most of the bullying behavior that ruptive behavior of adolescents with ASD. occurs, and this may explain the higher percentages of both It is important to note that no conclusions can be drawn bullying and victimization in the current study compared to about who the best reporter of bullying and victimization outcomes of other studies in this area. The level of bullying is. Teacher reports may be valuable because they contain and victimization reported by peers in the present study information gained by adults who are relative outsiders of was significantly lower than the amount of bullying and the adolescent peer group. However, what teachers report victimization reported by teachers and by the adolescents differs from what the adolescents perceive about their own themselves. This is in line with results from previous situation and about their peer group. They may all have studies in children in general education settings, in which different interpretations of the bullying that occurs in their the level of bullying and victimization reported by peers is class. Hence the different reports may represent different generally lower than the level of bullying and victimization aspects of bullying. reported by adolescents themselves (Salmivalli 2002; Stassen Berger 2007). Perceptions of Bullying The prevalence rates of bullying of adolescents with ASD in our sample, as reported by peers, is in agreement Our findings provide several indications that the percep- with the prevalence rates found in adolescents with ASD in tions of adolescents with ASD on bullying were likely to be accurate. The ASD adolescents made very few mistakes on general education settings. In a study by Montes and Hal- terman (2007), 26% of the adolescents with ASD were the video fragments and performed much better than could classified as bullies. have been expected by change, as indicated by the results The prevalence rates for victimization (moderate to from the binominal tests. In addition, their perceptions on severe victims) varied from 7 to 30%, with peers reporting bullying did not differ significantly from the perceptions the least victimization and teachers reporting the most of adolescents from the general population. These are victimization. These rates indicate that victimization is also important findings, because adolescents with ASD are a prevalent problem in adolescents with ASD attending found to have deficits in their social perception. However, special education. As in bullying, the most striking result because the current study is among the first to examine was that teachers reported far more victimization than the peer-, and self-reported bullying among adolescents with adolescents themselves. This difference may be explained ASD, further research is warranted to replicate our by the same reasons given above concerning bullying. findings. The prevalence rates in the present study are in line with Another important finding of the present study was that prevalence rates of victimization in children in general the more often adolescents were bullied, as rated by education settings in 28 countries (Due et al. 2005). teachers and the adolescents themselves, the more they However, the rates found in the present study are much misinterpreted non-bullying situations as bullying (i.e., had lower than those found by Little (2001), who found a higher levels of false positive mistakes), even though the prevalence rate of victimization of 75% in children and effect sizes of these findings were relatively small. Ado- adolescents with Asperger syndrome attending general lescents who are bullied a lot may experience many neg- education settings. The level of victimization in adoles- ative interactions and situations, and as a consequence may cents with ASD in special education is thus much lower be biased in their perception and interpret neutral or posi- than the level of victimization in adolescents with Asperger tive situations more negatively. That only teacher- and self- syndrome in general education settings. Although the reported victimization were related to the number of false 123 J Autism Dev Disord (2010) 40:63–73 71 positives is not surprising. The adolescents who rate bullying and victimization were used. Third, we examined themselves as being victims (whether it is true or not) will the perception of bullying through video fragments, which, have experienced negative situations and thus may have a to our knowledge, has never been done in previous research bias in their perception. on bullying. Furthermore, the teacher probably rated the adolescents The present study also has some shortcomings. First, we who were actually bullied, or at least had experienced found that the level of bullying and victimization were negative situations, as victim, because they were in the significant predictors of the number of false negative and position to observe most bullying and victimization. Peers, false positive mistakes, respectively. However, because the on the other hand, probably do not perceive all victimiza- current study was correlational, no conclusions could be tion that occurs, because of their limited insight in social drawn about causal influences. It could be that adolescents processes. Victimization of their class members could with high levels of bullying and victimization develop a especially be hard to observe for them, because it does not distorted perception as a result of these high levels of directly involve themselves. The level of bullying was not bullying and victimization. On the other hand, it may also significant in predicting the number of false positives. And, be possible that a distorted perception in adolescents results surprisingly, ToM was not related to the number of false in a high involvement in bullying and victimization. positives. Second, in bullying research in general education set- Another striking result in the current study concerns the tings, the results are often examined for boys and girls false negative mistakes. We found that the more often separately. Boys usually bully more than girls (Haynie adolescents bullied, as rated by teachers and peers, the et al. 2001) and use more direct, physical types of bul- more they misinterpreted bullying situations as non-bully- lying, while girls are more involved in indirect, relational ing. As was the case with the false positive mistakes, the bullying (Rivers and Smith 1994). In the present study, effect sizes for these findings were also relatively small. we could not examine the results for boys and girls, The relationship between the level of bullying and false because the sample size of girls was too small. This was negative mistakes could be explained in two ways. First, it not surprising, because ASD is more prevalent in boys is possible that adolescents who bully a lot make mistakes than in girls. However, in future research this could be an in processing social information, as was found in aggres- important topic, because results from past research have sive adolescents (Crick and Dodge 1996). Second, this shown that the amount and type of bullying differs for deficit in perception could be a form of cognitive disso- boys and girls. nance. These adolescents may know that their own bullying Third, differences in prevalence of bullying and vic- behavior is not permitted, and as a consequence they rate timization and in the perception of bullying may exist between the different subtypes of ASD. However, in the bullying situations as non-bullying, because by denying certain behavior as bullying they may try to condone their present study we could not distinguish between these types own bullying behavior. This may also explain why only of ASD because the sample sizes of these groups were too teacher- and peer-rated bullying were significant predictors small. for the number of false negative mistakes made, the ado- Next to these strengths and limitations, an implication lescents who report their own bullying behavior are less for practice can be derived from the current study. We likely to make more false negative mistakes than adoles- found that the more adolescents bullied themselves or were cents who deny their own bullying. Furthermore, ToM was bullied by others, the more mistakes they made in their negatively related to the number of false negatives, perception of bullying. This is important in designing implying that the better a participants’ ToM abilities are, interventions, because these results imply that interventions the fewer false negative mistakes he/she made. This rela- should focus on improving the perception of bullying and tionship could be expected based on common sense; the victimization. Up to now, most interventions focus on better understanding adolescents’ have of mental states of psycho education, behavior modification, teacher training, others, the better they can perceive and interpret social or the development of anti-bullying policies (Smith et al. situations. 2003; Vreeman and Carroll 2007). To our knowledge, no interventions have been evaluated in adolescents with Strengths, Limitations and Implications ASD, and no attention has been given to the perception of bullying, while this may especially be important in ado- The present study extends the literature in several ways. lescents with ASD. The results from the present study First, bullying and victimization have never been studied in imply that interventions aimed at reducing bullying among adolescents with ASD attending special education. Second, adolescents with ASD might specifically focus on altering three different sources of information for measuring the perception of bullying and victimization. 123 72 J Autism Dev Disord (2010) 40:63–73 Open Access This article is distributed under the terms of the Haynie, D. L., Nansel, T., Eitel, P., Davis Crump, A., Saylor, K., Yu, Creative Commons Attribution Noncommercial License which per- K., et al. (2001). 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Journal of Autism and Developmental Disorders – Pubmed Central

Published: Aug 8, 2009

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