When the Bully Is a Sibling

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abuse, aggression, anxiety, Bullying, Children, Depression, family, Self-esteem, siblings, young people

When the Bully Is a Sibling

Siblings have been bickering and trading blows since the time of Cain and Abel. But the torment and fighting that is often shrugged off as normal sibling rivalry may not always be so benign.

New research suggests that even when there are no physical scars, aggression between siblings can inflict psychological wounds as damaging as the anguish caused by bullies at school or on the playground. The findings offer an unusual look at an area of family life that has rarely been studied, in part because infighting among brothers and sisters is widely considered a harmless rite of passage.

But ordinary skirmishes over the remote or joystick are one thing, experts say, and chronic physical and verbal abuse, particularly when it is directed at one sibling, is another. The new study, which involved thousands of children and adolescents around the country, found that those who were attacked, threatened or intimidated by a sibling had increased levels of depression, anger and anxiety.

Corinna Jenkins Tucker, the lead author of the study, which was published in the journal Pediatrics, said that behaviors among siblings that cross the line into abuse deserve more recognition.

“Historically, the general thinking has been that it’s not a big deal, and sometimes it’s even viewed as being a good thing,” said Dr. Tucker, an associate professor of family studies at the University of New Hampshire. “There appears to be different norms of acceptability. Peer aggression is unacceptable, but it’s not the same for siblings.”

Dr. Tucker said that the growing number of programs and public service announcements aimed at stopping bullying and violence in schools and other settings should include a focus on sibling relationships as well.

“The aggression among siblings should be taken just as seriously as that among peers,” she said.

While normal rivalries with siblings can encourage healthy competition, the line between healthy relations and abuse is crossed when one child is consistently the victim of another and the aggression is intended to cause harm and humiliation, said John V. Caffaro, a clinical psychologist and the author of “Sibling Abuse Trauma.” Parents who fail to intervene, play favorites or give their children labels that sow divisions — like “the smart one” and “the athlete” — can inadvertently encourage conflict.

Nationwide, sibling violence is by far the most common form of family violence, occurring four to five times as frequently as spousal or parental child abuse, Dr. Caffaro said. According to some studies, nearly half of all children have been punched, kicked or bitten by a sibling, and roughly 15 percent have been repeatedly attacked. But even the most severe incidents are underreported because families are loath to acknowledge them, dismissing slaps and punches as horseplay and bullying as boys just being boys, he said.

“Our society tends to minimize child-on-child violence in general,” he added. “We have these ideas that if you’re hurt by a child it’s less injurious than if you’re hurt by an adult, but the data don’t support that.”

In the new report, Dr. Tucker and her colleagues studied 3,600 children using data from the National Survey of Children’s Exposure to Violence, which collects information on children and teenagers under 17. Previous studies of sibling violence, which are few in number, have typically been small or narrowly focused on specific forms of aggression.

But the new research, conducted through interviews with children and their parents, measured the impact of a broad range of violence. It looked at physical assaults with and without weapons and the destruction or stealing of property, as well as threats, name-calling and other forms of psychological intimidation.

The researchers also measured the same types of behaviors perpetrated by peers outside the home and accounted for them in their findings in order to tease apart the specific toll of sibling violence.

Over all, a third of the children in the study reported being victimized by a brother or sister in the previous year, and their scores were higher on measures of anxiety, depression and anger.

Catherine Bradshaw, an expert on bullying and the deputy director of the Center for the Prevention of Youth Violence at Johns Hopkins University, said the study was impressive in its scope and scale, and noted that it showed that all types of sibling aggression, from mild to severe, were associated with worse mental health.

“Parents at times might be thinking that their kids can fight it out or that a little bit of victimization might not be so bad,” she said. “But these findings suggest that the threshold is pretty low. It’s not just the rough stuff you have to keep an eye out for.”

Dr. Caffaro said that the effects of sibling abuse often continue into adulthood. Over the years he has treated patients who struggled with emotional issues and sabotaged themselves in their careers because of repeated humiliation they experienced at the hands of a brother or sister.

“It can erode their sense of identity and their self-esteem,” he said.

Massive rise in disruptive behaviour, warn teachers

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aggression, behavioural problems, boundaries, Children, emotional problems, family breakdown, low self-esteem, mental health issues, physical abuse, school, social media, stress, teachers, young people

Massive rise in disruptive behaviour, warn teachers

Teachers have warned that disruptive behaviour in classrooms has escalated sharply in recent years, as funding cuts to local services have left schools struggling to cope.

A survey by the Association of Teachers and Lecturers (ATL) found that the vast majority of staff had recorded a rise in the number of childrenwith emotional, behavioural or mental health problems.

The union collated numerous examples of challenging behaviour, ranging from violent assault to defamatory campaigns on social media.

Suggested reasons for the deteriorating behaviour include a lack of boundaries at home, attention-seeking, an absence of positive role models at home, low self-esteem and family breakdown.

The ATL, which has 160,000 members across the UK, said aggressive cuts to the traditional safety net of local services have left schools dealing with complex behavioural and mental health problems on their own.

Earlier this month it emerged that two-thirds of local authorities have cut their budgets for children and young people’s mental health services since the coalition government came to power in 2010. A freedom of information request by the YoungMinds charity found that 34 out of 51 local authorities which responded said their budgets for children’s and young people’s mental health services had been cut, one by 76%.

Alison Ryan, the union’s educational policy adviser, said: “Services are struggling for survival or operating with a skeleton staff, so there’s now a huge pressure on schools to almost go it alone. Schools are absolutely on the front line of dealing with these children and young people and trying to provide a service that means they don’t fall through the cracks.”

Mary Bousted, general secretary of the ATL, said: “The huge funding cuts to local services mean schools often have to deal with children’s problems without any help.”

The survey of 844 staff found that 62% felt there were more children with emotional, behavioural and mental health problems than two years ago, with 56% saying there were more than five years ago. Nearly 90% of support staff, teachers, lecturers, school heads and college leaders revealed that they had dealt with a challenging or disruptive student during this school year. One primary school teacher in Cheshire said: “I have been kicked in the head, spat at, called disgusting names, told to eff off, had the classroom trashed regularly and items thrown. We accept children who are excluded from other schools so they come to us with extreme behaviour issues.”

A teacher in a West Midlands secondary school said: “One colleague had a Twitter account set up in front of him on a mobile called Paedo ****** [their name], which invited others to comment on him and his sexual orientation.”

Another teacher in a secondary school in Dudley added: “I’ve been sworn at, argued with, shouted at, had books thrown at me, threatened with physical abuse and had things stolen and broken.”

Bousted added: “Regrettably, teachers and support staff are suffering the backlash from deteriorating standards of behaviour. They are frequently on the receiving end of children’s frustration and unhappiness and have to deal with the fallout from parents failing to set boundaries and family breakdowns.”

On the positive side, most of the disruptive behaviour facing staff was categorised as fairly low level, with 79% of staff complaining that students talked in class, did not pay attention and messed around.

Some 68% added that students were disrespectful and ignored their instructions, 55% said they had dealt with verbally aggressive students, and a fifth with a physically aggressive student. Among secondary and sixth-form students, smoking was considered a significant problem.

On most occasions challenging behaviour was deemed an irritation which disrupted class work, according to 74% of staff, but 42% revealed that they suffered stress and almost a quarter said they had lost confidence at work. Forty of those questioned said they had been physically hurt by a student.

ADHD study reveals children’s views

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ADHD, aggression, Bullying, Children, control, diagnosis, medication, stigma, treatment

ADHD study reveals children’s views

 

Children with hyperactivity problems do not feel that Ritalin and other drugs they are given turn them into zombies or robots, but say they feel the medication helps them control their behaviour, according to a study that has asked for their views, in what is claimed as a first.

Dosing children with stimulants to control angry, aggressive or overly-impulsive behaviour has excited controversy for many years. Critics say medication is the wrong way to go and that ADHD (attention deficit hyperactivity disorder) is an extreme form of normal behaviour that needs understanding and psychological therapy rather than drugs.

But, said biomedical ethicist Dr Ilina Singh from Kings College London, author of the research, nobody has asked the children themselves.

Her work, published as a book and an animated film to help inform the debate around the drugs, was funded by the independent Wellcome Trust. It offers insights into the feelings and experiences of children with ADHD and reveals, worryingly, that they are often bullied at school and that doctors do not talk to them about their condition as much as they would like.

The drugs, said Singh, are not the only answer – she would like to see research into meditation and other alternatives for the children – but “the assumed harms of stimulant medication were largely not supported by this study,” she said, although she added: “This is is no way a blanket endorsement of stimulant drug treatment.”

Children said the drugs gave them a time and space to consider their reaction to things that could make them behave aggressively. “They said what a great thing it is to have a bully come up to you in the playground and not react impulsively but have a moment to think, ‘what do I do next?’,” said Singh.

The children also talked about the downsides of medication. A small group felt the person on the drugs was not their authentic self. “I didn’t feel like myself when I was taking the medication,” was one comment, and “I was too quiet; it wasn’t me.”

“One of the messages that children have is that they want more treatment options outside of medication, but they aren’t available,” said Singh. “There are long waiting lists for any kind of behavioural treatments for kids.” But drugs, she said, are “absolutely not the only treatment we should be focusing on.”

The Voices (voices on identity, childhood, ethics and stimulants) study involved detailed interviews with 151 children aged 9 to 14 and their families in the UK and the United States. They were from three groups – children diagnosed with ADHD and on medication, children with a diagnosis who were not on drugs and children with no psychiatric diagnosis.

In the US, the drugs were most likely to have been prescribed to improve children’s school performance by helping their concentration.

Ian, a 12 year-old in a lower-middle-class suburb of a major east coast US city, has been on a variety of drugs for ADHD in the last three years. “I forget things a lot and I have trouble focusing and being mature,” he told researchers. “That means I’m not doing my work like I’m supposed to. The last time I felt good about my behaviour was when I got all Bs and Cs on like my gradecard, except for one D. That was a few weeks ago. My mom freaked out she was so happy. I want to keep doing better.”

UK children were diagnosed because of disruptive or difficult behaviour. Shaun, 11, lives in a large village on the outskirts of a small city in a lower-middle-class neighbourhood where his parents grew up and other family still live. He has been on stimulants for more than two years.

“It’s like sometimes I feel really cross with other people and I just want to go lashing, lashing out,” he said. “[Other children at school] know they can wind me up easily so they do it again and again and I can’t walk away that easy … if I get punched, I have to fight back. Teachers are not effective. They don’t help. In the future I guess I want to be less naughty.”

The research found a lot of stigma attached to ADHD. Children in the US tended not to tell people they were diagnosed. Children in the UK, among whom issues of aggression and anger made it more obvious, often reported they were bullied as a result.

“Their peers will go out of their way to wind up the child they know has difficulty managing their anger or aggression,” said Singh. US children would make jokes and tease those with ADHD, but actively attempting to make another child lose control was a particularly British thing, the research found.

Children reported little meaningful conversation with their doctors and said they did not understand their condition or why they were taking drugs. Check-ups focus on weight and side-effects and there is little discussion of how they are coping with their lives.

That needs to change, said Singh. “Given the ethical concerns that arise from ADHD and stimulant drug treatment, it is imperative that children are able to openly discuss the value of diagnosis and different treatments with a trusted professional,” she said.

Not just a boy thing: how doctors are letting down girls with autism

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aggression, anxiety, Depression, Eating Disorders, emotions, gender, mental health issues, misdiagnosis, OCD, relationships, social exclusion, stress, tics, vulnerability

Not just a boy thing: how doctors are letting down girls with autism

Annette Lewns has more experience than most of the different ways in which boys and girls with autism are treated. Her 14-year-old son, Ryan, was diagnosed when he was three and a half. But doctors refused to diagnose her 12-year-old daughter, Rachel, until she was nine.

“What angers me is that for years I was dismissed by doctors purely because Rachel was a girl. Ryan was spotted very quickly because the autism symptoms that doctors look for are so male-orientated,” said Lewns. “But Rachel’s autism was hidden unless you knew where to look for it.

“Rachel could express herself, she had a couple of friends and understood emotions if someone was at an extreme: really upset or really happy. But you didn’t really have to look too hard to see she didn’t genuinely understand emotions or relationships: she was just mimicking scripts and scenarios from TV.”

“The doctors failed time and time again to see through her coping strategies. I fought for years but I was confronted with a wall of disbelief and scepticism. They were simply unable to understand that a girl might present differently to a boy.”

While Ryan’s condition was acknowledged by their local authority, and he is now at a specialist school, Rachel continues to struggle at a mainstream school. “Ryan is being taught all sorts of tools and techniques to cope with his condition but Rachel is not,” said Lewns.

Estimates of the ratio of females to males diagnosed with Asperger’s syndrome or high-functioning autism varies from 1:4 to 1:10. No one understands this gender disparity: whether women really are less likely to be on the spectrum than men – or whether doctors are failing to spot the disorder in women.

Opinions are divided: Richard Mills, director of research at the National Autistic Society (NAS) says he “would not be surprised” if the true ratio was twice as high, with one woman on the spectrum for every two men. Dr Judith Gould, director of the NAS’s Lorna Wing Centre, thinks the ratio could be even narrower, with 1:1.5 female:male.

We may soon have an answer. Mills is leading the UK arm of a two-year international programme, Autism in Pink, which will look at the condition in women, focusing on the stress, social exclusion, vulnerability and misdiagnosis they suffer.

It follows concerns about reluctance to diagnose women. One recent survey by NAS found girls may wait longer than boys for a diagnosis and are more likely to be misdiagnosed: just one-fifth of girls with Asperger’s syndrome who responded to the survey were diagnosed by the age of 11, compared with half of boys.

The UK is leading the research side of the programme. Last week, Mills signed up the first two of the 12 women with Asperger’s he needs to work with researchers over a two-year period.

“I hope the programme will be the first step to ending the current trend for gender to be a barrier to diagnosis and post-diagnostic support,” he said. “Because research in the past has largely concentrated on males, the way we understand autism tends to be very much based on the experiences of men and boys with the condition. People are reluctant, for some reason, to make a diagnosis in girls and women.”

This reluctance is exacerbated by the fact that girls and women with Asperger’s or high-functioning autism can be more adaptive than boys: they are commonly better at hiding things or seeming more sociable, masking what doctors traditionally think of as the signs of autism.

But the strain of trying to appear “normal” can be immensely stressful. Gould said it results in “many of the girls we see having developed secondary problems such as anxiety, eating disorders or depression”.

This can also mean that misdiagnosis of girls and women is also a problem. The survey found 42% of females had been wrongly told they suffered psychiatric, personality or eating disorders, compared with 30% of males.

There is also the problem that the gender difference becomes a self-fulfilling prophecy: because more males are diagnosed than females, it is their symptoms and behaviours that experts have studied. The so-called screening tools, developed to help diagnosticians spot the syndrome, focus on culturally “male” interests, such as computers, trains and cars, rather than things more likely to appeal to a girl, such as animals, soap operas or fashion. Gould is rewriting the NAS’s diagnostic interview for social and communication disorders to include “gender-neutral” cues.

Even when an accurate assessment is given, however, it is no guarantee that the necessary support and help will materialise: the NAS survey found women continue to struggle after diagnosis, with half of females with Asperger’s or high-functioning autism – compared with 39% of males – saying it made no difference to the support they received.

Lucy Clapham, 25, spent years being turned away by doctors who insisted “girls don’t get autism” and told her to simply “act normal and read female magazines”. “I am certain that my diagnosis was delayed because of the fact that I am a girl,” she said. “My mum first noticed something when I was about six but our GP laughed at the suggestion. I’ve gone to counsellors, doctors and psychiatrists but all of them, including my teachers, refused to see I had classic autism even though I had casebook symptoms: almost no speech until I was five, no friends, hours spent staring at the washing machine, lining toys up and flicking my fingers in front of my eyes.”

When she was 12, Clapham became violent, aggressive and developed multiple tics, obsessions and compulsions. “I stopped talking outside of the house and sunk into an inner world,” she said.

After two more years and about eight counsellors, Clapham’s GP referred her to a child psychiatrist. “She was adamant that girls didn’t get autism, they just had ‘traits’,” said Clapham. “She claimed that I just needed to ‘act normal’ and that by buying nice clothes and reading women’s magazines I could learn to be ‘normal’. The only diagnosis I received from her was depression and anxiety.”

After leaving the children’s mental health service “none the wiser and possibly with more mental health problems than when I had arrived”, Clapham was sent to the adult mental health service and, after a long battle, to the Maudsley hospital in London, where she was finally diagnosed with autism, Tourette syndrome and obsessive-compulsive disorder.

“I was still refused services, however, partly because there were none available and partly because our local authority was not willing to fund an out-of-town, specialist autism service,” said Clapham. “I ended up getting sent to a college for the blind where I developed more mental health problems and became very aggressive because no one understood me or my autistic behaviour.

“When I was 20, I ended up in care because my mother couldn’t cope with my aggression and anxiety.”

Clapham stayed there for three years but still struggles. “Despite my diagnoses, some people still seem to believe that autism is a ‘boy thing’,” she said.

There is no clear understanding about how many girls and women are being missed – or wrongly diagnosed – and for how long. But that may soon change: the first neuroimaging analysis of women and men, with and without ASD, has been under way for the past two and a half years at King’s College’s Institute of Psychiatry (IoP) and the Autism Research Centre at the University of Cambridge. It’s hoped this research could provide the clues. The final stage of the project is about to begin, with results expected in months.

“It’s very exciting,” said Dr Michael Craig, a senior lecturer and honorary consultant at the IoP’s department of forensic and neurodevelopmental sciences. “We could well be looking at gender-specific treatments for Asperger’s being developed in quite a short period of time.”

What is autism?

First identified in the 1940s, autism is a developmental disability that lasts a lifetime and affects someone’s interaction with other people – how they communicate with and relate to them. It is a spectrum condition, affecting some more seriously than others. While some lead fairly independent lives, others suffer serious learning disabilities and need extensive support. Many who have an autism spectrum disorder can be badly affected because they have trouble processing sounds, sights and smells.

Around half a million people in the UK have autism, according to the National Autistic Society (NAS). What causes it is still unclear. “There is strong evidence to suggest that autism can be caused by a variety of physical factors, all of which affect brain development. It is not due to emotional deprivation or the way a person has been brought up,” the NAS says. Genetic factors are assumed to be responsible, and scientists are trying to pin down which genes are involved. Genetic testing to enable earlier diagnosis is therefore still a long way off.

Many people are not diagnosed until they reach adulthood. A recent NAS study of more than 8,000 people with autism, parents and carers found 52% were initially misdiagnosed. One in three adults with the condition say they have developed serious mental health problems because they have not received enough support to help them cope with the difficulties autism brings.