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One of the most common reasons children seek mental-health services today is being the victim of bullying. There is now good evidence that being bullied is associated with depression, anxiety, poor sleep, falling academic grades and poor long-term outcomes in general. With the advent of cyberbullying there is a perception that bullying is more prevalent than ever before, but that is probably a function of the availability of newer channels for this form of aggression to target a wider array of victims.

Bullying starts at an early age and can be very destructive to both the victim and the bully. It is simply an abuse of power and can take many forms including physical aggression, verbal put-downs, teasing and cyberbullying. There is a myth that it is a normal part of growing up and that kids have to develop a "thick skin" and simply "get over it" if they have been bullied. This is a dangerous way of thinking and patently false.

Aggressive behaviour is relatively common among toddlers, but then becomes much less common in the school years and during adolescence. In later childhood, aggressive behaviour is usually restricted to a relatively small cohort of kids who do not outgrow the aggression they demonstrated as toddlers. The aggression in these children is not normal at all and may occur as a result of a delay in developing the social skills they need to navigate conflict. There is also a common misperception that boys more commonly use physical aggression while girls are more verbally abusive. While it is true that boys are generally more aggressive than girls, both types of bullying commonly occur together.

Parents may not immediately recognize that their child is the victim of bullying at school or in the neighbourhood, or perhaps that their child is bullying others. We now know that those who bully are often also victims of bullying; it is as if unbridled aggression among peers has this cascading effect through an entire social network. It is important to recognize that children who bully need as much help as the victims who do not react by redirecting their aggression. Bullies often suffer as much as the victim but may not show their distress as readily.

There are several important things parents can do if they suspect their child is the victim of bullying or if their child may have participated in bullying activities. Parents need to be alert to the signs of bullying if they notice a change in their child's functioning or behaviour. Some common tell-tale signs, of both being bullied and bullying, include social withdrawal, irritability, difficulty sleeping, anxiety about going to school, unexplained medical symptoms, sadness and tears as a result of minor incidents that normally would not cause any distress. In short, any change in the social-emotional well-being of a child should be taken seriously and investigated.

Children need to be made to feel comfortable reporting incidents to a responsible adult like a teacher, a coach or a club leader. If the bullying is happening at school or over social media with a classmate, then the school needs to be informed and involved. Schools should have a "zero tolerance" policy toward bullying of any kind and should initiate an immediate investigation and assessment for counselling. Schools can play a vital role in anti-bullying programs by initiating activities and discussions about bullying and by making the school yard a safe place to play and socialize.

Open lines of communication between child and parent are essential so that the child feels comfortable sharing their feelings if they have been the victim of bullying. Parents of both parties (the victim and the bully) can help address the problem and stop the cycle of bullying spreading throughout a social network.

Parents can help by praising pro-social behaviour and by practising positive conflict resolution at home among siblings and between family members. Children need to see positive role models in their lives appropriately deal with conflict without verbal or physical abuse.

Children should be involved in several social groups outside of school so that if bullying happens at school there are still other social networks that the kids can turn to. Being part of a team sport can provide an outlet for children suffering from bullying; for bullies, this can be a great vehicle to reinforce positive teamwork, discipline and camaraderie.

Interventions that might work in the context of cyberbullying have not yet been fully evaluated. What we do know is that trying to prevent your child from being bullied by monitoring their social media too intrusively will not be helpful as kids may fear that their online activities will be restricted. Instead, always have the computer in a common area, not the child's bedroom, as this will allow you to more subtly monitor what is going on.

If you think your child is bullying other children, then confirming your suspicions with the school is a helpful first step. Then having a frank discussion with your child about their behaviour and how it might make others feel can be very useful. Remember, no one wants to be a bully – it's a tactic of last resort to achieve an elusive goal such as being more popular, dealing with frustration and unhappiness, or just feeling confused. Confrontation is never as useful as constructive communication.

We are lucky in Canada as some of the best research on bullying is happening right here. For more information about how to deal with bullying, visit the websites prevnet.ca and mac-cura.ca.

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Dr. Peter Szatmari is chief of the Child and Youth Mental Health Collaborative at SickKids, CAMH and the University of Toronto.

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