"Although

adults often dismiss it as a case of 'kids being kids,' bullying is a

serious public health problem that can have long-term effects on a victim's

psychological well being," said Dr. Ronald Davis, an AMA trustee

and a preventive medicine and public health physician in Detroit.

The report

parents and school officials in working to identify students who are bullies

or who are being bullied. It recommends that physicians be vigilant for

signs of bullying in young patients and counsel affected patients and

their families.

The report

defines bullying as "a negative behavior that involves a pattern

of repeated aggression; deliberate intent to harm or disturb a victim

despite apparent victim distress; and a real or perceived imbalance of

power ... with the more powerful child or group attacking a physically

or psychologically vulnerable victim." There are three forms of attack:

physical attacks involving bodily harm or damage to property, verbal attacks

seeking to damage self-esteem through name-calling, insults and teasing,

and relational attacks that persuade others to reject or exclude the victim.

About 7 percent

to 15 percent of school children are considered bullies, and they share

common personality traits. Most have been the victims of physical abuse

or bullying themselves, usually at home. They are aggressive, controlling

and dominating with an over-inflated self-image, and often have difficulty

empathizing with others. Both boys and girls can be bullies.

Victims, on

the other hand, are introverted, passive and easily intimidated. Sometimes

classmates perceive them as "different" in some way, such as

race, ethnicity, sexual orientation, exceptional academic ability or even

haircut or clothing style.

"In two-thirds

of the school shootings of the past few years, the shooters were carrying

out revenge on bullies," Davis said. "As a result of these tragedies,

researchers are turning their attention to bullying, and we are beginning

to understand its consequences."

Victims may

exhibit psychosomatic symptoms such as sleep disturbance, bedwetting,

abdominal pain and headaches, in addition to cuts, bruises and other injuries

that could be inflicted by physical confrontations. Adolescent victims

may also resort to alcohol or drug abuse, and some may be driven to suicide,

according to the report.

Sue Clendening,

principal of Graham Elementary School in the Chicago suburb of Naperville,

has her own prescription for dealing with bullying. She goes straight

to the source the students. For the past three years, students in third,

fourth and fifth grade have taken a survey asking them to name three classmates

who they think most need a friend.

The school

compiles a highly confidential list of the children named most often on

the survey, and teachers take subtle steps to help them succeed in the

social arena. Clendening said this "buddy list" works well because

it helps teachers catch potential victims they might not have noticed

otherwise, and also because having a friend is one of the best protections

against bullying.

"The kids

know first if a child is bullied or seems to need friends," she said.

"Kids are very honest. They may name a really shy, quiet child in

the back of class that the teacher never may have even thought of. So

we take the names the kids gave us and then the teachers get together.

We think, 'How can we throw some really positive things in this child's

way?'"

Teachers at

Graham Elementary are doing more group projects and activities where they

try to pair socially isolated children with potential friends. "We

arrange that as much as we can without being pushy," Clendening said.

"We try to put social success in the way of these kids."

Even though

bullying is found in playgrounds all over the United States, many school

administrators don't know that there is a problem at their school.

"Bullying

is underreported for several reasons," Davis said. "Some children

don't want to tell an authority figure because they are afraid the bully

will retaliate with greater force. Others are discouraged by adults' dismissive

reactions."

Clendening

said research indicates that teachers see about 50 percent of bullying

incidents, but only 36 percent of those incidents that are seen are addressed.

"The most important thing a teacher can do is address it say 'we

don't do that here' or give the bully a dirty look. By not addressing

it, you are condoning it," she said.

At home, parents

should watch for the warning signs and take appropriate action, the AMA

report says. Signs your child may be bullied include avoidance of certain

people or situations, sudden changes in behavior or academic performance,

signs of injuries, damaged self-image and threats of suicide.

If you think

your child is the victim of a bully:

It is essential

that you believe him or her about being bullied, the AMA says. When discussing

the situation, ask questions, listen and respond with caring and reassurance.

Talk to your

child's teacher and school principal and ask them to investigate. According

to the American Academy of Child and Adolescent Psychiatry (AACAP), confrontations

with bullies usually occur in unsupervised or undersupervised areas such

as hallways, bathrooms, locker rooms, school buses and playgrounds. Increased

supervision may alleviate the problem.

Teach your

child how to be assertive and seek help from an adult immediately when

confronted by a bully. Role playing or rehearsing responses to teasing

can help some children feel more confident. However, don't encourage your

child to fight back. Tell him or her to simply walk away, the AMA report

says.

Encourage

your child to join sports teams, music groups or extracurricular clubs

according to his or her interests. Involvement in these activities cultivates

self-confidence by sharpening social skills and allowing children to develop

new abilities, the AMA report says.

Make sure

your child has a friend. Graham Elementary's "buddy list" is

based on observations that children with friends are less likely to be

bullied.

If you think

your child is a bully:

Talk to your

child's teacher, school administrator or school counselor if they are

not aware of the behavior. They can monitor your child at school and alert

you about any discipline problems.

Seek the help

of a mental health professional if your child's aggressive behavior continues.

A pediatrician or family physician can provide a referral to a counselor,

child psychiatrist or someone to help you learn strategies for dealing

with her behavior. If you can't afford a psychiatrist, your child's school

can set you up with a social worker.

"Parents

and teachers are the first line of defense for identifying and preventing

bullying, and physicians are here to help them do that," Davis said.

"The earlier we can identify a child who is a bully or who is being

bullied, the better chance there is of stopping the behavior."

For more information,

visit www.ama-assn.org.

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