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    How to help your patients deal with bullying and dating violence

    Continuing societal concern about the impact of violence on children and adolescents, as well as new research on ways to reduce it, has led the American Academy of Pediatrics to update its decade-old policy statement on the role of the pediatrician in preventing youth violence.

    The updated statement is scheduled to appear in the July issue of Pediatrics. It is also available on the web at http://pediatrics.aappublications.org/papbyrecent.dtl.

    The 2009 document builds on the original by incorporating Connected Kids: Safe, Strong, Secure, a program the academy developed several years ago to give pediatricians tools and messages they can use in their practices for preventing violence. It also includes new research on the prevalence of bullying and dating violence and their impact on children and adolescents.

    Robert Sege, MD, PhD, chief of ambulatory pediatrics at the Boston Medical Center and one of the lead authors of the updated statement, explains that much of the research in it was just emerging when the original statement was published in 1999. That research was in response to what was perceived as an epidemic of youth violence, including a spate of high-profile school shootings. Among other things it found that many of the perpetrators of the shootings had been bullied. More recent research has explored bullying's relationship to somatic conditions, morbidity, and anti-social behaviors later in life among victims and perpetrators of bullying.

    Also in the intervening years, says Sege, more and more school districts have learned of the Olweus bullying prevention program, a comprehensive approach developed by the Swedish researcher Dan Olweus, and adapted it to fit the schools' circumstances. "The academy’s policy statement now talks to doctors about how to treat victims of bullying and bullies, and for us to be aware of what schools can do, and in many cases are doing, to prevent it," says Sege.

    On the topic of dating violence, the AAP statement calls for pediatricians to be aware of its symptoms, and to become resources for families, schools and other institutions that influence teen behavior. "Dating violence is at an earlier stage (than bullying) in that we understand the general approach of building self-esteem, but there isn't a cookbook a school can pull off the shelf in the way there is for bullying," he says.

    Ellen Rome, MD, MPH, head of the section of adolescent medicine and associate chief of staff at the Cleveland Clinic, says she "wholeheartedly supports" the updated statement. Rome says that pediatricians often look for the effects of low self esteem in their patients, such as declining grades and lack of connectedness to schools and friends. "All of these are commonly found in bullies and their victims," she says. To deal with these symptoms, "the pediatrician needs the knowledge, skills, and motivation to empower kids and families and help change the bully's behavior, and the victim and bystander's response to it," she says.

    She adds that asking questions such as “have you ever been in a situation where someone did something to you you didn’t want them to do?" enables her to identify victims of dating violence.

    Rome says the printed materials for the Connected Kids program "fly off the shelves." They are available to pediatricians' offices directly from the academy. Samples and additional information are available at http://www.aap.org/connectedkids/samples/index.htm.


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