Discussion

LSHSS

Research Article

School-Based Speech-Language Pathologists’ Knowledge and Perceptions of Autism

Spectrum Disorder and Bullying Erin E. Ofe,a Allison M. Plumb,a Laura W. Plexico,a and Nancy J. Haaka

Purpose: The purpose of the current investigation was to examine speech-language pathologists’ (SLPs’) knowledge and perceptions of bullying, with an emphasis on autism spectrum disorder (ASD). Method: A 46-item, web-based survey was used to address the purposes of this investigation. Participants were recruited through e-mail and electronic mailing lists for American Speech-Language-Hearing Association (ASHA) special interest divisions 1 (Language, Learning, and Education) and 16 (School-Based Issues). Also, an embedded link to the survey was posted on the ASHA Community website and ASHA Facebook page. Results: Participants demonstrated knowledge of many aspects of bullying research; however, they demonstrated

weaknesses in others. All respondents agreed that SLPs should intervene in moments of bullying, but not all indicated that they feel comfortable intervening. Few participants indicated that their school district implemented antibullying campaigns specific to children with special needs, such as ASD. Conclusions: As recognized experts in working with children with communication deficits, including individuals with ASD, SLPs have the opportunity to play a key role in antibullying efforts. Results revealed, however, that school-based SLPs may benefit from more information on bullying in order to understand the nature, context, and extent of this issue, as well as ways in which to respond to bullying when it is observed.

I n recent years bullying in the schools has received significantly increased attention. According to the 2011 Nationwide Study of Bullying by the National

Education Association, 43% of the members viewed bullying as a moderate or major problem in their schools, with 62% having witnessed bullying two or more times in the past month alone (Bradshaw, Waasdorp, O’Brennan, Gulemetova, & Henderson, 2011). In the same year, 28% of students aged 12–18 years reported being bullied at school, and 9% re- ported being cyberbullied during the school year (Robers, Kemp, Truman, & Snyder, 2013). Olweus (1997, p. 496), an often-cited expert in the field of bullying, defined bullying as having three characteristics: (a) It is aggressive behavior or intentional “harmdoing”; (b) it is carried out repeatedly and over time; and (c) it is done in an interpersonal relation- ship characterized by an imbalance of power.

Often, the driving force behind bullying is the desire for acceptance among social groups (Pellegrini & Bartini, 2000). Bullying is most common in early adolescence (11–14 years of age, sixth to ninth grades; Hazler, 1996). Pellegrini and Bartini (2000) explained that as children move schools from fifth grade to sixth grade, they make the transition from being the oldest students in elementary school to being the youngest, and usually physically smal- lest, students in middle school, which puts them at risk for being bullied by older students. Fear of being bullied, mixed with the need to find a place in the social hierarchy of middle school, drives adolescents to bully if they find this behavior to be socially advantageous, with the outcome of their actions being to achieve greater popularity among older students. Adolescents who lag in physical strength or social skills may be targets of the physically stronger, more outspoken students who become bullies (Carney & Merrell, 2001).

Types of Bullying Researchers have identified four types of bullying:

physical, verbal, relational, and cyber. Physical bullying is mainly carried out by boys and is action oriented, involving

aAuburn University, AL

Correspondence to Allison Margaret Plumb: [email protected]

Editor: Marilyn Nippold Associate Editor: Ellen Kelly

Received July 13, 2015 Revision received September 25, 2015 Accepted November 17, 2015 DOI: 10.1044/2015_LSHSS-15-0058

Disclosure: The authors have declared that no competing interests existed at the time of publication.

Language, Speech, and Hearing Services in Schools • Vol. 47 • 59–76 • January 2016 • Copyright © 2016 American Speech-Language-Hearing Association 59

overt, direct behaviors such as pushing, hitting, and kicking (Smokowski & Kopasz, 2005; Wang, Iannotti, & Nansel, 2009). Verbal bullying involves the use of hurtful words to humiliate or harm an individual (e.g., name-calling), and it has been found to be the most commonly used form of bullying from elementary school through college (Chapell et al., 2006; Smokowski & Kopasz, 2005). Relational bul- lying is generally used by girls and occurs through such means as spreading rumors, gossiping, and purposefully ex- cluding peers from social groups (Crick & Grotpeter, 1995). Cyberbullying provides anonymity through electronic means such as the Internet, text messages, online chat rooms, e-mail, and other media. It also provides endless opportunities for individuals to view the method of bullying, such as posting embarrassing pictures on the Internet (Slonje & Smith, 2008). According to Kowalski and Limber (2007), the ano- nymity of cyberbullying may appeal to bullies in that perpe- trators can deny they are doing anything wrong due to lack of knowledge of the victim’s feelings. This type of bullying may also have appeal to those who have been victims of bullying and now seek retaliation (bully-victims) because cyberbullying allows one to communicate without fear of being identified.

Roles in Bullying There are multiple roles within the cycle of bullying,

including bullies, victims, bully-victims, and bystanders. Olweus (1997) defined bullies as having an aggressive reac- tion pattern combined, in the case of boys, with physical strength. They tend to view violence more positively, and they are characterized by impulsivity and lack of empathy. Due to the aggressive and antisocial nature many bullies develop, their actions as young people can lead to later criminality (Olweus, 2011). Defining the opposite of bullies, Olweus (1997) described victims as having negative percep- tions of violence and as being physically weaker, anxious, insecure, sensitive, and quiet. Victims generally have very few, if any, friends for emotional support. Results from a study conducted by Wang et al. (2009) involving self-reports from 7,508 youth found that children’s relationships with others influence their susceptibility to being bullied, with a negative relationship between having more friends and being physically, verbally, or relationally bullied. The findings indicate that children with a strong group of friends are more likely to be protected.

Bully-victims are individuals who are bullied but also become aggressors. For instance, someone who is physically bullied at school may go home and cyberbully someone else, which serves to displace his or her aggression. Bully-victims experience the least favorable psychosocial functioning (Swearer, Song, Cary, Eagle, & Mickelson, 2001). Finally, according to Salmivalli, Lagerspetz, Björkqvist, Österman, and Kaukiainen (1996), bystanders are children in school who are aware of bullying but ignore it. By ignoring peer victimization, bystanders allow the bullying cycle to continue, given that bullies may interpret their silence as approval. In many cases bystanders may not intervene for fear of

being victimized themselves if they already have a low social status.

Victims of persistent bullying may suffer physical and/or psychological damage. A myriad of negative mental health consequences of bullying exist, including anxiety (Chapell et al., 2006; Espelage & Swearer, 2003; Hazler, Hoover, & Oliver, 1992), depression (Chapell et al., 2006; Espelage & Swearer, 2003), suicidal ideation (Carney, 2000; Chapell et al., 2006; Hinduja & Patchin, 2010; Rigby & Slee, 1999), stress or fear of environments in which bullying occurs (Jacobson, Riesch, Temkin, Kedrowski, & Kluba, 2011), as well as hopelessness, helplessness, isolation, poor interpersonal skills, and low self-esteem (J. Carney, 2000). Victims may also feel unsafe at school due to teas- ing, bullying, or other threats, resulting in skipping school, avoiding school-related activities (Jacobson et al., 2011), and having decreased academic performance (Hazler et al., 1992).

Bullying in the Educational System The degree to which teachers and other adults express

concern about bullying may significantly affect bullying situations (Cortes & Kochenderfer-Ladd, 2014). Adults are often unaware of bullying, thus inadvertently perpetuating the bullying cycle by failing to intervene (Craig, Henderson, & Murphy, 2000). Incidents of bullying may go unnoticed by adults because they can occur subtly, such as passing malicious notes in the classroom, or occur in areas in which adults are absent (Card & Hodges, 2008). Furthermore, school and teacher attitudes toward violence influence victims’ likelihood of reporting bullying (Cortes & Kochenderfer- Ladd, 2014; Unnever & Cornell, 2004). On the basis of self-reports of 2,437 middle school students, Unnever and Cornell (2004) determined that if a school generally toler- ates or overlooks bullying, victims are much less likely to seek help from school personnel. Similarly, Cortes and Kochenderfer-Ladd (2014) found that when teachers create classroom environments that are positive and supportive, students feel more comfortable telling their teachers about social problems at school. Therefore, teachers have a strong role in influencing bullying because lack of intervention results in students failing to report bullying and allows the bullying cycle to continue.

Kochenderfer-Ladd and Pelletier (2008) conducted a study in which questionnaires were administered to both teachers and elementary-age students to determine teachers’ management of bullying in relation to children’s coping strategies. Results indicated that common suggestions given to children who are being bullied include telling them to ignore the bully and walk away from the situation. How- ever, these types of avoidance behaviors are ineffective and often result in increased bullying. If school personnel fail to express concern or share advice about bullying, students may not feel comfortable approaching them for guidance and support (Cortes & Kochenderfer-Ladd, 2014). Davis and Nixon (2010) found that in bullying situations students reported the three most beneficial strategies used

60 Language, Speech, and Hearing Services in Schools • Vol. 47 • 59–76 • January 2016

by adults to be listening to the victim, giving the victim ad- vice and encouragement, and checking in with the victim later to see whether the behavior had stopped.

Bullying of Children With Special Needs Whereas much of the research on bullying has focused

on general education, a small but growing literature focuses on bullying of children with special needs and disabilities. Of the literature that does exist, the consensus is that children with special needs are particularly vulnerable to being bullied (Flynt & Morton, 2004; Hadley & Rice, 1991; Mepham, 2010; Mishna, 2003; Reiter & Lapidot-Lefler, 2007). Similar to the profile of victims presented by Olweus, children with special needs may have fewer friends (Hadley & Rice, 1991), are physically or mentally weaker than their peers (Flynt & Morton, 2004), and may be socially impaired (Reiter & Lapidot-Lefler, 2007). Mishna (2003) described that low social status, poor peer relationships, and rejec- tion by peers leave students with intellectual disabilities outside the safety network of friends and put them at an increased risk for victimization. Studies also indicate that a high percentage of children and adults who stutter (i.e., 43%–83%) report having experienced bullying behavior while in school (Blood & Blood, 2004, 2007; Hugh-Jones & Smith, 1999; Langevin, Bortnick, Hammer, & Wiebe, 1998).

Bullying of Children With Autism Spectrum Disorder Students with autism spectrum disorder (ASD) are

especially at risk for being bullied due to their deficits in communication and social skills (Cappadocia, Weiss, & Pepler, 2012; Schroeder, Cappadocia, Bebko, Pepler, & Weiss, 2014). According to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; American Psychiatric Association, 2013), ASD is characterized by persistent deficits in social communication and restricted, repetitive patterns of behaviors and interests. Individuals with ASD experience difficulty using and understanding pragmatic lan- guage (Paul & Norbury, 2012), which may limit their ability to connect with and form relationships with others. Some children with ASD are unable to interpret social situations appropriately (Loveland, Pearson, Tunali-Kotoski, Ortegon, & Gibbs, 2001) or are unable to discriminate manipulation and deceit from good intentions (Carter, 2009). Loveland et al. (2001) showed video fragments to children and adoles- cents with ASD and children of similar ages without ASD to determine whether participants with ASD could judge the social appropriateness of the videotaped scenes. They found that children with ASD were less likely to detect inappropriate behaviors for scenes that included verbal be- havior and more complex social situations. Inability to judge social cues or discriminate good from bad intentions may result in individuals with ASD being unaware of being bullied.

Despite the fact that some individuals with ASD may be unaware of their victimization, bullying of this popula- tion can have significant consequences. Little (2002) dis- tributed a questionnaire to 411 mothers of children with a

diagnosis of ASD to measure victimization and shunning of children with Asperger syndrome. The study revealed a 94% prevalence rate of peer victimization as reported by the mothers, who stated that many of these children had never been invited to a birthday party, were almost always picked last for teams in physical education class, or ate lunch alone every day. Carter (2009) replicated this survey and found a drop in prevalence rates, although the overall rate was still 65%. Frequent and prolonged victimization can result in mental health problems in children and youth with ASD, such as anxiety, hyperactivity, self-injurious and stereotypic behaviors, and oversensitivity (Cappadocia et al., 2012).

Just as children and youth in the general population experience many different types of bullying, the types of bullying endured by children and youth with ASD also vary. Based on parental and self-reports of 70 boys with ASD, Kloosterman, Kelley, Craig, Parker, and Javier (2013) found relational (i.e., social exclusion) and verbal (i.e., be- ing called mean names, made fun of, or teased) bullying to be most prevalent. Furthermore, Gray (2004) defined two types of bullying specific to children with ASD: Backhanded bullying and absurd information and requests. When aggres- sors engage in backhanded bullying, they use kind gestures or statements with the intent of misleading their victims. Aggressors utilize absurd information and requests in order to use directives to make victims engage in out-of-context, silly, or inappropriate activities, gestures, or tasks. Arick, Krug, Fullerton, Loos, and Falco (2005) explained that bullies use these forms of victimization because they capital- ize on youth with ASD having limited friendships and their tendency to interpret information literally.

SLPs’ Perceptions of Bullying of Children With ASD

To the authors’ knowledge, only one study directly exploring school-based SLPs’ perceptions of bullying of children with ASD has been conducted. Blood, Blood, Coniglio, Finke, and Boyle (2013) have previously explored school-based SLPs’ roles and perceptions of bullying of children with ASD via a vignette survey design. The sur- vey’s eight vignettes depicted all four types of bullying, with four of the situations having been witnessed by the SLP and four having been told to the SLP by a student vic- tim. The survey inquired how likely SLPs were to intervene in each situation and what intervention strategies they were most likely to use. Results indicated that the major- ity of SLPs were either “likely” (17.5%) or “very likely” (71.5%) to intervene in bullying situations, regardless of the type of bullying or whether or not the bullying was directly witnessed by the SLP. Results also indicated the most prevalent strategies as falling into the categories of “reporting the bullying and consulting others,” “educating the victim,” and “reassuring the victim.” Blood et al. con- sider the “report, educate, and reassure” sequence to be the most optimal bullying intervention strategies. Although the information provided by the Blood et al. study is an

Ofe et al.: SLPs’ Perceptions of Bullying and ASD 61

important step, further investigation is needed to identify SLPs’ knowledge of bullying and perceptions of bullying in real-life situations.

Summary Bullying has become a major concern in society for

both typically developing children and children with special needs. Individuals with ASD often lack appropriate social skills and have difficulty effectively communicating, even if they are higher functioning, making them particularly at risk for bullying. Along with attention to bullying in general is the issue of how authority figures respond to instances of bullying. Bullying may go unnoticed by adults, given that bullies often choose areas of low supervision to carry out their bullying behaviors. Adults who work one-on-one or in small groups with students, such as school-based SLPs, may have the greatest chance of detecting students who are enduring bullying and observing the effects that bullying is having on these students. Because SLPs frequently have students with ASD on their caseload, they may wit- ness bullying of these students by other students in treatment, the classroom, or other areas of the school. SLPs have the opportunity either to attend to these acts of bullying or to ignore them. Determining the role of the SLP in these situ- ations is essential to understanding how students with ASD cope with victimization.

The aim of the current study was to further investigate SLPs’ knowledge and perceptions of bullying, with a par- ticular emphasis on children with ASD in the school envi- ronment. By questioning SLPs about bullying conditions on their personal caseloads, a more realistic picture of bullying in the schools could be formed. Because very little research has focused on bullying of children with ASD in the schools, particularly through the perceptions of SLPs, this topic is of importance in determining the frequency and severity of bullying of this population in the schools and how SLPs approach bullying. Specifically, the current study hoped to answer the following questions:

1. What are SLPs’ knowledge and familiarity with current literature regarding bullying?

2. What are SLPs’ experiences and perceptions of bullying as it relates to their students with ASD?

3. How do SLPs perceive their role in management of bullying, and what management techniques do they use?

4. How much support do school districts provide for bullying awareness and/or prevention?

Method Participants

A total of 70 respondents completed the survey. Eli- gible participants were American Speech-Language-Hearing Association (ASHA)–certified speech-language pathologists or clinical fellows with experience working in the public

schools. If neither of these conditions were met they were taken to the end of the survey and their responses were not used for analysis. All respondents had achieved either a master’s degree (93%; n = 65) or a doctorate (7%; n = 5). In addition, all participants reported having experience working in the schools as an SLP, and 93% (n = 65) of them were currently practicing in the schools, with 7% (n = 5) indicating between 2 and 5 years of professional experience in the schools yet not currently practicing as school-based SLPs. Respondents were practicing in 26 different states and represented all four regions of the United States (South, Northeast, Midwest, and West); however, of the 68 respon- dents who indicated where they are currently practicing and professionally licensed (regardless of current setting), the largest number of participants lived in the South (40%; n = 27), followed by the Midwest (24%; n = 16), Northeast (20%; n = 14), and West (16%; n = 11).

Materials The investigators created a web-based, 46-item survey

via Qualtrics software to address questions in five main areas: (a) background information, (b) knowledge and per- ceptions of bullying, (c) bullying and ASD, (d) management of bullying, and (e) school district support. Questions with regard to bullying were adapted from Plexico, Plumb, and Beacham (2013), with further emphasis on bullying of children with ASD and intervention methods to stop bullying.

Procedure Participants in the current study were obtained via

four methods. Two special interest divisions of ASHA were contacted regarding the project: the Language Learning and Education Special Interest Division (Division 1) and the School-Based Issues Special Interest Division (Division 16). They were selected due to their focus on school-based speech-language pathology and the resulting probability that many of their members would be employed in a public school system. An introductory e-mail/information letter containing the web link to the online survey was posted on the respective electronic mailing lists. Within the e-mail/ information letter, potential participants were “invited to participate in a research study to learn about school-based speech-language pathologists’ knowledge and perceptions of bullying of children with autism spectrum disorder (ASD), as well as their management of instances of bullying and how much school district support is provided in the area of bullying.” Participants were informed that they would complete an online survey form (see Appendix) and that the time commitment would be approximately 15 minutes.

A search of the ASHA membership directory through the ASHA Community was also conducted to find potential participants who (a) had their master’s degrees and were licensed to practice speech-language pathology in their state (participants could be in their clinical fellowship year or hold their Certificate of Clinical Competence) and (b) listed

62 Language, Speech, and Hearing Services in Schools • Vol. 47 • 59–76 • January 2016

their current employment setting as either elementary school or secondary school. The researchers then e-mailed the same information letter that was posted on the electronic mailing lists to the first 50 and last 50 community members in all 50 states, in addition to the District of Columbia, to ensure equal representation across all geographic areas of the United States. In states where 100 or fewer potential participants resided (i.e., Alaska, District of Columbia, Hawaii, Montana, Wyoming), all potential participants were e-mailed. Finally, a message conveying a brief de- scription of the survey and its purpose was posted on the ASHA Community site and ASHA Facebook page. These messages also contained an embedded link to direct inter- ested individuals to the survey. Once potential participants clicked on the embedded link, they were directed to the survey, which also contained the information letter.

The survey was administered using the online survey tool Qualtrics, which is a secure Internet-based software program. All data were collected anonymously. A total of 4,987 e-mails were sent, and 95 potential participants ini- tiated the survey. Respondents were then filtered for survey completion, leaving a final participant pool of 70 responses. A total of 48 participants (69%) were recruited from e-mails via ASHA Community profile pages, yielding a response rate of 1.4% for that particular recruitment method. Al- though response rates could not be calculated for the other recruitment methods, three of the 70 participants (4%) were recruited from the ASHA Community discussion board; five (7%) were recruited from ASHA Special Interest Group 1; 11 (16%) were recruited from ASHA Special Interest Group 16, and three (4%) indicated “other.”

Results Background Information

A total of 70 participants completed the survey and met inclusion criteria. The majority of participants reported that they currently practice as an SLP in the schools (93%; n = 65), whereas only 7% (n = 5) responded that they do not currently practice in the schools but do have experience in this setting. Participants were asked to select all grade levels in which they currently work. The majority of partic- ipants reported currently working in elementary schools (79%; n = 55), with fewer participants providing services in middle school (44%; n = 31), high school (26%; n = 18), and specialized schools (7%; n = 5). The participants’ pro- fessional experience in the schools ranged from less than 1 year (1%; n = 1) to 16 or more years (36%; n = 25), with 27% (n = 19) reporting 1 to 5 years, 23% (n = 16) reporting 6 to 10 years, and 13% (n = 9) reporting 11 to 15 years.

To determine participants’ familiarity with ASD, the survey asked about past and current interactions with students on their caseload with the disorder. The number of students with a formal diagnosis of ASD with whom participants have worked in the past 5 years ranged from three to 30 or more students. Of the 67 participants who

responded to this question, the largest percentage reported experience with 30 or more students (28%; n = 19), followed by 11 to 15 students (18%; n = 12), 21 to 25 students (16%; n = 11), six to 10 (13%; n = 9), 16 to 20 (12%; n = 8), 26 to 30 (9%; n = 6), and one to five (3%; n = 2). No par- ticipants reported working with zero students with a formal diagnosis of ASD. With regard to the number of students with ASD currently on participants’ caseloads, of the 69 participants who answered the question, responses ranged from zero to 16 students, with the highest numbers of re- spondents reporting four to six students (23%; n = 16) and seven to nine students (22%; n = 15). This was followed by 16+ students (17%; n = 12), one to three students (14%; n = 10), 13 to 15 students (12%; n = 8), 10 to 12 students (9%; n = 6), and zero students (3%; n = 2). When asked the ages of children with ASD currently on participants’ case- loads, the largest number of respondents indicated working with children between 5 and 7 years (66%; n = 45), whereas 62% (n = 42) reported ages 8 to 10 years, 56% (n = 38) re- ported ages 11 to 13 years, and 16% (n = 24) reported ages 14 to 17 years.

Participants were also asked about their typical sessions with students with ASD. Of the 66 respondents who answered this question, the largest percentage of respondents reported that on average, they see students with ASD for two sessions per week (50%; n = 33), whereas 27% (n = 18) reported seeing students with ASD for one session per week and 23% (n = 15) reported three or more sessions per week. Respondents were then queried as to the location in which a typical intervention session was held. Of the 69 respondents who answered this query, the major- ity reported that they typically hold sessions with students with ASD in the speech room as a group session (58%; n = 40), with smaller numbers reporting holding sessions in the speech room in individual sessions (20%; n = 14), the special education classroom (inclusion; 17%; n = 12), and the regular education classroom (inclusion; 4%; n = 3).

General Knowledge and Perceptions Regarding Bullying

Participants were asked a series of true/false questions to determine their knowledge of the bullying literature. When asked if bullying is of greatest concern during ele- mentary school and early adolescence, of the 69 respon- dents who answered, the majority (68%; n = 47) correctly indicated true, whereas 32% (n = 22) incorrectly answered false. The majority of participants (67%; n = 47) also cor- rectly answered false when asked whether girls are more likely to be bullied than boys; however, 33% (n = 23) of participants incorrectly answered true. When asked whether bullying of children exists in the community outside of school as well as in school, all but one respondent correctly answered true (99%; n = 69). To the question asking whether victims are usually likely to report bullying to adults (e.g., parents, teachers, other school personnel), the majority (77%; n = 54) correctly answered false, whereas 23% (n = 16) incorrectly answered true.

Ofe et al.: SLPs’ Perceptions of Bullying and ASD 63

Participants were then given a list of types of bullying and were asked to indicate actual types of bullying as pre- sented in the bullying literature. Respondents were able to select more than one answer. Results indicated that the majority of respondents correctly selected cyberbullying (99%; n = 68), verbal bullying (81%; n = 56), physical bul- lying (100%; n = 69), and relational bullying (78%; n = 54); however, the foils situational bullying (74%; n = 51) and confrontational bullying (81%; n = 56) were also selected by the majority of participants.

Regarding perceptions of bullying, participants were presented with sliding scale questions to indicate how likely they feel that the victim would experience certain outcomes as a result of being bullied. Participants were asked to rate the degree to which victims would experience each outcome on a sliding scale from 0 (unlikely) to 100 (very likely), with 50 representing likely. Results were presented as averages of participants’ selections. Participants rated anxiety (M = 85.9, SD = 14.7) and impaired self-confidence (M = 81.6, SD = 16.7) as most likely to be experienced, followed by deep emotional trauma (M = 59.8, SD = 24.0), lower aca- demic success (M = 57.8, SD = 26.0), and impaired ability to form peer relationships (M = 57.6, SD = 24.7). Impaired ability to form adult relationships in the future (M = 45.3, SD = 25.0) and suicidal ideation (M = 41.2, SD = 22.8) fell slightly below a rating of 50 and thus were viewed by par- ticipants as the least likely of the presented outcomes.

Participants were additionally queried as to the likeli- hood that certain characteristics would put a child at an increased risk for being bullied. Results indicated that participants believed undeveloped social skills put a child most at risk for being victimized (M = 79.2, SD = 20.2). Although lower average scores were obtained for the other characteristics presented with this question, all were some- what above likely, indicating that a number of characteristics may put a child at risk of being bullied. These characteris- tics included low self-esteem (M = 67.0, SD = 22.5), intellec- tual disability (M = 64.1, SD = 25.0), speech impairment (M = 60.9, SD = 21.8), physical impairment (M = 59.2, SD = 24.4), lack of physical strength (M = 57.4, SD = 21.0), and anxiety (M = 55.7, SD = 24.7).

In response to the question asking to what degree participants consider bullying to be a problem in their schools, 9% (n = 6) indicated bullying to be a serious prob- lem in their schools, 54% (n = 38) indicated bullying in their schools to be somewhat of a problem, and 34% (n = 24) indicated bullying to be not much of a problem. Although 3% (n = 2) were unsure whether bullying was a problem, no participants indicated that it was not a problem at all.

Bullying and ASD With regard to bullying and ASD, participants were

asked whether they have witnessed bullying of children with ASD in their schools. Of the 68 participants who responded, 41% (n = 28) indicated that they have witnessed bullying of children with ASD, whereas 59% (n = 40) indi- cated that they have not. Participants were asked to rank

from least (1) to most (6) where they were likely to witness a child with ASD being bullied. As can be seen in Table 1, respondents indicated that they were least likely to witness bullying in the speech room (pullout) and most likely to witness bullying in the lunchroom and in the car line before or after school.

When asked to what degree participants considered bullying of children with ASD to be a problem in their schools, 26% (n = 18) indicated that it is a serious problem, whereas 59% (n = 41) indicated that it is somewhat of a problem, 11% (n = 8) indicated that it is not much of a problem, 3% (n = 2) indicated that it is not a problem at all, and 1% (n = 1) was unsure. Participants were then asked whether they feel that children with ASD are more susceptible to being bullied than children in the regular education population, to which 83% (n = 58) responded that they are and 17% (n = 12) responded that they are not. Similarly, results indicated that the majority of par- ticipants (60%; n = 42) believed children with ASD to be more susceptible to being victims of bullying than chil- dren with other communication disorders (e.g., stuttering, articulation, language impairment), whereas 40% (n = 28) responded that they are not. Participants were also queried as to which types of bullying they considered to be most problematic for children with ASD. The largest percentage of respondents selected verbal bullying (61%; n = 43), followed by relational bullying (27%; n = 19) and physical bullying (9%; n = 6). No participants selected cyberbullying.

When provided with four types of bullying, partici- pants were asked to indicate which type of bullying they witness most often in relation to children with ASD. Of the 69 participants who responded to this question, verbal bullying was most frequently reported (59%; n = 41). In addition, 6% (n = 4) chose physical bullying, 16% (n = 11) chose relational bullying, and 19% (n = 13) selected the option “none.” No participants selected cyberbullying.

Participants were then queried as to how they feel when they see a child with ASD being bullied and were instructed to select all answers that apply to them. The majority of respondents selected the choices “frustrated” (59%; n = 41), “annoyed with the situation” (55%; n = 38), and “sorry for the child” (54%; n = 37), with smaller per- centages selecting the choices “embarrassed for the child being bullied” (32%; n = 22), “anxious” (22%; n = 15), and “overwhelmed with the situation” (5%; n = 6). No partici- pants indicated that they would feel “unconcerned.” Of participants, 29% (n = 20) chose “other” and were given the opportunity to write in how they would feel in the situ- ation. Seventeen of these participants (85%) wrote in the provided text box, with the terms angry or mad written in most frequently (53%; n = 9).

Management of Bullying Participants were asked a number of questions to de-

termine how they manage instances of bullying of children with ASD. All respondents (n = 70) indicated that they feel it is their responsibility as SLPs to intervene in moments

64 Language, Speech, and Hearing Services in Schools • Vol. 47 • 59–76 • January 2016

of bullying. Seventy-four percent (n = 52) of participants indicated that they feel adequately prepared to intervene in moments of bullying, whereas 26% (n = 18) indicated that they do not. With regard to whether participants feel com- fortable intervening in moments of bullying, of the 69 respon- dents who answered this question, 83% (n = 57) indicated that they do feel comfortable and 17% (n = 12) selected that they do not. Participants who responded that they did not feel comfortable intervening in moments of bullying were then asked whether they tend to overlook instances of bullying; no participants indicated that they did so.

Participants were asked how they respond when a child is being bullied, with the instructions of selecting all that apply. Of the 69 participants who responded to this question, the largest percentage of respondents selected the choices “talk to the child being bullied and offer strategies for coping with bullying” (88%; n = 61) and “report the behavior to other school personnel” (84%; n = 58). This was followed by “have the bully apologize” (39%; n = 27), “talk to the child being bullied and offer condolence” (29%; n = 20), and “give the child who is bullying three warn- ings” (6%; n = 4). No participants selected “ignore the situation until the child being bullied confronts you with the problem.” Participants who selected “other” (33%; n = 23) were given the opportunity to write in how they would respond, with the most commonly reported answer being that they would talk to the bully about his or her behavior.

Participants were asked what type of advice they give children who are experiencing each type of bullying (rela- tional, physical, verbal, and cyberbullying), with the instruc- tions of selecting all choices that apply (see Table 2). For relational and physical bullying, all participants responded that they would give the advice to “tell an adult at school when someone is bullying you.” Responses that were written in under the category of “other” for relational bullying in- cluded “seek help from peers who are not part of the bully- ing,” “go over a list of appropriate comebacks with the child being bullied,” and “work to strengthen social skills and ways to make new friends.” One participant noted that his or her students with ASD often need to be informed that they are being bullied. Responses under the category of “other” for physical bullying included “ask friends to

stay close,” “stand up for yourself with peer support but do not use physical aggression,” “stay as far away as possible from the bully,” and “leave the situation.”

For verbal bullying, the largest percentage of respon- dents (97%; n = 68) selected “tell an adult at school when someone is bullying you.” Responses written under the category of “other” included “stand up for yourself but do not resort to name-calling in return,” “walk away,” “talk it out and tell the bully how it makes you feel,” and “get school counselor involved if possible for peer problem- solving groups.”

Regarding cyberbullying, the majority of participants indicated that they would give the advice to “tell an adult at school when someone is bullying you” and “tell your parents so that the situation can be handled outside of school.” Responses written in one or two times each under the category of “other” included “block the [bully],” “seek help from a trusted adult/mentor,” “don’t engage in social media,” and “do not get rid of the comments, as they will be proof of what has happened, and do not respond to the bully.” Several respondents noted that this type of bullying is not common at the elementary or primary school level, so they lack experience dealing with cyberbullying.

School District Support Participants were queried as to whether their school

districts are aware of bullying in schools. The majority of participants (97%; n = 68) indicated that their schools were aware of bullying, whereas only 3% (n = 2) indicated they were not aware. Eighty-four percent of participants (n = 59) indicated that their schools provide in-services regarding the management of bullying and use of antibullying lan- guage, whereas 16% (n = 11) indicated that their schools do not. When asked how often participants’ school districts hold in-services regarding the management of bullying and use of antibullying language, the largest percentage of re- spondents indicated that in-services occur one to two times per year (71%; n = 50), with smaller numbers indicating no annual discussions (20%; n = 14), three to four in-services per year (6%; n = 4), and seven or more in-services per year (3%; n = 2).

Table 1. Areas of school where bullying is likely to be witnessed.

Location

1 2 3 4 5 6

Nn (%) n (%) n (%) n (%) n (%) n (%)

In the car line before or after school 6 (10) 6 (10) 4 (7) 10 (17) 13 (22) 19 (33) 58 In the lunchroom 3 (5) 3 (5) 4 (6) 2 (3) 25 (38) 29 (44) 66 In the regular education classroom (inclusion) 1 (2) 4 (7) 5 (8) 31 (51) 15 (25) 5 (8) 61 In small group sessions 2 (3) 17 (28) 32 (52) 7 (11) 3 (5) 0 (0) 61 In the special education classroom 6 (10) 26 (44) 14 (24) 9 (15) 4 (7) 0 (0) 59 In the speech room (pullout) 48 (73) 9 (14) 2 (3) 1 2) 0 (0) 6 (9) 66 N 66 65 61 60 60 59

Note. N = total number of respondents; n = number of respondents per category; % = percentage of respondents; 1 = least likely; 6 = most likely.

Ofe et al.: SLPs’ Perceptions of Bullying and ASD 65

Participants were then queried as to whether their school districts provide access to printed materials about bullying and/or management of bullying. Of the 69 respon- dents who answered this question, 84% (n = 58) indicated that their school districts do provide access to printed ma- terials, whereas 16% (n = 11) indicated that their school districts do not provide access to printed materials. When asked whether participants were aware of where printed materials about bullying can be obtained, 76% (n = 53) in- dicated that they are aware, whereas 24% (n = 17) indicated that they were not aware. Participants were also asked whether their school district offers counseling services for bullies and victims, to which 90% (n = 63) indicated that counseling services are provided, whereas only 10% (n = 7) indicated that services are not provided.

With regard to antibullying campaigns, participants were asked whether their school district uses an antibullying campaign to address bullying. Of the 69 participants who responded to this question, 78% (n = 54) indicated that their school districts do use antibullying campaigns, whereas 22% (n = 15) do not. When asked whether participants’ school districts utilize antibullying campaigns specific to children with special needs, only 20% (n = 14) indicated that their schools do, whereas 80% (n = 56) reported their school districts do not. Finally, participants were queried as to whether their school district has implemented a formal pro- gram addressing intervention and prevention of bullying. The majority of respondents indicated that their districts do not use formally implemented antibullying campaigns (59%; n = 41), whereas 41% (n = 29) indicated that their school districts do use formal antibullying campaigns. Participants whose school districts utilize formal antibul- lying programs were asked to provide the name of the program. Of the 21 participants who answered this ques- tion, such programs included Olweus Bullying Prevention Program (9%; n = 2), Text Response (9%; n = 2), Positive Behavioral Interventions & Supports (PBIS; 9%; n = 2), Anti-Bullying Program (5%; n = 1), Boys Town Social Skills (5%; n = 1), Character Counts (5%; n = 1), Name It, Claim It, Stop It (5%; n = 1), Project Cornerstone (5%; n = 1), Safe School Ambassadors (5%; n = 1), Second Step (5%; n = 1), Stop It! (5%; n = 1), and Whole School Re- sponse (5%; n = 1).

Discussion Experience

All respondents reported that they had worked with students with a formal diagnosis of ASD within the past 5 years, and 98.5% reported that they work with students with ASD on their current caseload. This finding is not surprising in light of the increasing prevalence rate of ASD, which is currently reported as 1 in 68 (Autism and Devel- opmental Disabilities Monitoring Network Surveillance Year 2010 Principal Investigators, 2014). This finding also closely mirrors the findings of Plumb and Plexico (2013), who found that 98.8% of participants reported having at least one client with ASD on their caseload.

The ages of children on participants’ caseloads encompassed the period of elementary through late high school, with the smallest percentage serving students in high school. The large number of participants working in elementary schools is consistent with data from ASHA’s 2014 Schools Survey; of the 1,686 participants who answered this question, 60% reported working in elementary schools, versus 12% in secondary schools. More than half of par- ticipants in the current study indicated that they worked with students in the period of early adolescence, which is cited in the literature as the period in which bullying is most likely to occur (Chapell et al., 2006; Espelage & Swearer, 2003; Hazler, 1996; Pellegrini & Bartini, 2000); however, the largest number of respondents indicated work- ing with younger ages (5 to 10 years), which could indicate why the majority of participants later reported that they have not witnessed bullying of children with ASD. SLPs serving students in early adolescence are more likely to wit- ness the transition between elementary and middle school, as well as middle to high school, during which students strive to “fit in” their new social environments, often by bullying if such behavior is socially advantageous (Pellegrini & Bartini, 2000).

General Knowledge and Perceptions Regarding Bullying

The majority of respondents demonstrated appropri- ate knowledge of current research regarding bullying in the

Table 2. Types of advice given to children experiencing relational, physical, verbal, or cyber bullying.

Advice

Relational N = 69

Physical N = 70

Verbal N = 70

Cyber N = 68

n (%) n (%) n (%) n (%)

Tell an adult at school when someone is bullying you 69 (100) 70 (100) 68 (97) 57 (84) Tell your parents so that the situation can be handled outside of school 26 (38) 31 (44) 29 (41) 43 (63) Ignore the bully 27 (39) 3 (4) 26 (37) 13 (19) Stand up for yourself and fight back 15 (22) 13 (19) 13 (19) 6 (9) Deal with it because bullying is a normal part of growing up 3 (4) 0 (0) 1 (1) 0 (0) Deal with it because it will help you gain character 1 (1) 0 (0) 0 (0) 0 (0) Other 18 (26) 19 (27) 17 (24) 14 (21)

Note. N = total number of respondents; n = number of respondents per category of advice; % = percentage of respondents.

66 Language, Speech, and Hearing Services in Schools • Vol. 47 • 59–76 • January 2016

school system. However, up to 33% of participants answered some questions incorrectly, suggesting that almost a third of school-based SLPs could potentially benefit from further information about bullying in order to understand this issue. In addition, when asked to identify types of bullying, the majority of respondents correctly identified all four types of bullying (i.e., cyber, verbal, physical, relational); however, the majority also incorrectly selected the two foils as types of bullying (i.e., confrontational, situational). This result further highlights the need for education of school- based SLPs on the nature and types of bullying.

The possible outcomes of being bullied selected by participants were primarily consistent with the bullying lit- erature. Outcomes rated as most likely and likely to follow bullying that coincide with the literature include anxiety (Chapell et al., 2006; Espelage & Swearer, 2003; Hazler et al., 1992), lower academic success (Hazler et al., 1992), and impaired ability to form peer relationships (J. Carney, 2000; Nansel et al., 2001). Similar to impaired self-confidence, the literature cites impaired self-esteem as a common out- come of bullying (J. Carney, 2000). In addition, similar to deep emotional trauma, a number of studies have noted depression as an outcome (Chapell et al., 2006; Espelage & Swearer, 2003; Kaltiala-Heino, Rimpela, Matrunnen, Rimpela, & Rantanen, 1999). However, suicidal ideation was rated as the least likely outcome of being bullied in the current survey, which is inconsistent with the literature. Multiple studies have found suicidal ideation to be a severe outcome of bullying (J. Carney, 2000; Chapell et al., 2006; Hinduja & Patchin, 2010; Kaltiala-Heino et al., 1999; Rigby & Slee, 1999). It is possible that because the majority of participants in the current study serve children of younger ages who may not have experienced years of bullying, they are less likely to observe suicidal behavior. It is also pos- sible that this is not something expressed outwardly by students toward school professionals, as opposed to conse- quences that may be more visible to the outside observer, such as decreased peer relationships and impaired self- confidence.

Characteristics chosen to put children at risk for be- ing bullied were also consistent with the bullying literature. As indicated in the survey, low self-esteem (A. Carney & Merrell, 2001; Olweus, 1997), anxiety (Olweus, 1997), lack of physical strength (Olweus, 1997), undeveloped social skills (Cappadocia et al., 2012; Hughes, 2014; Loveland et al., 2001; Reiter & Lapidot-Lefler, 2007), intellectual disability (Flynt & Morton, 2004; Mepham, 2010; Mishna, 2003), speech impairment (Hadley & Rice, 1991), and physical impairment (Biggs, Simpson, & Gaus, 2010) have all been found to contribute to victimization. Given that participants rated all of these above 50, which indicated likely, respondents acknowledged that a number of charac- teristics may put children at risk for being bullied. “Un- developed social skills” was the only characteristic rated as most likely to put a child at risk for bullying; this answer could have been chosen most often due to the professional background of the survey population. Because SLPs are trained to evaluate and treat social communication deficits,

it is likely that this academic and clinical training in lan- guage use (i.e., pragmatics) allows SLPs to observe undevel- oped social skills among their students who are bullied as well as to understand the social impact that pragmatic defi- cits can have.

Bullying and ASD Results of this study indicated that the majority of

respondents consider bullying of children with ASD to be a problem in their schools. This is in keeping with the literature, given that several studies have found bullying of children with ASD to occur at a rate of 40% to 46% (Mepham, 2010; Sterzing, Shattuck, Narendorf, Wagner, & Cooper, 2012; Wainscott, Naylor, Sutcliffe, Tantam, & Williams, 2008). In addition, Cappadocia et al. (2012) reported that bullying is twice as likely to happen among students with ASD as in the general population.

Participants indicated that they were most likely to witness children with ASD being bullied in the lunchroom or the car line before or after school. This finding is consistent with studies regarding locations of bullying because it has been found that bullying often occurs in areas of minimal adult supervision (e.g., the lunchroom, the walk to and from school, playgrounds, hallways, and bathrooms). Results of this survey also indicated that bullying was unlikely to be witnessed in small group sessions and the special education classroom. Given the adult presence associated with these settings, this finding further highlights previous conclusions that bullying is more likely to be observed in situations with less adult supervision.

The most problematic type of bullying for children with ASD was indicated to be verbal bullying, followed by relational bullying. The finding with regard to relational bullying is somewhat surprising, given that it is frequently overlooked when compared with other types of bullying (i.e., verbal and physical) due to its covert nature (Boulton, Trueman, Chau, Whitehand, & Amatya, 1999). The possi- bility exists that SLPs’ training in social communication makes them particularly well suited to perceive instances of relational bullying. In addition, social skills training is often a crucial part of therapy for students with ASD, so SLPs may be perceptive of social behaviors that could result in students being bullied. Social vulnerability and exclusion have been recognized in the literature as factors that can have a negative impact on the quality of life and psychological well-being of children with ASD (Cappadocia et al., 2012; Sofronoff, Dark, & Stone, 2011); therefore, the finding that SLPs may be able to recognize relational bullying is positive.

No participants indicated cyberbullying as problem- atic for children with ASD, which is interesting in light of the increased risk of harassment for Internet users (Jones, Mitchell, & Finkelhor, 2012). This is somewhat consistent with the literature, though; several studies have determined verbal and relational bullying to be more common than cyberbullying for this population (Cappadocia et al., 2012; Carter, 2009; Kloosterman et al., 2013), whereas fewer

Ofe et al.: SLPs’ Perceptions of Bullying and ASD 67

have considered cyberbullying a threat (Kowalski & Fedina, 2011). The possibility also exists that cyberbullying may be more evident at home, where students are more likely to engage in social networking activities such as Facebook and Twitter (Dehue, Bolman, & Völlink, 2008; Tokunaga, 2010).

Management of Bullying Regarding management of bullying, all respondents

agreed that it is the responsibility of the SLP to intervene in moments of bullying. This is in keeping with the Blood et al. (2013) vignette study regarding SLPs’ perceptions of bullying of students with ASD, given that no participants noted being “not at all likely” to intervene in instances of bullying. In addition, the majority of respondents in the current survey indicated that they felt comfortable and prepared to intervene in moments of bullying; however, more than a quarter of respondents did not feel adequately prepared. These SLPs could most likely benefit from train- ing on bullying intervention strategies. Because SLPs are typically viewed as authorities on ASD and other special needs in the school environment, they may be distinctly qualified to help educate teachers and other school person- nel on how to create a safe environment for these students (Hughes, 2014).

When observing a child being bullied, the majority of respondents indicated two main methods of responding: talking to the child being bullied and offering strategies for coping with the situation as well as reporting the behavior to other school personnel. Both of these methods are sup- ported in the literature. Blood et al. (2013) found a “Re- port, Educate, Reassure” pattern among their participants’ choices of how to respond. No SLPs in the current study selected “ignore the situation until the child being bullied confronts you with the problem.” The fact that participants reported proactive methods of responding to bullying situations is a positive finding. Students are more likely to report bullying to adults who they believe will actively intervene in bullying situations (Cortes & Kochenderfer-Ladd, 2014). In addition, avoidance strategies, such as ignoring the bully and walking away from the situation, have been reported as ineffective (Kochenderfer-Ladd & Pelletier, 2008). Adults ignoring bullying situations has also been re- ported by students as one of the most likely factors for the perpetuation of bullying (Davis & Nixon, 2010).

Participants were also asked what type of advice they give to children experiencing the four different types of bullying. Similar responses were chosen for all four types of bullying. All participants chose the advice “Tell an adult at school when someone is bullying you” for relational and physical bullying, whereas 97% (n = 68) chose this answer for verbal bullying. For cyberbullying, the majority of participants selected both “Tell an adult at school when someone is bullying you” and “Tell your parents so that the situation can be handled outside of school.” Similar to the Blood et al. (2013) study, participants did not differ- entiate among verbal, relational, and physical bullying in

terms of how they would respond; however, responses for cyberbullying on the current survey differed. The high number of responses for both of the categories—telling an adult at school and telling parents at home—indicate that cyberbullying is an issue that may need to be resolved by adults in the school and/or the child’s home because home is where most cyberbullying usually occurs (Dehue et al., 2008; Tokunaga, 2010). However, just as studies have found that children are not likely to report bullying to teachers, the literature also cites that children are often unwilling to report cyberbullying to their parents because they fear losing their electronic privileges (Mishna, Saini, & Solomon, 2009).

School District Support The final section of the survey focused on support

SLPs receive from their school districts regarding bullying. Respondents indicated that the majority of school districts are aware of bullying and offer in-services about manage- ment of bullying one to two times per year. In addition, most participants reported that school districts provide access to printed materials about bullying and/or manage- ment of bullying, and a majority also knew where to obtain these materials. Awareness in the schools could coincide with the increase of awareness in society as a whole because a number of websites, organizations, and films have been created to combat bullying.

The majority of respondents indicated that their school districts utilize antibullying campaigns; however, only 20% of these school districts utilize antibullying campaigns specific to children with special needs. Given that more than half of SLPs in the current study indicated that children with ASD are more at risk for being bullied than children in the regular education population, more aware- ness of bullying of children with special needs, such as ASD, may be helpful to many professionals working with this population (Hughes, 2014; Mepham, 2010; Mishna, 2003; Sofronoff et al., 2011).

Limitations and Future Directions The primary limitation of this investigation is the

low response rate. Of the 4,987 individuals invited to par- ticipate in the survey by e-mail, 48 completed the survey through this recruitment method, yielding a 1% response rate. In addition, although participants represented the South, Northeast, Midwest, and West, the highest number of respondents were from the South. Therefore, the sample in the current survey may not represent the target popula- tion; however, similarities between the demographic data for the participant pool in the current investigation and that of the ASHA 2014 Schools Survey (i.e., the largest number of respondents came from the South and the largest number serve elementary-aged students) may increase the chance of generalization. According to ASHA’s 2014 Schools Survey, of the 1,690 participating SLPs who answered this

68 Language, Speech, and Hearing Services in Schools • Vol. 47 • 59–76 • January 2016

question, the largest number worked in the South (32%) versus the Northeast (27%), Midwest (24%), and West (17%).

Another factor that could limit generalization is the possibility that only SLPs particularly interested in ASD and bullying may have responded to this survey. For ex- ample, although reported knowledge of the bullying litera- ture and awareness from school districts was high, these results may be somewhat inflated. If an SLP has a particu- lar interest in this subject, they may seek out information on the topic and be more aware than an SLP who does not have a particular interest in the subject; thus, the possibil- ity exists that SLPs are not as knowledgeable about the topic of bullying as indicated by the results of this survey.

The current survey was developed via review of published surveys in the literature; however, its lack of val- idation through piloting could be considered a limitation. Also, several of the survey’s questions could have been leading. For example, when asked whether participants be- lieve it to be SLPs’ responsibility to intervene in bullying, all participants indicated that it is. The possibility exists that this answer could have been chosen due to the nature of the survey. Respondents may have felt obligated to choose the most socially and professionally appropriate answer. Rewording this question with the option for par- ticipants to respond using a sliding scale (e.g., To what de- gree are SLPs responsible for intervening with bullying?) would allow for more diversity of response and potentially decrease a sense of obligation.

A possible limitation to understanding participants’ knowledge and perceptions of bullying is that two ques- tions on the survey were omitted. Participants were asked which type of bullying has been shown to be the most prevalent among boys and which type is most prevalent among girls; however, it was necessary to omit these responses from analysis due to technical difficulties en- countered with the response format of those two survey questions.

It would be of interest to examine qualitative data pertaining to SLPs’ personal experiences with bullying of children with ASD, how they respond in these situations, and their preparation to do so. Interview of school-based SLPs could shed light on the perceptions of the roles and responsibilities of school-based SLPs related to bullying of children on their caseloads. For example, school-based SLPs could be interviewed.

Future research could also investigate how regular and special education teachers view the role of the SLP with regard to bullying of children with ASD. For in- stance, it would be of interest to examine whether teachers consult SLPs for potential collaboration when students with ASD are being bullied. Given that the literature high- lights the essential role of school personnel in stopping bullying, understanding how teachers and SLPs collaborate to help their students could provide further information on intervention strategies. Such strategies might include social skills intervention or direct bullying prevention or intervention strategies, such as peer or educator training (Hughes, 2014).

Conclusions and Clinical Implications The results of this study are consistent with the Blood

et al. (2013) findings regarding SLPs’ perceptions of bully- ing of children with ASD. Participants in the current investigation believed bullying of children with ASD to be a problem in their schools, and all indicated that it is their responsibility to intervene in moments of bullying; however, not all respondents demonstrated an in-depth knowledge of bullying nor did they feel comfortable inter- vening. Therefore, it appears that some SLPs in the schools could benefit from more information on bullying in order to understand the nature, context, and extent of this issue as well as ways in which to respond to bullying when it is observed.

In addition, although the majority of SLPs indicated their school used a specific antibullying campaign, very few indicated that a program was in place to specifically address the bullying of children with special needs such as ASD. Given that SLPs are trained in all areas of language, including social communication, they have the potential to take a primary role in both the management of social communication deficits and antibullying efforts for children on the autism spectrum. Given that the majority of SLPs reported seeing the students on their caseloads in small groups, for example, this may allow the opportunity to cre- ate a safe environment in which students feel free to report bullying incidents. The school-based SLP can then utilize a recommended response strategy, such as talking with the student being bullied and listening to his or her concerns, providing advice and coping strategies, and being proactive with intervention instead of ignoring the situation, which is known to be ineffective. Proactive SLPs who seek out this information can also consult with teachers and school personnel to provide constructive guidance on how to man- age both communication needs of children with ASD and antibullying efforts within the classroom.

References American Psychiatric Association. (2013). Diagnostic and statisti-

cal manual of mental disorders (5th ed.). Washington, DC: Author.

American Speech-Language-Hearing Association (ASHA). (2014). 2014 Schools Survey report: Survey methodology, respondent demographics, and glossary. Retrieved from http://www.asha. org/research/memberdata/schoolssurvey/

Arick, J., Krug, D., Fullerton, A., Loos, L., & Falco, R. (2005). School-based programs. In F. Volkmar, R. Paul, A. Klin, & D. Cohen (Eds.), Handbook of autism and pervasive devel- opmental disorders (3rd ed., pp. 1003–1028). Hoboken, NJ: Wiley.

Autism and Developmental Disabilities Monitoring Network Surveillance Year 2010 Principal Investigators. (2014, March). Prevalence of autism spectrum disorder among children aged 8 years—Autism and Developmental Disabilities Monitoring Network. MMWR Surveillance Summary, 63(SS02), 1–21.

Biggs, M., Simpson, C., & Gaus, M. (2010). Using a team ap- proach to address bullying of students with Asperger’s syndrome in activity-based settings. Children & Schools, 32, 135–142.

Ofe et al.: SLPs’ Perceptions of Bullying and ASD 69

Blood, G. W., & Blood, I. M. (2004). Bullying in adolescents who stutter: Communicative competence and self-esteem. Contemporary Issues in Communication Science and Disorders, 31, 69–79.

Blood, G. W., & Blood, I. M. (2007). Preliminary study of self- reported experience of physical aggression and bullying of boys who stutter: Relation to increased anxiety. Perceptual and Motor Skills, 194, 1060–1066.

Blood, G., Blood, I., Coniglio, A., Finke, E., & Boyle, M. (2013). Familiarity breeds support: Speech-language pathologists’ per- ceptions of bullying of students with autism spectrum disorders. Journal of Communication Disorders, 46, 169–180.

Boulton, M., Trueman, M., Chau, C., Whitehand, C., & Amatya, K. (1999). Concurrent and longitudinal links between friendship and peer victimization: Implications for befriending interven- tions. Journal of Adolescence, 22, 461–466.

Bradshaw, C., Waasdorp, T., O’Brennan, L., Gulemetova, M., & Henderson, R. (2011). Findings from the National Education Association’s nationwide study of bullying: Teachers’ and educa- tion support professionals’ perspectives. Retrieved December 16, 2013, from https://www.nea.org/assets/docs/2010_Survey.pdf

Cappadocia, C., Weiss, J., & Pepler, D. (2012). Bullying experi- ences among children and youth with autism spectrum dis- orders. Journal of Autism and Developmental Disorders, 42, 266–277.

Card, N., & Hodges, E. (2008). Peer victimization among school- children: Correlations, causes, consequences, and considerations in assessment and intervention. School Psychology Quarterly, 23, 451–461.

Carney, A., & Merrell, K. (2001). Bullying in schools: Perspectives on understanding and preventing an international problem. School Psychology International, 22, 364–382.

Carney, J. (2000). Bullied to death: Perceptions of peer abuse and suicidal behaviour during adolescence. School Psychology International, 21, 213–223.

Carter, S. (2009). Bullying of students with Asperger syndrome. Issues in Comprehensive Pediatric Nursing, 32, 145–154.

Chapell, M., Hasselman, S., Kitchin, T., Lomon, S., MacIver, K., & Sarullo, P. (2006). Bullying in elementary school, high school, and college. Adolescence, 41, 633–648.

Cortes, K., & Kochenderfer-Ladd, B. (2014). To tell or not to tell: What influences children’s decisions to report bullying to their teachers? School Psychology Quarterly, 29, 336–348.

Craig, W., Henderson, K., & Murphy, J. (2000). Prospective teachers’ attitudes toward bullying and victimization. School Psychology International, 21, 5–21.

Crick, N., & Grotpeter, J. (1995). Relational aggression, gender, and social-psychological adjustment. Child Development, 66, 710–722.

Davis, S., & Nixon, C. (2010). The Youth Voice Project. Retrieved from http://www.letamericaknow.com/YVPMarch2010.pdf

Dehue, F., Bolman, C., & Völlink, T. (2008). Cyberbullying: Youngsters’ experiences and parental perception. Cyber- Psychology & Behavior, 11, 217–223.

Espelage, D., & Swearer, S. (2003). Research on school bullying and victimization: What have we learned and where do we go from here? School Psychology Review, 32, 365–383.

Flynt, S., & Morton, R. (2004). Bullying and children with disabil- ities. Journal of Instructional Psychology, 31, 330–333.

Gray, C. (2004). Gray’s guide to bullying, parts I–III. Jenison Autism Journal, 16(1), 2–19.

Hadley, P., & Rice, M. (1991). Conversational responsiveness of speech- and language-impaired preschoolers. Journal of Speech and Hearing Research, 34, 1308–1317.

Hazler, R. (1996). Breaking the cycle of violence: Interventions for bullying and victimization. Washington, DC: Taylor & Francis.

Hazler, R., Hoover, J., & Oliver, R. (1992). What kids say about bullying. The Executive Educator, 14(11), 20–22.

Hinduja, S., & Patchin, J. W. (2010). Bullying, cyberbullying, and suicide. Archives of Suicide Research, 14, 206–212.

Hughes, S. (2014). Bullying: What speech-language pathologists should know. Language, Speech, and Hearing Services in Schools, 45, 3–13.

Hugh-Jones, S., & Smith, P. K. (1999). Self-reports of short- and long-term effects of bullying on children who stammer. British Journal of Educational Psychology, 69, 141–158.

Jacobson, G., Riesch, S., Temkin, B. M., Kedrowski, K., & Kluba, N. (2011). Students feeling unsafe in school: Fifth graders’ experi- ences. Journal of School Nursing, 27, 149–159.

Jones, L., Mitchell, K., & Finkelhor, D. (2012). Trends in youth Internet victimization: Findings from three youth Internet safety surveys 2000–2010. Journal of Adolescent Health, 50, 179–186.

Kaltiala-Heino, R., Rimpela, M., Matrunnen, M., Rimpela, A., & Rantanen, P. (1999). Bullying, depression, and suicidal idea- tion in Finnish adolescents: School survey. British Medical Journal, 319, 348–351.

Kloosterman, P., Kelley, E., Craig, W., Parker, J., & Javier, C. (2013). Types and experiences of bullying in adolescents with an autism spectrum disorder. Research in Autism Spectrum Disorders, 7, 824–832.

Kochenderfer-Ladd, B., & Pelletier, M. (2008). Teachers’ views and beliefs about bullying: Influences on classroom manage- ment strategies and students’ coping with peer victimization. Journal of School Psychology, 46, 431–453.

Kowalski, R., & Fedina, C. (2011). Cyber bullying in ADHD and Asperger syndrome populations. Research in Autism Spectrum Disorders, 5, 1201–1208.

Kowalski, R., & Limber, S. (2007). Electronic bullying among middle school students. Journal of Adolescent Health, 41, S22–S30.

Langevin, M., Bortnick, K., Hammer, T., & Wiebe, E. (1998). Teasing/bullying experienced by children who stutter: Toward development of a questionnaire. Contemporary Issues in Com- munication Science and Disorders, 25, 12–24.

Little, L. (2002). Middle-class mothers’ perceptions of peer and sibling victimization among children with Asperger’s syndrome and nonverbal learning disorders. Issues in Comprehensive Pediatric Nursing, 25, 43–57.

Loveland, K., Pearson, D., Tunali-Kotoski, B., Ortegon, J., & Gibbs, C. (2001). Judgments of social appropriateness by children and adolescents with autism. Journal of Autism and Developmental Disorders, 31, 367–376.

Mepham, S. (2010). Disabled children: The right to feel safe. Child Care in Practice, 16, 19–34.

Mishna, F. (2003). Learning disabilities and bullying: Double jeopardy. Journal of Learning Disabilities, 36, 336–347.

Mishna, F., Saini, M., & Solomon, S. (2009). Ongoing and online: Children and youth’s perceptions of cyber bullying. Children and Youth Services Review, 31, 1222–1228.

Nansel, T., Overpeck, M., Pilla, R., Ruan, J., Simons-Morton, B., & Scheidt, P. (2001). Bullying behaviors among US youth: Prevalence and association with psychosocial adjustment. The Journal of the American Medical Association, 285, 2094–2100.

Olweus, D. (1997). Bully/victim problems in school: Facts and intervention. European Journal of Psychology of Education, 12, 495–510.

70 Language, Speech, and Hearing Services in Schools • Vol. 47 • 59–76 • January 2016

Olweus, D. (2011). Bullying at school and later criminality: Findings from three Swedish community samples of males. Criminal Behaviour and Mental Health, 21, 151–156.

Paul, R., & Norbury, C. (2012). Language disorders from infancy through adolescence: Listening, speaking, reading, writing, and communicating. St. Louis, MO: Elsevier Mosby.

Pellegrini, A., & Bartini, M. (2000). A longitudinal study of bully- ing, victimization, and peer affiliation during the transition from primary school to middle school. American Educational Research Journal, 37, 699–725.

Plexico, L. W., Plumb, A. M., & Beacham, J. (2013). Teacher knowledge and perceptions of stuttering and bullying in school-age children. SIG 4 Perspectives on Fluency and Fluency Disorders, 23, 39–53.

Plumb, A. M., & Plexico, L. W. (2013). Autism spectrum disor- ders: Experience, training, and confidence levels of school-based speech-language pathologists. Language, Speech, and Hearing Services in Schools, 44, 89–104.

Reiter, S., & Lapidot-Lefler, N. (2007). Bullying among special education students with intellectual disabilities: Differences in social adjustment and social skills. Intellectual and Develop- mental Disabilities, 45, 174–181.

Rigby, K., & Slee, P. (1999). Suicidal ideation among adolescent school children, involvement in bully-victim problems, and perceived social support. Suicide and Life-Threatening Behavior, 29, 119–130.

Robers, S., Kemp, J., Truman, J., & Snyder, T. (2013). Indicators of school crime and safety: 2012 (NCES 2013-036/NCJ 241446). Washington, DC: Department of Education, National Center Education Statistics, and United States Department of Justice, Office of Justice Programs, Bureau of Justice Statistics. Retrieved from http://nces.ed.gov/pubs2013/2013036.pdf

Salmivalli, C., Lagerspetz, K., Björkqvist, K., Österman, K., & Kaukiainen, A. (1996). Bullying as a group process: Participant roles and their relations to social status within the group. Aggressive Behavior, 22, 1–15.

Schroeder, J., Cappadocia, M., Bebko, J., Pepler, D., & Weiss, J. (2014). Shedding light on a pervasive problem: A review of research on bullying experiences among children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 44, 1520–1534.

Slonje, R., & Smith, P. (2008). Cyberbullying: Another main type of bullying. Scandinavian Journal of Psychology, 49, 147–154.

Smokowski, P., & Kopasz, K. (2005). Bullying in school: An over- view of types, effects, family characteristics, and intervention strategies. Children and Schools, 27, 101–109.

Sofronoff, K., Dark, E., & Stone, V. (2011). Social vulnerability and bullying in children with Asperger syndrome. Autism, 15, 355–372.

Sterzing, P., Shattuck, P., Narendorf, S., Wagner, M., & Cooper, B. (2012). Bullying involvement in autism spectrum disorders: Prevalence and correlates of bullying involvement among adolescents with an autism spectrum disorder. Archives of Pediatrics and Adolescent Medicine, 166, 1058–1064.

Swearer, S., Song, S., Cary, P., Eagle, J., & Mickelson, W. (2001). Psychosocial correlates in bullying and victimization: The rela- tionship between depression, anxiety, and bully/victim status. Journal of Emotional Abuse, 2, 95–121.

Tokunaga, R. (2010). Following you home from school: A critical review and synthesis of research on cyberbullying victimization. Computers in Human Behavior, 26, 277–287.

Unnever, J., & Cornell, D. (2004). Middle school victims of bullying: Who reports being bullied? Aggressive Behavior, 30, 373–388.

Wainscott, J., Naylor, P., Sutcliffe, P., Tantam, D., & Williams, J. (2008). Relationships with peers and use of the school envi- ronment of mainstream secondary school pupils with Asperger syndrome (high-functioning autism): A case-control study. International Journal of Psychology and Psychological Therapy, 8, 25–38.

Wang, J., Iannotti, R., & Nansel, T. (2009). School bullying among adolescents in the United States: Physical, verbal, relational, and cyber. Journal of Adolescent Health, 45, 368–375.

Ofe et al.: SLPs’ Perceptions of Bullying and ASD 71

Appendix (p. 1 of 5)

Online Survey

Part I. Background 1. We appreciate your participation. How did you hear about the survey? E-mail via ASHA Community Profile Page ❍ ASHA Community Discussion Board ❍ ASHA Facebook Page ❍ ASHA Special Interest Group 1, Language Learning and Education ❍ ASHA Special Interest Group 16, School-based Issues ❍ Other ____________________

2. Highest degree received: ❍ Bachelor’s ❍ Master’s ❍ Doctorate

3. I have professional experience working as a speech-language pathologist in the schools. ❍ Yes ❍ No

4. Are you currently practicing as a speech-language pathologist in the schools? ❍ Yes ❍ No

5. In which state are you currently practicing and professionally licensed?

6. Years of professional experience in the schools: ❍ <1 year ❍ 1–5 years ❍ 6–10 years ❍ 11–15 years ❍ 16+ years

7. Grade levels I currently serve (check all that apply): ❑ Elementary school ❑ High school ❑ Middle school ❑ Specialized school

8. Autism Spectrum Disorder is defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as persistent deficits in social communication and restricted, repetitive patterns of behaviors and interests. These symptoms must be present in early childhood and must affect and limit them in their daily lives. Individuals with ASD range from low functioning, where they may be nonverbal with intellectual disabilities, to high functioning, where they are verbose and possess IQs above normal limits. Based on this definition, please indicate the number of students with a formal diagnosis of autism spectrum disorder (ASD) currently on your caseload: ❍ 0 students ❍ 1–3 students ❍ 4–6 students ❍ 7–9 students ❍ 10–12 students ❍ 13–15 students ❍ 16+ students

9. What is the approximate number of students with a formal diagnosis of ASD whom you have worked with in the past 5 years? ❍ 0 students ❍ 1–5 students ❍ 6–10 students ❍ 11–15 students ❍ 16–20 students ❍ 21–25 students ❍ 26–30 students ❍ 30+ students

72 Language, Speech, and Hearing Services in Schools • Vol. 47 • 59–76 • January 2016

10. What are the ages of children with ASD currently on your caseload? (Check all that apply.) ❑ 5–7 ❑ 8–10 ❑ 11–13 ❑ 14–17 ❑ N/A; I do not currently have children with ASD on my caseload 11. On average, how many sessions per week do you see students with ASD for speech therapy? ❍ 1 session ❍ 2 sessions ❍ 3+ sessions

12. Where is your typical session with a child with ASD held? (Check all that apply.) ❍ In the regular education classroom (inclusion) ❍ In the special education classroom (inclusion) ❍ In the speech room (pull-out; individual sessions) ❍ In the speech room (pull-out; group sessions)

Part II. Familiarity With Current Research on Bullying 13. Bullying is of greatest concern during elementary school and early adolescence. ❍ True ❍ False

14. Girls are more likely to bully and be bullied than boys. ❍ True ❍ False

15. Bullying of children exists in the community outside of school as well as in school. ❍ True ❍ False

16. Victims are usually likely to report bullying to adults (e.g., parents, teachers, other school personnel). ❍ True ❍ False

17. Please answer the following questions with regard to types of bullying.

18. How likely do you feel that the victim would experience the following outcomes as a result of being bullied? ______ Anxiety ______ Deep emotional trauma ______ Impaired ability to form adult relationships in the future ______ Impaired ability to form peer relationships ______ Impaired self-confidence ______ Lower academic success ______ Suicidal ideation

19. What is the likelihood that the following characteristics would put a child at an increased risk for being bullied? ______ Anxiety ______ Intellectual disability ______ Lack of physical strength ______ Low self-esteem ______ Physical impairment ______ Speech impairment ______ Undeveloped social skills

Which of the following are types of bullying?

Which has been shown to be the most prevalent amongst males?

Which has been shown to be the most prevalent amongst females?

Select all that apply Select only one Select only one

Cyberbullying ❑ ❑ ❑ Confrontational ❑ ❑ ❑ Physical ❑ ❑ ❑ Relational ❑ ❑ ❑ Situational ❑ ❑ ❑ Verbal ❑ ❑ ❑

Appendix (p. 2 of 5)

Ofe et al.: SLPs’ Perceptions of Bullying and ASD 73

Part III. Familiarity With and Perceptions of Bullying of Children With ASD 20. To what degree do you consider bullying to be a problem in your schools? ❍ Serious ❍ Somewhat of a problem ❍ Not much of a problem ❍ Not a problem at all ❍ Unsure

21. Have you witnessed bullying of children with ASD? ❍ Yes ❍ No

22. Please rank from least (1) to most (6) where you are likely to witness a child being bullied. ______ In the car line before or following school ______ In the lunchroom ______ In the regular education classroom (inclusion) ______ In small group sessions ______ In the special education classroom (inclusion) ______ In the speech room (pull-out)

23. To what degree do you consider bullying of children with ASD to be a problem? ❍ A serious problem ❍ Somewhat of a problem ❍ Not much of a problem ❍ Not a problem at all ❍ Unsure

24. Do you feel that children with ASD are more susceptible to being bullied than children in the regular education population? ❍ Yes ❍ No

25. Do you feel that children with ASD are more susceptible to bullying than children with other communication disorders (e.g., stuttering, articulation, language impairment)? ❍ Yes ❍ No

26. Which of the following types of bullying do you consider to be the most problematic for children with ASD? ❍ Cyberbullying ❍ Physical ❍ Relational ❍ Verbal ❍ None

27. Which of the following types of bullying do you witness the most with children with ASD? ❍ Cyberbullying ❍ Physical ❍ Relational ❍ Verbal ❍ None

28. How do you feel when you see a child with ASD being bullied? (Check all that apply.) ❑ Annoyed with the situation ❑ Anxious ❑ Embarrassed for the child being bullied ❑ Frustrated ❑ Overwhelmed with the situation ❑ Sorry for the child ❑ Unconcerned ❑ Other ____________________

Appendix (p. 3 of 5)

74 Language, Speech, and Hearing Services in Schools • Vol. 47 • 59–76 • January 2016

Part IV. Management of Bullying 29. Do you feel that it is your responsibility as a speech-language pathologist to intervene in moments of bullying? ❍ Yes ❍ No

30. Do you feel adequately prepared to intervene in moments of bullying? ❍ Yes ❍ No

31. Do you feel comfortable intervening in moments of bullying? ❍ Yes ❍ No

32. Do you tend to overlook instances of bullying? ❍ Yes ❍ No

33. How do you respond when a child is being bullied? (Check all that apply.) ❑ Give the child who is bullying three warnings ❑ Have the bully apologize ❑ Ignore the situation until the child being bullied confronts you with the problem ❑ Report the behavior to other school personnel ❑ Talk to the child being bullied and offer strategies for coping with bullying ❑ Talk to the child being bullied and offer condolence ❑ Other ____________________

34. What type of advice do you give to children who are being ostracized by their peers or victims of gossip? (Check all that apply.) ❑ Deal with it because bullying is a normal part of growing up ❑ Deal with it because it will help you gain character ❑ Ignore the bully ❑ Stand up for yourself and fight back ❑ Tell an adult at school when someone is bullying you ❑ Tell your parents so that the situation can be handled outside of school ❑ Other ____________________

35. What type of advice do you give to children who are being bullied through such means as pushing, hitting, and kicking? (Check all that apply.) ❑ Deal with it because bullying is a normal part of growing up ❑ Deal with it because it will help you gain character ❑ Ignore the bully ❑ Stand up for yourself and fight back ❑ Tell an adult at school when someone is bullying you ❑ Tell your parents so that the situation can be handled outside of school ❑ Other ____________________

36. What type of advice do you give children who are being bullied through hurtful words meant to humiliate them (e.g., excessive name-calling)? (Check all that apply.) ❑ Deal with it because bullying is a normal part of growing up ❑ Deal with it because it will help you gain character ❑ Ignore the bully ❑ Stand up for yourself and fight back ❑ Tell an adult at school when someone is bullying you ❑ Tell your parents so that the situation can be handled outside of school ❑ Other ____________________

37. What type of advice do you give children who report being bullied over the Internet, text messages, or social media? (Check all that apply.) ❑ Deal with it because bullying is a normal part of growing up ❑ Deal with it because it will help you gain character ❑ Ignore the bully ❑ Stand up for yourself and fight back ❑ Tell an adult at school when someone is bullying you ❑ Tell your parents so that the situation can be handled outside of school ❑ Other ____________________

Appendix (p. 4 of 5)

Ofe et al.: SLPs’ Perceptions of Bullying and ASD 75

Part V. School District Support 38. My school district is aware of bullying in schools. ❍ Yes ❍ No

39. My school district offers in-services regarding the management of bullying and use of anti-bullying language. ❍ Yes ❍ No

40. My school district holds in-services regarding the management of bullying and use of anti-bullying language. ❍ 1–2 times per year ❍ 3–4 times per year ❍ 5–6 times per year ❍ 7 or more times per year ❍ No annual discussions

41. My school district provides access to printed materials about bullying and/or management of bullying. ❍ Yes ❍ No

42. I am aware of where printed materials about bullying can be obtained if needed. ❍ Yes ❍ No

43. My school district offers counseling services for bullies and victims. ❍ Yes ❍ No

44. My school district utilizes an anti-bullying campaign to address bullying. ❍ Yes ❍ No

45. My school district utilizes an anti-bullying campaign specific to children with special needs. ❍ Yes ❍ No

46. My school district has implemented a formal program addressing intervention and prevention of bullying (e.g., Olweus Bullying Prevention Program, Quit It!, Whole School Response). ❍ Yes ❍ No

Name of formal bullying intervention and prevention program: _________________

Appendix (p. 5 of 5)

76 Language, Speech, and Hearing Services in Schools • Vol. 47 • 59–76 • January 2016

Copyright of Language, Speech & Hearing Services in Schools is the property of American Speech-Language-Hearing Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.