Bullying: It's Not OK

General Information

Studies have shown that medication is effective in treating the symptoms of ADHD alone or in combination with behavioral interventions. There are several types of medications, and they are grouped into 2 major categories: stimulants and non-stimulant medications. Most children are initially treated with stimulants, although there are reasons why your doctor may choose to treat your child with a non-stimulant. Deciding which medication is right for your child may take time. Your doctor may try several different doses or switch to different medications to find the best choice. Discuss any family history of heart disease, high blood pressure, or substance use with your doctor.

Stimulant medications usually work within 15 to 90 minutes, depending on dose and formulation. Stimulant medications come in short-acting preparations that need to be given 2 or 3 times per day and long-acting preparations that are given only once a day. Although the medications are similar, each child may experience different benefits and side effects with different medications.

Stimulant medications should be given at the same time of the day, and you should never give 2 doses at the same time to make up for a missed dose. Non-stimulant medications may take up to 2 or 3 weeks before a beneficial effect is seen.

Follow-up

Currently, there is no way to know which medication will be best for any particular child. To make sure that your child is receiving the dosage that gives the best effect with the least amount of side effects, your doctor will need to start at a low dose and increase the dose until a good effect or fewer side effects are seen. To judge whether the medication is helping, your doctor will obtain completed rating scales of your child's symptoms from you and your child's teachers when your child is at baseline (without medication) and is taking different medication doses. If there is no beneficial effect at the maximum recommended dose, your doctor will usually try another stimulant medication. Approximately 80% to 90% of children will respond to one of the stimulants.

Side Effects

There are several side effects that can be associated with stimulant medications. These include stomachache, headache, decreased appetite, sleep problems, and increased symptoms as the medication wears off (known as rebound). Preschool children may also experience emotional outbursts, repetitive behaviors or thoughts, or irritability. Usually these effects are mild and often decrease after the first 1 to 2 weeks. Your doctor will adjust medications or discuss other strategies at follow-up visits if these side effects continue. It is helpful to observe the time of day when side effects occur. Serious side effects are rare, but you should contact your doctor's office if your child experiences dizziness, fainting, severe irritability, tics, or serious behavioral changes.

Setting a Follow-up Plan

Your child will need to be seen frequently during the initial treatment phase. After a satisfactory dose has been found, your child will be scheduled for a follow-up visit at regular intervals, usually every 2 to 3 months.

At follow-up visits, your doctor will review rating scales from you and your child's teachers and will check weight, blood pressure, and emotional status and review any medication side effects.

Parent's follow-up responsibilities include

Discuss your child's treatment program with appropriate school personnel.
Bring copies of completed parent and teacher follow-up rating scales to all follow-up visits.
Schools may be willing to fax completed follow-up rating scales to your doctor's office.
Inform the doctor before the next scheduled visit if your child is experiencing serious medication side effects.
Ask your child how he or she feels on the medication.
Schedule follow-up visits.

Your doctor will set up an anticipated follow-up schedule with you at the time medication is started. They are more frequent, typically weekly at the beginning since there is the need to increase dose until the most effective dose is achieved. There should be a visit within 14 to 30 days after any change in medication and dosage. Once that stabilization occurs, the frequency of routine follow-up stretches out.

Remember: If you have any questions or if you see side effects that cause concern, do not wait for the next scheduled visit. Call and speak with the doctor, and the doctor will arrange an appropriate immediate or interval follow-up.

The recommendations in this resource do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate. Original resource included as part of Caring for Children With ADHD: A Practical Resource Toolkit for Clinicians , 3rd Edition.

Inclusion in this resource does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of the resources mentioned in this resource. Website addresses are as current as possible but may change at any time.

The American Academy of Pediatrics (AAP) does not review or endorse any modifications made to this resource and in no event shall the AAP be liable for any such changes.

PDF | Print or Share

Bullying Affects All Children

CONNECTED KIDS: Bullying is when one child picks on another child again and again. Usually children who are being bullied are either weaker or smaller, are shy, and generally feel helpless. Bullying most commonly takes place at school, when adults are not watching, or through email or instant messages. Whether your child is the one being bullied, doing the bullying, or simply a bystander, there are a number of measures you can take as a parent to improve their social skills and decrease their involvement in this detrimental practice.

Victims of bullying can learn how to respond safely to physical, verbal, and social bullying.
Children who are bullies can change their behavior. When bullies are allowed to continue, it often leads to future problems.
Bystanders—children who watch the bullies pick on others—can help stop bullying.
Concerned and involved adults can reduce bullying in schools and neighborhoods.

Bullying is when one child picks on another child again and again. Usually children who are being bullied are either weaker or smaller, are shy, and generally feel helpless.

Facts About Bullying

Both girls and boys can be bullies.
Bullies target children who cry, get mad, or easily give in to them.
There are 3 types of bullying.
- Physical—hitting, kicking, pushing, choking, punching
- Verbal—threatening, taunting, teasing, hate speech
- Social—excluding victims from activities or starting rumors about them
Bullying happens:
- At school—in the halls, at lunch, or in the bathroom, when teachers are not there to see what is going on.
- When adults are not watching—going to and from school, on the playground, or in the neighborhood.
- Through e-mail or instant messaging—rumors are spread or nasty notes are sent.

Bullying is Different From Fighting or Teasing

A bully has power over another child.
Bullies try to control other children by scaring them.
Being picked on over and over can make your child a victim.
Bullying usually happens when other children are watching.

Talk With Your Child About Bullying

Even if you don't think your child is bullied, a bully, or a bystander, you will be helping to protect your child just by asking these questions:

“How are things going at school?”
“What do you think of the other kids in your class?”
“Does anyone get picked on or bullied?”

When Your Child is Bullied

Talk with your child about how to stay safe. Bullies always pick on smaller or weaker children. If there is a fight, and the bully “wins,” this will only make matters worse for your child.

Help your child learn how to respond.

“Let's talk about what you can do and say if this happens again.”

Teach your child how to:

Look the bully in the eye.
Stand tall and stay calm in a difficult situation.
Walk away.

Teach your child how to say in a firm voice:

“I don't like what you are doing.”
“Please do NOT talk to me like that.”
“Why would you say that?”

Just telling your child to do and say these things is not enough. For many children, these skills do not come naturally. It is like learning a new language—lots of practice is needed. Practice so that, in the heat of the moment, these skills will come to your child naturally.

Teach your child when and how to ask for help.

Your child should not be afraid to ask an adult for help when bullying happens. Since some children are embarrassed about being bullied, parents need to let their children know that being bullied is not their fault.

Encourage your child to make friends with other children.

There are many adult-supervised groups, in and out of school, that your child can join. Invite your child's friends over to your home. Children who are loners are more likely to get picked on.

Support activities that interest your child.

By participating in activities such as team sports, music groups, or social clubs, your child will develop new abilities and social skills. When children feel good about how they relate to others, they are less likely to be picked on.

Alert school officials to the problems and work with them on solutions.

Since bullying often occurs outside the classroom, talk with the principal, guidance counselor, or playground monitors, as well as your child's teachers. When school officials know about bullying, they can help stop it.
Write down and report all bullying to your child's school. By knowing when and where the bullying occurs, you and your child can better plan what to do if it happens again.
Some children who are bullied will fear going to school, have difficulty paying attention at school, or develop symptoms like headaches or stomach pains.

Make sure an adult who knows about the bullying can watch out for your child's safety and well-being when you cannot be there.

When Your Child is the Bully

If you know that your child is bullying others, take it very seriously. Now is the time when you can change your child's behavior.

In the long run, bullies continue to have problems. These problems often get worse. If the bullying behavior is allowed to continue, then when these children become adults, they are much less successful in their work and family lives and may even get in trouble with the law.

Set firm and consistent limits on your child's aggressive behavior.

Be sure your child knows that bullying is never OK.

Be a positive role model.

Children need to develop new and constructive strategies for getting what they want. Show children that they can get what they want without teasing, threatening, or hurting someone. All children can learn to treat others with respect.

Use effective, nonphysical discipline, such as loss of privileges.

When your child needs discipline, explain why the behavior was wrong and how your child can change it.

Help your child understand how bullying hurts other children.

Give real examples of the good and bad results of your child's actions.

Develop practical solutions with others.

Together with the school principal, teachers, counselors, and parents of the children your child has bullied, find positive ways to stop the bullying.

Supervise your child and help develop individual skills and interests.

Children with too much “time on their hands” are more likely to find themselves in violent or dangerous situations.

Ask for help.

If you find it difficult to change the behavior, reach out to a professional, like a teacher, counselor, or pediatrician.

When Your Child is a Bystander

Most children are neither bullied nor bullies— they just watch. There are things that your child can do to help stop bullying.

Tell your child not to cheer on or even quietly watch bullying.

This only encourages the bully who is trying to be the center of attention.

Encourage your child to tell a trusted adult about the bullying.

Talking to an adult is not “tattling.” Standing up for another child by getting help is an act of courage and safety. To make it easier, suggest taking a friend.

Help your child support other children who may be bullied.

Encourage your child to include these children in activities.

Encourage your child to join with others in telling bullies to stop.

Knowing what to say is important. If your child feels safe, the following statement may help to stop the bully: “Cool it! This isn't going to solve anything.”

< Back to all behavior articles

The Text of Your Heading