Understanding the Effects of Bullying on People with ID
By Melissa Kaplowith, Ph.D and Taylor Philcrantz, LMHC
Bullying can have particularly severe and far-reaching effects on individuals but especially those diagnosed with intellectual disabilities (ID). The impacts of bullying are often more pronounced in people with ID due to cognitive impairment, their increased vulnerability, and the unique challenges that people with ID face. The psychological, social, physical, and behavioral effects can result in long-term trauma and even suicide.
“Traumatic events often generate secondary adversities, life changes, and distressing reminders in children’s daily lives” (NCTSN, 2016). Recognizing and remediating the impact of bullying with evidence-based, timely, and effective treatment will promote inclusive environments and minimize the impact of bullying.
Individuals with ID have more adverse life events beginning at an early age, such as bullying, when compared with their peers without ID (Cook et al., 2021). Individuals with ID who are bullied may experience heightened rates of mental health issues including anxiety, depression, substance use, and post-traumatic stress disorder (Haruvi-Lamdan et al., 2020; Au-Yeung, et al., 2019). Individuals with ID are also at increased risk of self-harm behaviors due to interpersonal issues such as bullying (van den Bogaard, et al., 2018). Furthermore, those with ID who experience adverse life events such as bullying are at an increased risk for chronic medical conditions as adults (Cook et al., 2021).
Bullying can make individuals with ID feel inferior, incapable, and hopeless. Bullying can interfere with academic success, concentration, socialization, and job performance. In the academic realm, bullying may prevent the individual with ID from seeking support or advocating for themselves, which leads to poorer academic outcomes. Bullying may prevent a person with ID from advancing in their occupation and professional growth. Often, behavioral issues such as regression or self-harm are noted after experiencing bullying (Maddox et al., 2017). The longer treatment is delayed, the more intense symptoms may occur. When these symptoms compound, and the impacts of bullying increase in number, the risk of trauma and other mental health disorders increases, furthering the impacts of bullying.
“Individuals with ID who are bullied may experience heightened rates of mental health issues including anxiety, depression, substance use, and post-traumatic stress disorder.”
Although timely intervention after bullying is critical, signs and symptoms of bullying in people with ID may go unrecognized or may solely be attributed to ID alone, thus delaying necessary treatment. When treatment is delayed, individuals with ID experience decreased self-esteem and self-worth, increased emotional distress which contributes to feelings of sadness, anger, fear, loneliness, helplessness, and suicidal ideation and attempts. Withdrawal, acting out, disengagement from social activities, self-harm may increase and contribute to suicidal ideation (Maddox et al., 2017; Cassidy et.al., 2018). However, it is worth noting that suicidal ideation and warning signs of suicide are often missed or dismissed in people with ID (Cassidy et al. 2020, Camm-Crosbie, et al., 2019). Because individuals with ID do not always use the same language that may alert a practitioner that there is a risk of suicide, it is imperative to understand that reports of loneliness or decreased communication may be a key sign of bullying.
Providers working with individuals with IDD who have experienced bullying should work through a trauma-informed lens. Unfortunately, a study done by Rich, et al (2020), found that most organizations that work with individuals with an ID report that they do not have a good understanding of trauma. Understanding “what happened” versus “what’s wrong with” can help providers increase compassion and empathy when working with individuals with some of the challenging behaviors and symptoms that might result from bullying. Being able to recognize the effects of bullying is the first step in helping individuals increase their sense of safety, value, and quality of life (NCTSN, 2015). Increasing an individual’s protective factors and recognizing the individual’s promotive factors can aid in supporting those with ID who have experienced bullying (NCTSN, 2015).
It is critical to implement evidenced-based treatment practices that are effective when working with individuals with ID who have been bullied. Protective measures and meaningful support such as family members can reduce the long- term effects of trauma and PTSD. Brown (2017) has found that Dialectical Behavior Therapy (DBT) can be adapted and applied to people with ID. Increasing mindfulness and emotional regulation skills help individuals shift negative mood states to more adaptive and positive mood states. The ability to identify an emotion and then formulate an opposite action, an important DBT skill enhances behavior change. A study of Progressive Counting (PC) by Keesler, et al., (2023) demonstrated that the use of PC and with individuals with an intellectual disability reduced trauma symptoms post-treatment. Using similar techniques to EMDR, PC has individuals discuss a trauma, with bookends of positive events before and after the event. Limitations include an individual's ability to recall both positive and traumatic events to recall when the clinician is conducting PC. A variety of assessment measures and treatment strategies especially developed for people with ID exist such as: Lancaster and Northgate Trauma Scales (LANTS), Impact of Events Scale - Intellectual Disabilities (IES-ED) (Hall, 2012), and International Trauma Questionnaire - Intellectual Disabilities (ITQ-ID) (Langdon, et al., 2023). These measures can assist providers in identifying traumatic symptoms related to bullying events, and better assist those providers in associating the symptoms with traumatic reactions.
Due to the complex nature of working with those with an ID, providers are often at a higher risk of secondary trauma and compassion fatigue. It is essential that providers are utilizing self-care, and supervision to address their own feelings. Those who are experiencing secondary trauma may struggle even further to recognize the effects of bullying on an individual with ID, contributing to the distress of the provider and individual.
References
Au-Yeung, S. K., Bradley, L., Robertson, A. E., Shaw, R., Baron-Cohen, S., & Cassidy, S. (2019). Experience of mental health diagnosis and perceived misdiagnosis in autistic, possibly autistic and non-autistic adults. Autism, 23(6), 1508–1518. https://doi.org/10.1177/1362361318818167
Brown, J.F. (2017). Emotional regulation skills system for cognitive challenged clients: A DBT-informed approach. The Guilford Press.
Camm-Crosbie, L., Bradley, L., Shaw, R., Baron-Cohen, S., & Cassidy, S. (2019). “People like me don’t get support”: Autistic adults’ experiences of support and treatment for mental health difficulties, self-injury and suicidality. Autism: The International Journal of Research and Practice, 23(6), 1431–1441. https://doi.org/10.1177/1362361318816053
Cassidy, S. A. (2020). Suicidality and self-harm in autism spectrum conditions. In S. W. White, B. B. Maddox, & C. A. Mazefsky (Eds.), The Oxford handbook of autism and co-occurring psychiatric conditions (pp. 349–370). Oxford University Press. https://doi.org/10.1093/oxfordhb/9780190910761.013.18
Cassidy, S., Bradley, L., Shaw, R., & Baron-Cohen, S. (2018). Risk markers for suicidality in autistic adults. Molecular Autism, 9(1), 42. https://doi.org/10.1186/s13229-018-0226-4
Cook, S., Hole, R. (2021). Trauma, intellectual and/or developmental disability, and multiple, complex needs: A scoping review of the literature. Research in Developmental Disabilities, 11. https://doi-org.corvette.salemstate.edu/10.1016/j.ridd.2021.103939
Hall, J. C. (2012). Assessment of trauma symptomatology in adults with intellectual disabilities : validation of the Lancaster and Northgate Trauma Scales.
Haruvi-Lamdan, N., Horesh, D., Zohar, S., Kraus, M., & Golan, O. (2020). Autism spectrum disorder and post-traumatic stress disorder: An unexplored cooccurrence of conditions. Autism: The International Journal of Research and Practice, 24(4), 884–898. https://doi.org/10.1177/1362361320912143
Keesler, J. M., McCoy, P., & Wiltz, J. (2023). Trauma-Specific Treatment among Individuals with Intellectual/Developmental Disabilities: A Case Series with Progressive Counting. British Journal of Learning Disabilities, 51(3), 296–306. https://doi-org.corvette.salemstate.edu/10.1111/bld.12456
Langdon, P. E., Bisson, J. I., Rogers, G., Swain, S., Hiles, S., Watkins, A., & Willner, P. (2023). Evaluation of an adapted version of the International Trauma Questionnaire for use by people with intellectual disabilities. British Journal of Clinical Psychology, 62(2), 471–482. https://doi-org.corvette.salemstate.edu/10.1111/bjc.12421
Maddox, B. B., Trubanova, A., & White, S. W. (2017). Untended wounds: Nonsuicidal self-injury in adults with autism spectrum disorder. Autism: The International Journal of Research and Practice, 21(4), 412–422. https://doi.org/10.1177/1362361316644731
NCTSN. (2015, November). The road to recovery: Supporting children with IDD who have experienced trauma toolkit. [Facilitator Guide]. https://learn.nctsn.org/mod/resource/view.php?id=11646
Rich, A.J., DiGregorio, N., & Strassle, C. (2020). Trauma-informed care in the context of intellectual and developmental disability services: Perceptions of service providers. Journal of Intellectual Disabilities, 25(4), 603-618. https://doi.org/10.1177/1744629520918086
van den Bogaard, K., Nijman, H., Palmstierna, T., Embregts, P. (2018). Self-injurious behavior in people with intellectual disabilities and co-occurring psychopathology using the self-harm scale: A pilot study. Journal of Developmental and Physical Disabilities, 30(5), 707-722. https://doi-org.corvette.salemstate.edu/10.1007/s10882-018-9614-0
About the Authors
Dr. Melissa Kaplowitch is an Assistant Professor in the Department of Psychology and the Program Coordinator of the M.S. in Counseling Program at Salem State University where she has trained students to become licensed mental health counselors for the past 22 years. Trained in Counseling Psychology, at Northeastern University, where she earned her Ph.D., Columbia University where she earned her M.A. and M.Ed. and Clark University where she earned her B.A., Dr. Kaplowitch has worked with children and adults in both inpatient and outpatient settings. Her clinical work has had an emphasis on effective treatment for people who suffer from chronic mental illness. Her areas of research have focused on examining diversity and contextual factors when diagnosing men and boys with anorexia nervosa and the effects of using a trauma-focused cognitive behavioral approach when treating victims of rape and gang rape.
In addition to many volunteer positions, Dr. Kaplowitch serves as the community representative to the Marblehead Mental Health Task Force and serves as an executive board member of the Boston Regional Anti-Defamation League. In 2016, she received the Combined Jewish Philanthropy Edith Block Leadership award. In 2017, Dr. Kaplowitch was selected as a Salem State Distinguished Teaching award winner. In 2023, Dr. Kaplowitch was inducted into the Salem State University Civic Engagement Center Hall of Fame. In 2024, Dr. Kaplowitch was the Salem State University recipient of the Martin Luther King, Jr. Leadership award for outstanding and significant contributions to the causes of freedom, justice, peace, and equality.
Taylor Philcrantz has a Bachelor of Arts in Psychology and a Masters of Science in Counseling and Psychological Services. She also is a Licensed Mental Health Counselor (LMHC) and Licensed Marriage and Family Therapist (LMFT) in Massachusetts. Taylor has worked in multiple therapeutic settings, with a variety of ages and populations. She has been teaching for twelve years at local colleges, teaching both undergraduate and graduate psychology. She enjoys working with students to not only learn the information in the courses she teaches but find ways to apply the given material to their lives and careers.
