Being “left out,” bullied increases risk of depression, anxiety for special needs children more than medical condition

Heather Woolwine

April 30, 2012

Being 'left out,' bullied increases risk of depression, anxiety for special needs children more than medical condition

CHARLESTON -- Special needs children with chronic medical or developmental conditions already have it tough, but a study from the Medical University of South Carolina (MUSC) indicates that being bullied or shunned poses a greater risk of anxiety or depression than the challenges presented by a medical condition.

The study, presented by lead investigator Margaret Ellis McKenna, M.D., senior fellow in MUSC’s Developmental-Behavioral Pediatrics department, investigated the impact of bullying, ostracism, and diagnosis of chronic medical condition on the emotional well-being of children with special health care needs, ages 8-17 years. When looking at both parent and child reports, McKenna found ostracism (being left out or ignored) by peers was consistently the strongest indicator of symptoms for depression or anxiety, and that ostracism and bullying often go hand-in-hand. This finding may come as a surprise to some, particularly given the immense physical health challenges these children must face.

“These findings show that despite all the many challenges these children face in relation to their chronic diagnoses, being bullied or excluded by their peers was the factor most likely to predict whether or not they reported symptoms of depression,” McKenna said.

Participants were recruited from MUSC during routine visits to their physician. Participants and their parent or guardian completed three questionnaires which screened for emotional well-being (psychosocial adjustment). In all, there were 109 participants with a variety of chronic medical or developmental diagnoses. Main categories of diagnosis included:

•ADHD (39 percent)

•cystic fibrosis (22 percent)

•type I and II diabetes (19 percent)

•learning disability (11percent)

•sickle cell disease (11 percent)

•obesity (11 percent)

•autism spectrum disorder (9 percent)

•short stature (6 percent)

There were several children who had a combination of these diagnoses. One questionnaire screened for symptoms of depression, while the other two questionnaires broadly screened for “internalizing conditions,” which include anxiety and depression. The child’s age, gender, and scored self-reports of being bullied or ostracized were analyzed. Previous research has shown that ostracism and being bullied often occur together, which McKenna also found in this group of children. Based on the children’s answers, these two factors were the strongest indicators of depression or other internalizing symptoms.

Given these findings, McKenna recommends that health and education professionals increase the levels of vigilance needed to identify bullying and ostracism in this already vulnerable group of children. For example, she suggests that all schools adopt clear policies to prevent and address bullying and ostracism, with the goal of implementing programs that promote a culture of inclusion and a sense of belonging for all students.

About MUSC Children’s Hospital

MUSC Children's Hospital is one of the largest and most comprehensive pediatric medical centers in the Southeastern United States. Three Neonatal Nurseries provide Level II and Level III care for pre-mature and newborn term infants. Using a family-centered approach, families are not considered visitors, rather essential participants in care and decisions that affect the total healing of the child. Mother-baby couplet nursing is the primary model of care for the obstetrical patient. Our extensive network of caring professionals, entirely devoted to the health and well-being of children, are driven by a commitment to adaptability and outcome accountability. Respect, dignity, information sharing, participation and collaboration are at the core of our culture. As a result, MUSC Children’s Hospital has earned top rankings from Child magazine and American Health Magazine. In 2010, U.S. News & World Report ranked our pediatric heart program among the top 20 in America. For more information about MUSC Children’s Hospital, visit or