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Kids with diabetes and other endocrine disorders face more bullying than others, UF study finds

Children with endocrine disorders such as type 1 diabetes or short stature deal with unique challenges in life, not the least of which is an increased risk of being teased, snubbed or even attacked by school classmates, University of Florida researchers report in an article published online today in The Journal of Pediatrics.

Researchers surveyed 93 children 8 to 18 who were visiting UF endocrinologists for checkups and found a third reported being bullied in the past month — more than the national average, said study co-author Eric Storch, a UF assistant professor of psychiatry and pediatrics at UF’s College of Medicine. Many suffered adjustment problems related to bullying, such as depression, anxiety and loneliness, which in some cases might hinder management of their endocrine disorders, Storch said. Parents sometimes reported instances where children were inattentive or defiant at home, which parents attributed to bullying.

Researchers are concerned that children might jeopardize their health to avoid being picked on.

It’s possible youngsters who are bullied — particularly those with type 1 diabetes, which affects about one in every 400 to 500 U.S. children and adolescents — would skip their self-care practices to reduce the chances of appearing different from their peers, Storch said. In extreme cases, such neglect could lead to complications or even hospitalization, he said.

“If you know kids may tease you because you have to go to the bathroom to check your blood sugar or you can’t eat some foods, you might begin avoiding those things,” he said. “The idea behind it starts with social fears.”

An estimated 15 percent to 25 percent of all U.S. children are bullied regularly, according to the U.S. Health Resources and Services Administration.

“One of the things I often hear is, ‘Everyone goes through this, why make a big deal of it?’ I don’t argue that this happens,” Storch said. “The point is if it’s chronic bullying, it’s often distressing.” Researchers were surprised to learn that children with disorders that affected their appearance, which included early or late puberty, short stature and male breast development, reported fewer adjustment problems related to bullying than those with type 1 diabetes or low thyroid function, which may not be noticeable, Storch said.

“It may be these kids get extra support from peers and teachers that help them cope with the negative peer experience,” he said.

The endocrine system includes the pituitary gland, thyroid gland, the testicles or ovaries and other structures that release hormones to regulate growth, metabolism, sexual maturation and other functions. Many common endocrine disorders occur when too much or too little of a specific hormone is produced, said study co-author Gary Geffken, a UF associate professor of pediatrics, psychiatry and clinical and health psychology.

Bullies may target children with chronic health conditions because they stand out as different, but the differences can take several forms, he said. Endocrine disorders that cause changes in appearance are easily recognized, but children with type 1 diabetes — which often accompanies low thyroid function — may not look physically unusual yet often must inject insulin or avoid sugary foods.

More fundamentally, chronic illnesses of all types may require children to see medical specialists and make more visits to the doctor than their peers, which could carry a stigma, Geffken said.

“It may also be that when you know something is chronically wrong, you develop psychological characteristics that make you more susceptible to bullying,” he said.

Fear of social situations was the most frequent consequence of bullying in the UF study, reported by almost 20 percent of the children, Storch said. Almost 8 percent reported significant symptoms of depression, and nearly 6 percent had high levels of loneliness. These statistics are comparable to findings for random groups of bullied children, he said. Among parents and guardians accompanying the bullied children, 13 percent reported the child showed signs of damaged self-esteem and 9 percent said the child was significantly misbehaving, again comparable to statistics reported by parents of randomly selected bullied children.

It’s uncertain whether bullying causes social anxiety to develop or whether it may be a factor that causes bullies to target specific children, said social anxiety researcher Deborah Roth Ledley, an assistant professor of psychology in psychiatry with the University of Pennsylvania’s department of psychiatry. The truth may lie somewhere in between, she said.

“It actually seems as if it’s a bit of a vicious cycle,” said Roth Ledley, who has previously collaborated with Storch but did not participate in the current UF study. “Shy, socially reticent kids might be targets for teasing, but then they might also react in such a way that invites further teasing. And as kids are teased and they come to see the world as a dangerous or threatening place, it’s likely that they’ll withdraw even further.”

The study, funded by $8,000 from the Human Growth Foundation and the UF Center for Pediatric and Family Psychology, asked children to complete four written surveys and asked each child’s parent or guardian to complete a separate one, Storch said. Of the 93 children surveyed, 33 had type 1 diabetes, 26 had low thyroid function, 25 had short stature, three had male breast development, three had early puberty and three had delayed puberty.

The UF findings should be a wake-up call for primary-care providers, who often see children with endocrine disorders before they are referred to specialists, Geffken said.

“Pediatricians and their nurses or nurse practitioners should be looking for that (evidence of bullying) in these kids with chronic illnesses, because they’re more at risk with chronic conditions — I don’t think it’s just endocrine conditions,” Geffken said. “They need to treat the whole person, which is what we all want when we go to the doctor.”