1. Jane Timmons-Mitchell, Ph.D. Emerging Ethical and Legal Challenges In Chronic Neurological Conditions In Chronic Neurological Conditions October 9, 2014 October 9, 2014 Cleveland, OH Cleveland, OH Stigma in Neurological Conditions of Childhood: Bullying 1

2. Children who are obviously different due to neurological conditions are often the targets of stigma at home, in school and in the community. Children who are obviously different due to neurological conditions are often the targets of stigma at home, in school and in the community. Stigma may take the form of being bullied. Stigma may take the form of being bullied. Recommendations on how to address are included. Focus on Children with Chronic Neurological Conditions

3. Many chronic neurological conditions affect children, including: ADHD, Autism Spectrum, Epilepsy, Cerebral Palsy, Spina Bifida, and more. Children with chronic neurological conditions are often bullied. Impact

4. Conditions are unfair and random which places an ethical burden on those who care for them to help them combat stigma While the patient may also bear some responsibility to help combat stigma this must be tempered by developmental issues. Parents need to advocate for their children and to teach kids age appropriate self-advocacy skills. Parents need to advocate for their children and to teach kids age appropriate self-advocacy skills. A 13 year old can do more than a 6 year old Ethical Burden on Caregivers

5. Bullying is unwanted, aggressive behavior among school aged children In order to be considered bullying, the behavior must be aggressive and include: An Imbalance of Power: Kids who bully use their power— such as physical strength, access to embarrassing information, or popularity—to control or harm others. Repetition: Bullying behaviors happen more than once or have the potential to happen more than once. Bullying includes actions such as making threats, spreading rumors, attacking someone physically or verbally, and excluding someone from a group on purpose. Stopbullying.gov Definition of Bullying

6. A child with ADHD is set up to do something mean to another child. He takes blame and punishment since it's consistent with expected behavior; stigma prevents looking into incident. Autistic teen who took ice bucket challenge--other teens filled the bucket with urine. Examples of Bullying

7. Burden falls to parents to advocate for their children and teach age appropriate self-advocacy skills. Burden falls to parents to advocate for their children and teach age appropriate self-advocacy skills. Promote expectation that there is something positive to do that child can participate in and adults can make happen. Attend school meeting; point out student’s strengths. What can parents do?

8. When parents try to interrupt bullying at school or on the community, it can have consequences. When parents try to interrupt bullying at school or on the community, it can have consequences. Sometimes when parents take a stand, they can alienate other parents or the school. In extreme cases, kid might have to change schools and/or the family might decide to move. Sometimes when parents take a stand, they can alienate other parents or the school. In extreme cases, kid might have to change schools and/or the family might decide to move. Other parents support their kids who are bullying, as court cases have made clear. Other parents support their kids who are bullying, as court cases have made clear. Remedies Have Consequences

9. Ethical Dilemma The ethical dilemma about involving the child in self- advocacy: balancing skills development and promotion with the chance that the child will not be supported, will be ostracized, and will blame the parent. Stress produces growth but if the stress is too extreme it can lead to harm.

10. Use your best judgment Advocate for your child, since your child must be safe Know that others who are also tasked with keeping your child safe may not agree with you Know when to compromise Balance the risks: will advocating for your child improve things for him or her, or will it make things worse? (unintended consequences) What to Do?