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Cyberbullying Victimization and Perpetration in Adolescents with High-Functioning Autism Spectrum Disorder: Correlations with Depression, Anxiety, and Suicidality

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Title: Cyberbullying Victimization and Perpetration in Adolescents with High-Functioning Autism Spectrum Disorder: Correlations with Depression, Anxiety, and Suicidality
Language: English
Authors: Hu, Huei-Fan, Liu, Tai-Ling, Hsiao, Ray C., Ni, Hsing-Chang, Liang, Sophie Hsin-Yi, Lin, Chiao-Fan, Chan, Hsiang-Lin, Hsieh, Yi-Hsuan, Wang, Liang-Jen, Lee, Min-Jing, Chou, Wen-Jiun, Yen, Cheng-Fang (ORCID 0000-0003-1156-4939)
Source: Journal of Autism and Developmental Disorders. Oct 2019 49(10):4170-4180.
Availability: Springer. Available from: Springer Nature. 233 Spring Street, New York, NY 10013. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-348-4505; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
Peer Reviewed: Y
Page Count: 11
Publication Date: 2019
Document Type: Journal Articles
Reports - Research
Descriptors: Bullying, Computer Mediated Communication, Adolescents, Depression (Psychology), Anxiety, Suicide, Psychological Patterns, Victims, Parent Attitudes, Age Differences, Severity (of Disability), Autism, Pervasive Developmental Disorders, Attention Deficit Hyperactivity Disorder, Behavior Disorders, Comorbidity, Correlation
DOI: 10.1007/s10803-019-04060-7
ISSN: 0162-3257
Abstract: The present study examined the associations between cyberbullying involvement and sociodemographic characteristics, autistic social impairment and attention-deficit/hyperactivity disorder and oppositional defiant disorder (ODD) symptoms in 219 adolescents with high-functioning autism spectrum disorder (ASD). Moreover, the associations between cyberbullying involvement and depression, anxiety, and suicidality were also examined. Adolescents self-reported higher rates of being a victim or perpetrator of cyberbullying than were reported by their parents. Increased age and had more severe ODD symptoms were significantly associated with being victims or perpetrators of cyberbullying. Being a victim but not a perpetrator of cyberbullying was significantly associated with depression, anxiety, and suicidality. Cyberbullying victimization and perpetration should be routinely surveyed in adolescents with high-functioning ASD.
Abstractor: As Provided
Entry Date: 2019
Accession Number: EJ1228795
Database: ERIC
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  Value: <anid>AN0138689614;aut01oct.19;2019Sep20.02:15;v2.2.500</anid> <title id="AN0138689614-1">Cyberbullying Victimization and Perpetration in Adolescents with High-Functioning Autism Spectrum Disorder: Correlations with Depression, Anxiety, and Suicidality </title> <p>The present study examined the associations between cyberbullying involvement and sociodemographic characteristics, autistic social impairment and attention-deficit/hyperactivity disorder and oppositional defiant disorder (ODD) symptoms in 219 adolescents with high-functioning autism spectrum disorder (ASD). Moreover, the associations between cyberbullying involvement and depression, anxiety, and suicidality were also examined. Adolescents self-reported higher rates of being a victim or perpetrator of cyberbullying than were reported by their parents. Increased age and had more severe ODD symptoms were significantly associated with being victims or perpetrators of cyberbullying. Being a victim but not a perpetrator of cyberbullying was significantly associated with depression, anxiety, and suicidality. Cyberbullying victimization and perpetration should be routinely surveyed in adolescents with high-functioning ASD.</p> <p>Keywords: Cyberbullying; Autism spectrum disorder; Depression; Anxiety; Suicidality</p> <p>Studies have reported that individuals with autism spectrum disorder (ASD) spend more time using electronic screen media than those without ASD (MacMullin et al. [<reflink idref="bib24" id="ref1">24</reflink>]; Must et al. [<reflink idref="bib31" id="ref2">31</reflink>]; Shane and Albert [<reflink idref="bib38" id="ref3">38</reflink>]). The Internet is currently one of the most popular and accessible uses for electronic screen media among individuals with ASD for several reasons. First, adolescents with ASD and socio-communicative deficits may find entertainment in nonsocial Internet activities and be able to avoid frustration and humiliation from face-to-face interactive activities (Mazurek et al. [<reflink idref="bib28" id="ref4">28</reflink>]). Second, adolescents with ASD may feel more comfortable anonymously interacting with others on Internet chat rooms or during online gaming (Wilkinson et al. [<reflink idref="bib50" id="ref5">50</reflink>]). Third, the Internet provides adolescents with ASD with an abundance of resources for finding essential information regarding their particular interests and the chances to share them with others (Whalen et al. [<reflink idref="bib49" id="ref6">49</reflink>]). Fourth, adolescents with ASD and hyperreactivity to stimuli such as lights, sounds, tastes, and touch may prefer solitude and entertaining themselves on the Internet (Gwynette et al. [<reflink idref="bib13" id="ref7">13</reflink>]). Fifth, neurocognitive deficits such as difficulties with impulse control and response inhibition (Mazurek and Engelhardt [<reflink idref="bib27" id="ref8">27</reflink>]) or inattention (Chan and Rabinowitz [<reflink idref="bib7" id="ref9">7</reflink>]) may also prompt adolescents with ASD to engage in online activities in which they are not required to exercise self-control. Sixth, decreased emotional regulation and low levels of peer connectedness increase the risk of Internet gaming addiction in children with autistic traits (Liu et al. [<reflink idref="bib23" id="ref10">23</reflink>]). A study in Japan reported that 10.8% of adolescents with ASD alone and 20.0% of adolescents with comorbid ASD and attention-deficit/hyperactivity disorder (ADHD) had Internet addiction (So et al. [<reflink idref="bib40" id="ref11">40</reflink>]).</p> <hd id="AN0138689614-2">Cyberbullying in ASD</hd> <p>A review study concluded that unhealthy and improper use of electronic screen media render children and adolescents with ASD at greater risk for negative health outcomes, including physiological, cognitive, social, emotional, and legal/safety problems (Gwynette et al. [<reflink idref="bib13" id="ref12">13</reflink>]). Cyberbullying is a new challenge for adolescents with ASD in the digital age and requires the attention of professionals in the fields of mental health and education. Cyberbullying involves bullying through the use of electronic platforms, such as social networking sites, e-mail, chat rooms, instant messaging, websites, online games, and text messaging (Kowalski and Limber [<reflink idref="bib22" id="ref13">22</reflink>]). Cyberbullying is a form of psychological, relational, and indirect bullying (Patchin and Hinduja [<reflink idref="bib34" id="ref14">34</reflink>]). Research on the general adolescent population has revealed that both adolescent victims and perpetrators of cyberbullying are more likely than those who are not involved in cyberbullying to have psychological problems such as depression (Yang et al. [<reflink idref="bib53" id="ref15">53</reflink>]), anxiety (Kowalski and Limber [<reflink idref="bib22" id="ref16">22</reflink>]; Yang et al. [<reflink idref="bib53" id="ref17">53</reflink>]), suicidality (Kowalski and Limber [<reflink idref="bib22" id="ref18">22</reflink>]; van Geel et al. [<reflink idref="bib44" id="ref19">44</reflink>]), or adjustment problems in school (Kowalski and Limber [<reflink idref="bib22" id="ref20">22</reflink>]). One study on male adolescents with ADHD also revealed that victims of cyberbullying reported more severe depression and suicidality than those who were not victims of cyberbullying (Yen et al. [<reflink idref="bib54" id="ref21">54</reflink>]). Therefore, cyberbullying among adolescents is a serious health problem that warrants further investigation by mental health and education professionals.</p> <hd id="AN0138689614-3">Topics of Cyberbullying Warranted Further Study in ASD</hd> <p>The prevalence of cyberbullying victimization and perpetration and their association with depression, anxiety, and suicidality in adolescents clinically diagnosed with ASD have not been thoroughly investigated. The present study addresses several topics. First, it explores the rates of self-reported and parent-reported cyberbullying victimization and perpetration in adolescents with high-functioning ASD. Regarding traditional forms of bullying, such as verbal, social, and physical bullying, some studies have reported that adolescents with ASD have a significantly lower ability to understand bullying than adolescents with typical development (Hodgins et al. [<reflink idref="bib15" id="ref22">15</reflink>]; van Roekel et al. [<reflink idref="bib45" id="ref23">45</reflink>]). Others, however, have concluded that adolescents with ASD have the ability to accurately report peer victimization (Adams et al. [<reflink idref="bib1" id="ref24">1</reflink>]; DeNigris et al. [<reflink idref="bib10" id="ref25">10</reflink>]). However, parents may not be aware of what adolescents encounter on the Internet because of their personal privacy.</p> <p>Second, this study explores whether the sociodemographic characteristics and severity of autistic social impairment, ADHD, and oppositional defiant disorder (ODD) symptoms are factors that correlate to cyberbullying involvement in adolescents with high-functioning ASD. Research on children and adolescents with ASD has revealed that young age (Cappadocia et al. [<reflink idref="bib5" id="ref26">5</reflink>]) and comorbid ADHD (Zablotsky et al. [<reflink idref="bib57" id="ref27">57</reflink>]) are significantly associated with traditional bullying victimization, whereas older age (Hebron and Humphrey [<reflink idref="bib14" id="ref28">14</reflink>]), living in a low-income household (Montes and Halterma [<reflink idref="bib30" id="ref29">30</reflink>]), and comorbid ODD (Zablotsky et al. [<reflink idref="bib57" id="ref30">57</reflink>]) are significantly associated with traditional bullying perpetration. Based on the developmental theory of aggression (Björkqvist et al. [<reflink idref="bib3" id="ref31">3</reflink>]), older adolescents may have more developed skills for indirect modes of expressing aggression such as cyberbullying (Björkqvist et al. [<reflink idref="bib3" id="ref32">3</reflink>]). Perpetrators may use cyberbullying as a form of aggression because of its lower risk of detection compared with traditional face-to-face bullying. ADHD symptoms may increase the conflicts between the youths and peers and the potentials of the youths to involve in bullying (Holmberg and Hjern [<reflink idref="bib16" id="ref33">16</reflink>]). The characteristics of ODD, including frequent and persistent anger, irritability, arguing, defiance, and vindictiveness toward authority figures (American Psychiatric Association [<reflink idref="bib2" id="ref34">2</reflink>]), may instigate the perpetration of cyberbullying in adolescents with ASD. However, whether these sociodemographic characteristics and the severity of ADHD and ODD symptoms also increase the risk of cyberbullying victimization and perpetration among adolescents with ASD warrants further study. Regarding autistic social impairment, the fifth edition of the <emph>Diagnostic and Statistical Manual of Mental Disorders</emph> (DSM-5) characterizes difficulties in social communication and social interaction core ASD symptoms (American Psychiatric Association [<reflink idref="bib2" id="ref35">2</reflink>]). Research has revealed that deficits in socio-communicative ability correlate to traditional bullying victimization among children and adolescents with ASD (Cappadocia et al. [<reflink idref="bib5" id="ref36">5</reflink>]; Paul et al. [<reflink idref="bib35" id="ref37">35</reflink>]; Sterzing et al. [<reflink idref="bib41" id="ref38">41</reflink>]). Proper social skills are warranted to initiate and maintain social relationship online. The individuals with ASD may misinterpret bullying situations as non-bullying (Hwang et al. [<reflink idref="bib19" id="ref39">19</reflink>]) and reduce their ability to keep away from being cyberbullied. Deficits in social-emotional reciprocity in the individuals with ASD such as abnormal social approach and failure of normal back-and-forth conversation may also offend others and therefore increase the risk of cyberbullying. The individuals may interact with others online not only by the messages but also by verbal conservation or images. Ritualized verbal or nonverbal behaviors may make the individuals with ASD unacceptable and excluded in the Internet. Social communication deficits can make the individuals with ASD misinterpret others' affect and reactions in the interactive processes (Champion [<reflink idref="bib6" id="ref40">6</reflink>]) and continue their improper verbal or nonverbal behaviors that may be perceived by others as perpetrating cyberbullying. However, the with the risk of cyberbullying victimization and perpetration among adolescents with ASD warrants further study.</p> <p>Third, this research explores whether adolescent involvement in cyberbullying is significantly associated with depression, anxiety, and suicidality in adolescents with high-functioning ASD. Relevant studies have reported that both the victimization and perpetration of traditional bullying correspond to increased risk of depression (Bond et al. [<reflink idref="bib4" id="ref41">4</reflink>]; Kaltiala-Heino et al. [<reflink idref="bib20" id="ref42">20</reflink>]; Nansel et al. [<reflink idref="bib32" id="ref43">32</reflink>]; Yen et al. [<reflink idref="bib55" id="ref44">55</reflink>]), anxiety (Bond et al. [<reflink idref="bib4" id="ref45">4</reflink>]; Kaltiala-Heino et al. [<reflink idref="bib20" id="ref46">20</reflink>]; Nansel et al. [<reflink idref="bib32" id="ref47">32</reflink>]; Yen et al. [<reflink idref="bib55" id="ref48">55</reflink>]), and suicidality (Kim and Leventhal [<reflink idref="bib21" id="ref49">21</reflink>]) in the general adolescent population. Moreover, research on adolescents with ADHD has also indicated that victims of cyberbullying report more severe depression and suicidality than those who are not victims of cyberbullying (Yen et al. [<reflink idref="bib54" id="ref50">54</reflink>]). However, only one study examined the association between cyberbullying victimization and mental health problems in adolescents with ASD and found that cyberbullying victimization was associated positively with anxiety and depression (Wright and Wachs [<reflink idref="bib52" id="ref51">52</reflink>]). The correlations between being a perpetrator of cyberbullying and depression, anxiety, and suicidality have never been examined in adolescents with high-functioning ASD.</p> <hd id="AN0138689614-4">Aims of the Present Study</hd> <p>The aim of this study was to examine the self-reported and parent-reported rates of cyberbullying victimization and perpetration as well as their related factors and associations with depression, anxiety, and suicidality among adolescents with high-functioning ASD. We hypothesized that the agreement between self-reported and parent-reported cyberbullying victimization and perpetration in adolescents with ASD would be low. We also hypothesized that sociodemographic characteristics and the severity of autistic social impairment, ADHD, and ODD symptoms would be significantly associated with cyberbullying victimization and perpetration and that experiences of cyberbullying victimization and perpetration would be significantly associated with depression, anxiety, and suicidality.</p> <hd id="AN0138689614-5">Methods</hd> <p></p> <hd id="AN0138689614-6">Participants</hd> <p>The study participants were enrolled from five child psychiatry outpatient clinics in Taiwan; four clinics were at university-affiliated teaching hospitals, and one was at a regional teaching hospital. Patients enrolled in the Taiwan National Health Insurance program are permitted to visit the outpatient clinics of teaching hospitals without referrals from general practitioners. Therefore, the adolescents enrolled from these five child psychiatry outpatient clinics in the present study are representative of similar-age populations in Taiwan. The inclusion criteria were as follows: (<reflink idref="bib1" id="ref52">1</reflink>) in the age range of 11–18 years, (<reflink idref="bib2" id="ref53">2</reflink>) diagnosed with ASD made by certified child psychiatrists according to the fifth edition of the <emph>Diagnostic and Statistical Manual of Mental Disorders</emph> (DSM-5; American Psychiatric Association [<reflink idref="bib2" id="ref54">2</reflink>]), (<reflink idref="bib3" id="ref55">3</reflink>) full-scale intelligence quotient of > 80 as determined using the Chinese version of the fourth edition of the Wechsler Intelligence Scale for Children (Wechsler [<reflink idref="bib48" id="ref56">48</reflink>]), (<reflink idref="bib4" id="ref57">4</reflink>) possessing verbal communication ability, and (<reflink idref="bib5" id="ref58">5</reflink>) currently studying in an inclusive classroom rather than in a special education classroom. Child psychiatrists reviewed the medical records when the adolescents with ASD visited the outpatient clinics. Adolescents who met the criteria described above were consecutively approached in the outpatient clinics between August 2013 and July 2016. Child psychiatrists also made an interview with adolescents' parents and excluded parents who had an intellectual disability, schizophrenia, bipolar disorder, or any cognitive deficit resulting in significant communication difficulties from this study. Child psychiatrists explained the purposes and procedures of the study to the adolescents and their parents and answered any question about the study. Adolescents and their parents were also assured that their responses to the research questionnaire are confidential and that their participation or nonparticipation will not influence their right to receive medical services.</p> <p>A total of 228 adolescents with high-functioning ASD were invited to participate in this study. Of them, 219 (96.1%) adolescents and their parents agreed to participate in this study and were interviewed by research assistants using the research questionnaire after providing the written informed consent. This study was approved by the Institutional Review Board of Kaohsiung Medical University (KMUHIRB-20120084).</p> <hd id="AN0138689614-7">Measures</hd> <p></p> <hd id="AN0138689614-8">Cyberbullying Experiences Questionnaire (CEQ)</hd> <p>We invited adolescents and their parents to report the adolescents' experiences of cyberbullying in the previous year on the CEQ. The CEQ contains six items that could be answered using a 4-point Likert-like scale ranging from 0 (<emph>never</emph>) to 3 (<emph>all the time</emph>) (Yen et al. [<reflink idref="bib54" id="ref59">54</reflink>]). This scale comprised two 3-item subscales for evaluating experiences with cyberbullying perpetration and victimization through e-mails, blogs, social media (namely Facebook, Twitter, and Plurk), and pictures or video clips. The first three items addressed experiences with posting mean or hurtful comments; posting pictures, photos, or videos that upset someone; and spreading rumors online. The final three items addressed experiences with the types of victimization mentioned in the first three cyberbullying items. The Cronbach's α of the two subscales was.64 and.70, respectively. For analyses, participants who gave a score of 1, 2, or 3 on any item among Items 1–3 and Items 4–6 were identified as self-reported cyberbullying perpetrators and victims, respectively.</p> <hd id="AN0138689614-9">Chinese Social Responsiveness Scale (SRS)</hd> <p>The parent-reported Chinese SRS contains 60 items evaluated on a 4-point Likert-like scale for assessing autistic social impairment in adolescents (Constantino et al. [<reflink idref="bib9" id="ref60">9</reflink>]; Gau et al. [<reflink idref="bib11" id="ref61">11</reflink>]). The Chinese SRS comprised four subscales, namely on social communication, autism mannerisms, social awareness, and social emotion. A higher total score on a subscale indicated greater autistic social impairment. Research has found that the SRS can effectively distinguish between children and adolescents with and without ASD (Constantino et al. [<reflink idref="bib9" id="ref62">9</reflink>]; Gau et al. [<reflink idref="bib11" id="ref63">11</reflink>]).</p> <hd id="AN0138689614-10">Short form of the Swanson, Nolan, and Pelham Version IV Scale (SNAP-IV)-Chinese version</hd> <p>The parent-reported short form of the SNAP-IV-Chinese version comprises 26 items rated on a 4-point Likert-like scale from 0 (not at all) to 3 (very much) for assessing the inattention, hyperactivity/impulsivity, and ODD symptoms of adolescents based on the criteria for ADHD and ODD specified in the fourth edition of the DSM (Gau et al. [<reflink idref="bib12" id="ref64">12</reflink>]; Swanson et al. [<reflink idref="bib42" id="ref65">42</reflink>]). Higher total scores on the subscales indicate more severe ADHD and oppositional symptoms. In the present study, Cronbach's α values for the inattention, hyperactivity/impulsivity, and ODD subscales were.91,.91, and.92, respectively.</p> <hd id="AN0138689614-11">Taiwanese Version of the Center for Epidemiological Studies Depression Scale (CESD)</hd> <p>The adolescent-reported Taiwanese version of CESD comprises 20 items evaluated on a 4-point Likert-like scale from 1 (rarely or never) to 4 (most of the time or always) to assess the frequency of depressive symptoms in the preceding 1 month (Chien and Cheng [<reflink idref="bib8" id="ref66">8</reflink>]; Radloff [<reflink idref="bib37" id="ref67">37</reflink>]). A higher total score on the Taiwanese version of CESD indicated more severe depression. In the present study, Cronbach's α of the T-CES-D was.88.</p> <hd id="AN0138689614-12">Taiwanese Version of the Multidimensional Anxiety Scale for Children (MASC-T)</hd> <p>The adolescent-reported MASC-T comprises 39 items evaluated on a 4-point Likert-like scale that assess the severity of anxiety symptoms in the preceding 1 month (March [<reflink idref="bib25" id="ref68">25</reflink>]; Yen et al. [<reflink idref="bib56" id="ref69">56</reflink>]). A higher total score on the MASC-T indicates more severe anxiety symptoms. The results of a previous study proved that the MASC-T has acceptable reliability and validity (Yen et al. [<reflink idref="bib56" id="ref70">56</reflink>]). In the present study, Cronbach's α for the MASC-T was.88.</p> <hd id="AN0138689614-13">Suicidality</hd> <p>The adolescent-reported suicidality module of the epidemiological version of the Kiddie Schedule for Affective Disorders and Schizophrenia (Puig-Antich and Chambers [<reflink idref="bib36" id="ref71">36</reflink>]) contains five self-reported items requiring a "yes" or "no" response that assess the occurrence of suicide attempts and four forms of suicidal ideation in the preceding year (Tang et al. [<reflink idref="bib43" id="ref72">43</reflink>]). In another study, Cohen's kappa coefficient of agreement (κ) between adolescents' self-reported suicidality and their parents' reports was.541 (p <.001) (Tang et al. [<reflink idref="bib43" id="ref73">43</reflink>]). Cronbach's α for the questionnaire on suicidality was.79. In the present study, participants who answered "yes" to any item were classified as having suicidality.</p> <hd id="AN0138689614-14">Sociodemographic Characteristics</hd> <p>We examined the participants' sex, age, parental education duration, and parental occupational socioeconomic status (SES). The levels of parental occupational SES were assessed using the Close-Ended Questionnaire of the Occupational Survey (CEQ-OS), which classifies paternal and maternal occupational SES into five levels (Hwang [<reflink idref="bib18" id="ref74">18</reflink>]). A high level indicates a high occupational SES. The CEQ-OS has been proven to have high reliability and validity and has been frequently used in studies on children and adolescents in Taiwan (Hwang [<reflink idref="bib18" id="ref75">18</reflink>]). In the present study, levels 1–3 and levels 4 and 5 were classified as low and high occupational SES, respectively.</p> <hd id="AN0138689614-15">Procedure</hd> <p>Adolescents with high-functioning ASD and their parents completed the research questionnaires at their clinical intake at outpatient clinics. Research assistants conducted interviews to collect data on the adolescents' self-reported cyberbullying experiences on the CEQ, depression on the Taiwanese version of the CESD, anxiety on the MASC-T, and suicidality. The parents completed the CEQ, Chinese SRS, and short form of the SNAP-IV.</p> <hd id="AN0138689614-16">Statistical Analysis</hd> <p>A data analysis was performed using SPSS 20.0 statistical software (SPSS Inc., Chicago, IL, USA). The rates of self-reported and parent-reported cyberbullying involvement were calculated. The agreement between self reports and parental reports of being cyberbullying victims and perpetrators was calculated using Cohen's <emph>kappa</emph> coefficient (κ). We examined the factors related to cyberbullying victimization and perpetration in two steps. First, we compared the sociodemographic characteristics, autistic social impairment, and ADHD and ODD symptoms between cyberbullying victims and nonvictims and between cyberbullying perpetrators and nonperpetrators using Chi square and <emph>t</emph> tests. A two-tailed <emph>p</emph> value of less than.05 was considered statistically significant. Second, the statistically significant factors in the first step were further selected for use in multivariate logistic analysis models to examine their association with cyberbullying victims and perpetrators. The associations of victims and perpetrators of cyberbullying (independent variables) with depression, anxiety, and suicidality (dependent variables) were also examined first using a <emph>t</emph> test and then multiple and logistic regression analysis models, in which the effects of sociodemographic characteristics were controlled. Odds Ratio (OR) and its 95% confidence interval (CI) represented the level of significance.</p> <hd id="AN0138689614-17">Results</hd> <p>Table 1 shows parental sociodemographic characteristics and adolescents' sociodemographic characteristics, intelligence quotient, severity of autistic social impairment, ADHD and ODD symptoms, depression, anxiety, and suicidality. Table 2 presents the rates of self-reported and parent-reported cyberbullying victims and perpetrators in adolescents with high-functioning ASD. The results indicate that a greater number of adolescents with high-functioning ASD self-reported experiences of being a victim (13.7% vs. 2.3%) or perpetrator (8.2% vs. 2.3%) of cyberbullying than did their parents. Twelve adolescents (5.5%) were self-reported or parent-reported cyberbullying victim-perpetrators. The agreement between the self-reported and parent-reported occurrence of being a victim (κ =.138) or perpetrator (κ =.053) of cyberbullying was low. In total, 14.6% and 10.0% of adolescents with high-functioning ASD were self-reported or parent-reported to be victims and perpetrators of cyberbullying, respectively.</p> <p>Sociodemographic characteristics of adolescents and parents, intelligence quotient, severity of autistic social impairment, ADHD and ODD symptoms, depression, anxiety, and suicidality (N = 219)</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" /><th align="left"><p><italic>n</italic> (%)</p></th><th align="left"><p>Mean (SD)</p></th><th align="left"><p>Range</p></th></tr></thead><tbody><tr><td align="left" colspan="4"><p>Sex</p></td></tr><tr><td align="left"><p> Girls</p></td><td char="(" align="char"><p>27 (12.3)</p></td><td align="left" /><td align="left" /></tr><tr><td align="left"><p> Boys</p></td><td char="(" align="char"><p>192 (87.7)</p></td><td align="left" /><td align="left" /></tr><tr><td align="left"><p>Age (years)</p></td><td align="left" /><td char="(" align="char"><p>13.7 (2.1)</p></td><td align="left"><p>11–18</p></td></tr><tr><td align="left"><p>Intelligence quotient</p></td><td align="left" /><td char="(" align="char"><p>92.4 (10.9)</p></td><td align="left"><p>80–127</p></td></tr><tr><td align="left" colspan="4"><p>Parental sex</p></td></tr><tr><td align="left"><p> Female</p></td><td char="(" align="char"><p>186 (84.9)</p></td><td align="left" /><td align="left" /></tr><tr><td align="left"><p> Male</p></td><td char="(" align="char"><p>33 (15.1)</p></td><td align="left" /><td align="left" /></tr><tr><td align="left"><p>Parental age (years)</p></td><td align="left" /><td char="(" align="char"><p>43.7 (5.4)</p></td><td align="left"><p>38–64</p></td></tr><tr><td align="left" colspan="4"><p>Marriage status of parents</p></td></tr><tr><td align="left"><p> Married and living together</p></td><td char="(" align="char"><p>189 (86.3)</p></td><td align="left" /><td align="left" /></tr><tr><td align="left"><p> Divorced or separate</p></td><td char="(" align="char"><p>30 (13.7)</p></td><td align="left" /><td align="left" /></tr><tr><td align="left"><p>Paternal education duration (years)</p></td><td align="left" /><td char="(" align="char"><p>14.7 (2.9)</p></td><td align="left"><p>6–23</p></td></tr><tr><td align="left"><p>Maternal education duration (years)</p></td><td align="left" /><td char="(" align="char"><p>14.2 (2.5)</p></td><td align="left"><p>6–22</p></td></tr><tr><td align="left" colspan="4"><p>Paternal occupational SES</p></td></tr><tr><td align="left"><p> High</p></td><td char="(" align="char"><p>129 (58.9)</p></td><td align="left" /><td align="left" /></tr><tr><td align="left"><p> Low</p></td><td char="(" align="char"><p>90 (41.1)</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" colspan="4"><p>Maternal occupational SES</p></td></tr><tr><td align="left"><p> High</p></td><td char="(" align="char"><p>88 (40.2)</p></td><td align="left" /><td align="left" /></tr><tr><td align="left"><p> Low</p></td><td char="(" align="char"><p>131 (59.8)</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" colspan="4"><p>Deficits in autistic social impairment on the SRS</p></td></tr><tr><td align="left"><p> Socio-communication</p></td><td align="left" /><td char="(" align="char"><p>68.5 (14.0)</p></td><td align="left"><p>31–103</p></td></tr><tr><td align="left"><p> Autism mannerism</p></td><td align="left" /><td char="(" align="char"><p>33.7 (7.5)</p></td><td align="left"><p>14–52</p></td></tr><tr><td align="left"><p> Social awareness</p></td><td align="left" /><td char="(" align="char"><p>31.5 (4.6)</p></td><td align="left"><p>18–42</p></td></tr><tr><td align="left"><p> Social emotion</p></td><td align="left" /><td char="(" align="char"><p>20.7 (3.9)</p></td><td align="left"><p>9–31</p></td></tr><tr><td align="left" colspan="4"><p>ADHD and ODD symptoms on the SNAP-IV</p></td></tr><tr><td align="left"><p> Inattention</p></td><td align="left" /><td char="(" align="char"><p>14.7 (6.5)</p></td><td align="left"><p>0–27</p></td></tr><tr><td align="left"><p> Hyperactivity/impulsivity</p></td><td align="left" /><td char="(" align="char"><p>10.0 (6.7)</p></td><td align="left"><p>0–27</p></td></tr><tr><td align="left"><p> Oppositional defiant</p></td><td align="left" /><td char="(" align="char"><p>10.7 (6.3)</p></td><td align="left"><p>0–24</p></td></tr><tr><td align="left"><p>Depression on the MC-CES-D</p></td><td align="left" /><td char="(" align="char"><p>14.6 (10.1)</p></td><td align="left"><p>0–52</p></td></tr><tr><td align="left"><p>Anxiety symptoms on the MASC-T</p></td><td align="left" /><td char="(" align="char"><p>35.2 (16.8)</p></td><td align="left"><p>0–97</p></td></tr><tr><td align="left"><p>Suicidality</p></td><td char="(" align="char"><p>45 (20.5)</p></td><td align="left" /><td align="left" /></tr></tbody></table> </ephtml> </p> <p> <emph>ADHD</emph> attention-deficit/hyperactivity disorder, <emph>MASC</emph>-<emph>T</emph> Taiwanese version of the Multidimensional Anxiety Scale for Children, <emph>MC</emph>-<emph>CES</emph>-<emph>D</emph> Mandarin Chinese version of the Center for Epidemiological Studies Depression Scale, <emph>ODD</emph> oppositional defiant disorder, <emph>SES</emph> socioeconomic status, <emph>SNAP</emph>-<emph>IV</emph> swanson, nolan, and pelham, version IV scale, <emph>SRS</emph> social responsiveness scale</p> <p>Prevalence rates of being a victims or perpetrator of cyberbullying (N = 219)</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" /><th align="left"><p><italic>n</italic> (%)</p></th></tr></thead><tbody><tr><td align="left" colspan="2"><p>Cyberbullying victims</p></td></tr><tr><td align="left"><p> Self-reported</p></td><td char="(" align="char"><p>30 (13.7)</p></td></tr><tr><td align="left"><p> Parent-reported</p></td><td char="(" align="char"><p>5 (2.3)</p></td></tr><tr><td align="left"><p> Self-reported or parent-reported</p></td><td char="(" align="char"><p>32 (14.6)</p></td></tr><tr><td align="left" colspan="2"><p>Cyberbullying perpetrators</p></td></tr><tr><td align="left"><p> Self-reported</p></td><td char="(" align="char"><p>18 (8.2)</p></td></tr><tr><td align="left"><p> Parent-reported</p></td><td char="(" align="char"><p>5 (2.3)</p></td></tr><tr><td align="left"><p> Self-reported or parent-reported</p></td><td char="(" align="char"><p>22 (10.0)</p></td></tr><tr><td align="left"><p>Self-reported or parent-reported cyberbullying victim-perpetrators</p></td><td char="(" align="char"><p>12 (5.5)</p></td></tr></tbody></table> </ephtml> </p> <p>Tables 3 and 4 present the results of comparing the sociodemographic characteristics, autistic social impairment, ADHD and ODD symptoms, depression, anxiety, and suicidality between cyberbullying victims and nonvictims and between perpetrators and nonperpetrators using Chi square and <emph>t</emph> tests, respectively. The results indicated that cyberbullying victims were older (<emph>t</emph> = − 2.497, <emph>p</emph> =.013), had more severe ODD (<emph>t</emph> = − 2.002, <emph>p</emph> =.046), depression (<emph>t</emph> = − 4.894, <emph>p</emph> <.001), and anxiety symptoms (<emph>t</emph> = − 3.130, <emph>p</emph> =.002) and were more likely to exhibit suicidality (χ<sups>2</sups> = 12.358, <emph>p</emph> <.001) than nonvictims. Moreover, cyberbullying perpetrators were older (<emph>t</emph> = − 4.585, <emph>p</emph> <.001), had more severe deficits in terms of social communication (<emph>t</emph> = − 2.723, <emph>p</emph> =.007) and social emotion (<emph>t</emph> = − 2.548, <emph>p</emph> =.012), exhibited more noticeable autistic mannerisms (<emph>t</emph> = − 2.276, <emph>p</emph> =.024), had more severe symptoms of ODD (<emph>t</emph> = − 3.169, <emph>p</emph> =.002), depression (<emph>t</emph> = − 2.491, <emph>p</emph> =.013), and anxiety (<emph>t</emph> = − 2.526, <emph>p</emph> =.012), and were more likely to exhibit suicidality (χ<sups>2</sups> = 9.294, <emph>p</emph> =.002) than nonperpetrators.</p> <p>Comparison of the sociodemographic characteristics and severity of autistic social impairment, ADHD and ODD symptoms, depression, anxiety, and suicidality between victims and nonvictims of cyberbullying</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" /><th align="left"><p>Victims (<italic>n</italic> = 32) <italic>n</italic> (%)</p></th><th align="left"><p>Non-victims (<italic>n</italic> = 187) <italic>n</italic> (%)</p></th><th align="left"><p>χ<sup>2</sup> or <italic>t</italic></p></th><th align="left"><p><italic>p</italic></p></th></tr></thead><tbody><tr><td align="left" colspan="5"><p>Sex, <italic>n</italic> (%)</p></td></tr><tr><td align="left"><p> Girls</p></td><td char="(" align="char"><p>6 (18.8)</p></td><td char="(" align="char"><p>21 (11.2)</p></td><td char="." align="char"><p>1.430</p></td><td char="." align="char"><p>.232</p></td></tr><tr><td align="left"><p> Boys</p></td><td char="(" align="char"><p>26 (81.3)</p></td><td char="(" align="char"><p>166 (88.8)</p></td><td align="left" /><td align="left" /></tr><tr><td align="left"><p>Age (years), mean (SD)</p></td><td char="(" align="char"><p>14.5 (2.2)</p></td><td char="(" align="char"><p>13.6 (2.0)</p></td><td char="." align="char"><p>− 2.497</p></td><td char="." align="char"><p>.013</p></td></tr><tr><td align="left"><p>Paternal education duration (years), mean (SD)</p></td><td char="(" align="char"><p>14.3 (3.1)</p></td><td char="(" align="char"><p>14.8 (2.9)</p></td><td char="." align="char"><p>.788</p></td><td char="." align="char"><p>.431</p></td></tr><tr><td align="left"><p>Maternal education duration (years), mean (SD)</p></td><td char="(" align="char"><p>13.7 (2.1)</p></td><td char="(" align="char"><p>14.3 (2.6)</p></td><td char="." align="char"><p>1.154</p></td><td char="." align="char"><p>.250</p></td></tr><tr><td align="left" colspan="5"><p>Paternal occupational SES, <italic>n</italic> (%)</p></td></tr><tr><td align="left"><p> High</p></td><td char="(" align="char"><p>18 (56.2)</p></td><td char="(" align="char"><p>111 (59.4)</p></td><td char="." align="char"><p>0.109</p></td><td char="." align="char"><p>.741</p></td></tr><tr><td align="left"><p> Low</p></td><td char="(" align="char"><p>14 (43.8)</p></td><td char="(" align="char"><p>76 (40.6)</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" colspan="5"><p>Maternal occupational SES, <italic>n</italic> (%)</p></td></tr><tr><td align="left"><p> High</p></td><td char="(" align="char"><p>18 (56.2)</p></td><td char="(" align="char"><p>113 (60.4)</p></td><td char="." align="char"><p>0.198</p></td><td char="." align="char"><p>.656</p></td></tr><tr><td align="left"><p> Low</p></td><td char="(" align="char"><p>14 (43.8)</p></td><td char="(" align="char"><p>74 (39.6)</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" colspan="5"><p>Deficits in autistic social impairment on the SRS</p></td></tr><tr><td align="left"><p> Socio-communication</p></td><td char="(" align="char"><p>71.5 (12.3)</p></td><td char="(" align="char"><p>68.0 (14.3)</p></td><td char="." align="char"><p>− 1.321</p></td><td char="." align="char"><p>.188</p></td></tr><tr><td align="left"><p> Autism mannerism</p></td><td char="(" align="char"><p>35.4 (6.1)</p></td><td char="(" align="char"><p>33.5 (7.7)</p></td><td char="." align="char"><p>− 1.337</p></td><td char="." align="char"><p>.183</p></td></tr><tr><td align="left"><p> Social awareness</p></td><td char="(" align="char"><p>30.3 (3.9)</p></td><td char="(" align="char"><p>31.7 (4.7)</p></td><td char="." align="char"><p>1.500</p></td><td char="." align="char"><p>.135</p></td></tr><tr><td align="left"><p> Social emotion</p></td><td char="(" align="char"><p>21.3 (3.8)</p></td><td char="(" align="char"><p>20.7 (4.0)</p></td><td char="." align="char"><p>−.778</p></td><td char="." align="char"><p>.438</p></td></tr><tr><td align="left" colspan="5"><p>ADHD and ODD symptoms on the SNAP-IV</p></td></tr><tr><td align="left"><p> Inattention</p></td><td char="(" align="char"><p>15.9 (5.9)</p></td><td char="(" align="char"><p>14.4 (6.6)</p></td><td char="." align="char"><p>− 1.193</p></td><td char="." align="char"><p>.234</p></td></tr><tr><td align="left"><p> Hyperactivity/impulsivity</p></td><td char="(" align="char"><p>11.6 (7.3)</p></td><td char="(" align="char"><p>9.7 (6.6)</p></td><td char="." align="char"><p>− 1.529</p></td><td char="." align="char"><p>.128</p></td></tr><tr><td align="left"><p> Oppositional defiant</p></td><td char="(" align="char"><p>12.8 (7.2)</p></td><td char="(" align="char"><p>10.4 (6.0)</p></td><td char="." align="char"><p>− 2.002</p></td><td char="." align="char"><p>.046</p></td></tr><tr><td align="left"><p>Depression on the MC-CES-D</p></td><td char="(" align="char"><p>22.3 (11.4)</p></td><td char="(" align="char"><p>13.3 (9.2)</p></td><td char="." align="char"><p>− 4.894</p></td><td char="." align="char"><p><.001</p></td></tr><tr><td align="left"><p>Anxiety symptoms on the MASC-T</p></td><td char="(" align="char"><p>43.6 (16.7)</p></td><td char="(" align="char"><p>33.8 (16.4)</p></td><td char="." align="char"><p>− 3.130</p></td><td char="." align="char"><p>.002</p></td></tr><tr><td align="left" colspan="5"><p>Suicidality</p></td></tr><tr><td align="left"><p> No</p></td><td char="(" align="char"><p>18 (56.2)</p></td><td char="(" align="char"><p>156 (83.4)</p></td><td char="." align="char"><p>12.358</p></td><td char="." align="char"><p><.001</p></td></tr><tr><td align="left"><p> Yes</p></td><td char="(" align="char"><p>14 (43.8)</p></td><td char="(" align="char"><p>31 (16.6)</p></td><td align="left" /><td align="left" /></tr></tbody></table> </ephtml> </p> <p> <emph>ADHD</emph> attention-deficit/hyperactivity disorder, <emph>MASC</emph>-<emph>T</emph> Taiwanese version of the Multidimensional Anxiety Scale for Children, <emph>MC</emph>-<emph>CES</emph>-<emph>D</emph> Mandarin Chinese version of the Center for Epidemiological Studies Depression Scale, <emph>ODD</emph> oppositional defiant disorder, <emph>SES</emph> socioeconomic status, <emph>SNAP</emph>-<emph>IV</emph> swanson, nolan, and pelham, version IV scale, <emph>SRS</emph> social responsiveness scale</p> <p>Comparison of the sociodemographic characteristics and severity of autistic social impairment, ADHD and ODD symptoms, depression, anxiety, and suicidality between perpetrators and nonperpetrators of cyberbullying</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" /><th align="left"><p>Perpetrators (<italic>n</italic> = 22) <italic>n</italic> (%)</p></th><th align="left"><p>Non- perpetrators (<italic>n</italic> = 197) <italic>n</italic> (%)</p></th><th align="left"><p>χ<sup>2</sup> or <italic>t</italic></p></th><th align="left"><p><italic>p</italic></p></th></tr></thead><tbody><tr><td align="left" colspan="5"><p>Sex, <italic>n</italic> (%)</p></td></tr><tr><td align="left"><p> Girls</p></td><td char="(" align="char"><p>2 (9.1)</p></td><td char="(" align="char"><p>25 (12.7)</p></td><td char="." align="char"><p>0.237</p></td><td char="." align="char"><p>.626</p></td></tr><tr><td align="left"><p> Boys</p></td><td char="(" align="char"><p>20 (90.9)</p></td><td char="(" align="char"><p>172 (87.3)</p></td><td align="left" /><td align="left" /></tr><tr><td align="left"><p>Age (years), mean (SD)</p></td><td char="(" align="char"><p>15.6 (2.3)</p></td><td char="(" align="char"><p>13.5 (2.0)</p></td><td char="." align="char"><p>− 4.585</p></td><td char="." align="char"><p><.001</p></td></tr><tr><td align="left"><p>Paternal education duration (years), mean (SD)</p></td><td char="(" align="char"><p>14.2 (3.2)</p></td><td char="(" align="char"><p>14.8 (2.9)</p></td><td char="." align="char"><p>.833</p></td><td char="." align="char"><p>.406</p></td></tr><tr><td align="left"><p>Maternal education duration (years), mean (SD)</p></td><td char="(" align="char"><p>13.9 (2.0)</p></td><td char="(" align="char"><p>14.2 (2.6)</p></td><td char="." align="char"><p>.646</p></td><td char="." align="char"><p>.519</p></td></tr><tr><td align="left" colspan="5"><p>Paternal occupational SES, <italic>n</italic> (%)</p></td></tr><tr><td align="left"><p> High</p></td><td char="(" align="char"><p>13 (59.1)</p></td><td char="(" align="char"><p>116 (58.9)</p></td><td char="." align="char"><p>0.000</p></td><td char="." align="char"><p>.985</p></td></tr><tr><td align="left"><p> Low</p></td><td char="(" align="char"><p>9 (40.9)</p></td><td char="(" align="char"><p>81 (41.1)</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" colspan="5"><p>Maternal occupational SES, <italic>n</italic> (%)</p></td></tr><tr><td align="left"><p> High</p></td><td char="(" align="char"><p>14 (63.6)</p></td><td char="(" align="char"><p>117 (59.4)</p></td><td char="." align="char"><p>0.148</p></td><td char="." align="char"><p>.700</p></td></tr><tr><td align="left"><p> Low</p></td><td char="(" align="char"><p>8 (36.4)</p></td><td char="(" align="char"><p>80 (40.6)</p></td><td align="left" /><td align="left" /></tr><tr><td align="left" colspan="5"><p>Deficits in autistic social impairment on the SRS</p></td></tr><tr><td align="left"><p> Socio-communication</p></td><td char="(" align="char"><p>76.1 (14.3)</p></td><td char="(" align="char"><p>67.6 (13.8)</p></td><td char="." align="char"><p>− 2.723</p></td><td char="." align="char"><p>.007</p></td></tr><tr><td align="left"><p> Autism mannerism</p></td><td char="(" align="char"><p>37.5 (7.3)</p></td><td char="(" align="char"><p>33.3 (7.4)</p></td><td char="." align="char"><p>− 2.548</p></td><td char="." align="char"><p>.012</p></td></tr><tr><td align="left"><p> Social awareness</p></td><td char="(" align="char"><p>31.6 (4.2)</p></td><td char="(" align="char"><p>31.5 (4.7)</p></td><td char="." align="char"><p>−.172</p></td><td char="." align="char"><p>.864</p></td></tr><tr><td align="left"><p> Social emotion</p></td><td char="(" align="char"><p>22.5 (4.0)</p></td><td char="(" align="char"><p>20.5 (3.9)</p></td><td char="." align="char"><p>− 2.276</p></td><td char="." align="char"><p>.024</p></td></tr><tr><td align="left" colspan="5"><p>ADHD and ODD symptoms on the SNAP-IV</p></td></tr><tr><td align="left"><p> Inattention</p></td><td char="(" align="char"><p>16.8 (6.0)</p></td><td char="(" align="char"><p>14.4 (6.6)</p></td><td char="." align="char"><p>− 1.601</p></td><td char="." align="char"><p>.111</p></td></tr><tr><td align="left"><p> Hyperactivity/impulsivity</p></td><td char="(" align="char"><p>11.2 (7.2)</p></td><td char="(" align="char"><p>9.8 (6.7)</p></td><td char="." align="char"><p>−.905</p></td><td char="." align="char"><p>.367</p></td></tr><tr><td align="left"><p> Oppositional</p></td><td char="(" align="char"><p>14.7 (5.9)</p></td><td char="(" align="char"><p>10.3 (6.2)</p></td><td char="." align="char"><p>− 3.169</p></td><td char="." align="char"><p>.002</p></td></tr><tr><td align="left"><p>Depression on the MC-CES-D</p></td><td char="(" align="char"><p>19.6 (9.3)</p></td><td char="(" align="char"><p>14.1 (10.0)</p></td><td char="." align="char"><p>− 2.491</p></td><td char="." align="char"><p>.013</p></td></tr><tr><td align="left"><p>Anxiety symptoms on the MASC-T</p></td><td char="(" align="char"><p>43.7 (12.9)</p></td><td char="(" align="char"><p>34.3 (16.9)</p></td><td char="." align="char"><p>− 2.526</p></td><td char="." align="char"><p>.012</p></td></tr><tr><td align="left" colspan="5"><p>Suicidality</p></td></tr><tr><td align="left"><p> No</p></td><td char="(" align="char"><p>12 (54.5)</p></td><td char="(" align="char"><p>162 (82.2)</p></td><td char="." align="char"><p>9.294</p></td><td char="." align="char"><p>.002</p></td></tr><tr><td align="left"><p> Yes</p></td><td char="(" align="char"><p>10 (45.5)</p></td><td char="(" align="char"><p>35 (17.8)</p></td><td align="left" /><td align="left" /></tr></tbody></table> </ephtml> </p> <p> <emph>ADHD</emph> attention-deficit/hyperactivity disorder, <emph>MASC</emph>-<emph>T</emph> Taiwanese version of the Multidimensional Anxiety Scale for Children, <emph>MC</emph>-<emph>CES</emph>-<emph>D</emph> Mandarin Chinese version of the Center for Epidemiological Studies Depression Scale, <emph>ODD</emph> oppositional defiant disorder, <emph>SES</emph> socioeconomic status, <emph>SNAP</emph>-<emph>IV</emph> swanson, nolan, and pelham, version IV scale, <emph>SRS</emph> social responsiveness scale</p> <p>The sociodemographic characteristics and severity of both autistic social impairment and ADHD and ODD symptoms that were significantly associated with cyberbullying involvement according to the results of the Chi square and <emph>t</emph> tests were further selected for input into the logistic analysis models (Table 5). The results indicated that those who were older (OR 1.265, 95% CI 1.061–1.508) and had more severe ODD symptoms (OR 1.073, 95% CI 1.008–1.142) were more likely to be victims of cyberbullying. Those who were older (OR 1.670, 95% CI 1.313–2.124) and had more severe ODD symptoms (OR 1.153, 95% CI 1.043–1.275) were more likely to be perpetrators of cyberbullying. The results of the multivariate logistic regression analysis indicated no significant associations between deficits in social communication and social emotion or severity of autism mannerisms with being a perpetrator of cyberbullying.</p> <p>Factors related to the likelihood of being a victim or perpetrator of cyberbullying: logistic regression analysis</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" /><th align="left" colspan="2"><p>Victims OR 95% CI of OR</p></th><th align="left" colspan="2"><p>Perpetrators OR 95% CI of OR</p></th></tr></thead><tbody><tr><td align="left"><p>Age</p></td><td char="." align="char"><p>1.265</p></td><td align="left"><p>1.061–1.508</p></td><td char="." align="char"><p>1.670</p></td><td align="left"><p>1.313–2.124</p></td></tr><tr><td align="left"><p>Socio-communication</p></td><td align="left" /><td align="left" /><td char="." align="char"><p>1.007</p></td><td align="left"><p>.911–1.114</p></td></tr><tr><td align="left"><p>Autism mannerism</p></td><td align="left" /><td align="left" /><td char="." align="char"><p>.989</p></td><td align="left"><p>.833–1.174</p></td></tr><tr><td align="left"><p>Social emotion</p></td><td align="left" /><td align="left" /><td char="." align="char"><p>1.039</p></td><td align="left"><p>.834–1.294</p></td></tr><tr><td align="left"><p>Oppositional defiant symptoms</p></td><td char="." align="char"><p>1.073</p></td><td align="left"><p>1.008–1.142</p></td><td char="." align="char"><p>1.153</p></td><td align="left"><p>1.043–1.275</p></td></tr></tbody></table> </ephtml> </p> <p>The associations of depression and anxiety with being a victim of cyberbullying were examined using a multiple regression analysis. The results indicated that after controlling for the effects of sociodemographic characteristics, victims of cyberbullying exhibited more severe depression (beta =.271, <emph>t</emph> = 3.967, <emph>p</emph> <.001) and anxiety (beta =.148, <emph>t</emph> = 2.067, <emph>p</emph> =.040) than nonvictims, whereas no difference was observed in terms of depression (beta = −.014, <emph>t</emph> = −.193, <emph>p</emph> =.847) or anxiety (beta =.070, <emph>t</emph> =.949, <emph>p</emph> =.343) between perpetrators and nonperpetrators of cyberbullying. The associations of suicidality with being a victim or perpetrator of cyberbullying were examined using a logistic regression analysis. The results indicated that after controlling for the effects of sociodemographic characteristics, victims of cyberbullying were more likely to exhibit suicidality than nonvictims (OR 2.836, 95% CI 1.155–6.968), whereas no difference was observed in terms of suicidality between perpetrators and nonperpetrators of cyberbullying (OR 2.283, 95% CI.784–6.647).</p> <hd id="AN0138689614-18">Discussion</hd> <p></p> <hd id="AN0138689614-19">Agreement Between Self-reported and Parent-Reported Cyberbullying</hd> <p>The present study discovered that the prevalence of being self-reported or parent-reported cyberbullying victims and perpetrators in adolescents with high-functioning ASD was 14.6% and 10.0%, respectively. Although the prevalence rate of cyberbullying involvement in adolescents with ASD was lower than that in Taiwanese adolescents with ADHD using the same survey instrument (19.1% for being self-reported victims of cyberbullying and 14.3% for being perpetrators; Yen et al. [<reflink idref="bib54" id="ref76">54</reflink>]), cyberbullying involvement was not rare in adolescents with ASD. The present study found a low level of agreement between self-reported and parent-reported cyberbullying involvement in adolescents with ASD. A previous study on 35 high functioning individuals with ASD who were preparing to attend college also found the discordance between self-report and parent-report of bullying: 51% percent of the sample reported being recent victims of bullying, whereas only 31% of parents reported their child was a victim of bullying (van Schalkwyk et al. [<reflink idref="bib46" id="ref77">46</reflink>]). Several possible causes may account for this discrepancy. First, because the Internet usage behaviors of adolescents are private, parents may not be aware of what adolescents encounter online. Second, adolescents with ASD may have different perceptions of their online behaviors compared with their parents. Third, other factors may influence the level of agreement between self-reported and parent-reported cyberbullying involvement. The results indicated that parents may not be aware of adolescents' cyberbullying involvement. A recent systematic review supports that one of components of effective intervention for cyberbullying is educating both the individual youth and parent on cyberbullying (Hutson et al. [<reflink idref="bib17" id="ref78">17</reflink>]). Therefore, parents of adolescents with ASD should must be invited into the prevention and intervention programs for cyberbullying.</p> <p>Traditional bullying has been defined as an aggressive behavior characterized by three defining conditions: (<reflink idref="bib1" id="ref79">1</reflink>) negative or malicious behavior intended to harm or distress; (<reflink idref="bib2" id="ref80">2</reflink>) behavior repeated over a time period; and (<reflink idref="bib3" id="ref81">3</reflink>) a relationship in which there is an imbalance in strength or power between the parties involved (Olweus, [<reflink idref="bib33" id="ref82">33</reflink>]). However, research debated whether the three criteria also apply to cyberbullying (Menesini et al. [<reflink idref="bib29" id="ref83">29</reflink>]) and concluded that intentionality is reliable as a criterion for cyberbullying (Vandebosch and Cleemput [<reflink idref="bib47" id="ref84">47</reflink>]), whereas repetition (Smith [<reflink idref="bib39" id="ref85">39</reflink>]) and imbalance of power (Wolak et al. [<reflink idref="bib51" id="ref86">51</reflink>]) may be less reliable as the criteria for cyberbullying. Adolescents with ASD who reported cyberbullying perpetration may deny that they act with malicious intention but just joke or fight back. There may be no significant imbalance of power between adolescents with ASD and the cyberbullying victims. Moreover, adolescents with ASD may not be aware of or care about the harm and distress of victims caused their cyberbullying behavior. All these characteristics described above may contribute the likelihood that the adolescents with ASD report themselves to be a cyberbullying perpetrator.</p> <hd id="AN0138689614-20">Related Factors of Cyberbullying in ASD</hd> <p>The present study found that older individuals were more likely to be victims or perpetrators of cyberbullying. Older adolescents may spend more time in cyberspace than younger adolescents, thus increasing their likelihood of cyberbullying involvement. Older adolescents may also perpetrate bullying in cyberspace to reduce the possibility of detection and being blamed for their bullying behaviors. Research has indicated that comorbid ODD increases the likelihood of children with ASD perpetrating traditional bullying (Mayes et al. [<reflink idref="bib26" id="ref87">26</reflink>]; Zablotsky et al. [<reflink idref="bib57" id="ref88">57</reflink>]). The present study found that more severe ODD symptoms were significantly associated with both cyberbullying victimization and perpetration in adolescents with ASD. Adolescents with ASD who have severe ODD symptoms such as anger, irritability and arguing may instigate perpetrating bullying in cyberspace. Moreover, the symptoms of ODD may lead adolescent Internet users with ASD to be targets of cyberbullying.</p> <p>The results of the t test performed in the present study revealed that perpetrators of cyberbullying reported more severe socio-communication deficits and autism mannerisms on the Chinese SRS than nonperpetrators; however, the difference was nonsignificant in a multivariate logistic regression analysis after controlling for age and ODD symptoms. One study on traditional bullying in children with ASD also revealed that increased risk for being a perpetrator or both a victim and perpetrator was nonexistent after controlling for comorbid psychopathology and other demographic factors (Hwang et al. [<reflink idref="bib19" id="ref89">19</reflink>]). The present study did not note a significant difference between cyberbullying victims and nonvictims with ASD in terms of autistic social impairment. Furthermore, no significant difference in ADHD symptoms was observed between adolescents with ASD who were involved in cyberbullying and those with ASD who were not. One possible reason for this finding is that autistic social impairment and ADHD symptoms are not as noticeable or easily detected during online interactions and therefore contribute less to bullying victimization compared with real-world interactions.</p> <hd id="AN0138689614-21">Cyberbullying, Depression, Anxiety and Suicidality</hd> <p>The present study discovered that victims of cyberbullying had more severe depression and anxiety and a higher risk of suicidality than nonvictims. The age and sex distribution of the participants in the present study were similar with those in the previous study (89% male; mean age = 13.8) that found the positive association of cyberbullying victimization with anxiety and depression in adolescents with ASD (Wright and Wachs [<reflink idref="bib52" id="ref90">52</reflink>]). Another study also reported a similar significant association between cyberbullying victimization and depression and suicidality in adolescents with ADHD (Yen et al. [<reflink idref="bib54" id="ref91">54</reflink>]). The Internet is a prominent space in which many adolescents spend their time. Cyberbullying may damage the self-esteem of ASD victims and thus result in compromised mental health. Cyberbullying may also limit the opportunities of adolescents with ASD to develop the social skills necessary to appropriately interact with others on the Internet, which may further result in more negative effects on their lives when engaging in online activities. Furthermore, adolescents with ASD who also have anxiety and depression may use the Internet to relieve their negative emotions, which increases their likelihood of being subjected to bullying. Clinicians and education professionals should routinely screen adolescents for cyberbullying involvement to detect their negative emotions and risk of suicide in a timely manner. The present study did not find significant differences between perpetrators and nonperpetrators of cyberbullying in terms of depression, anxiety, or suicidality. This result was in line with that of a study on cyberbullying perpetration in adolescents with ADHD (Yen et al. [<reflink idref="bib54" id="ref92">54</reflink>]). However, another study on the general adolescent population reported that perpetrators of traditional bullying had more severe depression, anxiety, and suicidality than nonperpetrators (Yen et al. [<reflink idref="bib55" id="ref93">55</reflink>]). This indicates that the relationship between bullying perpetration and mental health problems may vary depending on the type of bullying perpetration and confirmation of a psychiatric diagnosis. This hypothesis warrants further study.</p> <hd id="AN0138689614-22">Limitations</hd> <p>This study had several limitations that require attention. First, the cross-sectional research design limited our ability to draw conclusions regarding causal relationships between cyberbullying involvement and negative emotions. Second, the study participants were adolescents with high-functioning ASD who visited medical units for treatment or to complete the survey, meaning that the results of this study may not be generalizable to all adolescents with high-functioning ASD. Third, we examined the symptoms but not the diagnoses of ADHD, ODD, and depressive and anxiety disorders.</p> <hd id="AN0138689614-23">Conclusion</hd> <p>The results of this study indicate that cyberbullying victimization and perpetration are not rare among adolescents with ASD. Victims of cyberbullying reported more severe depression and anxiety and were more likely to have suicidality than those who were not victims of cyberbullying. High age and severe ODD symptoms were factors that were significantly associated with being a victim or perpetrator of cyberbullying. Clinicians, education professionals, and parents of adolescents should monitor relatively old adolescents with ASD and comorbid ODD symptoms for their potential involvement in cyberbullying.</p> <hd id="AN0138689614-24">Acknowledgments</hd> <p>This study was supported by the Grant NSC 102-2628-B-037-007-MY3 awarded by the National Science Council, Taiwan. The data presented, the statements made and the expressed views are solely the responsibility of the authors.</p> <hd id="AN0138689614-25">Author Contributions</hd> <p>HFH, TLL, WJC and CFY conceived of the study and its design, carried out the study, performed the preliminary statistical analyses and drafted the manuscript. RCH, HCN, SHYL, CFL and HLC contributed to the study design, performed the final statistical analyses and helped to draft the manuscript. YHH, LJW and MJL contributed to the study design and helped to draft the manuscript. All authors read and approved the final manuscript.</p> <hd id="AN0138689614-26">Compliance with Ethical Standards</hd> <p></p> <hd id="AN0138689614-27">Conflict of interest</hd> <p>The authors declare that they have no conflict of interests.</p> <hd id="AN0138689614-28">Ethical Approval</hd> <p>All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.</p> <hd id="AN0138689614-29">Research involving Human and Animal Rights</hd> <p>This article does not contain any studies with animals performed by any of the authors.</p> <hd id="AN0138689614-30">Informed Consent</hd> <p>Written informed consent was obtained from all individual participants included in the study.</p> <hd id="AN0138689614-31">Publisher's Note</hd> <p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p> <ref id="AN0138689614-32"> <title> References </title> <blist> <bibl id="bib1" idref="ref24" type="bt">1</bibl> <bibtext> Adams RE, Fredstrom BK, Duncan AW, Holleb LJ, Bishop SL. 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Hsiao; Hsing-Chang Ni; Sophie Hsin-Yi Liang; Chiao-Fan Lin; Hsiang-Lin Chan; Yi-Hsuan Hsieh; Liang-Jen Wang; Min-Jing Lee; Wen-Jiun Chou and Cheng-Fang Yen</p> <p>Reported by Author; Author; Author; Author; Author; Author; Author; Author; Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib24" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib31" firstref="ref2"></nolink> <nolink nlid="nl3" bibid="bib38" firstref="ref3"></nolink> <nolink nlid="nl4" bibid="bib28" firstref="ref4"></nolink> <nolink nlid="nl5" bibid="bib50" firstref="ref5"></nolink> <nolink nlid="nl6" bibid="bib49" firstref="ref6"></nolink> <nolink nlid="nl7" bibid="bib13" firstref="ref7"></nolink> <nolink nlid="nl8" bibid="bib27" firstref="ref8"></nolink> <nolink nlid="nl9" bibid="bib23" firstref="ref10"></nolink> <nolink nlid="nl10" bibid="bib40" firstref="ref11"></nolink> <nolink nlid="nl11" bibid="bib22" firstref="ref13"></nolink> <nolink nlid="nl12" bibid="bib34" firstref="ref14"></nolink> <nolink nlid="nl13" bibid="bib53" firstref="ref15"></nolink> <nolink nlid="nl14" bibid="bib44" firstref="ref19"></nolink> <nolink nlid="nl15" bibid="bib54" firstref="ref21"></nolink> <nolink nlid="nl16" bibid="bib15" firstref="ref22"></nolink> <nolink nlid="nl17" bibid="bib45" firstref="ref23"></nolink> <nolink nlid="nl18" bibid="bib10" firstref="ref25"></nolink> <nolink nlid="nl19" bibid="bib57" firstref="ref27"></nolink> <nolink nlid="nl20" bibid="bib14" firstref="ref28"></nolink> <nolink nlid="nl21" bibid="bib30" firstref="ref29"></nolink> <nolink nlid="nl22" bibid="bib16" firstref="ref33"></nolink> <nolink nlid="nl23" bibid="bib35" firstref="ref37"></nolink> <nolink nlid="nl24" bibid="bib41" firstref="ref38"></nolink> <nolink nlid="nl25" bibid="bib19" firstref="ref39"></nolink> <nolink nlid="nl26" bibid="bib20" firstref="ref42"></nolink> <nolink nlid="nl27" bibid="bib32" firstref="ref43"></nolink> <nolink nlid="nl28" bibid="bib55" firstref="ref44"></nolink> <nolink nlid="nl29" bibid="bib21" firstref="ref49"></nolink> <nolink nlid="nl30" bibid="bib52" firstref="ref51"></nolink> <nolink nlid="nl31" bibid="bib48" firstref="ref56"></nolink> <nolink nlid="nl32" bibid="bib11" firstref="ref61"></nolink> <nolink nlid="nl33" bibid="bib12" firstref="ref64"></nolink> <nolink nlid="nl34" bibid="bib42" firstref="ref65"></nolink> <nolink nlid="nl35" bibid="bib37" firstref="ref67"></nolink> <nolink nlid="nl36" bibid="bib25" firstref="ref68"></nolink> <nolink nlid="nl37" bibid="bib56" firstref="ref69"></nolink> <nolink nlid="nl38" bibid="bib36" firstref="ref71"></nolink> <nolink nlid="nl39" bibid="bib43" firstref="ref72"></nolink> <nolink nlid="nl40" bibid="bib18" firstref="ref74"></nolink> <nolink nlid="nl41" bibid="bib46" firstref="ref77"></nolink> <nolink nlid="nl42" bibid="bib17" firstref="ref78"></nolink> <nolink nlid="nl43" bibid="bib33" firstref="ref82"></nolink> <nolink nlid="nl44" bibid="bib29" firstref="ref83"></nolink> <nolink nlid="nl45" bibid="bib47" firstref="ref84"></nolink> <nolink nlid="nl46" bibid="bib39" firstref="ref85"></nolink> <nolink nlid="nl47" bibid="bib51" firstref="ref86"></nolink> <nolink nlid="nl48" bibid="bib26" firstref="ref87"></nolink>
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Items – Name: Title
  Label: Title
  Group: Ti
  Data: Cyberbullying Victimization and Perpetration in Adolescents with High-Functioning Autism Spectrum Disorder: Correlations with Depression, Anxiety, and Suicidality
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Hu%2C+Huei-Fan%22">Hu, Huei-Fan</searchLink><br /><searchLink fieldCode="AR" term="%22Liu%2C+Tai-Ling%22">Liu, Tai-Ling</searchLink><br /><searchLink fieldCode="AR" term="%22Hsiao%2C+Ray+C%2E%22">Hsiao, Ray C.</searchLink><br /><searchLink fieldCode="AR" term="%22Ni%2C+Hsing-Chang%22">Ni, Hsing-Chang</searchLink><br /><searchLink fieldCode="AR" term="%22Liang%2C+Sophie+Hsin-Yi%22">Liang, Sophie Hsin-Yi</searchLink><br /><searchLink fieldCode="AR" term="%22Lin%2C+Chiao-Fan%22">Lin, Chiao-Fan</searchLink><br /><searchLink fieldCode="AR" term="%22Chan%2C+Hsiang-Lin%22">Chan, Hsiang-Lin</searchLink><br /><searchLink fieldCode="AR" term="%22Hsieh%2C+Yi-Hsuan%22">Hsieh, Yi-Hsuan</searchLink><br /><searchLink fieldCode="AR" term="%22Wang%2C+Liang-Jen%22">Wang, Liang-Jen</searchLink><br /><searchLink fieldCode="AR" term="%22Lee%2C+Min-Jing%22">Lee, Min-Jing</searchLink><br /><searchLink fieldCode="AR" term="%22Chou%2C+Wen-Jiun%22">Chou, Wen-Jiun</searchLink><br /><searchLink fieldCode="AR" term="%22Yen%2C+Cheng-Fang%22">Yen, Cheng-Fang</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0003-1156-4939">0000-0003-1156-4939</externalLink>)
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+Autism+and+Developmental+Disorders%22"><i>Journal of Autism and Developmental Disorders</i></searchLink>. Oct 2019 49(10):4170-4180.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Springer. Available from: Springer Nature. 233 Spring Street, New York, NY 10013. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-348-4505; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 11
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2019
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Bullying%22">Bullying</searchLink><br /><searchLink fieldCode="DE" term="%22Computer+Mediated+Communication%22">Computer Mediated Communication</searchLink><br /><searchLink fieldCode="DE" term="%22Adolescents%22">Adolescents</searchLink><br /><searchLink fieldCode="DE" term="%22Depression+%28Psychology%29%22">Depression (Psychology)</searchLink><br /><searchLink fieldCode="DE" term="%22Anxiety%22">Anxiety</searchLink><br /><searchLink fieldCode="DE" term="%22Suicide%22">Suicide</searchLink><br /><searchLink fieldCode="DE" term="%22Psychological+Patterns%22">Psychological Patterns</searchLink><br /><searchLink fieldCode="DE" term="%22Victims%22">Victims</searchLink><br /><searchLink fieldCode="DE" term="%22Parent+Attitudes%22">Parent Attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Age+Differences%22">Age Differences</searchLink><br /><searchLink fieldCode="DE" term="%22Severity+%28of+Disability%29%22">Severity (of Disability)</searchLink><br /><searchLink fieldCode="DE" term="%22Autism%22">Autism</searchLink><br /><searchLink fieldCode="DE" term="%22Pervasive+Developmental+Disorders%22">Pervasive Developmental Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Attention+Deficit+Hyperactivity+Disorder%22">Attention Deficit Hyperactivity Disorder</searchLink><br /><searchLink fieldCode="DE" term="%22Behavior+Disorders%22">Behavior Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Comorbidity%22">Comorbidity</searchLink><br /><searchLink fieldCode="DE" term="%22Correlation%22">Correlation</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1007/s10803-019-04060-7
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0162-3257
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: The present study examined the associations between cyberbullying involvement and sociodemographic characteristics, autistic social impairment and attention-deficit/hyperactivity disorder and oppositional defiant disorder (ODD) symptoms in 219 adolescents with high-functioning autism spectrum disorder (ASD). Moreover, the associations between cyberbullying involvement and depression, anxiety, and suicidality were also examined. Adolescents self-reported higher rates of being a victim or perpetrator of cyberbullying than were reported by their parents. Increased age and had more severe ODD symptoms were significantly associated with being victims or perpetrators of cyberbullying. Being a victim but not a perpetrator of cyberbullying was significantly associated with depression, anxiety, and suicidality. Cyberbullying victimization and perpetration should be routinely surveyed in adolescents with high-functioning ASD.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2019
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1228795
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1228795
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        Value: 10.1007/s10803-019-04060-7
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 11
        StartPage: 4170
    Subjects:
      – SubjectFull: Bullying
        Type: general
      – SubjectFull: Computer Mediated Communication
        Type: general
      – SubjectFull: Adolescents
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      – SubjectFull: Depression (Psychology)
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      – SubjectFull: Psychological Patterns
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      – SubjectFull: Victims
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      – SubjectFull: Parent Attitudes
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      – SubjectFull: Severity (of Disability)
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      – SubjectFull: Autism
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      – SubjectFull: Pervasive Developmental Disorders
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      – SubjectFull: Comorbidity
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      – SubjectFull: Correlation
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      – TitleFull: Cyberbullying Victimization and Perpetration in Adolescents with High-Functioning Autism Spectrum Disorder: Correlations with Depression, Anxiety, and Suicidality
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