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School Engagement, Epilepsy Severity, and Frequency of Victimization in School Age Children

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Title: School Engagement, Epilepsy Severity, and Frequency of Victimization in School Age Children
Language: English
Authors: Jessica Emick (ORCID 0000-0001-6762-8706), Nathan M. Griffith, Hannah Schweitzer
Source: Psychology in the Schools. 2025 62(1):24-40.
Availability: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
Peer Reviewed: Y
Page Count: 17
Publication Date: 2025
Document Type: Journal Articles
Reports - Research
Education Level: Elementary Education
Descriptors: Epilepsy, Severity (of Disability), Students with Disabilities, Parents, Children, Data, Bullying, Victims of Crime, Data Analysis, Peer Relationship, Chronic Illness, Social Bias, Negative Attitudes, Learner Engagement, School Role, Student Characteristics, Educational Environment, Elementary Education
DOI: 10.1002/pits.23312
ISSN: 0033-3085
1520-6807
Abstract: Epilepsy is one of the most common neurological disorders in young people, which disrupts daily life and results in an increased risk of victimization. Archival data from the 2018/2019 National Survey of Children's Health (NSCH), a nationally representative cross-sectional survey, were used. Data from the NSCH were collected via parent reports and analyzed for children aged 6-17 years (N = 25500). The results indicated that children with epilepsy (CWE) were significantly more likely to be frequently bullied than children with less stigmatizing chronic health conditions (i.e., asthma) and typical peers, but there was no significant association between the severity of epilepsy and the frequency of victimization. Furthermore, the degree of school engagement did not significantly moderate the relationship between epilepsy severity and frequency of victimization. However, the degree of school engagement was associated with the frequency of victimization in CWE, such that more school engagement was associated with less parent-reported victimization. Overall, these findings support the growing evidence that CWE are at a higher risk of being bullied and need unique interventions regardless of epilepsy severity and that school engagement should be further examined to reduce victimization among CWE.
Abstractor: As Provided
Entry Date: 2024
Accession Number: EJ1452692
Database: ERIC
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  Value: <anid>AN0181548958;pis01jan.25;2024Dec12.05:05;v2.2.500</anid> <title id="AN0181548958-1">School engagement, epilepsy severity, and frequency of victimization in school age children </title> <p>Epilepsy is one of the most common neurological disorders in young people, which disrupts daily life and results in an increased risk of victimization. Archival data from the 2018/2019 National Survey of Children's Health (NSCH), a nationally representative cross‐sectional survey, were used. Data from the NSCH were collected via parent reports and analyzed for children aged 6–17 years (N = 25500). The results indicated that children with epilepsy (CWE) were significantly more likely to be frequently bullied than children with less stigmatizing chronic health conditions (i.e., asthma) and typical peers, but there was no significant association between the severity of epilepsy and the frequency of victimization. Furthermore, the degree of school engagement did not significantly moderate the relationship between epilepsy severity and frequency of victimization. However, the degree of school engagement was associated with the frequency of victimization in CWE, such that more school engagement was associated with less parent‐reported victimization. Overall, these findings support the growing evidence that CWE are at a higher risk of being bullied and need unique interventions regardless of epilepsy severity and that school engagement should be further examined to reduce victimization among CWE.</p> <p>Practitioner Points: Children with epilepsy are at a higher risk of being bullied than their healthy peers or peers with less stigmatizing chronic health conditions.Children with less severe epilepsy were equally likely to be victimized as were children with more severe epilepsy.Increasing school engagement should be examined further as one way to reduce the frequency of victimization among children with epilepsy.</p> <p>Keywords: adolescents; chronic health conditions; epilepsy; school engagement; school psychologists; victimization</p> <hd id="AN0181548958-2">INTRODUCTION</hd> <p>Children with epilepsy (CWE) often experience significant challenges in their daily lives, primarily because of seizures. These challenges include emotional, developmental, and behavioral difficulties, and they are also at an increased risk of being bullied. Research has shown that nearly a quarter of typically developing children face victimization; however, the risk of CWE being bullied is almost twice as high as that of their peers without epilepsy (Pinquart, [<reflink idref="bib31" id="ref1">31</reflink>]; Zhang et al., [<reflink idref="bib43" id="ref2">43</reflink>]). This study aimed to compare the prevalence of parent‐reported bullying across three groups: CWE, children with asthma, and their typical peers. Valuable comparisons can be made between clinical populations for targeted interventions, thereby aiding clinicians and researchers in their work. These comparisons are particularly useful for identifying potential areas for intervention and for developing strategies to improve patient outcomes. Therefore, such analyses are essential components of evidence‐based medicine and healthcare research. Children with asthma were chosen as the comparison group because asthma, like epilepsy, is a common childhood condition. Existing research has shown a correlation between asthma and increased risk of bullying (Charles et al., [<reflink idref="bib5" id="ref3">5</reflink>]; Joseph et al., [<reflink idref="bib18" id="ref4">18</reflink>]). Additionally, both conditions often require ongoing medication management, can affect social functioning, and may exacerbate symptoms owing to stress.</p> <p>To better understand and address this heightened risk of victimization within an already vulnerable CWE population, this study draws upon the ecological systems theory. Ecological systems theory provides a valuable framework for understanding the factors that influence vulnerability to bullying. This theory considers various layers of the environment that may contribute to or mitigate the risk of victimization. According to Bronfenbrenner's ecological systems theory (Bronfenbrenner, 1979), individuals are situated within a complex network of interconnected systems, encompassing the microsystem (e.g., family, school, and peers), mesosystem (e.g., interactions between microsystems), exosystem (e.g., community and societal institutions), and macrosystem (e.g., cultural values and ideologies). Applying this model, at the innermost individual level, CWE exhibited distinctive traits that might increase their vulnerability to bullying, stemming from their peers' lack of understanding or misconceptions. This study underscores the significance of the school environment as a microsystem that significantly influences a child's development. Considering that children in the United States spend approximately 30 h weekly in this setting, which is a primary location for bullying incidents, school engagement is identified as a potentially protective and changeable factor worth exploring (Turner et al., [<reflink idref="bib37" id="ref5">37</reflink>]).</p> <p>This theory focuses on examining the factors in a child's environment that can either increase or decrease the risk of bullying. These environmental factors are viewed as layers, ranging from closest to the child to the most distant. Given that school‐age children in the United States spend an average of 30 h per week in schools, and schools are the most common setting for bullying incidents, this study emphasizes school engagement as a potentially protective and changeable factor to explore.</p> <hd id="AN0181548958-3">Epilepsy</hd> <p>Epilepsy is the most common treatable neurological condition in childhood, involving recurrent seizures due to excessive disorderly discharge of cerebral neurons (Lee, [<reflink idref="bib19" id="ref6">19</reflink>]). These seizures, lasting between a few seconds and several minutes, can be classified as focal/partial, generalized, or partial complex depending on the hemisphere of the brain in which neuronal discharges occur. It is estimated that 1.2% of individuals in the United States have active epilepsy (Zack & Kobau, [<reflink idref="bib42" id="ref7">42</reflink>]), while 10% have experienced a single seizure over the course of their lives (Lee, [<reflink idref="bib19" id="ref8">19</reflink>]). The etiology of pediatric epilepsy is highly contingent on the age of seizure onset, with birth injury, fever, maternal drug use, head trauma, and genetic metabolic disorders being the most common potential causes of epilepsy in infants and children (Epilepsy Foundation of America, [<reflink idref="bib8" id="ref9">8</reflink>]). Certain populations are considered more at risk for developing epilepsy, such as children with cerebral palsy, intellectual disabilities, or parents with epilepsy (Epilepsy Foundation of America, [<reflink idref="bib8" id="ref10">8</reflink>]). Childhood epilepsy has been linked to a higher risk of several comorbid conditions, including mental health conditions (i.e., depression and anxiety), learning disabilities, neurodevelopmental disorders including ADHD, and developmental delays, compared to children without epilepsy (Epilepsy Foundation of America, [<reflink idref="bib8" id="ref11">8</reflink>]; Jones et al., [<reflink idref="bib17" id="ref12">17</reflink>]; Nickels, [<reflink idref="bib26" id="ref13">26</reflink>]; Stough et al., [<reflink idref="bib28" id="ref14">28</reflink>]).</p> <hd id="AN0181548958-4">Victimization</hd> <p>Victimization is a well‐known issue affecting approximately 20–25% of typically developing school‐aged children in their everyday lives (Zhang et al., [<reflink idref="bib43" id="ref15">43</reflink>]). It has been widely acknowledged as a significant public health concern with both direct and indirect negative consequences for school‐aged children (Armitage, [<reflink idref="bib2" id="ref16">2</reflink>]; Forster et al., [<reflink idref="bib9" id="ref17">9</reflink>]; Zych et al., [<reflink idref="bib44" id="ref18">44</reflink>]). Specifically, an increase in peer victimization has been linked to a higher risk of anxiety and depression (Reijntjes et al., [<reflink idref="bib32" id="ref19">32</reflink>]).</p> <p>Although the definition of bullying can vary across the literature, it generally involves repeated and deliberate aggressive actions that create an imbalance of power, making it difficult for victims to defend themselves effectively (Pinquart, [<reflink idref="bib31" id="ref20">31</reflink>]; Zych et al., [<reflink idref="bib44" id="ref21">44</reflink>]). A more recent understanding of bullying recognizes that victimization can manifest in various forms, ranging from direct to indirect. Direct bullying typically involves face‐to‐face interactions between the bully and the victim, encompassing both verbal and physical aggression. In contrast, indirect bullying, also known as relational bullying, tends to be more subtle, relying on covert methods, such as social manipulation, social isolation, or the spreading of rumors to cause harm (Zych et al., [<reflink idref="bib44" id="ref22">44</reflink>]).</p> <hd id="AN0181548958-5">Victimization and childhood chronic health conditions</hd> <p>Research on victimization among children with chronic health conditions has yielded mixed results; however, most studies suggest that children with such conditions are at a higher risk of being victimized (Pinquart, [<reflink idref="bib31" id="ref23">31</reflink>]). To better understand these mixed findings, Pinquart ([<reflink idref="bib31" id="ref24">31</reflink>]) conducted a comprehensive meta‐analysis of 62,855 children and adolescents from 107 studies. The primary goal was to assess the risk of bullying based on different types of bullying (e.g., physical, relational, verbal, cyberbullying, and appearance/weight‐related bullying) and specific chronic health conditions. Overall, the results of the meta‐analysis revealed that young people with chronic health conditions were more likely to experience bullying in general (odds ratio [OR] = 1.65). This increased risk was consistent across the various types of bullying, with effect sizes ranging from OR = 1.38 to 1.67. Particularly noteworthy was the significantly higher prevalence of bullying related to weight or appearance teasing related to their illness (OR = 5.29) compared with their healthy peers. Additionally, this study examined different chronic illnesses and found that the unique risk of being bullied varied depending on the type of illness (OR = 0.68 to 5.50). Specifically, children with conditions such as craniofacial issues, epilepsy, chronic headaches, visual impairments, and obesity were at a greater risk of being bullied, while those with spina bifida/cerebral palsy or asthma were not more frequently victimized than their healthy counterparts.</p> <p>As researchers continue to unravel the complex relationship between chronic health conditions and the risk of victimization, it becomes evident that further research is necessary. This includes a closer examination of specific chronic health conditions, such as epilepsy, to gain a deeper understanding of the unique risk factors and protective measures associated with each condition.</p> <hd id="AN0181548958-6">Victimization and epilepsy</hd> <p>Previous studies have consistently shown a strong positive association between epilepsy and victimization (Hamiwka et al., [<reflink idref="bib10" id="ref25">10</reflink>]; Johnson et al., [<reflink idref="bib16" id="ref26">16</reflink>]; Jones et al., [<reflink idref="bib17" id="ref27">17</reflink>]; Pinquart, [<reflink idref="bib31" id="ref28">31</reflink>]). It has been proposed that children and adolescents with epilepsy, compared to those with other chronic health conditions, exhibit unique symptoms that could lead to a heightened risk of stigma, subsequently increasing their susceptibility to victimization (Hamiwka et al., [<reflink idref="bib10" id="ref29">10</reflink>]). Moreover, researchers have suggested that CWE face an elevated risk of bullying because of their increased likelihood of behavioral problems and decreased social competence (Pinquart, [<reflink idref="bib31" id="ref30">31</reflink>]).</p> <p>Hamiwka et al. ([<reflink idref="bib10" id="ref31">10</reflink>]) reported that school‐age CWE experienced bullying more frequently (42%) than their typically developing peers (21%) or children with less stigmatizing chronic health conditions (18%). Several potential reasons may contribute to CWE's greater likelihood of experiencing victimization. First, there is well‐documented evidence of a relationship between stressful events, such as bullying, and the onset and intensity of seizures (van Campen et al., [<reflink idref="bib4" id="ref32">4</reflink>]), even when accounting for common seizure triggers such as sleep deprivation and medication noncompliance. This complex bidirectional relationship implies that increased bullying can cause additional stress, potentially leading to more frequent and severe seizures and thereby amplifying the risk of stigma and victimization. Second, CWE commonly experiences co‐occurring mental health conditions (Jones et al., [<reflink idref="bib17" id="ref33">17</reflink>]; Nickels, [<reflink idref="bib26" id="ref34">26</reflink>]; Odar Stough et al., [<reflink idref="bib28" id="ref35">28</reflink>]), which may further increase their vulnerability to victimization.</p> <p>While prior research on victimization and epilepsy has mainly focused on prevalence rates, one qualitative study delving into school experiences of CWE revealed recurring themes of social isolation, feeling different from peers, bullying, and teasing. Importantly, it also highlights the significance of peer support and friendships. Some participants emphasized "the importance of positive social relationships, suggesting its importance in positive school experiences" (Whiting‐MacKinnon & Roberts, [<reflink idref="bib40" id="ref36">40</reflink>], p. 27). This suggests that factors such as school engagement may play an important role in moderating the relationship between epilepsy and victimization, potentially serving as protective factors. Previous researchers have advocated the development of targeted interventions to reduce victimization in CWE (Hamiwka et al., [<reflink idref="bib10" id="ref37">10</reflink>]; Jones et al., [<reflink idref="bib17" id="ref38">17</reflink>]). This study aimed to investigate whether school engagement could act as a moderator in the relationship between epilepsy severity and frequency of victimization, thereby potentially serving as a target for intervention.</p> <hd id="AN0181548958-7">School engagement</hd> <p>School engagement is a vital concept within the framework of the ecological model of development, which underscores various influences on human development within different ecological systems. According to Bronfenbrenner's ecological systems theory (Bronfenbrenner, 1979), individuals are situated within a complex network of interconnected systems, encompassing the microsystem (e.g., family, school, peers), mesosystem (e.g., interactions between microsystems), exosystem (e.g., community, societal institutions), and macrosystem (e.g., cultural values, ideologies). Among these systems, the school, which functions as a microsystem, plays a pivotal role in shaping a child's development by offering opportunities for cognitive, social, emotional, and behavioral growth. School engagement, which includes a student's cognitive, emotional, and behavioral investments in learning, has consistently demonstrated associations with positive developmental outcomes. These outcomes encompass academic achievement, social‐emotional well‐being, and long‐term success in adulthood (Fredricks et al., 2004; Wang et al., [<reflink idref="bib39" id="ref39">39</reflink>]). Consequently, school engagement serves as a crucial link connecting the microsystem (school) with other ecological systems, effectively influencing a child's development. Notably, recent efforts have highlighted the importance of developing intervention programs aimed at enhancing student engagement to reduce victimization (Chen, Wang, et al., [<reflink idref="bib6" id="ref40">6</reflink>]).</p> <p>CWE in schools often receives support through the Individualized Education Program (IEP) and the 504 Plan. The IEP is a comprehensive plan for students with diagnosed disabilities, outlining academic goals, accommodations, and services. It involves collaboration among parents, teachers, and specialists, with regular reviews. The 504 Plan accommodates students with disabilities, impacting major life activities. It focuses on equal access to education through tailored support but is less comprehensive than the IEP. Both plans include emergency responses and medication administration protocols for epilepsy. Teacher training, awareness programs, and regular check‐ins ensure a supportive and inclusive environment, fostering communication among the school staff, parents, and healthcare professionals. These measures collectively aim to address the educational and health‐related needs of youth with epilepsy in a school setting.</p> <hd id="AN0181548958-8">School engagement and epilepsy</hd> <p>School engagement is a vital concept within the framework of the ecological model of development, which underscores various influences on human development within different ecological systems. According to Bronfenbrenner's ecological systems theory (Bronfenbrenner, 1979), individuals are situated within a complex network of interconnected systems, encompassing the microsystem (e.g., family, school, peers), mesosystem (e.g., interactions between microsystems), exosystem (e.g., community, societal institutions), and macrosystem (e.g., cultural values, ideologies). Among these systems, the school, which functions as a microsystem, plays a pivotal role in shaping a child's development by offering opportunities for cognitive, social, emotional, and behavioral growth. School engagement, which includes a student's cognitive, emotional, and behavioral investments in learning, has consistently demonstrated associations with positive developmental outcomes. These outcomes encompass academic achievement, social‐emotional well‐being, and long‐term success in adulthood (Fredricks et al., 2004; Wang et al., [<reflink idref="bib39" id="ref41">39</reflink>]). Consequently, school engagement serves as a crucial link connecting the microsystem (school) with other ecological systems, effectively influencing a child's development. Notably, recent efforts have highlighted the importance of developing intervention programs aimed at enhancing student engagement to reduce victimization (Chen, Wang, et al., [<reflink idref="bib6" id="ref42">6</reflink>]).</p> <p>CWE in schools often receives support through the IEP and the 504 Plan. The IEP is a comprehensive plan for students with diagnosed disabilities, outlining academic goals, accommodations, and services. It involves collaboration among parents, teachers, and specialists, with regular reviews. The 504 Plan accommodates students with disabilities, impacting major life activities. It focuses on equal access to education through tailored support but is less comprehensive than the IEP. Both plans include emergency responses and medication administration protocols for epilepsy. Teacher training, awareness programs, and regular check‐ins ensure a supportive and inclusive environment, fostering communication among the school staff, parents, and healthcare professionals. These measures collectively aim to address the educational and health‐related needs of youth with epilepsy in a school setting.</p> <hd id="AN0181548958-9">School engagement and epilepsy</hd> <p>Emerging research has consistently supported a connection between school experiences in children with chronic health needs, such that children with chronic health needs have less student engagement, poorer school motivation, and fewer high‐quality teacher‐peer relationships (Sentenac et al., [<reflink idref="bib36" id="ref43">36</reflink>]). This may be partly due to the fact that children with chronic health conditions are more likely to miss school, which may cause them to repeat grades and achieve less academic achievement. Specifically, school‐aged CWE are at a higher risk for a range of poor outcomes, including memory and attentional challenges that negatively impact academic progress, as well as challenges related to executive functioning, including organization and planning (Chambers et al., [<reflink idref="bib24" id="ref44">24</reflink>]; Reilly et al., [<reflink idref="bib33" id="ref45">33</reflink>]). These challenges increase the risk of school disengagement. Additionally, children and adolescents with epilepsy are at a higher risk of learning disabilities, academic underachievement, and missing more days of school, all of which are connected to school engagement (Aguiar et al., [<reflink idref="bib1" id="ref46">1</reflink>]; Johnson et al., [<reflink idref="bib16" id="ref47">16</reflink>]; Pastor et al., [<reflink idref="bib29" id="ref48">29</reflink>]; Reilly et al., [<reflink idref="bib33" id="ref49">33</reflink>]). While increased school engagement has consistently been linked to a range of positive outcomes such as improved grades, better academic performance, reduced depression, and decreased delinquency (Liu et al., [<reflink idref="bib21" id="ref50">21</reflink>]; Wang & Degol, [<reflink idref="bib38" id="ref51">38</reflink>]; Wang et al., [<reflink idref="bib39" id="ref52">39</reflink>]), it has traditionally been seen as an outcome rather than a protective factor. In this study of school‐aged children, we examined three main aspects: (a) the relationship between health conditions (type, severity, and duration) and the frequency of victimization, (b) the association between the presence and severity of chronic health conditions (epilepsy and others) and the frequency of victimization, and (c) whether school engagement moderates the relationship between the severity of epilepsy and frequency of victimization, serving as a protective factor.</p> <hd id="AN0181548958-10">METHODS</hd> <p></p> <hd id="AN0181548958-11">Data source</hd> <p>Data was collected by the Maternal and Child Health Bureau in collaboration with the National Center for Health Statistics. The 2018–2019 NSCH SPSS Indicator Data Set was prepared by the Data Resource Center for Child and Adolescent Health, Child and Adolescent Health Measurement Initiative. The NSCH is a nationally representative, cross‐sectional survey of randomly selected households conducted by the United States Census Bureau and the United States Health Resources and Services Administration (HRSA). The NSCH consists of data from online and mailed surveys to households with at least one child between the ages of 0 and 17 years old. The properties and coding of all variables used are publicly available in NSCH variable codebooks. The full methodology regarding the sampling and data generation can be found at https://<ulink href="http://www.census.gov/programs-surveys/nsch.html">www.census.gov/programs-surveys/nsch.html</ulink>.</p> <hd id="AN0181548958-12">Participants</hd> <p>Archival data from the combined 2018/2019 National Survey of Children's Health (NSCH), a nationally representative, cross‐sectional survey, was used. Data from the NSCH was collected via parent/guardian report for children aged 6–17 years (epilepsy: <emph>n</emph> = 178, asthma: <emph>n</emph> = 3850, typically developing: <emph>n</emph> = 21472) for the current study. See Table 1 for demographic details of the participants. In all analyses in this study, children with autism or severe intellectual deficiency (ID) were excluded as the study was specifically designed to investigate victimization related to CWE that may not align with the additional complexities associated with ASD or ID. Excluding these conditions allows for a more targeted examination of the factors directly related to CWE and creates a more homogenous sample, reducing variability and potential confounding factors. Additionally, cases in which a participant had both asthma and epilepsy were also excluded from analyses.</p> <p>1 Table Sociodemographic Characteristics.</p> <p> <ephtml> <table><thead valign="bottom"><tr valign="bottom"><th /><th>Epilepsy</th><th>Asthma</th><th align="left">Healthy peers</th><th /></tr><tr valign="bottom"><th>Health condition</th><th><italic>n</italic></th><th>%</th><th><italic>n</italic></th><th>%</th><th><italic>n</italic></th><th>%</th><th><italic>χ</italic><sup>2</sup></th></tr></thead><tbody valign="top"><tr><td>Sex</td><td /><td /><td /><td /><td /><td /><td>25.040<ext-link href="b" /></td></tr><tr><td>Male</td><td>81</td><td>45.5</td><td>2075</td><td>54.0</td><td>10649</td><td>49.7</td><td /></tr><tr><td>Female</td><td>97</td><td>54.5</td><td>1771</td><td>46.1</td><td>10780</td><td>50.3</td><td /></tr><tr><td>Race/ethnicity</td><td /><td /><td /><td /><td /><td /><td>179.728<ext-link href="b" /></td></tr><tr><td>White, Non‐Hispanic</td><td>128</td><td>75.9</td><td>2445</td><td>63.7</td><td>14531</td><td>67.8</td><td /></tr><tr><td>Black, Non‐Hispanic</td><td>18</td><td>10.1</td><td>467</td><td>12.1</td><td>1342</td><td>6.2</td><td /></tr><tr><td>Hispanic</td><td>15</td><td>8.4</td><td>490</td><td>12.8</td><td>2708</td><td>12.6</td><td /></tr><tr><td>Other, Non‐Hispanic</td><td>17</td><td>9.5</td><td>434</td><td>11.3</td><td>2848</td><td>13.3</td><td /></tr><tr><td>Poverty level</td><td /><td /><td /><td /><td /><td /><td>−0.055<ext-link href="#pits23312-tbl1-note-0001 #pits23312-tbl1-note-0002" title="a,b" /></td></tr><tr><td>0–99% FPL</td><td>31</td><td>17.4</td><td>595</td><td>15.1</td><td>2309</td><td>10.8</td><td /></tr><tr><td>100–199% FPL</td><td>41</td><td>23.0</td><td>694</td><td>17.6</td><td>3321</td><td>15.5</td><td /></tr><tr><td>200–399% FPL</td><td>44</td><td>24.7</td><td>1136</td><td>28.9</td><td>6712</td><td>31.3</td><td /></tr><tr><td>>400% FPL</td><td>62</td><td>34.8</td><td>1509</td><td>38.4</td><td>9087</td><td>42.4</td><td /></tr><tr><td>Working poor</td><td /><td /><td /><td /><td /><td /><td>19.671<ext-link href="b" /></td></tr><tr><td>Working poor</td><td>23</td><td>13.1</td><td>373</td><td>9.9</td><td>1684</td><td>8.1</td><td /></tr><tr><td>Not working poor</td><td>152</td><td>86.9</td><td>3393</td><td>90.1</td><td>19215</td><td>91.9</td><td /></tr></tbody></table> </ephtml> </p> <p>1 a Kendall's tau‐b used.</p> <p>2 b <emph>p</emph> < .001.</p> <hd id="AN0181548958-13">Measures</hd> <p></p> <hd id="AN0181548958-14">Outcome variables</hd> <p></p> <hd id="AN0181548958-15">Victimization</hd> <p>Victimization was operationally defined as being "bullied, picked on, or excluded by others." The victimization variable, which was treated as ordinal, was recoded to have three levels (in order of frequency: 0–2 instances in the last 12 months, 1–2 instances per month, 1–7 instances per week).</p> <hd id="AN0181548958-16">Predictor variables</hd> <p></p> <hd id="AN0181548958-17">School engagement</hd> <p>In the current study, school engagement was a composite score that measured parents' perceptions of whether the child (<reflink idref="bib1" id="ref53">1</reflink>) cares about doing well in school, and (<reflink idref="bib2" id="ref54">2</reflink>) completes all required homework, during the previous month. The response options to both questions were "never," "sometimes," "usually," and "always." The NSCH provided a composite variable that was used for the current study. Children whose parents reported that their child "always" cares about doing well in school AND does required homework are categorized as "always" engaged in school. Children who "usually engaged in school" are defined if parents responded "usually" to both questions or "always" to either question and "usually" to another question. The remaining children were categorized as sometimes or never engaged in school.</p> <hd id="AN0181548958-18">Epilepsy severity</hd> <p>Epilepsy severity, which was treated as ordinal, was based on a parent report of severity level (i.e., mild, moderate, or severe). Severity levels were re‐coded into two categories for analysis (i.e., mild and moderate/severe) because when analyses were run with three levels, too many cells had an expected count less than five.</p> <hd id="AN0181548958-19">Asthma severity</hd> <p>Asthma severity, which was treated as ordinal, was based on a parent report of severity level (i.e., mild, moderate, or severe).</p> <hd id="AN0181548958-20">Health conditions</hd> <p>Health conditions, which was treated as an ordinal variable, had three levels (in order of severity: does not have any current or lifelong health conditions, only has asthma, only has epilepsy).</p> <hd id="AN0181548958-21">Asthma ascertainment</hd> <p>Parents in the telephone survey were asked if they had ever been told by their doctor/health care provider that their child had asthma. Children who currently had or were ever diagnosed with asthma were considered as having asthma.</p> <hd id="AN0181548958-22">Epilepsy ascertainment</hd> <p>Parents in the telephone survey were asked if they had ever been told by their doctor/health care provider that their child had epilepsy or seizure disorder. Children who currently had or were ever diagnosed with epilepsy were considered as having epilepsy.</p> <hd id="AN0181548958-23">RESULTS</hd> <p>Kendall's tau‐b (<emph>τ</emph><subs>b</subs>) was used for analyses for research questions 1 and 2 because the health condition, asthma severity, epilepsy severity, and bullying variables were treated as ordinal. Ordinal logistic regression was used in research question 3 because the predictors (epilepsy severity, school engagement) and outcome variable (bullying frequency) were ordinal.</p> <p>The first research question was whether there was a significant association of health condition status and frequency of victimization. The hypothesis was that there would be a significant association between health condition and frequency of bullying such that as presence and severity of health condition increases, frequency of bullying increases. Figure 1 provides a visual representation of bullying frequency and health condition. There was a significant weak positive association between health condition and frequency of bullying, <emph>τ</emph><subs>b</subs> (<reflink idref="bib25" id="ref55">25</reflink>,<reflink idref="bib500" id="ref56">500</reflink>) = 0.132, <emph>p</emph> < .001, bootstrap confidence interval (CI): 0.118–0.147, which indicates that this association is likely in the population.</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/PIS/01jan25/pits23312-fig-0001.jpg?ephost1=dGJyMMvl7ESepq84yOvsOLCmsE6epq5Srqa4SK6WxWXS" alt="pits23312-fig-0001.jpg" title="1 Association of health condition and bullying frequency." /> </p> <p></p> <p>The second research question was whether there was an association between presence and severity of disorder (epilepsy and asthma) and bullying in school age children. As to epilepsy severity, the hypothesis was that there would be a significant association such that as severity of epilepsy increases frequency of bullying increases. Figure 2 provides a visual representation of epilepsy severity and bullying frequency. There was a nonsignificant weak association between severity of epilepsy and frequency of bullying, <emph>τ</emph><subs>b</subs> (<reflink idref="bib209" id="ref57">209</reflink>) = 0.015, <emph>p</emph> = .822, bootstrap CI: −0.118 to 0.143, which indicates that this association is not likely in the population.</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/PIS/01jan25/pits23312-fig-0002.jpg?ephost1=dGJyMMvl7ESepq84yOvsOLCmsE6epq5Srqa4SK6WxWXS" alt="pits23312-fig-0002.jpg" title="2 Association of epilepsy severity and bullying frequency." /> </p> <p></p> <p>As to asthma severity, the hypothesis was that there would be a significant association such that as severity of asthma increases frequency of bullying increases. Figure 3 provides a visual representation of the association of asthma severity and bullying frequency. There was a significant weak positive association between severity of asthma and frequency of bullying, <emph>τ</emph><subs>b</subs> (3869) = 0.071, <emph>p</emph> < .001, bootstrap CI: 0.036–0.104, which indicates that this association is likely in the population.</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/PIS/01jan25/pits23312-fig-0003.jpg?ephost1=dGJyMMvl7ESepq84yOvsOLCmsE6epq5Srqa4SK6WxWXS" alt="pits23312-fig-0003.jpg" title="3 Association of asthma severity and bullying frequency." /> </p> <p></p> <p>The third research question was whether school engagement would moderate the strength of the relationship between epilepsy severity and bullying. The hypothesis was that school engagement would significantly moderate the strength of the relationship between epilepsy severity and bullying. An important assumption of ordinal logistic regression, whether there were proportional odds (i.e., each independent variable has an identical effect at each cumulative split of the ordinal dependent variable), was tested. A cumulative odds ordinal logistic regression with proportional odds was run to determine the effect of epilepsy severity and school engagement on frequency of bullying. There were proportional odds, as assessed by a full likelihood ratio test comparing the fitted model to a model with varying location parameters, <emph>χ</emph><sups>2</sups>(<reflink idref="bib5" id="ref58">5</reflink>) = 4.624, <emph>p</emph> = .463. As to goodness of fit, a final model including only the two predictors marginally significantly predicted the dependent variable over and above the intercept‐only model, <emph>χ</emph><sups>2</sups>(<reflink idref="bib3" id="ref59">3</reflink>) = 7.410, <emph>p</emph> = .060. A final model including the two predictors and the interaction terms did not significantly predict the dependent variable over and above the intercept‐only model, <emph>χ</emph><sups>2</sups>(<reflink idref="bib5" id="ref60">5</reflink>) = 8.155, <emph>p</emph> = .148.</p> <p>Epilepsy severity did not have a statistically significant effect on the prediction of frequency of bullying, Wald <emph>χ</emph><sups>2</sups>(<reflink idref="bib1" id="ref61">1</reflink>) = 0.004, <emph>p</emph> = .834. In other words, the odds of children with mild epilepsy severity experiencing less frequent bullying was 0.878 (95% CI, 0.259 to 2.975) times that of children with moderate and severe epilepsy severity, which was not statistically significant, <emph>χ</emph><sups>2</sups>(<reflink idref="bib1" id="ref62">1</reflink>) = 0.044, <emph>p</emph> = .834. Degree of school engagement did have a marginally statistically significant effect on the prediction of frequency of bullying, Wald <emph>χ</emph><sups>2</sups>(<reflink idref="bib2" id="ref63">2</reflink>) = 5.918, <emph>p</emph> = .052. For children with the highest level of school engagement, the odds of experiencing more frequent bullying was 0.320 (95% CI, 0.128 to 0.801) times, or roughly 1/3, that of children with the lowest level of school engagement, which was statistically significant, <emph>χ</emph><sups>2</sups>(<reflink idref="bib1" id="ref64">1</reflink>) = 5.916, <emph>p</emph> = .015. For children with a moderate level of school engagement, the odds of experiencing more frequent bullying was 0.610 (95% CI, 0.252 to 1.474) times that of children with the lowest level school engagement, which was not statistically significant, <emph>χ</emph><sups>2</sups>(<reflink idref="bib1" id="ref65">1</reflink>) = 1.206, <emph>p</emph> = .272. However, there was no evidence of a significant interaction of epilepsy severity and degree of school engagement on frequency of bullying. Two interaction terms were created to represent the combination of levels of epilepsy severity and degree of school engagement, and neither interaction term was a statistically significant predictor of frequency of bullying, <emph>χ</emph><sups>2</sups>(<reflink idref="bib1" id="ref66">1</reflink>) = 0.033, <emph>p</emph> = .857; <emph>χ</emph><sups>2</sups>(<reflink idref="bib1" id="ref67">1</reflink>) = 0.323, <emph>p</emph> = .570.</p> <p>In summary, epilepsy severity was not a significant predictor of bullying, school engagement was a marginally significant predictor of bullying, but school engagement did not significantly moderate the relationship between epilepsy severity and bullying.</p> <hd id="AN0181548958-27">DISCUSSION</hd> <p>The findings of this study support the idea that CWE are more likely to experience bullying than their healthy peers or peers with less stigmatized chronic health conditions. This aligns with prior research, highlighting that epilepsy‐specific factors contribute to an increased risk of being bullied, beyond the risk associated with having any chronic health condition (Hamiwka et al., [<reflink idref="bib10" id="ref68">10</reflink>]). Additionally, these results support the rationale for population‐targeted assessments, either by clinical inquiry or by specific measures, followed by appropriate interventions, when indicated, to better understand the unique needs of different populations of children with chronic health conditions. These findings underscore the importance of routinely considering bullying in psychological and medical assessments of children and adolescents with epilepsy and the need for tailored anti‐bullying interventions for this group (Hamiwka et al., [<reflink idref="bib10" id="ref69">10</reflink>]; Whiting‐MacKinnon & Roberts, [<reflink idref="bib40" id="ref70">40</reflink>]).</p> <p>Contrary to our initial hypothesis, epilepsy severity did not appear to be significantly linked to the frequency of victimization. This suggests that there may not be a meaningful difference in the extent of bullying experienced by school‐aged children with mild versus moderate/severe epilepsy. However, it is noteworthy that a higher percentage of severe victimization occurred across all levels of epilepsy severity (Table 2) compared to the corresponding levels of asthma severity (Table 3). This further emphasizes that having epilepsy, regardless of its severity, places a child at risk of victimization, even compared to other chronic health conditions. Reisert et al. ([<reflink idref="bib34" id="ref71">34</reflink>]) using the same database, but other chronic health and mental conditions reported similar findings and indicated the need to directly examine bullying involvement among children with varying severity of individual conditions. Therefore, interventions should be considered for all school‐age CWE.</p> <p>2 Table Association of health condition and bullying frequency.</p> <p> <ephtml> <table><thead valign="bottom"><tr valign="bottom"><th /><th align="left">Bullying frequency<ext-link href="a" /></th><th /></tr><tr valign="bottom"><th /><th align="left">Mild</th><th align="left">Moderate</th><th align="left">Severe</th><th align="left">Total</th></tr></thead><tbody valign="top"><tr><td>Health condition</td><td>Healthy</td><td>Count</td><td>19,514</td><td>1398</td><td>560</td><td>21,472</td></tr><tr><td>% within health condition</td><td>90.9</td><td>6.5</td><td>2.6</td><td>100.0</td></tr><tr><td>Asthma</td><td>Count</td><td>3089</td><td>439</td><td>322</td><td>3850</td></tr><tr><td>% within health condition</td><td>80.2</td><td>11.4</td><td>8.4</td><td>100.0</td></tr><tr><td>Epilepsy</td><td>Count</td><td>123</td><td>24</td><td>31</td><td>178</td></tr><tr><td>% within health condition</td><td>69.1</td><td>13.5</td><td>17.4</td><td>100.0</td></tr><tr><td>Total</td><td>Count</td><td>22,726</td><td>1861</td><td>913</td><td>25,500</td></tr><tr><td>% within health condition</td><td>89.1</td><td>7.3</td><td>3.6</td><td>100.0</td></tr></tbody></table> </ephtml> </p> <ulist> <item>3 a 0–2 times in last 12 months, 1–2 times per month, 1–7 times per week.</item> <item>3 Table Results of ordinal logistic regression.</item> </ulist> <p> <ephtml> <table><thead valign="bottom"><tr valign="bottom"><th /><th /><th>95%Wald CI</th><th>Hypothesis test</th><th /><th align="left">95% Wald CI for Exp(B)</th></tr><tr valign="bottom"><th>Parameter</th><th align="left"><italic>B</italic></th><th>SE</th><th>Lower</th><th>Upper</th><th>Wald <italic>x</italic><sup><italic>2</italic></sup></th><th><italic>df</italic></th><th><italic>p</italic></th><th>OR</th><th align="left">Lower</th><th align="left">Upper</th></tr></thead><tbody valign="top"><tr><td>Epilepsy severity (mild vs. mod/severe)</td><td>−0.130</td><td>0.6227</td><td>−1.35I</td><td>1.090</td><td>0.044</td><td>1</td><td>.834</td><td>0.878</td><td>0.259</td><td>2.975</td></tr><tr><td>School engagement I (never vs. usually)</td><td>−1.140</td><td>0.4685</td><td>−2.058</td><td>−0.221</td><td>5.916</td><td>1</td><td>.015</td><td>0.320</td><td>0.128</td><td>0.801</td></tr><tr><td>School engagement 2 (sometimes vs. usually)</td><td>−0.495</td><td>0.4504</td><td>−1.377</td><td>.388</td><td>1.206</td><td>1</td><td>.272</td><td>0.610</td><td>0.252</td><td>1.474</td></tr><tr><td>Epilepsy severity × School engagement I</td><td>−0.148</td><td>0.8200</td><td>−1.755</td><td>1.459</td><td>0.033</td><td>1</td><td>.857</td><td>0.862</td><td>0.173</td><td>4.303</td></tr><tr><td>Epilepsy severity × School engagement 2</td><td>0.441</td><td>0.7754</td><td>−1.079</td><td>1.960</td><td>0.323</td><td>1</td><td>.570</td><td>1.554</td><td>0.340</td><td>7.101</td></tr></tbody></table> </ephtml> </p> <p>4 <emph>Note</emph>: Dependent Variable: Bullying. Model: (Threshold), Epilepsy severity, School engagement, Interaction I, Interaction 2.</p> <p>Previous studies (Forster et al., [<reflink idref="bib9" id="ref72">9</reflink>]; Liu et al., [<reflink idref="bib21" id="ref73">21</reflink>]) have established a relationship between school engagement and victimization among children without chronic health conditions. Our study found that the degree of school engagement was associated with the frequency of victimization among CWE. This is a significant finding, based on a large, nationally representative data set. However, contrary to our hypothesis, this study did not identify the degree of school engagement as a moderator in the relationship between the severity of epilepsy and frequency of victimization. These findings may have been influenced by measurement and methodological challenges, in smaller samples, data may be more highly influenced by outlierswhich are discussed further below.</p> <p>Given the association between school engagement and the frequency of victimization in CWE, it is crucial to explore ways to support school engagement in this population. When considering school engagement as a protective factor within an ecological model, it is hypothesized that school‐aged children who are more engaged in school are likely to form positive connections with teachers and school staff. Consequently, they are more inclined to engage in constructive prosocial behaviors and school activities, reducing their vulnerability to bullying. Research has supported the idea that, among children with chronic health conditions, having access to supportive teachers and school staff is associated with higher levels of school engagement (Lum et al., [<reflink idref="bib22" id="ref74">22</reflink>]). Recent research has identified school engagement as a significant protective factor against various forms of bullying among typically developing children and adolescents (Zych et al., [<reflink idref="bib44" id="ref75">44</reflink>]). However, previous studies have not specifically considered the unique risks faced by children with CWE, which makes the findings of this study important. Future research should delve into the unique role of school engagement in reducing bullying among children with chronic health conditions, and determine the most effective school engagement strategies for CWE.</p> <p>One potential approach to improve school engagement among children with chronic health conditions is to raise awareness about these conditions among school staff, promoting more supportive attitudes (Hinton & Kirk, [<reflink idref="bib13" id="ref76">13</reflink>]). Healthcare providers can play a pivotal role in educating teaching staff on ways to support children with chronic health needs. Additionally, it is essential to consider various school staff members (e.g., school psychologists, counselors, teachers, special education staff, etc.) who could play crucial roles in supporting students with epilepsy and how key information can be effectively shared with these groups. Other interventions to enhance school engagement have proven successful for children with various chronic health conditions and could potentially be adapted for CWE. For instance, Pereira et al. ([<reflink idref="bib30" id="ref77">30</reflink>]) developed an interactive narrative aimed at helping children with cerebral palsy learn how to successfully complete daily activities, overcome obstacles, and openly discuss their fears and barriers when stepping out of their comfort zones. This narrative approach provided a supportive environment in which children could develop self‐efficacy skills before applying them in a school setting, resulting in a significant increase in school engagement among children with cerebral palsy. This narrative format can be adapted to address the unique challenges faced by CWE, or tailored individually based on the specific type of epilepsy experienced by students.</p> <p>Creating an inclusive educational environment for CWE often begins with the development of school‐wide interventions for all students using a multi‐tiered approach. Although bullying is a prevalent issue in schools, research has shown that effective anti‐bullying strategies can significantly reduce its incidence. Implementing multi‐tiered systems of support has been particularly effective in prevention and reduction efforts. Despite the existence of numerous anti‐bullying programs, meta‐analyses have revealed varying degrees of effectiveness ranging from small to moderate effect sizes. Therefore, it is crucial to identify the factors that contribute to the success of these programs. A study by Lee et al. ([<reflink idref="bib20" id="ref78">20</reflink>]) identified several key components that significantly impact the reduction of bullying. These include the incorporation of emotional control techniques, peer counseling initiatives, and the establishment of clear school policies regarding bullying prevention. In another study by Jiménez‐Barbero et al. ([<reflink idref="bib15" id="ref79">15</reflink>]), interventions of shorter duration targeting younger children showed a greater impact.</p> <p>Few studies have examined the efficacy of bullying prevention programs that target children with chronic health conditions. Sentenac et al. ([<reflink idref="bib35" id="ref80">35</reflink>]) highlighted the challenges in comparing findings from other clinical populations to another clinical population but noted that effective interventions in general populations involve whole‐school approaches, parent involvement, disciplinary measures, and sufficient program intensity. Notably, programs aiming to improve attitudes toward chronic conditions have shown mixed effectiveness, with structured contact between children with and without disabilities showing the most promise (Sentenac et al., [<reflink idref="bib35" id="ref81">35</reflink>]). Notably, research has suggested that school‐based stigma reduction programs that foster face‐to‐face contact among children with and without disabilities, including epilepsy, will improve understanding and promote inclusion (Hartman et al., [<reflink idref="bib12" id="ref82">12</reflink>]).</p> <hd id="AN0181548958-28">Implications for practitioners</hd> <p>A key finding for practitioners is that CWE face a significantly elevated risk of bullying regardless of the severity of their epilepsy. Thus, it is essential to adopt a comprehensive approach to address this issue. Schools and their staff should provide extra support to all CWE, irrespective of the severity of their condition. This support should be integrated into standard practice and should include measures such as ensuring access to school psychologists, counselors, and social workers who can offer mental health assistance. For example, integrating emotional, developmental, or behavioral screening, as well as asking questions about friendship and bullying as part of special education or 504 processes, may increase mental health service utilization and navigation by enhancing collaboration regardless of the severity of epilepsy (Njoroge et al., [<reflink idref="bib27" id="ref83">27</reflink>]). CWE should undergo routine screening for comorbid disorders, and the risk of bullying and their caregivers and families should be educated about the potential risk of these comorbid conditions (Mula et al., [<reflink idref="bib25" id="ref84">25</reflink>]). Additionally, it is vital to establish safe channels through which CWE can report bullying incidents.</p> <p>Several evidence‐based strategies (e.g., checking and connecting) have been developed to improve school engagement; however, much of the original school engagement research has targeted those at risk of dropping out (Martins et al., [<reflink idref="bib23" id="ref85">23</reflink>]). In a recent review, Martins et al. noted that models to increase school engagement have varied, but typically indicated that balanced and high‐quality support from peers, teachers, and parents has a positive impact on school engagement. While no specific interventions were identified to improve school engagement specifically with CWE, regarding enhancing school engagement, recent research suggests that individualized narrative therapy could be a potential intervention method worth exploring. Furthermore, our research underscores the importance of considering the child's entire psychosocial environment, with a particular focus on school engagement as a protective factor when tackling bullying issues in CWE.</p> <p>Lastly, it is crucial to acknowledge the unique risk factors faced by CWE, such as higher susceptibility to victimization, stigma, the negative impact of stress on seizure occurrence, and increased behavioral challenges. Schools should ensure that their staff are adequately trained not only to identify and address academic and behavioral needs but also to support the social well‐being of all students with and without CWE. To this end, research suggests that one way to reduce bullying for all students, including those with CWE, is to implement an anti‐bullying program that includes clear policies (Sentenac et al., [<reflink idref="bib36" id="ref86">36</reflink>]).</p> <hd id="AN0181548958-29">Limitations</hd> <p>The present study has some inherent limitations owing to its use of archival data, which impacted the study's design and subsequent data analysis. First, it must be considered that all variables included in these analyses were collected through a parent report. A parental report provides a subjective, unidimensional lens that may be affected by stigma and response bias. Previous research has suggested that parents tend to under‐report victimization compared to child reports (Holt et al., [<reflink idref="bib14" id="ref87">14</reflink>]). First, the data relied on parent reports, and the study's outcomes depended on the accuracy of parents' reporting of their children's experiences of victimization and school engagement, which may not always be entirely accurate. Future research should consider using multi‐trait multi‐method designs to ensure that constructs are measured in a more robust manner (Hart et al., [<reflink idref="bib11" id="ref88">11</reflink>]). On a related note, epilepsy severity was measured via parent report without clear behavioral descriptions, such as frequency or intensity, to differentiate between each category (i.e., mild, moderate, or severe). This may have resulted in heterogeneity between the categories, which may have affected the findings of this study.</p> <p>Given the somewhat limited sample size of CWE patients in the current study, our model did not consider sex differences. Previous research related to victimization, sex, and school engagement has been inconsistent with some studies finding differences by sex (Williford et al., [<reflink idref="bib41" id="ref89">41</reflink>]) and not others (Chen et al., [<reflink idref="bib6" id="ref90">6</reflink>]); however, to date, no studies have examined victimization, sex, and school engagement in children and adolescents with epilepsy. Future research should examine sex differences as they relate to both epilepsy and school engagement to examine whether the current results related to victimization apply similarly to males and females.</p> <p>While the current study excluded two common comorbid conditions that might increase the risk of victimization, such as the presence of an intellectual disability or autism spectrum disorder, it is crucial to recognize that children and adolescents with epilepsy represent a diverse spectrum in terms of severity and comorbid conditions. This diversity can complicate research on this population (Jones et al., [<reflink idref="bib17" id="ref91">17</reflink>]; Nickels, [<reflink idref="bib26" id="ref92">26</reflink>]). For instance, different forms of idiopathic generalized epilepsy can lead to varying outcomes, emphasizing the need for more research on the diversity in presentation, comorbid conditions, and outcomes of school‐age CWE (Nickels, [<reflink idref="bib26" id="ref93">26</reflink>]).</p> <p>Finally, the construct of victimization was measured using a single parent‐reported item and did not differentiate between various types of victimization. Other studies have considered specific types of victimization (e.g., cyberbullying, covert aggression, overt aggression) and how these specific types of victimization may produce different outcomes and involve different predictors (Arseneault et al., [<reflink idref="bib3" id="ref94">3</reflink>]; Chen, Wu, et al., [<reflink idref="bib7" id="ref95">7</reflink>]; Forster et al., [<reflink idref="bib9" id="ref96">9</reflink>]). In future research, it would be important to consider different types of victimization and how prevalence rates for CWE may vary by type of victimization, and consider how to develop school engagement interventions unique to the type of victimization most likely experienced by CWE.</p> <hd id="AN0181548958-30">CONCLUSION</hd> <p>In summary, the study added to the body of literature that indicates CWE are more likely to be victims of bullying than children with other chronic health conditions and found that the degree of school engagement was associated with the frequency of bullying among CWE. This further highlights the need for healthcare providers, school psychologists, school counselors, teachers, and parents of school‐aged CWE to recognize the increased risk of victimization regardless of the severity of epilepsy and to consider school engagement‐related interventions to mitigate this risk. Future research should address the methodological challenges of the current study and consider evidence‐based strategies to support CWE.</p> <hd id="AN0181548958-31">CONFLICT OF INTEREST STATEMENT</hd> <p>The authors declare no conflict of interest.</p> <hd id="AN0181548958-32">DATA AVAILABILITY STATEMENT</hd> <p>The National Survey of Children's Health is a publicly available data set funded by the Health Resources and Services Administration and the Maternal and Child Health Bureau. Data are publicly available at https://<ulink href="http://www.childhealthdata.org/">www.childhealthdata.org/</ulink>.</p> <ref id="AN0181548958-33"> <title> REFERENCES </title> <blist> <bibl id="bib1" idref="ref46" type="bt">1</bibl> <bibtext> Aguiar, B. V. K., Guerreiro, M. M., McBrian, D., & Montenegro, M. A. (2007). Seizure impact on the school attendance in children with epilepsy. 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Items – Name: Title
  Label: Title
  Group: Ti
  Data: School Engagement, Epilepsy Severity, and Frequency of Victimization in School Age Children
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  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Jessica+Emick%22">Jessica Emick</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0001-6762-8706">0000-0001-6762-8706</externalLink>)<br /><searchLink fieldCode="AR" term="%22Nathan+M%2E+Griffith%22">Nathan M. Griffith</searchLink><br /><searchLink fieldCode="AR" term="%22Hannah+Schweitzer%22">Hannah Schweitzer</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Psychology+in+the+Schools%22"><i>Psychology in the Schools</i></searchLink>. 2025 62(1):24-40.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 17
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2025
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Elementary+Education%22">Elementary Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Epilepsy%22">Epilepsy</searchLink><br /><searchLink fieldCode="DE" term="%22Severity+%28of+Disability%29%22">Severity (of Disability)</searchLink><br /><searchLink fieldCode="DE" term="%22Students+with+Disabilities%22">Students with Disabilities</searchLink><br /><searchLink fieldCode="DE" term="%22Parents%22">Parents</searchLink><br /><searchLink fieldCode="DE" term="%22Children%22">Children</searchLink><br /><searchLink fieldCode="DE" term="%22Data%22">Data</searchLink><br /><searchLink fieldCode="DE" term="%22Bullying%22">Bullying</searchLink><br /><searchLink fieldCode="DE" term="%22Victims+of+Crime%22">Victims of Crime</searchLink><br /><searchLink fieldCode="DE" term="%22Data+Analysis%22">Data Analysis</searchLink><br /><searchLink fieldCode="DE" term="%22Peer+Relationship%22">Peer Relationship</searchLink><br /><searchLink fieldCode="DE" term="%22Chronic+Illness%22">Chronic Illness</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Bias%22">Social Bias</searchLink><br /><searchLink fieldCode="DE" term="%22Negative+Attitudes%22">Negative Attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Learner+Engagement%22">Learner Engagement</searchLink><br /><searchLink fieldCode="DE" term="%22School+Role%22">School Role</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Characteristics%22">Student Characteristics</searchLink><br /><searchLink fieldCode="DE" term="%22Educational+Environment%22">Educational Environment</searchLink><br /><searchLink fieldCode="DE" term="%22Elementary+Education%22">Elementary Education</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1002/pits.23312
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0033-3085<br />1520-6807
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Epilepsy is one of the most common neurological disorders in young people, which disrupts daily life and results in an increased risk of victimization. Archival data from the 2018/2019 National Survey of Children's Health (NSCH), a nationally representative cross-sectional survey, were used. Data from the NSCH were collected via parent reports and analyzed for children aged 6-17 years (N = 25500). The results indicated that children with epilepsy (CWE) were significantly more likely to be frequently bullied than children with less stigmatizing chronic health conditions (i.e., asthma) and typical peers, but there was no significant association between the severity of epilepsy and the frequency of victimization. Furthermore, the degree of school engagement did not significantly moderate the relationship between epilepsy severity and frequency of victimization. However, the degree of school engagement was associated with the frequency of victimization in CWE, such that more school engagement was associated with less parent-reported victimization. Overall, these findings support the growing evidence that CWE are at a higher risk of being bullied and need unique interventions regardless of epilepsy severity and that school engagement should be further examined to reduce victimization among CWE.
– Name: AbstractInfo
  Label: Abstractor
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  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2024
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1452692
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1452692
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  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1002/pits.23312
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 17
        StartPage: 24
    Subjects:
      – SubjectFull: Epilepsy
        Type: general
      – SubjectFull: Severity (of Disability)
        Type: general
      – SubjectFull: Students with Disabilities
        Type: general
      – SubjectFull: Parents
        Type: general
      – SubjectFull: Children
        Type: general
      – SubjectFull: Data
        Type: general
      – SubjectFull: Bullying
        Type: general
      – SubjectFull: Victims of Crime
        Type: general
      – SubjectFull: Data Analysis
        Type: general
      – SubjectFull: Peer Relationship
        Type: general
      – SubjectFull: Chronic Illness
        Type: general
      – SubjectFull: Social Bias
        Type: general
      – SubjectFull: Negative Attitudes
        Type: general
      – SubjectFull: Learner Engagement
        Type: general
      – SubjectFull: School Role
        Type: general
      – SubjectFull: Student Characteristics
        Type: general
      – SubjectFull: Educational Environment
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      – SubjectFull: Elementary Education
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    Titles:
      – TitleFull: School Engagement, Epilepsy Severity, and Frequency of Victimization in School Age Children
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              Y: 2025
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