Children with special health care needs (CSHCN) are defined as those who either have or are at increased risk for having chronic physical, developmental, behavioral, or emotional conditions and who require health and health-related services of a type or amount beyond that generally required by other children (McPherson et al. 1998). CSHCN are at higher risk of bullying and victimization from bullying compared with children without such diagnoses (Twyman et al. 2010). CSHCN also are twice as likely to be bully-victims (Van Cleave and Davis 2006). CSHCN use more care than other children, and are likely to encounter clinicians more often due to their chronic health needs (Van Cleave and Davis 2006). It may be beneficial, therefore, for the clinicians who care for these children, and who are likely to have formed a strong bond with these children and their families, to screen for bullying involvement (Van Cleave and Davis 2006).

Early research on bullying and peer victimization emerged from the field of special education (Hoover and Hazler 1994; Hoover et al. 1993), but a dearth of research addressed bullying experiences among this population until a few years ago. This research indicates that students with disabilities are twice as likely to be identified as perpetrators and victims than students without disabilities (Rose et al. 2011a; Rose and Espelage 2012). In a recent study of bully victimization among students with disabilities using the Special Education Elementary Longitudinal Study and the National Longitudinal Transition Study-2 longitudinal datasets revealed a prevalence rate of 24.5 % in elementary school (Blake et al. 2012). Students with disabilities that are characterized or have diagnostic criteria associated with low social skills and low communication skills have a higher likelihood for involvement in bullying incidents (Rose et al. 2011b). Further, a meta-analysis of 152 studies found that eight of 10 children with a learning disability (LD) were peer-rated as rejected; 8 of 10 were rated as deficient in social competence and social problem solving; LD students were less often selected as friends by their peers (Baumeister et al. 2008).

Recent empirical investigations have suggested that victimization may be predicted by the severity of the disability (Rose 2010). For example, students with autism may be victimized more (Bejerot and Mörtberg 2009), and students with learning disabilities may be victimized less than other subgroups of students with disabilities (Wallace et al. 2002; White and Loeber 2008). Studies show that 40–50 % of children who stutter have been teased or bullied about their stuttering, and children who stutter are more likely to be victimized by bullying and to be socially-rejected by peers (Blood et al. 2010). Children with functional limitations or with an emotional, developmental, or behavioral problem are almost twice as likely to be victimized by bullying (Van Cleave and Davis 2006), and children with an emotional, developmental, or behavioral problem are three times more likely to be bullies or bully/victims (Van Cleave and Davis 2006).

To address subgroup differences among students with disabilities, Rose and Espelage (2012) examined rates of bullying involvement and the intersection of individual attributes among middle school students identified with specific disabilities and their peers without disabilities. Students with emotional and behavioral disorders (EBD) engaged in significantly higher levels of bullying and fighting than other subgroups of students. Additionally, higher levels of anger predicted higher levels of bully perpetration for students with EBD, whereas higher levels of victimization predicted higher levels of bully perpetration for students with disabilities other than EBD. These findings demonstrate the importance of recognizing the influence of the characteristic differences between subgroups of students with disabilities, and the unique influence these characteristics may have on student involvement within the bullying dynamic.

Children with attention deficit hyperactivity disorder (ADHD) are almost four times as likely to be victimized by bullying as children without ADHD; relational bullying and ostracism are particularly prevalent in this group (Twyman et al. 2010). Children with ADHD may be victimized due to differences in social development and social interactions (Twyman et al. 2010). Children with cancer, diabetes, and vision problems also are at higher risk of victimization (Van Cleave and Davis 2006).

Children with autism spectrum disorder (ASD) are at particularly high risk for victimization from bullying. ASD consists of a spectrum of neurodevelopmental disorders with prominent features of deficits in social communication and relational problems (Sterzing et al. 2012). Teacher-reported victimization from bullying among adolescents with ASD was 30 %, compared with 17 % self-reported, 7 % peer-reported, and 94 % parent-reported. Bullying perpetration among adolescents with ASD was 46 % by teacher report, 19 % by self-report, and 15 % by peer report (Sterzing et al. 2012). Overall, studies have found that victimization from bullying is higher among adolescents with ASD compared with the general population, whereas perpetration rates are similar (Sterzing et al. 2012). Children who have both ASD and ADHD have increased risk of perpetration (Sterzing et al. 2012; Twyman et al. 2010). Children with ASD experience high rates of relational bullying in the form of social exclusion, with over eight times the likelihood compared with children without an ASD diagnosis; over half of these children experience ostracism (Twyman et al. 2010). Adolescents with ASD who have most of their classes in general education rather than special education settings may experience higher rates of victimization if they are not appropriately integrated into peer groups in general education (Sterzing et al. 2012).

Weight-based bullying is identified as the most common reason for victimization at 41 %, followed by perceived sexual orientation at 38 %, and intellectual ability or academic performance at school at 10 % (Puhl et al. 2011). It occurs more often than bullying due to race or religion.

Obese adolescents are at high risk of being bullied compared with normal-weight peers (DeSmet et al. 2014; Puhl et al. 2011; Olvera et al. 2013). This weight-based bullying may be particularly damaging in adolescence, an important time for identify formation and peer acceptance. Although it is known that physical appearance, and in particular being overweight, is a major factor in being targeted for peer teasing and ridicule (Hayden-Wade et al. 2005), few studies have examined the subjective teasing experiences of obese youth. One study of perceived stigmatization among overweight adolescent females found that, in this sample of 50 girls, 96 % reported stigmatizing experiences due to their weight, the most frequent occurrences cited as weight-based teasing, jokes, and derogatory names (Neumark-Sztainer et al. 1998). Other studies have found that one-third of adolescent females and one-fourth of adolescent males report victimization from weight-related teasing (Olvera et al. 2013; Puhl et al. 2011); the prevalence of weight-related teasing is 60 % among the most obese students. Obese adolescents also have higher rates of cyber-victimization, with about 12 % reporting cyber victimization in the past 6 months, and are twice as likely to be victimized using electronic media as normal-weight peers (DeSmet et al. 2014). Weight-based victimization of overweight children may begin at an earlier age and last longer than bullying among non-overweight children (Puhl et al. 2013a). Of youth who report weight-based bullying, almost 80 % reported that the bullying lasted for more than 1 year, with more than one in three experiencing it for more than 5 years (Puhl et al. 2013b).

A high proportion of students also report observing weight-based bullying (Puhl et al. 2011). Almost 90 % of students report observing weight-based bullying at school, with less than 5 % stating they have never observed weight-based bullying. Forms of observed weight-based teasing include calling overweight students names, teasing students during physical activity, ignoring or avoiding overweight or obese students, teasing or making fun of overweight students in the cafeteria, excluding them from school social activities, verbal threats, physical harassment, and spreading negative rumors about them. Although the majority of students are willing to help, most report not doing anything when witnessing a peer being teased (Puhl et al. 2011).

In a Canadian sample of over 7,000 youth, Janssen et al. found that overweight and obese children 11–16 years old were at higher risk of victimization from verbal, physical, and relational bullying compared with normal-weight children (Janssen et al. 2004). Boys and girls were equally as likely to be victimized by overt and relational bullying. Obese youth were most likely to be victimized, followed by overweight youth, and the lowest likelihood in normal-weight youth. Overweight and obese boys, however, were no more likely to be physically-victimized than normal-weight boys. Victimization based on weight declined with increasing age among boys, but not among girls.

In this same study, with regard to being a perpetrator of bullying, independent of sex, no associations were detected with BMI status (Janssen et al. 2004). However, associations in bully-perpetrating were found in 15–16-year-old boys and girls; specifically overweight and obese boys were more likely to demonstrate relational bullying compared to their normal-weight peers and associations were also seen for both overweight and obese boys and girls in being more likely to exhibit overt forms of bullying (i.e., name-calling, teasing, hitting, or pushing). Overweight and obese children were more likely to perpetrate verbal bullying by teasing others because of race, color, or religion, but not based on weight (Janssen et al. 2004). It is unclear whether overweight and obese children in this study engaged in perpetration of bullying in retaliation for weight-based victimization.

The likelihood of being bullied may increase by weight status (Brixval et al. 2012; Puhl et al. 2013b). Overweight girls and boys have about one and a half times the likelihood of being victimized, whereas obese girls have more than three and a half times the likelihood (Brixval et al. 2012). The relationship between weight status and bullying may be mediated by body image, with likelihood of victimization increasing with degree of body image dissatisfaction (Brixval et al. 2012).

In a study by Neumark-Sztainer and colleagues (2003), both overweight and underweight middle school students reported higher levels of teasing than average weight participants. Very overweight youth (BMI 95th percentile) were most likely to be teased about their weight; 63 % of overweight girls and 58 % of overweight boys reported teasing by peers, while weight-related teasing by family members was reported by 47 % of these girls and 34 % of these boys. In another study (Hayden-Wade et al. 2005) a significantly higher percentage of overweight students (78 %) reported having been teased or ridiculed about some aspect of their appearance than non-overweight students (37 %). Moreover, the overweight sample was teased significantly more for weight-related aspects of their appearance; 89 % relative to 31.3 %, noting that for the non-overweight children, this percentage included teasing about both underweight and overweight status. Lastly, overweight children reported more frequent teasing, over longer duration, and they found the teasing to be more upsetting, compared with the non-overweight sample.

Weight-based victimization in childhood may predict future overweight (Puhl et al. 2013a). Adams and Bukowski (2008) found that for obese girls, victimization led to higher body mass whereas for obese boys, victimization was linked to decreases in the body mass index. Following preadolescents over 3 years, Lunde et al. (2006) found that early victimization did not predict feelings about appearance, changes in evaluations attributed to others (e.g., how others viewed them), or changes in weight satisfaction. However, for boys and girls being teased about appearance at age ten was linked to more negative self-evaluations and lower weight satisfaction 3 years later.

Overweight and obese children are more likely to experience depressive symptoms compared with normal-weight children (Janssen et al. 2004). Victimization from bullying can further compound this risk. Obese youth who are victimized by traditional bullying are three times as likely to rate lower quality of life, and those victimized by cyber-bullying are five times more likely to have had suicidal ideation (DeSmet et al. 2014).

Weight-related teasing may contribute to negative weight control behaviors, but this relationship may differ by gender. Perceived weight-related teasing is significantly associated with disordered eating behaviors among both overweight and non-overweight boys and girls (Neumark-Sztainer et al. 2003). Degree of teasing also is positively correlated with bulimic behaviors (Hayden-Wade et al. 2005). Neumark-Sztainer et al. (2003) found that weight-body concerns were strongly correlated with unhealthy weight-control behaviors, and family-peer weight norms were correlated with weight-body concerns. After adjusting for family-peer weight norms, however, weight-related teasing was found to be significantly related with weight-body concerns only among boys. Neumark-Sztainer et al. (2003) suggested that girls may be so sensitive to weight norms within their family-peer environments that weight-related teasing does not make any further contribution to weight-body concerns, whereas among boys, the more direct experience of being teased does make an additional contribution. Olvera and colleagues (2013) showed that weight-related teasing is associated with poor body image, binge-eating, and eating disorders among males and females. Teasing from peers and parents was associated with emotional eating, and teasing from parents was associated with binge eating (Olvera et al. 2013).

Overweight and obese children encounter bullying from various sources. Peers are the most common source, followed by parents, siblings, other relatives, and friends (Olvera et al. 2013; Hayden-Wade et al. 2005). Participants in one study reported experiencing bullying by physical education teachers or coaches (42 %), parents (37 %), and other teachers (27 %) (Puhl et al. 2013b). Weight-based bullying from peers and adults may persist even after obese or overweight youth lose weight and have BMIs in the healthy weight range.

Obese adolescents who are bullied demonstrate lower levels of motivation for, and enjoyment of, physical activity (DeSmet et al. 2014). Victims of traditional bullying are more likely to engage in emotional eating and to avoid physical activity and lower-weight peers (DeSmet et al. 2014). Physical education teachers, who may be in a position to intervene in weight-based peer victimization and to encourage physical activity engagement by obese students, may not always intervene appropriately, thereby increasing risk for physical activity avoidance among these students (DeSmet et al. 2014). One study of physical education teachers and coaches showed that participants were more likely to intervene to address bullying of overweight females, but not of overweight males. Female educators were more likely to intervene in bullying than male educators (Peterson et al. 2012).