UNIVERSITY OF CALGARY. Exploring Social Cognition as a Risk Factor for Peer Victimization for. Students with Autism Spectrum Disorder

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1 UNIVERSITY OF CALGARY Exploring Social Cognition as a Risk Factor for Peer Victimization for Students with Autism Spectrum Disorder by Melanie Elizabeth Fenwick A THESIS SUBMITTED TO THE FACULTY OF GRADUATE STUDIES IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE GRADUATE PROGRAM IN EDUCATIONAL PSYCHOLOGY CALGARY, ALBERTA SEPTEMBER, 2016 Melanie Elizabeth Fenwick 2016

2 Abstract In light of striking prevalence rates and adverse effects of bullying on interpersonal, psychological, and academic functioning, this study investigated a potentially influential risk factor, social cognition, for peer victimization of the uniquely at-risk population of students with Autism Spectrum Disorder (ASD). Two of the most common constructs that comprise social cognition include Theory of Mind (ToM) and Emotional Intelligence (EI). Forty-five students with High Functioning ASD (HFASD) completed measures assessing ToM, EI, and the prevalence and frequency of Bullying. Parent-report was also provided for the measure of bullying. According to student-report, verbal bullying was endorsed most (26.7%), followed by physical (17.8%) and social (15.6%) forms of bullying, while social bullying of student participants was endorsed most by parents (57.8%), followed by verbal (55.6%) and disability (35.6%) forms of bullying. Results indicated that neither ToM or EI predicted the prevalence or frequency of peer victimization for students with HFASD. Research efforts should continue to explore relevant risk factors for students with HFASD to inform policy and program development to effectively support this vulnerable group of students. Keywords: HFASD, peer victimization, theory of mind, emotional intelligence ii

3 Acknowledgments First, and most importantly, I would like to thank the students and families for volunteering their time to make this research project possible. I greatly appreciate your generosity. I would like to express my sincerest gratitude to my supervisor, Dr. Adam McCrimmon. Your guidance, support, and expertise have helped shape me into a stronger researcher and clinician. Thank you for your dedication, your patience, and your encouragement during this process. I would also like to thank my committee members, Drs. Michelle Drefs and Jim Brandon, for your time, expertise, and feedback on this document and during my defense. To my ASERT lab members, Ryan Matchullis, Amanda Smith, Melissa Soares, Sarah Cadogan, Stephany Huynh, Marian Coret, Keely Murphy, and Patricia Azarkam, thank you for your kindness and support. A special thanks to Alyssa Altomare for her mentorship on this project. To my SACP friends, I could not have survived my MSc experience without each and every one of you. Thank you for your generosity, your empathy, and your love, for all of the unforgettable memories, and for your friendships that will continue to grow beyond this program. A special shout out to Jacquie Glazier, for all of the shared laughter and tears, wine and dairy milks, fierce girl and yoga, bar nights and East Side Mario s. I m so grateful to have had you by my side for this rollercoaster ride see you in Tel Aviv! To my long distance besties, thank you for your words of wisdom and encouragement, for listening to my successes as well as my struggles, and for showing me that there is more to life than just school. A special thanks to Jessica Carmichael for the endless advice, support, and escapades that you ve brought to my life, personally and professionally. To my family, thank you for always believing in me and for never letting me give up on my dreams. Your encouragement, support and unconditional love have been a constant throughout my life that have meant more to me than you ll ever know. I wouldn t be the woman I am today without all of you. I love you, to the moon and back. To my best friend and my other half, Aaron, thank you for being my rock during the best and most difficult of times, for always making me your priority, and for embracing my dreams with me. These past two years together have truly been life changing. Your unwavering support, infectious personality, and at times, tough love, helped me finally accomplish this academic milestone, and I can t wait to celebrate with you! I love you, always and forever. iii

4 Table of Contents Abstract... ii Acknowledgments... iii Table of Contents... iv List of Tables... 7 Chapter One: Introduction... 8 Chapter Two: Literature Review Bullying: Definition, Prevalence, and Outcomes Risk Factors for Bullying in the Typically Developing Population Autism Spectrum Disorder Bullying of Students with ASD Informants of Peer Victimization Experiences Risk Factors for Bullying of the ASD Population Social Cognition as a Risk Factor for Bullying in ASD Theory of Mind ToM and ASD ToM and Bullying ToM, ASD, and Bullying Emotional Intelligence EI and ASD EI and Bullying EI, ASD, and Bullying Summary Present Study Hypotheses Chapter Three: Methods Participants Procedure Setting iv

5 Data Collection Measures Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) Wechsler Abbreviated Scale of Intelligence, Second Edition (WASI-II) Theory of Mind Emotional Intelligence Bullying Chapter Four: Results Data Analysis Overall Prevalence of Peer Victimization Prevalence of Specific Forms of Peer Victimization Overall Frequency of Student Reported Peer Victimization Frequency of Specific Forms of Peer Victimization Student Performance on the RME and BarOn EQ-i:YV (S) Discriminant Function Analysis Ordinal Regression Analysis Chapter Five: Discussion Overall Prevalence of Victimization Prevalence of Specific Forms of Peer Victimization Overall Frequency of Student Reported Victimization Frequency of Specific Forms of Victimization Student Performance on the RME and BarOn Research Questions and Hypotheses Limitations Strengths Implications Future Directions Conclusion References v

6 Appendix A: Recruitment Flyer Appendix B: Parent Consent Form Appendix C: Parental Consent for Teacher Participation vi

7 List of Tables Table 1 Demographic and Clinical Information...50 Table 2: Prevalence of Peer Victimization across Raters...57 Table 3: Prevalence of Specific Forms of Peer Victimization across Raters..58 Table 4: Student Frequency of Peer Victimization.58 Table 5: Frequency of Seven Forms of Peer Victimization across Raters..60 Table 6: Student Performance on RME and BarOn EQ-i YV (S) 61 Table 7: Ordinal Regression Predicting Frequency of Peer Victimization by ToM and EI

8 Chapter One: Introduction Bullying (peer victimization) is a form of abuse that occurs within a relationship in which there is a power imbalance and is characterized by repeated aggression with the intent to harm the other person (Craig & Pepler, 2007; Glew, Rivara, & Feudtner, 2000). Due to the significant negative impact of bullying on academic, behavioural, social, physical, and psychological domains (Baumeister, Storch, & Geffken, 2008; Brank, Hoetger, & Hazen, 2012; Vivolo, Holt, & Massetti, 2011), peer victimization has become a major public health issue for children of all ages. Specifically, peer victimization has been associated with poor social and emotional adjustment, low academic achievement, physical and mental health issues, delinquent behaviour, and suicidal ideation and attempts (Glew et al., 2000; Vivolo et al., 2011). Moreover, prevalence rates among typically-developing (TD) students range from 10-30% (Bear, Mantz, Glutting, & Yang, 2015; Glew et al., 2000; Nansel et al., 2001; Scheithauer, Hayer, Petermann, & Jugert, 2006; Solberg & Olweus, 2003), further highlighting the importance of this global issue. As such, a large body of research on TD children and youth has indicated several individual and contextual risk factors such as age, mental health, disability status, and poor peer relationships as risk factors for being bullied (Baumeister et al., 2008; Craig & Pepler, 2007; Fekkes, Pijpers, Fredriks, Vogels, Verloove-Vanhorick, 2006; Glew et al., 2000; Sentenac et al., 2012; Vivolo et al., 2011). Recently, children with Autism Spectrum Disorder (ASD) have received increasing attention as a uniquely at-risk population for peer victimization (Chen & Schwartz, 2012; Humphrey & Hebron, 2015; Maiano, Normand, Salvas, Moullec, & Aime, 2015; Schroeder, Cappadocia, Bebko, Pepler, & Weiss, 2014; Sreckovic, Brunsting, & Able, 2014). Specifically, prevalence rates of peer victimization in children with ASD are two to three times higher than TD children (Cappadocia et al., 2012; Little, 2002; Molcho et al., 2009). ASD is a neurodevelopmental disorder characterized by persistent and pervasive impairments in reciprocal social communication and social interaction, as well as the presence of 8

9 restricted and repetitive patterns of behaviour, interests, and/or activities (RRBs; DSM-5; American Psychiatric Association [APA], 2013). ASD emerges early in development and is a pervasive life-long disorder that causes clinically significant impairment across social, occupational, and other critical domains of functioning (APA, 2013; Karst & Van Hecke, 2012). Over the past decade, ASD has been identified as the fastest growing neurodevelopmental disorder, impacting as many as one in 68 children and their families (Centers for Disease Control and Prevention, 2014). While extensive research has identified several factors such as social and communication impairments, ASD symptom severity, poor peer relationships, mental health challenges, and problem behaviour that increase the vulnerability of children with ASD to peer victimization (Cappadocia et al., 2012; Sterzing, Shattuck, Narendorf, Wagner & Cooper, 2012), there is a paucity of research exploring social cognition as a specific risk factor for peer victimization within this uniquely vulnerable population. Social cognition refers to the cognitive processes that mediate social experiences such as how individuals perceive, interpret, and apply social information (Senju, 2013). Specifically, Theory of Mind (ToM) and Emotional Intelligence (EI) are two of the most common constructs that comprise social cognition. While ToM is the ability to conceive of the mental states of oneself and others (Baron- Cohen, Leslie, & Frith, 1985), EI is the ability to perceive, analyze, regulate, and communicate one s own and others emotions (Salovey & Mayer, 1990). Individuals with ASD, particularly those with intact cognitive functioning (High-functioning ASD; HFASD), have been found to demonstrate deficits in ToM and EI (Baron-Cohen et al., 1985; Baron-Cohen, Wheelwright, Spong, Scahill, & Lawson, 2001; Happe, 1994; Begeer et al., 2008; Montgomery et al., 2010; Sofronoff et al., 2011). These deficits have been associated with the social communication impairments characteristic of ASD (Baron-Cohen et al., 1985; Klin, 2000; Sasson et al., 2012; Senju, 2013, 2013), highlighting the importance of social cognition for this population. As such, 9

10 students with ASD may be especially vulnerable to peer victimization due to impairments in these specific areas of social cognition; however, despite this evidence, atypical development of ToM and EI has received limited attention as a risk factor for peer victimization in students with ASD. The primary objective of the current study was to investigate social cognition, specifically ToM and EI, as a potentially influential risk factor for peer victimization within the HFASD population. The proposed research questions are: 1) Is prevalence of peer victimization in students with HFASD predicted from ToM and EI abilities?, and 2) Can ToM and EI abilities predict the frequency of peer victimization in students with HFASD? 10

11 Chapter Two: Literature Review Bullying is an international issue that imposes significant adverse effects on children s physical and mental health, social and behavioural functioning, and academic and occupational achievement. Although there are several factors that increase a student s risk of being bullied, students with Autism Spectrum Disorder (ASD) experience unique risk for peer victimization due to the characteristics of the disorder (Cappadocia et al., 2012; Chen & Schwartz, 2012; Little, 2002; Rose, Simpson, & Ross, 2015; Sterzing et al., 2012; Zablotsky, Bradshaw, Anderson, & Law, 2014). One of those characteristics, social cognition, has received little attention as a potential risk factor for victimization of students with ASD. As such, the present study was conducted to explore social cognition, specifically Theory of Mind and Emotional Intelligence, as a risk factor for bullying for the ASD population. This chapter includes a review of pertinent literature regarding: the nature, prevalence, and impact of bullying; the risk factors for bullying in typically developing (TD) students; the unique risk for peer victimization experienced by students with ASD; limitations in the literature concerning risk factors for bullying of the ASD population; and social cognition as an under researched risk factor for bullying within the ASD population. Finally, this chapter concludes with the research questions and hypotheses for the current study. Bullying: Definition, Prevalence, and Outcomes Bullying (peer victimization) is a form of abuse that occurs within a relationship in which there is a power imbalance and is characterized by repeated aggression with the intent to harm the other person (Craig & Pepler, 2007; Glew et al., 2000). The power dynamic is one in which the bully is at a physical (i.e., size, strength) or social (i.e., dominant role or status with peers) advantage, and/or uses the victim s vulnerability (i.e., disability, appearance, cultural background) to cause physical, psychological, social, and/or academic distress (Craig & Pepler, 2007; Gladden, Vivolo-Kantor, Hamburger, & 11

12 Lumpkin, 2014). The repeated nature of this type of aggression affirms the power dynamic between the bully and the victim. Peer victimization has become a major public health issue for children of all ages due to the significant negative impact on development (Gina & Pozzoli, 2009). Indeed, prevalence rates among TD students range from 10-30% (Bear et al., 2015; Glew et al., 2000; Nansel et al., 2001; Scheithauer et al., 2006; Solberg & Olweus, 2003), with 33% of students reporting occasional victimization (defined as once or more in the past couple months) and 10% of students reporting chronic victimization (defined as two or more times in the past couple months; Molcho et al., 2009). It is important to highlight the significant variability in methodological considerations used to evaluate the prevalence of peer victimization. Specifically, bullying studies apply diverse definitions and conceptualizations of bullying, reference periods (i.e., past month, past 6 months, past year), frequency cut off scores (i.e., sometimes, often), informants (i.e., students, parents, teachers), and data collection approaches (i.e., questionnaire, interview, observation; Bear et al., 2015; Blake et al., 2012; Schroeder et al., 2014). Although the variability in methodology complicates the comparison of prevalence rates across studies, it is evident that peer victimization is a pervasive issue with devastating effects that warrants further research and public attention. Bullying occurs in many forms and in a variety of contexts. Although bullying most frequently occurs at school during times of limited supervision, these acts can also occur while traveling between home and school, within the neighborhood, and on social media (Glew et al., 2000). Some acts of bullying are a direct attack of aggression on the victim whereas others are indirectly communicated to the victim (Glew et al., 2000). Specifically, the four most common forms of bullying include physical fighting, verbal aggression, social exclusion, and bullying via interactive technology, referred to as cyberbullying (Monks, 2011). Physical bullying includes aggressive acts such as hitting, pushing, and shoving. Verbal bullying includes name-calling, insults, and teasing. Social bullying includes rumour 12

13 spreading, gossiping, and purposeful social rejection. Cyber bullying refers to bullying that occurs via technological means such as the internet or cellular phone. The form of bullying experienced varies with age and gender, such that younger children and boys experience more physical bullying while older children and girls experience more relational (verbal and social) bullying (Carbone-Lopez, Esbensen, & Brick, 2010; Glew et al., 2000; Nansel et al., 2001). While various terms exist to refer to victims of bullying in the literature (Hawker & Boulton, 2000), peer victimization will be used in this paper to refer to the victims of unwanted repetitive peer aggression. Extensive research has revealed the negative effects of bullying on developmental outcomes and overall quality of life for the victim. These negative effects span academic, behavioural, social, physical, and psychological domains, and in the most severe cases, suicide (Baumeister et al., 2008; Brank et al., 2012; Chen & Schwartz, 2012; Craig & Pepler, 2007; Gwen et al., 2000; Sterzing et al., 2012; Vivolo et al., 2011). To highlight the severity and pervasiveness of the impact of bullying on victims, a detailed report of the associated negative outcomes is discussed below. Academic. According to the National Association of School Psychologists, over 160,000 students are absent from school each day out of fear that they will be bullied (Swearer Napolitano, 2011). Bullying interferes with learning by imposing fear and distracting students, interrupting lessons, and occupying teachers time (Glew et al., 2000). As such, peer victimization is associated with academic difficulties, low academic achievement, school avoidance, and an increased risk of dropping out of school (Sterzing et al., 2012; Vivolo et al., 2011). Moreover, in a recent longitudinal study comparing victimized students to non-victimized students, Juvonen, Wang, and Espinoza (2011) found that victimized students had significantly lower grade point averages and academic engagement than their non-victimized peers. As such, the effects of victimization are of significant concern for children s long-term academic potential, and in turn, occupational achievement and success (Glew et al., 2011). 13

14 Behavioural. Victimization of children during their early academic years has been shown to contribute significantly to maladjustment, such that victims struggled with greater behavioural difficulties at 7 years of age irrespective of preexisting adjustment problems at 5 years of age (Arseneault et al., 2006). Victims of bullying often participate in delinquent behaviour including substance abuse, physical fighting, carrying weapons at school, and various types of criminal activity (Glew et al., 2000; Vivolo et al., 2011). In recent years, violent acts including murder and killing sprees have become one of the most extreme societal consequences of peer victimization, such that victims feel an overwhelming sense of powerlessness, anger, and pain, and in turn, react in retaliation toward others (Glew et al., 2000). Social. Victimized children have also been found to have poor social and emotional adjustment. For example, Nansel et al. (2001) found that victimized students in grades 6 through 10 reported greater difficulties with building friendships, poorer relationships with peers, and greater loneliness. Victims of bullying present with clinically significant social problems, antisocial behaviour, and are more emotionally distressed and marginalized compared to children who have not been victimized. Victims also report a loss of friends and social life as a result of being bullied and are often described as socially weak, shy, and anxious (Glew et al., 2000). Physical and Mental Health. A large body of research has demonstrated a link between peer victimization and children s physical and psychological health. Specifically, Fekkes et al. (2006) found that victims of bullying were at a heightened risk of developing new health-related symptoms, including psychosomatic and psychological problems, compared to children who were not bullied. Peer victimization is also significantly related to internalizing mental health issues, including depression, loneliness, anxiety, low self-esteem, and negative self-concept (Cook, Williams, Guerra, Kim, & Sadek, 2010; Hawker & Boulton, 2000; Vivolo et al., 2011; Wang, Nansel, & Iannotti, 2011). For example, 14

15 Arseneault et al. (2006) found that victims showed more internalizing difficulties and unhappiness at age 5-7 years compared to non-victims. Gladstone, Parker, and Malhi (2006) found that the experience of victimization in childhood persisted into adulthood, such that victimization was strongly related to high levels of comorbid general anxiety, social phobia, and agoraphobia anxiety as adults. Research has further shown that victims may experience suicidal ideation and suicidal attempts (Brank et al., 2012), and in severe cases, commit suicide which has been viewed by some researchers as a way to end the torture of the victimization that they experienced (Glew et al., 2000). While it is no surprise that the adverse impact of victimization is evident in childhood, the effects of bullying persist into adolescence and adulthood, including negative outcomes such as antisocial behaviour, drug use and abuse, and criminal behaviour (Monks, 2011; Vivolo et al., 2011). In fact, Adams and Lawrence (2011) found that the negative impact of bullying in junior high and/or high school continued into college, such that the effects of being bullied were still present after students enrolled in an institution of higher education. Moreover, these negative outcomes are pervasive across school, family, and community settings (Brank et al., 2012). Thus, the devastating impact of peer victimization on long-term outcomes across diverse contexts in combination with strikingly high prevalence rates highlights the severity and significance of bullying as a major public health issue, and emphasizes the importance of identifying factors that increase a child s risk for peer victimization to identify and address these factors in prevention and intervention efforts. Risk Factors for Bullying in the Typically Developing Population In light of the high prevalence rates and adverse impact of bullying, it is critical to understand the factors that place individuals at risk for peer victimization. A large body of research on TD children and youth has suggested several individual and contextual risk factors (Baumeister et al., 2008; Craig & Pepler, 2007; Fekkes et al., 2006; Glew et al., 2000; Sentenac et al., 2012; Vivolo et al., 2011). 15

16 Chronological age. Age as a risk factor for peer victimization has been well documented in the bullying literature such that researchers have found that the prevalence of bullying of TD children is highest for younger children (Baumeister et al., 2008; Khamis, 2015; Scheithauer et al., 2006; Sentenac et al., 2012; Vivolo et al., 2011). Consistent with this finding, Glew et al. (2000) surveyed Norwegian students from second to ninth grade and found that the highest percentage of victimization occurred at 7 years of age (2 nd grade) and that this rate steadily declined over the years to age 15 (9 th grade). While this decreased incidence of bullying as children age may be related to the bully s increased empathy and decreased tolerance for individuals who are mean, the authors suggest that it is also possible that parents are less likely to be informed of their child s victimization due to increased independence at that age and thus incidents of victimization are less likely to be captured in parent report (Glew et al., 2000). Alternatively, as Turner et al. (2010) found, younger students (i.e., elementary school-age) with high levels of mental health symptoms were especially vulnerable to peer victimization, whereas older students (i.e., early adolescence) with mental health symptoms were especially vulnerable to sexual victimization, highlighting the changing nature of peer victimization as children grow older. Mental health. Recently, mental health problems have received growing attention as a risk factor for bullying in childhood and adolescence (Vivolo et al., 2011). According to a national longitudinal study of 1,467 children aged 2-17, children with high levels of comorbid internalizing (anxiety, depression) and externalizing (anger/aggression) mental health symptoms, irrespective of sociodemographic characteristics, were more likely to experience victimization (Turner et al., 2010). While externalizing behaviour problems (e.g., conduct disorder) are more often associated with bullies and bully-victims (children who are both victimized and victimize others; Cook et al., 2010; Kokkinos & Panayiotou, 2014), internalizing mental health problems such as anxiety and depression are consistently associated with an increased risk of peer victimization over time (Fekkes et al., 2006; 16

17 Karlsson et al., 2014). These internalizing symptoms can make a child appear more vulnerable to aggressive peers as the victim tends to exhibit less assertiveness and self-confidence than their peers (Macklem, 2004). Low social self-efficacy, which refers to an individual s confidence and positive outlook on their ability to interact with peers, has also been found to increase the risk of bullying among children and adolescents (Navarro, Yubero, & Larranaga, 2015). Peer relationships/psychosocial support. Research has highlighted the elevated risk of peer victimization among students with fewer high-quality friendships (i.e., provide support, protection and help) compared to non-victims (Holt & Espelage, 2007; Kendrick, Jutengren, & Stattin, 2012). Victims are often chosen by bullies based on social isolation, vulnerability to others, and an inability to defend themselves (Mangope, Dinama, & Kefhilwe, 2012). As such, the student is easier to target and at greater risk of victimization given their lack of friends, social support, and positive social interaction (Kendrick et al., 2012). These findings are consistent with Navarro et al. (2015) who reported that closeness to friends (i.e., communication, support, understanding), social companionship (i.e., how often the student can rely on peers to listen when they need to talk), and social reputation (i.e., reality and ideal perception of social status) were associated with the experience of victimization among children aged years old. The importance of peer relationships is further highlighted by the meta-analytic finding that peer status had the largest effect size related to victimization, and as such, was the strongest individual predictor of peer victimization across 153 studies (Cook et al., 2010). Disability status. Several studies have indicated that students with disabilities are at a greater risk for being victimized than their TD peers (Bear et al., 2015; Blake et al., 2012; Blake et al., 2016; Rose, Monda-Amaya, & Espelage, 2011; Rose et al., 2015). As Blake et al. (2012) note, individuals with disabilities have long been perceived as unable to defend themselves or report abuse due to characteristics of their disability (p. 210). Across studies, rates of victimization are higher overall for 17

18 students with disabilities compared to TD students, and are especially high for specific disabilities, including students with Learning Disability, Intellectual Disability, speech-language disabilities, Attention-Deficit/Hyperactivity Disorder, and ASD (Blake et al., 2016). In a study of 312 youth (8-17 years old) with a variety of special health care needs (including ASD, Attention-Deficit/Hyperactivity Disorder, Learning Disability, behavioural or mental health disorders, or Cystic Fibrosis), Twyman et al. (2010) aimed to compare victimization and ostracism experiences among these groups to TD peers. Ostracism was defined as a form of social exclusion whereby the victim was ignored and made to feel as if they are nonexistent. Twyman et al. (2010) found that of all the special health care groups included in the study, individuals with ASD reported the highest percentage of ostracism experiences. Moreover, children with ASD reported a 3- to 4-fold increase in victimization score when compared to a TD group. Although disability status has been identified as a relevant risk factor, Swearer, Wang, Maag, Siebecker, and Frerichs (2012) recently found that disability status only explained 2% of the variance in peer victimization, highlighting the importance of exploring multiple factors that increase the risk of victimization for students with disabilities. In light of these results, it is not surprising that students with ASD have received increased attention as an at-risk population for peer victimization. In the following sections, existing research exploring the relation between ASD and peer victimization will be discussed, as will the risk factors that increase the vulnerability of this specific population. Autism Spectrum Disorder In recent years, children with ASD have received increasing attention as an at-risk population for peer victimization (Humphrey & Hebron, 2015; Maiano et al., 2015; Schroeder et al., 2014; Sreckovic et al., 2014). According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association [APA], 2013), ASD is a neurodevelopmental disorder characterized by 18

19 persistent and pervasive impairments in reciprocal social communication as well as the presence of restricted and repetitive patterns of behaviour, interests, and/or activities (RRBs). Impairments in social communication and social interaction include deficits in social-emotional reciprocity, nonverbal communication, and peer relationships. RRBs are defined as the presence of unusual maladaptive behaviours and interests, such as strict adherence to nonfunctional routines/rituals or a persistent preoccupation with parts of an object, that are not usually seen in TD children (APA, 2013; Chawarska, Klin, & Volkmar, 2008). ASD is a life-long disorder that emerges early in development and is pervasive in nature, causing clinically significant impairment across social, occupational, and other critical domains of functioning (APA, 2013; Karst & Van Hecke, 2012). ASD is four times more common in boys than girls (APA, 2013). Over the past decade, ASD has been identified as the fastest growing neurodevelopmental disorder, impacting as many as one in 68 children and their families (Centers for Disease Control and Prevention, 2014). ASD is a new DSM-5 diagnostic category encompassing the four previously separate DSM-IV disorders of autistic disorder (autism), Asperger s disorder, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified (APA, 2000, 1994). ASD is now conceptualized as a single condition with varying levels of symptom severity in the two core domains of this disorder: social communication and RRBs. In addition to symptom severity, chronological age, developmental level, and the presence of comorbid conditions also impact the clinical presentation of ASD (APA, 2013). Student participants in the current sample will be referred to as ASD, as opposed to the previous DSM-IV disorders. Comorbidity. Many individuals with ASD also have comorbid conditions, including intellectual impairment, attention and psychological disorders, and medical conditions. Prevalence rates range from 46-72% of children and adolescents with ASD being diagnosed with at least one comorbid disorder 19

20 (Gjevik, Eldevik, Fjaeran-Granum, & Sponheim, 2011; Mannion, Brahm, & Leader, 2014; Mannion & Leader, 2013; Mannion, Leader, & Healy, 2013; Matson & Goldin, 2013). The most common comorbid conditions for individuals with ASD are detailed below. Intellectual disability. Intellectual Disability (ID) is the most common comorbid condition, occurring in up to 70% of individuals with ASD (Isaksen, et al., 2013; Mandell et al., 2012; Matson & Kozlowski, 2011). When a comorbid diagnosis of ASD and ID is made, the child s social communication and interaction abilities should be significantly impaired relative to the developmental level of the child s nonverbal skills (APA, 2013). In contrast, some individuals with ASD possess intact cognitive abilities and are referred to as High-Functioning (HFASD). Compared to other individuals with ASD, HFASD individuals tend to have less prominent social communicative symptom severity. Attention disorder. One of the most prevalent comorbid diagnoses with ASD is Attention- Deficit/Hyperactivity Disorder (ADHD), with comorbid prevalence rates at over 50% (Matson & Goldin, 2013), and 31% for individuals with HFASD (Leyfer et al., 2006). Although the DSM-IV did not previously allow for comorbid diagnoses of ADHD and ASD, these two conditions are now known to co-occur at strikingly high rates and are no longer mutually exclusive (APA, 2013). In an investigation into the shared and individual symptoms in ASD and ADHD, Mayes, Calhoun, Mayes and Molitoris (2012) found that while Autism is distinct from ADHD, the core symptoms of inattention, hyperactivity, and impulsivity are part of autism. The authors concluded that ASD and ADHD are neurobiological disorders with similar underlying neuropsychological deficits (p.283). Psychological disorders. Many individuals with ASD suffer from comorbid mental health disorders. In fact, approximately 70% of individuals with ASD experience one mental health disorder whereas 40% of individuals with ASD may have two or more (APA, 2013). One of the most prevalent comorbid psychological disorders is anxiety, with White, Oswald, Ollendick, and Scahill (2009) finding 20

21 prevalence rates ranging from 11-84% in their literature review of the experience of anxiety among children with ASD. The range often depends on the child s specific ASD diagnosis, the level of cognitive functioning, and the severity of social impairment. Studies examining anxiety in ASD have found prevalence rates of 55% (for at least one anxiety disorder) and 42% (overall anxiety disorder diagnosis; de Bruin, Ferdinand, Meester, de Nijs, & Verheij, 2006; Simonoff, Pickles, Charman, Chandler, Loucas, & Baird, 2008), highlighting the relevance of anxiety problems for individuals with ASD. Additionally, depressive disorders commonly co-occur in individuals with ASD and the presence of comorbid psychological disorders increase the likelihood of suicidal ideation/attempts (Mannion & Leader, 2013; Matson & Goldin, 2013). Medical conditions. Several medical conditions, such as epilepsy, sleep problems, and gastrointestinal symptoms are also commonly associated with ASD (APA, 2013). Prevalence rates of epilepsy range from 10-30% in individuals with ASD, compared to 2-3% in the general population (Bolton, Carcani-Rathwell, Hutton, Goode, Howlin, & Rutter, 2011; Mannion, Leader, Healy, 2013; Tuchman & Rapin, 2002), while sleep and gastrointestinal rates range from 77-81% and 9-91%, respectively (Mannion et al., 2013). In addition, individuals with ASD often present with extreme and narrow food preferences or aversions and may be diagnosed with avoidant-restrictive food intake disorder (APA, 2013). In light of the core characteristics and prevalence of ASD, peer victimization has become a serious public health concern for students with ASD. The relation between ASD and peer victimization is illustrated in the following sections. Bullying of Students with ASD According to Sterzing et al. (2012), children with ASD are uniquely vulnerable to bullying due to the hallmark social and relational impairments characteristic of the condition (p.1058). Although 21

22 research examining bullying in children with ASD is in its infancy, several studies indicate that both children with ASD and cognitive impairment (Cappadocia, Weiss, & Pepler, 2012; Chen & Schwartz, 2012; Rose et al., 2015; Twyman et al., 2010; Sterzing et al., 2012; Zablotsky et al., 2014) and children with HFASD (Carter, 2009; Little, 2002; Kowalski & Fedina, 2011; Rowley et al., 2012; Sofronoff, Dark, & Stone, 2011; Wainscot, Naylor, Sutcliffe, Tantam, & Williams, 2008) are at a greater risk of being bullied than TD children. According to a recent review of 15 studies conducted from 2002 to 2014 that explored bullying prevalence rates, students with ASD were victimized at alarmingly high rates (Sreckovic et al., 2014, p. 1161), more frequently than students with other disabilities and students without disabilities (Humphrey & Hebron, 2015; Maiano, Normand, Salvas, Moullec, & Aime, 2015; Schroeder et al., 2015). Specifically, studies have reported that the rate of victimization in children with ASD is two to three times higher than TD children (Cappadocia et al., 2012; Little, 2002; Molcho et al., 2009). Prevalence rates range from 28-57% according to student report (Chen and Schwartz, 2012; Kowalski & Fedina, 2011; Twyman et al., 2010; Rose et al., 2015; Rowley et al., 2012; Wainscot et al., 2008) and 30-94% according to parent report (Bear et al., 2015; Cappadocia et al., 2012; Carter, 2009; Chen & Schwartz, 2012; Little, 2002; Kowalski & Fedina, 2011; Rowley et al., 2012; Sterzing et al., 2012; Zablotsky et al., 2014), thus highlighting the elevated prevalence among students with ASD. These statistics are consistent with a recent 2015 review of the compared risk of general school peer victimization between children with ASD and TD children (Maiano, Normand, Salvas, Moullec, & Aime, 2015). Specifically, Maiano et al. (2015) found that the risk for peer victimization among schoolaged youth with ASD was three times higher than school-age TD peers. Informants of Peer Victimization Experiences Although studies have typically relied on parent report as the primary source of information regarding peer victimization, some research has found that the prevalence of bullying may be 22

23 underestimated from parent-report due to limited opportunity to observe school-related victimization (Adams et al., 2014; Blake et al., 2012; Shakoor et al., 2011). As such, the inclusion of self-report has received growing attention for the purpose of understanding the nature and impact of peer victimization that other individuals (i.e., parents, teachers, peers) may not be privy to (Blake et al., 2012; Shakoor et al., 2011). As such, self-report is uniquely valuable for gaining insight into the victim s experience, and how peer victimization is associated with negative outcomes (Hawker & Boulton, 2000). According to the TD literature, self-report is a valid and reliable method to evaluate bullying, and is especially important for understanding victimization in children and adolescents given that parents are less likely to be present or informed of school-based bullying (Begeer et al., 2015; Shakoor et al., 2011; Shakoor et al., 2012). As Shakoor et al. (2011) emphasize, gaining perspectives from multiple informants is ideal in order to accurately and effectively capture all incidents of peer victimization (p. 379). In contrast, mixed results have been found regarding the accuracy and reliability of using individuals with ASD as self-reporters of their peer victimization experiences (Chen & Schwartz, 2012; Van Roekel, Scholte, & Didden, 2010). Some studies have suggested that individuals with ASD are poor self-reporters, likely due to challenges accurately perceiving their own and others mental states (Baron- Cohen et al., 1985), which in turn may cause individuals with ASD to fail to identify peer victimization when it occurs or misinterpret non-bullying acts as bullying (Bauminger & Kasari, 2000). Conversely, some studies have found acceptable levels of agreement between parent and self-report of peer victimization experiences, suggesting that individuals with ASD are able to accurately recognize and report acts of bullying (Chen & Schwartz, 2012; Rieffe, Camodeca, Pouw, Lange, & Stockmann, 2012; van Roekel et al., 2010; Zeedyk, Rodriguez, Tipton, Baker, & Blacher, 2014). For example, in a qualitative exploration of victimization experiences of youth with ASD, Zeedyk et al. (2014) found that many youths with ASD do perceive themselves as victims (Zeedyk et al., 2014). In addition, Van Roekel 23

24 et al. (2010) showed that individuals with ASD and TD peers equally perceived and reported on peer victimization. Chen & Schwartz (2012) also found that student and parent report of victimization did not significantly differ, and that student and parents showed a high level of agreement regarding peer victimization scores. Additional support for the use of self-report with individuals with ASD comes from comparisons with TD peer report. Begeer et al. (2015) found self and peer-report of peer victimization rates were comparable, further highlighting that children with ASD are just as capable as their TD peers at reporting on their own and their peer s bullying-related behaviour. Moreover, research in mental health and quality of life of individuals with ASD has further highlighted the use of self-report as a reliable and valid source of information. For example, Ozsivadjian, Hibberd, and Hollocks (2014) found good agreement between children with ASD and parent report on measures of anxiety and depression, suggesting that individuals with ASD are reliable reporters of their own mental health symptoms. In addition, Shipman, Sheldrick, and Ellen (2011) revealed that adolescents with ASD reliably and validly reported on their own quality of life (i.e., physical, emotional, social, and school functioning). Collectively, these studies indicate that individuals with ASD are reliable informants that are capable of providing a valuable and valid perspective regarding their own personal experiences. As such, the current exploration investigates social cognition, specifically Theory of Mind and Emotional Intelligence, as a risk factor for peer victimization in children with HFASD using parent and self-report. Risk Factors for Bullying of the ASD Population To understand the elevated prevalence of bullying among children with ASD better, it is critical to explore some of the possible explanations for the increased risk of bullying within this population. A review of the research was conducted to identify factors that increase the vulnerability of children with 24

25 ASD to peer victimization and to highlight gaps in the existing literature that will be addressed by the current investigation. Social and communication impairments. Although several factors emerged throughout the research exploring risk factors for peer victimization among the ASD population, deficits in social and communication skills were most prevalent across studies. According to Volkmar, Klin, Schultz, Robin, and Bronen (2000), children with ASD are perfect victims for peer victimization due to their unique social and communication impairments (p. 266). For example, children with ASD often interpret language literally and have difficulty accurately interpreting social cues and nonverbal behaviours such as gestures, facial expressions, and body language (Carter, 2009; Chen & Schwartz, 2012; Rowley et al., 2012). Studies exploring the relation between peer victimization and social and communication skills have found mixed results. While one study found no association between peer victimization and social skill deficits (Storch et al., 2012), several studies found that greater severity of social communication deficits were related to increased peer victimization (Adams et al., 2014; Cappadocia et al., 2012; Sofronoff, Dark, & Stone, 2011; Sterzing et al., 2012). In an exploration of factors related to peer victimization, Cappadocia et al. (2012) asked parents of 192 students with ASD aged 5-21 to complete an online survey. The authors found that the victimized students (70%) were five times more likely to have severe levels of communication deficits than the youth who were not victimized. Similar results were found in a nationally representative survey examining correlates of peer victimization whereby students with ASD who had more severe social skill deficits were significantly more likely to be victimized (Sterzing et al., 2012). Adams et al. (2014) and Sofronoff, Dark, and Stone (2011) also found peer victimization to be related to lower levels of social skills in students with ASD. However, Sofronoff et al. (2011) reported that social vulnerability, defined as the ability to make appropriate social judgments, was the strongest predictor of peer victimization across all potential risk factors. Thus, 25

26 students with higher levels of social vulnerability may not be able to determine good versus ill-intended peers, be naïve, and trust ill-intended peers, and as such, may be easy targets for peer victimization (Sofronoff et al., 2011). Collectively, these studies suggest that youth with ASD are less likely to experience peer victimization when they possess stronger social and communication skills. In contrast, some studies have found the opposing relation between the severity of social and communication impairments and peer victimization in individuals with ASD. For example, teacher data comparing 100 children with ASD to an IQ-matched control group with special needs found that peer victimization was higher among the students with ASD who had less severe social and communication impairments (Rowley et al., 2012). Rowley and colleagues (2012) proposed two possible explanations for this finding. First, children with stronger social and communication abilities may be more likely to notice and report bullying than children with greater challenges in social and communication skills. Second, children with stronger social abilities may be more likely to be socially involved and interested in engaging their peers in social interaction, therefore providing more opportunity for these children to be victims of bullying. In line with this reasoning, Sterzing and colleagues (2012) found that adolescents with ASD with higher levels of conversational ability were significantly more likely to be bullied compared to adolescents with no conversational ability. The authors suggest that adolescents with no conversational ability may be protected by lower teacher-student classroom ratios or the failure of teachers to inform parents about the child s experience of being bullied. As Sterzing et al. (2012) highlight, individuals with an observable disability are often victimized at a higher rate, and therefore individuals with ASD with any observable differences in communication or social abilities are at an increased risk for peer victimization. Severity of ASD symptomology. The severity of ASD symptomology has also been associated with peer victimization. In Zablotsky et al. s (2014) study of 1221 children with ASD, parent-report 26

27 indicated that children exhibiting moderate to high levels of autistic traits (more severe communication difficulties, social interaction impairments, and repetitive or stereotyped behaviours) were the most likely to be victims rather than bullies or bully-victims. A similar relation between the severity of symptoms and the experience of victimization was reported by Shtayermman s (2007) small parent survey of 10 adolescents and adults. Adams et al. (2014) similarly found that the severity of ASD symptoms, specifically RRBs, were associated with elevated rates of victimization across 54 adolescent males. The core characteristic traits of ASD can make these children stand out from their TD peers and their vulnerability to peer victimization increases with the severity of symptoms. However, as Cappadocia et al. (2012) point out, although there is a negative correlation between the severity of ASD symptoms and successful social inclusion, even children with HFASD (and therefore less severe ASD symptoms) are still at risk for bullying likely due to their unique struggle with peer relationships and social competence. Indeed, Zablotsky et al. (2014) found that children with HFASD were more likely to be victimized compared to children with ASD. Zablotsky et al. s (2014) finding is consistent with Wainscot and colleagues (2008) conclusion that HFASD is a particularly powerful risk factor for being the target of bullying (p.37). Collectively, the research suggests that the symptoms that define ASD put these children at a unique risk for peer victimization. Chronological age. Age is strongly linked to peer victimization as a risk factor in both TD and ASD children. The majority of studies exploring bullying in students with ASD include school-age participants. Consistent with research on TD populations, results of some studies examining ASD populations indicate that bullying decreases with age (students aged 11-14; Storch et al., 2012) and that younger students are more likely to be bullied (students aged 5-21; Cappadocia et al., 2012). In contrast, Zablotsky et al. (2013) and Hebron and Humphrey (2013) studied the prevalence of victimization among a wider age range of students with ASD (aged 6-15 and 5-15 respectively) and found that middle school 27

28 and older students were more likely to be victimized. However, the form of bullying experienced has been found to differ according to the age of the victim. For example, Little (2002) explored mothers perceptions of bullying among 411 youth (aged 4-17) with ASD and nonverbal learning disorders and found that older students with ASD were more likely to experience emotional bullying, whereas younger students with ASD were more likely to experience physical bullying. Little s (2002) representation of emotional bullying (being called bad names, being socially excluded) is characteristic of a combination of social and verbal bullying. This finding is consistent with research in the TD student population in that physical bullying is more common in elementary school while verbal/relational forms of bullying (such as verbal and social bullying) are more common as students get older and develop their social skills (Carbone-Lopez, Esbensen, & Brick, 2010; Glew et al., 2000; Nansel et al., 2001). Overall, despite the varying participant ages across these studies, the results indicate a similar trend to the TD student population, such that students with ASD transitioning from elementary to middle school experience elevated rates of peer victimization. Mental health. Mental health issues have received increasing attention as a risk factor for peer victimization of youth with ASD. According to a parent survey, victimized children with ASD (ages 5-21) were 11 times more likely to have higher levels of internalizing mental health problems (e.g., anxiety, insecurity, depression) compared to children with ASD who were not bullied (Cappadocia et al., 2012). This startling statistic is consistent with other findings regarding the association between internalizing mental health conditions and peer victimization (Adams et al., 2014; Storch et al., 2012; Zablotsky et al., 2013). For example, Zablotsky et al. (2013) found that frequently victimized students had higher parent-reported internalizing symptoms compared to infrequent victims and non-victims. It is important to recognize the bidirectional nature of this relation, such that the stress of social isolation and bullying can potentially lead to internalizing mental health problems and, alternatively, internalizing 28

29 mental health problems may make children appear less self-confident and assertive, and thus more vulnerable and at greater risk for victimization (Cappadocia et al., 2012; Fekkes et al., 2006). Problem behaviour. In addition to internalizing mental health problems, externalizing problem behaviour has also been identified as a risk factor related to peer victimization of youth with ASD. According to parent and teacher report, students with ASD who exhibit externalizing behaviour difficulties experience higher rates of peer victimization (Hebron & Humphrey, 2013). Self-report data from students with ASD also found a positive relation between problem behaviour (specifically anger) and peer victimization (Rieffe et al., 2012). Additional studies have explored ADHD as a potential correlate of peer victimization in students with ASD (Sterzing et al., 2012; Zablotsky et al., 2013). Both studies found that students with ASD and comorbid diagnoses of ADHD showed a significantly higher risk of peer victimization compared to children without an ADHD comorbid diagnoses. In fact, according to the reporting of 1221 parents of students with ASD, children diagnosed with ADHD were the second highest group for being at risk for victimization, just slightly below children with comorbid diagnoses of depression (Zablotsky et al., 2013). Racial background. Peer victimization has also been associated with racial background. Although Zablotsky et al. (2014) found Caucasian students with ASD to be less likely to be victimized compared to African American, Hispanic, and other racial backgrounds, Sterzing et al. (2012) found Hispanic students with ASD to be less likely to experience victimization compared to non-hispanic students with ASD. These findings differ from research in the TD population indicating that Caucasian students report the highest level of victimization while Asian students report the least (Robers et al., 2013). Further research is required to understand the relation between race and peer victimization in the ASD population better. 29

30 Academic achievement. Limited research has explored the relation between academic achievement and peer victimization for students with ASD. However, parent-report from Zablotsky et al. (2014) indicates that high academic achievers were more likely to be victimized. This finding is in contrast to research in TD populations that report low academic achievement is associated with peer victimization (Schwartz, Gorman, Nakamoto, & Toblin, 2005). Similar to race, additional research is required to determine the significance of academic achievement as a risk factor for peer victimization in the ASD population. Peer relationships. Friendships and peer relationships are one of the most highly researched contextual factors related to peer victimization in children with ASD. As Rowley et al. (2012) explain, the social and communication challenges characteristic of ASD can impede a child s ability to interact and engage with peers to form friendships, thereby increasing their risk for social isolation and peer victimization compared to their TD peers. In a comparison study of 30 children with ASD to 27 TD children, Wainscot et al. (2008) found that children with ASD were less likely to engage in frequent social interaction and report having fewer friends as compared to TD children. In turn, these same children were more likely to report being victims of bullying (Wainscot et al., 2008). Cappadocia et al. (2012) found that children with ASD who were bullied had fewer friendships at school than children with ASD who were not bullied. Moreover, according to parent report, children identified as struggling to make friends are more likely to be targets of bullying (Zablotsky et al., 2014). Collectively, these studies highlight that children with poor peer relationships are especially vulnerable to peer victimization. Not surprisingly, teacher data from Hebron and Humphrey (2013) found that positive peer relationships are associated with reduced rates of peer victimization among students with ASD. Across studies, friendship has been emphasized as a powerful protective factor against bullying (Bollmer, Milich, Harris, & Maras, 2005; Cappadocia et al., 2012), such that the presence of close 30

31 friends and supportive peers reduces the risk of children being bullied. Little (2002) highlights that having friends may act as a buffer from peer victimization as the bullied child is able to rely on friends as social support when being teased or bothered by other children. Furthermore, Bollmer et al. (2005) found that children with higher quality best friendships, based on child report, were less likely to be victimized by their peers compared to children with lower quality best friendships, suggesting that friendship may protect children from becoming targets of bullying. As such, these studies highlight the significant protective value of positive friendships and peer relationships when it comes to the victimization of children with ASD by their peers. Home environment. In addition to the mental health difficulties faced by victimized children, parental mental health may also serve as a risk factor for peer victimization in the ASD population. However, this contextual factor is under researched to date, with very few studies having explored the relation between parental mental health and peer victimization in ASD children (Cappadocia et al., 2012). According to Cappadocia et al. (2012), parents of victimized children with ASD were 3 times more likely to have mental health problems than parents of children with ASD who were not bullied. The impact of increased mental health problems among parents may be evident in parents decreased ability to create an optimal social environment for their children at home and may inhibit their ability to advocate for appropriate school-based supports to help facilitate positive peer relationships (Cappadocia et al., 2012). In turn, the authors also posit that parental knowledge of their child s peer victimization may lead to parent mental health problems (Cappadocia et al., 2012). Consistent with the view of parental mental health as a risk factor for bullying, Weiss, Cappaocia, and Pepler (2015) explored the role of parenting stress as a moderator between peer victimization and anxiety for 101 adolescents and young adults with ASD. Maternal report indicated that bullying and anxiety were most strongly associated in individuals with mothers who reported high levels of parenting stress and not significantly 31

32 associated for individuals with mothers who reported low levels of parenting stress. Together, Cappadocia et al. (2012) and Weiss et al. (2015) highlight the adverse effects of parental mental health difficulties on children s outcomes, including peer victimization. In contrast, parental engagement and confidence have been found to reduce the risk of peer victimization among ASD children. Specifically, researchers report a negative relation between parental engagement and confidence and victimization of children with ASD (Hebron & Humphrey, 2013). As such, Hebron and Humphrey (2013) concluded that higher levels of parental engagement and confidence in schools, such as actively participating in school policies/practices and reporting bullying incidents missed by school staff, act as a potential protective factor and may reduce the likelihood of peer victimization of children with ASD. These results are consistent with previous research among the TD population that emphasizes the importance of positive parenting, warm parent-child relationships, family support, and safe home environments (Bowes, Maughan, Caspi, Moffitt, & Arseneault, 2010; Holt, Kantor, & Finkelhor, 2009). Understood within a developmental-contextual framework, the family represents the primary socialization agent for the child, and as such, is influential in a child s social development (Monks, 2011). As Holt et al. (2009) found, victim s homes were characterized by higher levels of parental criticism, child maltreatment, and fewer rules. Holt (2009) further highlighted the positive association between family support and students disclosing to their parents about being bullied. Moreover, in a study examining the mediating role of maternal warmth for TD children being bullied, Bowes et al. (2010) studied identical twins to identify environmental protective factors on children s behavioural adjustment following bullying. Results revealed that the twin who received the greatest maternal warmth displayed fewer behavioural problems, thus identifying maternal warmth as an environmental protective factor against the adverse effects of peer victimization. 32

33 In addition, family socioeconomic status (SES) has been explored as a potential risk factor for peer victimization in children with ASD. According to Zablotsky et al. (2013), parent report indicated that victimized children were more likely to receive free or reduced priced meals. This finding is consistent with research in the TD population, whereby adolescents from low SES families reported higher rates of peer victimization (Due et al., 2009). Sreckovic et al. (2014) suggest that students who come from low SES families may wear clothing or lack technology (e.g., computer or cell phone) that make them stand out from their peers, in turn making them more vulnerable to peer victimization. This risk factor requires further exploration in the ASD population. School environment. Multiple studies have explored the relation between classroom settings and peer victimization of students with ASD. The finding that students educated in mainstream classrooms are more likely to experience victimization compared to students who are educated in segregated special needs classrooms is consistent across studies (Hebron & Humphrey, 2013; Rowley et al., 2012; Sterzing et al., 2012; Zablotsky et al., 2013). However, Rowley et al. (2012) reported that the relation between classroom setting and peer victimization of students with ASD was mediated by the severity of the student s social support needs. As such, students with ASD with less social support needs were more likely to be victimized in mainstream classrooms, whereas victimization of students with more severe social support needs did not differ according to classroom setting (Rowley et al., 2012). According to Hebron and Humphrey (2013), segregated classrooms are typically smaller in size and require more adult supervision than mainstream classes, fundamentally providing more protection and fewer opportunities for bullying to occur. In addition, students with ASD may be less likely to stand out from their peers in segregated classrooms (Hebron & Humphrey, 2013). Interestingly, Begeer and colleagues (2015) found that peer victimization rates, according to self and peer report, did not differ 33

34 between 26 boys with ASD attending a specialized school for students with ASD compared to 23 TD boys attending a mainstream school. A second risk factor related to the school environment is the relation between school/ public transport and peer victimization. Hebron and Humphrey (2013) were the first to empirically establish a positive relation between student s use of public/school transport to school and peer victimization. Specifically, teacher data indicated that students travelling to school using public/school transport were at an increased risk for victimization (Hebron & Humphrey, 2013). The authors suggest that the nature of public/school transport as an unstructured social situation with limited adult supervision is a uniquely vulnerable setting for peer victimization, especially for children with ASD. Further research using selfreport will be important in confirming transportation as a risk factor for bullying in the ASD population. Social Cognition as a Risk Factor for Bullying in ASD Although there is growing research on the risk factors that help to explain the elevated prevalence of bullying for students with ASD, there is a paucity of research exploring social cognition as a specific risk factor for peer victimization within this uniquely vulnerable population. Social cognition refers to the cognitive mechanisms underlying social behaviour and social experiences, such as how individuals perceive, interpret, and apply social information (Senju, 2013, p. 96). Specifically, processing of emotional information, perception of nonverbal social cues, and judgement of social interactions are some of the cognitive processes that comprise social cognition (Gokcen, Petrides, Hudry, Frederickson & Smillie, 2014; Sasson, Nowlin, & Pinkham, 2012). As such, social cognition is an essential prerequisite for effective social functioning. Impairments in social cognition have long been associated with ASD (Baron-Cohen et al., 1985; Happe, 1994; Klin, 2000; Senju, 2013), such that deficits in social cognition directly contribute to social functioning impairments in ASD (Sasson et al., 2012, p. 656). Specifically, studies have 34

35 demonstrated that individuals with ASD perform poorly on social cognition tasks, such as Theory of Mind, facial processing, empathic understanding, and imitation (Baron-Cohen et al., 2001; Frith & Frith, 2003). In fact, it has been suggested that ASD could be understood as a case of atypical development of social cognition that in turn explains the social and communication impairments characteristic of ASD (Senju, 2013). Although ASD impairments have traditionally been associated with poor social cognition, individuals with ASD and intact cognitive functioning (HFASD) have shown inconsistent performance across social cognition tasks, with some studies reporting comparable performance to TD controls (Montgomery et al., 2010; Scheeren et al., 2012; Spek et al., 2010) and others reporting impaired performance (Baron-Cohen et al., 2001; Happe, 1994; Montgomery et al., 2012). Performance variation for individuals with HFASD is likely due to the aspect of social cognition measured (i.e., trait EI vs. ability EI, simple vs. advanced ToM) and the method of measurement used. Despite these varied findings, poor social cognition may contribute to the social and communication impairments that individuals with HFASD struggle with in their daily lives, which may in turn contribute to their risk for peer victimization. As such, students with HFASD and poor social cognition may be at an increased risk for peer victimization, and this will be further explored in the current study. Two of the most common constructs within social cognition include Theory of Mind and Emotional Intelligence. The following sections will define and describe these constructs, as well as provide an overview of the relevance of these constructs as potential risk factors for peer victimization of students with ASD. Theory of Mind Theory of Mind (ToM) is the ability to conceive of the mental states of oneself and others, including thoughts, intentions, emotions, and beliefs (Baron-Cohen et al., 1985; Baron-Cohen et al., 2001). ToM represents an individual s ability to attribute subjective mental states to oneself and to 35

36 others. As such, ToM is critical for understanding, predicting, and explaining one s own and other s behaviour (Baron-Cohen et al., 1985; Baron-Cohen et al., 2001). High ToM has been associated with effective interpretation of social cues, appropriate adaptation of one s own behaviour, and successful interpersonal functioning, which in turn contributes to healthy social relationships (Astington, 2001; Kimhi, 2014). ToM and ASD. Extensive research has demonstrated the relation between impaired ToM and children with ASD, suggesting that poor ToM may explain the characteristic social and communicative impairments in children with ASD (Baron-Cohen et al., 1985; Baron-Cohen et al., 2001; Happe, 1994; Senju, 2013). According to Klin (2000), social deficits in individuals with ASD are largely a result of a very specific, and primarily cognitive, incapacity to impute mental states such as beliefs, intentions, desires, to others and to self (p. 831). As such, individuals with ASD struggle across multiple domains of social functioning, including awareness and understanding of verbal and non-verbal social cues from others. For example, children with ASD have been shown to have difficulty reading peers nonverbal behaviour, resulting in misunderstandings, conflict, exclusion, and peer victimization (Schroeder et al., 2014). Impairments in ToM are further reflected in the inability to differentiate between good and ill intended peers. As such, children with ASD may be more likely to trust or comply with malicious peer requests, such as saying or doing something inappropriate without appreciating the social appropriateness or consequences of the behaviour (Sreckovic et al., 2014). Studies examining ToM in individuals with ASD have shown significantly poorer performance on ToM tasks compared to TD peers (Baron-Cohen et al., 1985; Baron-Cohen et al., 2001; Happe, 1994; Senju, 2013). In one of the earliest studies of ToM in children with autism, Baron-Cohen and colleagues (1985) compared performance on Wimmer and Perner s puppet play paradigm across children with autism (n = 20), children with Down s Syndrome (n = 14), and TD controls (n = 27). Although the 36

37 group of children with autism had a higher mental age than the group of children with Down s Syndrome, only the children with autism failed to take into account the beliefs of others. Specifically, 80% (16/20) of the children with autism failed to differentiate between their own knowledge and the knowledge attributed to the doll. As such, the authors concluded that this impairment is independent of mental retardation and specific to autism (Baron-Cohen et al., 1985, p. 37). Moreover, Baron-Cohen et al., (2001) found that elementary school age children with ASD underperformed relative to TD children on the Reading the Mind in the Eyes (RME) test, which requires children to review 28 photographs of the eye region of the face to select the emotion (e.g., sad, happy, mad, frustrated) that best represents what the person in the photo is thinking or feeling. Performance on this task revealed a significant impairment in the ability of children with AS to identify the mental states and emotions of others. Many of the studies investigating ToM in ASD have explored first-order false belief tasks that require an individual to infer the thoughts and actions of another person based on a false belief (Baron- Cohen, 1989; Baron-Cohen et al., 1985; Leslie & Frith, 1988; Wellman, Cross & Watson, 2001; Wimmer & Perner, 1983). Compared to TD children who master first-order false belief tasks at 4-5 years of age, children with ASD generally fail these tasks, especially if the child has a comorbid ID diagnosis (Scheeren, Rosnay, Koot, & Begeer, 2012). Baron-Cohen (1989) was the first to examine false belief performance among children with autism, finding that none of the 10 child participants passed the belief question. However, the child participants in Baron-Cohen s (1989) study also had comorbid ID and therefore these results are not particularly surprising. Consistent with this line of thinking, studies have found a positive association between cognitive functioning, particularly verbal ability, and performance on false-belief ToM tasks, indicating that children with ASD with average cognitive functioning are likely to perform better on ToM tasks than children with ASD and cognitive deficits (Happe, 1994; Yirmiya, Solomonica-Levi, Shulman, & Pilowsky, 1996). 37

38 Although first-order belief tasks have received considerable attention when exploring ToM in children with ASD, advanced ToM tasks have begun to emerge as an area of growing interest in children with ASD. For example, Happe (1994) developed the Strange Stories task which requires children to infer the thoughts and feelings of fictional characters in a variety of social situations. Happe (1994) found that children with autism were impaired on the Strange Stories task compared to TD and intellectually disabled controls, indicating a deficit in their ability to recognize and communicate the internal mental states of the story characters. An alternative type of advanced ToM task includes secondorder false belief, which occurs when one takes into account what people think about other people s thoughts (Bauminger & Kasari, 1999, p. 83). Bowler (1992) found that children with HFASD performed comparably to TD children in their ability to pass a second-order belief task, but did differ in their ability to justify their response. As such, Bowler s findings revealed that children with HFASD may struggle to explain and justify their responses to the belief question, likely due to the need for higher cognitive abilities and more extensive social understanding. Bauminger and Kasari (1999) sought to further explore children with HFASD s performance on second-order false belief tasks, both in terms of the belief and justification component. Children with HFASD and a TD comparison group (7-15 years old) were provided with a social story in which they were asked a belief question ( where does Mary think that John has gone to buy ice cream? ) as well as a justification question ( why? ), that indicates the child s ability to take another s perspective (i.e., Mary s in this social story). Results indicated that the HFASD group did not significantly differ from their TD peers on accurately responding to the belief component of the question; however, the HFASD group was more likely to provide an inaccurate justification when asked to explain their belief response. As the authors emphasize, this result suggests that intact cognitive abilities do not compensate for limitations in social awareness and understanding. Across the small number of studies exploring advanced ToM in school- 38

39 age children with HFASD, there is consensus of some level of impairment when compared to TD peers (Beaumont & Sofronoff, 2008; Brent, Rios, Happe, & Charman, 2004; White et al., 2009). However, as White et al. (2009) highlight, there are significant individual differences in ToM performance, as the authors found that a large proportion of children with HFASD performed comparably or better than their TD peers on advanced mental state reasoning. In contrast to the literature base on children with HFASD, limited research has explored the performance of adolescents with HFASD on advanced ToM tasks and has yielded inconsistent results. While some studies have found impairments in advanced ToM in adolescents with HFASD (Baron- Cohen, Joliffe, Mortimore, & Robertson, 1997; Kleinman, Marciano, & Ault, 2001), others have failed to find any such impairment (Senju, Southgate, White, & Frith, 2009; Spek, Scholte, & Van Berckelaer- Onnes, 2010). To further elucidate ToM performance within the HFASD population, Montgomery, Stoesz, and McCrimmon (2012) sought to explore the role of ToM as a predictor variable of social outcomes for young adults (16-21 years old) with AS. Social stress and interpersonal relations from the BASC-2 were used as the social outcomes of interest. Consistent with some of the existing literature (Bowler, 1992; Ziatas, Durkin, & Pratt, 1998), the AS group demonstrated subtle ToM impairments when compared to a combined AS/autism group, but significant impairments when compared to the normative group. However, the authors highlighted that many individuals with AS have relatively intact ToM compared to individuals with autism and are thus able to successfully pass ToM tasks in experimental settings. ToM performance, determined using the RME, significantly predicted selfreported social stress but did not predict self-reported interpersonal relations. These results suggest that ToM may not explain the poor social interactions that are characteristic of individuals with AS (Montgomery et al., 2012). 39

40 In light of these mixed findings, Scheeren, de Rosnay, Koot, and Begeer (2012) aimed to evaluate and compare the advanced ToM abilities of 194 school-age children and adolescents with HFASD (6-20 years old) to a TD comparison group. Advanced ToM abilities were assessed using social stories that required second-order false beliefs, display rules, double bluff, faux pas, and sarcasm. Contrary to previous research and the author s hypotheses, no differences were found in the performance of school-age children and adolescents with HFASD on advanced ToM tasks when compared to the TD control group. However, adolescents were found to outperform school-age children across tasks. In addition, performance on the advanced ToM tasks was positively associated with participants age, verbal abilities, and general reasoning abilities, leading the authors to suggest that these three factors likely facilitate advanced ToM abilities (Scheeren et al., 2013). Despite the mixed results regarding performance of children with HFASD on experimental ToM tasks, research has shown that children and adolescents with HFASD struggle to understand the thoughts and intentions of others in everyday living (Bauminger & Kasari, 1999). For example, Ozonoff and Miller (1995) successfully taught children with ASD how to apply the concept of ToM, such that their performance over time on false belief tasks improved. However, there was minimal improvement in their global performance in social skills (Ozonoff & Miller, 1995). This finding is consistent with other studies highlighting that even children and adolescents with HFASD struggle to appropriately apply ToM concepts in real life situations (Bowler, 1992; Happe, 1994; Rutter & Bailey, 1993). Most recently, Begeer et al. (2011) explored the effectiveness of a randomized controlled trial of a 16-week ToM treatment for children ages 8-13 with HFASD. Although the results indicated improved conceptual ToM skills in the HFASD group compared to the TD control group, there was no improvement in selfreported empathic skills or parent-reported social skills. The findings of this study further highlights the limitations of generalizing improved conceptual ToM skills to daily life skills for children with HFASD. 40

41 ToM and bullying. According to research in the TD literature, ToM is relevant for everyday social interactions and for the development of healthy social relationships (Astington, 2001), and as such, students with delays or impairments in ToM may experience social difficulties and be exposed to negative social situations, such as peer victimization (Shakoor, Jaffe, Bowes et al., 2012). Specifically, the association between poor ToM and peer victimization has been proposed for several reasons. First, poor understanding of others intentions and thoughts may interfere with a student s ability to read and judge other s nonverbal social cues, in turn putting them at risk for peer victimization. Second, students with poor ToM may struggle to negotiate and resolve conflict by advocating for themselves, which may increase the risk of peer victimization due to being viewed as vulnerable and an easy target. Third, students with poor ToM may incorrectly interpret social cues and ambiguous situations as being hostile, and in turn experience peer victimization (Shakoor et al., 2012; Sutton, Smith, & Swettenham, 1999). Across studies of TD students, victims of bullying have demonstrated impairments in ToM, suggesting that the inability to understand one s own and other s perspectives may contribute to peer victimization (Gini, 2006; Sutton et al., 1999). For example, Gini (2006) and Sutton et al. (1999) found that school-age victims of bullying performed poorly on stories designed to assess their understanding of cognitions and emotions. Victims in both studies scored lower than non-victimized children in ToM skills, revealing the potential role of ToM for peer victimization. Moreover, in a longitudinal study exploring the predictive relevance of ToM skills in childhood for adolescent involvement in bullying, Shakoor et al. (2012) found that poor ToM predicted victimization in early adolescence, even after controlling for individual and family factors. As such, poor ToM was highlighted as an independent risk factor for increased exposure to peer victimization. In contrast, Caravita, Di Blasio, and Salmivalli (2010) did not find an association between ToM skills and peer victimization among primary school students, concluding that poor ToM abilities may not be a relevant risk factor for bullying. 41

42 ToM, ASD, and bullying. Emerging research has highlighted the association between deficits in ToM in individuals with ASD and the experience of peer victimization. Specifically, impaired ToM in children with ASD makes it difficult for them to read others social cues, which can result in increased experiences of peer victimization (Schroeder et al., 2014). The inability to perceive and attribute the mental states or emotions of oneself or others may potentially play a role in the vulnerability of children with ASD to being bullied. This suggestion is consistent with research highlighting the relation between bullying and social vulnerability, such that lacking social insight and social judgment heightens the risk of victimization for children with ASD (Sofronoff et al., 2011). Furthermore, a few studies have demonstrated that individuals with ASD struggle to accurately interpret social situations, which may be impacted by poor social insight. Pierce et al. (1997) asked children with ASD and a comparison group to interpret videotaped vignettes of positive and negative social interactions that featured various social cues (e.g., verbal behaviour, tone, nonverbal behaviour with and without an object). The authors found that children with ASD had difficulty interpreting social situations when the story contained more than one social cue. Loveland et al. (2001) also compared a group of children with ASD to a non-asd group on detecting inappropriate behaviours in video fragments. The authors found that the group with ASD had significantly more difficulty with detecting these inappropriate behaviours, but only for scenes that included verbal behaviour. Taken together, these two studies suggest that children with ASD can perceive and understand simple social situations with limited cues but significantly struggle to understand more complex social situations accurately, which may in turn place adolescents with ASD at an increased risk of peer victimization. In contrast, one of the few studies examining the relation of ToM to peer victimization perception among adolescents with ASD (12-19 years old), van Roekel, Scholte, and Didden (2010) required the ASD and non-asd group to evaluate videotaped fragments of social interaction as well as 42

43 complete bullying questionnaires and computerized ToM tasks. Teacher and peer ratings on victimization were also collected for both groups. When compared to the control group, the ASD adolescents did not significantly differ in their scores on the video fragments, indicating that the ASD adolescents were just as able as the non-asd adolescents to accurately perceive and report on bullying. With regard to the relation between reported prevalence of victimization and the extent of victimization, self and teacher-reported victimization were significantly related to the number of errors in evaluating the videotaped fragments. Specifically, the more the adolescents were victimized, as reported by themselves and teachers, the more they misinterpreted non-bullying situations as bullying (i.e., false positive errors). This relation was not found between self, peer, or teacher reported victimization and false negative errors (i.e., misinterpreting bullying situations as non-bullying). Furthermore, while ToM was not found to be related to the number of false positive errors, ToM was found to be negatively related to the number of false negative errors, indicating that individuals with higher ToM abilities made fewer false negative errors. This finding is to be expected as individuals are more likely to accurately perceive social situations with greater insight and understanding of others subjective mental states. In addition to ToM, Emotional Intelligence will be discussed to describe the second social cognition construct and its potential relation to peer victimization in the HFASD population. Emotional Intelligence Emotional Intelligence (EI) is the ability to accurately perceive, analyze, regulate, communicate, and produce one s own and others emotions (Mayer, Roberts, & Barsade, 2008; Salovey & Mayer, 1990). EI is necessary for effective awareness and expression of emotions, and in turn allows for the integration of feelings and thoughts for effective social functioning (Goleman, 1995). Specifically, EI encompasses a wide variety of competencies including perception and identification of emotions, emotional reasoning and understanding, emotional self-regulation, and the use of emotional information 43

44 to facilitate thought and behaviour (Mayer et al., 2008). As such, individuals with well-developed EI are typically more aware of their own and other s emotions, and are more effective at regulating and expressing their emotions (Mayer, Salovey, & Caruso, 2004). Moreover, high EI is associated with positive outcomes such as prosocial behaviour and positive peer and family relationships (Lopes, Salovey, & Straus, 2003), as well as high levels of well-being and better psychological adjustment (i.e., low levels of depression and deviant behaviour) (Davis & Humphrey, 2014). EI is comprised of two distinct constructs: ability EI and trait EI. While ability EI is conceptualized as a set of emotion-related cognitive abilities that are subject to improvement and are assessed using achievement tests, trait EI is conceptualized as a diverse set of emotion-related personality traits and behavioural tendencies that either exist or do not and are assessed through selfreport (Davis & Humphrey, 2014; Mavroveli, Petrides, Shove, & Whitehead, 2008; Kokkinos & Kipritsi, 2012). Characteristics of ability EI include understanding the meaning of emotions and the interconnected relation between emotions, reasoning, and problem solving (Davis & Humphrey, 2014; Mayer, Salovey, & Caruso, 2004), while characteristics of trait EI include self-perceptions such as selfawareness, self-esteem, and optimism (Davis & Humphrey, 2014; Bar-On, 1997). EI and ASD. Extensive research has highlighted the presence of emotional difficulties in children with ASD (Begeer et al., 2008; Sofronoff et al., 2011), particularly with regard to impaired trait EI. For example, Petrides, Hudry, Michalaria, Swami, and Sevdalis (2011) compared trait EI in individuals with and without AS, and found that participants with AS scored significantly lower than control participants. This finding was expected given the close alignment between trait EI factors (i.e., emotion expression, emotion perception, empathy, social awareness) and the social communication impairments characteristic of AS individuals. Moreover, Montgomery et al. (2010) found that while ability EI remained largely intact, individuals with ASD were significantly impaired in trait EI. As such, 44

45 these individuals performed appropriately on cognitive tasks related to emotional information, but selfreported impaired EI characteristics and performance across emotional interactions in real-life settings (Montgomery et al., 2010). In contrast, McCrimmon, Matchullis, and Altomare (2016) reported that children with HFASD did not significantly differ from TD children on a measure of trait EI. The authors suggest that EI may be intact in childhood, as the sample ranged from 8-12 years old, and that impairments in trait EI may develop over time if direct intervention is absent (McCrimmon et al., 2016). To explore the predictive relation between EI and social outcomes in ASD, Montgomery, Stoesz, and McCrimmon (2013) examined the role of EI as a predictor of social stress and interpersonal relations in young adults (16-21 years old) with AS. Trait EI performance significantly predicted both social stress and interpersonal relations. These results suggest that trait EI plays an important role in determining social outcomes. This finding is consistent with earlier research demonstrating the influence of trait EI on children s peer relations and the association between higher trait EI and prosocial behaviour (Mavroveli et al., 2007). For the purpose of the present study, the focus moving forward will be on trait EI in relation to peer victimization in students with ASD. EI and bullying. Emotional functioning plays a critical role in peer relations, bullying behaviour, and the risk of victimization (Arsenio & Lemerise, 2001). For example, Austin et al. (2005) observed that peer acceptance was related to students accurate emotion perception (trait EI), which in turn contributed to better peer relationships. The association between trait EI and school-based peer relations was further highlighted by Petrides, Sangareau, Furnham, and Frederickson (2006), such that primary-school aged children with high trait EI scores displayed more prosocial behaviour and received more nominations by their classmates for being co-operative and possessing leadership qualities (as 45

46 opposed to disruptive or aggressive). In contrast, students with impairments or ineffective emotional skills report higher levels of distress and social exclusion, which may lead to victimization. In light of research that school-age children with higher trait EI tend to experience more positive interpersonal relationships, adaptive coping styles, socioemotional competence, and lower scores on self-reported bullying behaviours (Ciarrochi et al., 2001; Frederickson, Petrides, & Simmonds, 2012; Mavroveli, Petrides, Rieffe, & Bakker, 2007; Mavroveli & Sachez-Ruiz, 2011), a negative association between trait EI and peer victimization has been suggested (Kokkinos & Kirpritsi, 2012). Specifically, Kokkinos and Kipritsi (2012) found that trait EI was negatively correlated with peer victimization in school-age (10-13 years old) children, and that trait EI emerged as a significant predictor with regards to peer victimization. Moreover, Mavroveli and Sanchez-Ruiz (2012) found that the child s EI score was negatively associated with both self and peer-reported bullying. These results suggest that a poor ability to recognize, understand, regulate, and express one s own or others emotions (trait EI) may increase the risk of peer victimization for students. In an exploration of the predictive relation of trait EI for peer victimization, Lomas, Stough, Hansen, and Downey (2012) found that lower scores on EI dimensions, specifically Emotions Direct Cognition (e.g., I use my gut feelings when I try to solve problems ) and Emotional Management and Control ( I find it hard to think clearly when I am worried about something ) significantly predicted the propensity at which adolescents (12-16 years old) self-reported peer victimization (Lomas et al., 2012). Therefore, these findings suggest that the risk for peer victimization is in part related to the victim s trait EI competencies, particularly the ability to manage emotions and use emotions in decision making to guide cognitive processes. These findings highlight that adolescents with better developed trait EI skills are less likely to become victims of bullying, and as such, a proactive approach targeting social skills and emotional intelligence may reduce the risk of peer victimization. 46

47 EI, ASD, and bullying. Although research has highlighted the importance of emotional functioning to peer victimization in TD children (Arsenio & Lemerise, 2001; Camodeca & Goossens, 2005; Spence, De Young, Toon, & Bond, 2009), few studies have examined the extent to which emotional functioning plays a role in peer victimization for children with ASD. As one of the few studies exploring this topic, Rieffe et al. (2012) examined the association between self-reported basic emotions (anger and fear) and moral emotions (shame and guilt) with peer victimization for children with ASD and TD children. Reiffe et al. (2012) found that although fear was reported more by children with ASD than TD children, fear was only related to victimization in TD children. In contrast, anger was uniquely associated with victimization in the ASD group, providing the strongest contribution to the prediction of peer victimization for children with ASD. These results suggest that dysregulation of anger may play an important role in peer victimization for children with ASD in two possible ways. On the one hand, children with ASD lack the social competence and awareness to appropriately respond to peer victimization, and their angry reactions may provoke or exacerbate the victimization. On the other hand, children with ASD lacking the ability to effectively regulate their emotions may easily overreact and thus become likely targets for victimization. As Rieffe et al. (2012) highlight, future research is required to better understand the role of emotional intelligence in the victimization of children with ASD. Summary Bullying is a highly prevalent international issue that poses significant adverse effects on children s development and quality of life. While there are several factors (e.g., age, mental health issues, and disability status) that increase a student s risk for peer victimization, students with ASD are uniquely at risk for peer victimization due to the core features of the disorder. Despite extensive research that has identified severity of ASD symptomology, social communication deficits, and poor peer relationships as risk factors for peer victimization within the ASD population, social cognition has been 47

48 under researched as a potential risk factor in the ASD bullying literature. For example, in two comprehensive literature reviews on the risk factors for bullying in the ASD population, neither author noted studies exploring ToM or EI as risk factors for peer victimization in this population (Schroeder et al., 2014; Sreckovic et al., 2014). In light of the research related to ToM and EI deficits in children with ASD, this population may be especially vulnerable to peer victimization due to impairments in these specific areas of social cognition. However, despite this evidence, atypical development of social cognition in children with ASD, specifically ToM and EI, has received limited attention as a risk factor for peer victimization. Present Study Previous research exploring risk factors for bullying of children with ASD have focused on symptom severity, social and communication skills, and peer relations, among many others; however, there is a paucity of research exploring social cognition, specifically ToM and EI, as a risk factor for peer victimization in the ASD population. ToM and EI have been used to help explain the social difficulties experienced by individuals with ASD, and as such, may help to explain the increased prevalence of bullying among children with ASD. Therefore, the purpose of the present study was to elucidate the relation between social cognition and peer victimization, and to understand the role of ToM and EI as predictors of peer victimization in students with HFASD better. Specifically, the current research questions seek to determine the relation between peer victimization and social cognition (EI and ToM) in students with HFASD. 1. Is prevalence of peer victimization for students with HFASD predicted from ToM or EI abilities? 2. Can ToM or EI abilities predict the frequency of peer victimization for students with HFASD? 48

49 Hypotheses 1. Students with HFASD with poor ToM and EI, as denoted by poor performance on ToM and EI tasks, will be more likely to experience peer victimization. 2. Students with HFASD with poor ToM and EI, as denoted by poor performance on ToM and EI tasks, will be more likely to experience more frequent peer victimization. 49

50 present study. Participants Chapter Three: Methods Chapter Three describes the participants, procedure, measures, and method used to conduct the The sample included 45 students with HFASD aged 8 to 17. All participants were required to have a previous diagnosis of ASD (Autism, Asperger Syndrome, or PDD-NOS) by a licensed professional and average or greater cognitive ability (i.e., a score of 80 or greater on the Full Scale Intelligence Quotient (FSIQ)) to ensure that the requirements for HFASD were met and that the participants had the necessary cognitive ability to complete the self-report questionnaires adequately. The participants ASD diagnosis was confirmed using the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2; Lord et al., 2012) and their cognitive ability was evaluated by the Wechsler Abbreviated Scale of Intelligence, Second Edition (WASI-II; Weschler, 2012). A parent and teacher for each student were also invited to participate. Parent data was collected for 44 students, while teacher data was only returned for 30 students. Due to poor response rate, teacher data was not used in the current analysis. Descriptive statistics were run to determine participant demographics. The ages of the student participants ranged from 8.12 to (M = 12.74, SD = 2.52), 39 of which were boys. Student s FSIQ scores ranged from 80 to 135 with a mean score of (SD = 14.02). Demographic information about the student participants can be seen in Table 1. Table 1. Demographic and Clinical Information. N Minimum Maximum Mean SD Child age (years) FSIQ

51 Note: Child age is reported in decimalized format (e.g., 11 years, 6 months is 11.5 years). FSIQ scores are from the Wechsler Abbreviated Scale of Intelligence, 2 nd Edition (WASI-II). Mean and standard deviation performance for the WASI-II is reported in standard score units. Recruitment occurred via a variety of methods. Principals of local school districts were contacted by regarding the study and asked to distribute information about the study to appropriate families. Similarly, community agencies and health professionals were asked to share the information with families who may be interested. Social media, including Facebook and television news, was used to reach families of individuals with ASD. Lastly, participants from prior or current research projects within the lab who gave consent to be contacted for further research were also invited to participate in the present study. Interested families contacted the research assistant by or phone. At that time, information pertaining to the child s eligibility for the study (age, diagnosis, estimated cognitive ability) was obtained and a time to meet was scheduled at the family s convenience. The child participant s parent was asked to inform the child s teacher about the study and inquire as to whether he/she would be willing to participate before meeting the researcher. Procedure The present study is part of a larger study exploring risk factors related to bullying in students with HFASD, which included the measures and procedures required to conduct the present study. Ethical approval was provided by the Conjoint Faculties Research Ethics Board at the University of Calgary. In addition, ethical approval was obtained from the local school districts to recruit students through those organizations. 51

52 Setting. Participation in the larger study required families to attend one or two sessions, equating to three to four hours total, at a post-secondary academic institution close to their home location (University of Calgary, York University, University of Manitoba, University of Alberta, and Grand Prairie Regional College). Parking costs were covered by the study. Data collection. Student participants and a parent came to their respective location to meet with the research assistant. Consent from parents and assent from students was obtained prior to beginning the study. Students and parents completed their respective measures simultaneously in different rooms. The student s eligibility for the study (ADOS-2 and WASI-II) was confirmed prior to their completion of the self-report measures. Students and parents completed questionnaires, computer tasks, and measures examining forms and prevalence of bullying, social cognition, and mental health difficulties. For the purpose of this study, self-report measures evaluating ToM and EI, and self and parent-report measures of peer victimization, were used for analysis. Parental involvement required approximately one hour, while student participation required three to four hours total. Students were offered drinks, snacks, and breaks throughout their involvement in the study. Teachers interested in participating were identified by parents and were mailed a package that included a consent form and their versions of questionnaires that were completed by parents and students. All students received a $25 gift card; parents and teachers received a $10 gift card. Measures Autism Diagnostic Observation Schedule, Second Edition (ADOS-2). Student participants completed the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2, Lord et al., 2012) to evaluate ASD symptomatology. The ADOS-2 is a semi-structured standardized assessment tool that includes play and interview activities to evaluate behaviour characteristic of ASD (including social, play, communication, and restricted and repetitive behaviour). The ADOS-2 is regarded as the gold 52

53 standard to aid in reliably assessing and diagnosing ASD in children 12 months of age through adulthood (Kanne, Randolph, & Farmer, 2008). Administration requires approximately minutes. It was administered by research reliable administrators. The ADOS-2 is comprised of five modules, each designed according to examinee language ability requirements and chronological age recommendations. Modules 3 and 4 were used in the current study. Module 3 is designed for individuals 16 and younger with expressive language skills typical of a 4-year-old or beyond whereas Module 4 is designed for verbally fluent adolescents and adults over the age of 16. The number and nature of activities that comprise each Module varies to best reflect the interests and abilities of examinees. In addition, each Module is comprised of unique coding items that are grouped into five broad categories: language and communication; reciprocal social interactions; play; stereotyped social interaction; and other behaviours. The ADOS-2 was standardized on a sample of children and adults with ASD, with other developmental disabilities, and with typically developing individuals. Internal consistency of the measure ranges from for the Communication and Social domains and for the Stereotyped Behaviors and Restricted Interests domain totals. Similarly, internal consistency for Module 4 was.84 and.61 for Social Affect and RRBs, respectively (Hus & Lord, 2014). Test-retest reliability scores for Modules 1-3 were calculated based on two administrations of the same module within one year, and ranged from Interrater reliability indicates high agreement (.79 or.98) across ratings on the three scoring domains, and a 92-98% agreement rate in diagnostic classification on Modules 1-3. Wechsler Abbreviated Scale of Intelligence, Second Edition (WASI-II). Students completed the Wechsler Abbreviated Scale of Intelligence, Second Edition (WASI-II, Wechsler, 2011) to evaluate their cognitive ability. The WASI-II is an abbreviated measure of intelligence for individuals aged 6 to 90 that takes minutes to administer. It consists of two indexes, Verbal Comprehension Index 53

54 (VCI; comprised of the Vocabulary and Similarities subtests) and Perceptual Reasoning Index (PRI; comprised of the Block Design and Matrix Reasoning subtests), and a Full Scale Intelligence Quotient (FSIQ; consisting of all four subtests). The WASI-II was standardized on a nationally representative sample of 2,300 American individuals aged 6-90 (Wechsler, 2011). An analysis of the measure s reliability and validity indicates internal consistency values ranging from for children and for adults. Test-retest reliability scores ranged from for the child sample and for the adult sample. Interrater reliability was high on both the PRI ( ) and VCI ( ). Theory of Mind. Students completed the children s version of the Reading the Mind in the Eyes Test (RME; Baron-Cohen et al., 2001) to assess ToM. The measure consists of 28 black and white photographs that depict an area around an individual s eyes. Each item provides four words (that differ for each picture) and the participants are asked to select the word that best describes the emotion that they believe that the person is feeling. According to Baron-Cohen et al. (2001), this measure is regarded as an assessment of how well an individual can put themselves into the mind of another person, and is therefore described as an advanced ToM test. Test-retest reliability has been deemed adequate (r =.72), and the test is considered reliable for children ages 8 to 17 (Baron-Cohen et al., 2001). Emotional Intelligence. Student participants completed the short form of the BarOn EQ-i Youth Version (BarOn EQ-i: YV (S); Bar-On & Parker, 2000) to assess trait EI. The measure requires participants to report their level of agreement with each of 30 items on a four-point Likert scale, ranging from one (never) to four (very often). The BarOn EQ-i YV(S) items are distributed across 5 scales: Total Emotional Intelligence, Interpersonal, Intrapersonal, Adaptability, and Stress Management. A sixth scale, Positive Impression, is used to identify exaggerated positive impressions of oneself. 54

55 Normative data for the BarOn EQ-i YV (S) was established based on a sample of children and adolescents from large English-speaking communities across the United States and Canada. Internal and test retest reliability for the subscale and total BarOn EQ-i: YV (S) scores have been reported as high (r =.93,.84, and.89 respectively; Bar-On & Parker, 2000). Bullying. Student and parent participants completed the PREVNet s Bullying Evaluation and Strategies Tool (PREVNet s BEST; Craig et al., 2013) to measure experiences of being bullied. The BEST measures multiple forms of bullying: physical, verbal, social, electronic, cultural, sexual, and disability. Participants reported their level of agreement with each statement on a four-point Likert scale ranging from zero (never) to four (more than four times) for the child s experience of being bullied in the past four weeks. Test-retest reliability of the PREVNet measure is deemed adequate (r =.77). Cross-validation with the Negative Acts Questionnaire, which measures the extent of negative behaviour (e.g., bullying) an individual experiences in a year, is high (r =.89; Craig et al., 2013). 55

56 Chapter Four: Results The current chapter provides an overview of the descriptive statistics, primary analyses, and the findings of the present study. Data Analysis The present study explored ToM and EI as risk factors for peer victimization in students with HFASD using a cross-sectional design with multiple raters. Specifically, 45 students and 44 parents participated in the study. Students completed measures evaluating their ToM (RME) and EI (BarOn EQi: YV (S)). Students and a parent individually completed a measure evaluating the student's prevalence and frequency of peer victimization (PREVNet s BEST). Descriptive statistics were initially run to provide student demographics, prevalence and frequency of peer victimization, and student performance on the RME and BarOn EQ-i: YV (S). A discriminant function analysis was proposed to address the first research question which sought to determine whether ToM and/or EI abilities predict peer victimization prevalence (victim vs. no victim status). In addition, an ordinal regression analysis was proposed to explore the second research question which sought to determine the prediction of peer victimization frequency via ToM and EI abilities. Overall Prevalence of Peer Victimization The PREVNet BEST data were examined to determine the prevalence of peer victimization according to student and parent participants. Students responded to questions asking how often they had experienced each of several specific forms of bullying (e.g., physical, verbal, social) in the past four weeks. Parents responded to similar questions in their form of the measure. Student and parent responses were categorized to determine the prevalence of peer victimization. Specifically, students were categorized as a victim if either they or their parent indicated that the student had been victimized via any of the seven forms of bullying in the past four weeks, irrespective of the form of bullying or the 56

57 frequency of bullying reported. While 35.6% of students reported being victimized in the past four weeks, 80.0% of parents reported that their child had been victimized in the past four weeks. Moreover, of the 35.6% of students who reported victimization in the past four weeks, 81.3% (13/16) of these students parents also indicated that their child was victimized in that time frame. Prevalence of peer victimization according to student and parent raters is outlined in Table 2. Table 2. Prevalence of Peer Victimization across Raters Victim (%) Non-Victim (%) Student Parent Prevalence of Specific Forms of Peer Victimization The PREVNet BEST data were also examined to determine the prevalence of the students experience of each form of peer victimization according to student and parent report. For each form of bullying, raters were provided with four response options to identify the frequency of bullying that the student experienced in the past four weeks: never; once or twice; three or four times; more than four times. All response options, with the exception of never, were combined to calculate the overall prevalence of peer victimization across the different forms of bullying in the past four weeks. According to student report, verbal bullying was endorsed most (26.7%), followed by physical (17.8%), social (15.6%), sexual (6.7%), disability (4.4%), electronic (4.4%), and racial bullying (2.2%). In comparison, social bullying of student participants was endorsed most by parents (57.8%), followed by verbal (55.6%), disability (35.6%), physical (20.0%), electronic (8.9%), sexual (8.9%), and racial bullying (2.2%). Prevalence of the seven forms of peer victimization according to student and parent raters is included in Table 3. 57

58 Table 3. Prevalence of Specific Forms of Peer Victimization across Raters Physical Verbal Social Electronic Race Sexual Disability Student (%) Parent (%) Overall Frequency of Student Reported Peer Victimization The PREVNet BEST data were further examined to determine the frequency of student reported peer victimization. Frequency of peer victimization was ranked on a scale from never to more than four times in the past 4 weeks (never was given a value of 0; one to two times was given a value of 1; three to four times was given a value of 2; and four or more times was given a value of 3). According to student report, the frequency of peer victimization in the past month ( how many times have you been bullied in the past 4 weeks? ), irrespective of the form of bullying (e.g., physical, verbal, social etc.,), was analyzed. Student report was analyzed exclusively for overall frequency, irrespective of the form of bullying, as parents were only asked frequency questions regarding the seven specific forms of bullying. It is worth noting that it was not possible to collapse across parent-reported frequencies of the specific forms of bullying to provide an overall frequency of parent reported victimization as it does not provide an accurate representation of overall parent-reported frequency. Frequency of peer victimization according to student report is detailed in Table 4. Table 4. Student Frequency of Peer Victimization. Student (%) Never times/month times/month times/month

59 Frequency of Specific Forms of Peer Victimization The PREVNet BEST data were also examined to determine the frequency of student s experience of seven specific forms of peer victimization according to student and parent report. For each form of bullying, raters were provided with four response options to identify the frequency of bullying that the student experienced in the past four weeks: never (value of 0); once or twice (value of 1); three or four times (value of 2); more than four times (value of 3). Frequency of the seven specific forms of peer victimization according to student and parent raters is highlighted in Table 5. Across the seven forms of bullying, students reported that they experienced verbal bullying most frequently, with 15.6% of students reporting having experienced verbal bullying once or twice in the past month, and 11.1% of students having experienced verbal bullying more than four times in the past month. Physical bullying was the next most frequently reported form of bullying, with 11.1% of students reporting having experienced physical bullying one or two times in the past month, 4.4% reporting three or four times times in the past month, and 2.2% reporting more than four times in the past month. Social bullying was the third most frequent form of bullying reported by students, with 11.1% of students reported having experienced social bullying one or two times in the past month and 4.4% reporting more than four times in the past month. Sexual bullying was reported by 2.2% of students as having been experienced one or two times in the past month and 4.4% reporting victimization four times in the past month. Disability bullying was reported by 4.4% of students as having occurred more than four times in the past month. The two least frequently reported forms of bullying include electronic and racial bullying, reported by 4.4% of students and 2.2% of students as having been experienced one or two times in the past month, respectively. Consistent with student report, verbal bullying was reported most frequently by parents, with 37.8% of parents indicating their child was victimized once or twice in the past month, 11.1% indicating 59

60 it occurred three or four times in the past month, and 15.6% indicating it occurred more than four times in the past month. Social bullying was reported by parents as the second most frequent form of bullying, with 31.1% of parents indicating their child was victimized once or twice in the past month, 11.1% indicating it occurred three or four times in the past month, and 15.6% indicating it occurred more than four times in the past month. Disability bullying was the third most frequent form of bullying according to parent report, with 26.7% of parents indicating their child was victimized once or twice in the past month, 6.7% indicating it occurred three or four times in the past month, and 2.2% indicating it occurred more than four times in the past month. Physical bullying was reported by 15.6% of parents as occurring once or twice in the past month, while 4.4% of parents indicated their child was physically victimized three or four times in the past month. Sexual bullying was the next most frequently reported form of bullying, with 4.4% of parents reporting their child was sexually victimized one or two times in the past month, and another 4.4% of parents reporting sexual victimization more than four times in the past month. The two least frequent forms of bullying according to parent report include electronic bullying, which was reported by 8.9% of parents as having occurred one to two times in the past month, and racial bullying, which was reported by 2.2% of parents as having occurred one to two times in the past month. Table 5. Frequency of Seven Forms of Peer Victimization across Raters. Student Parent Physical (%) 0= = 80.0 Verbal (%) Social (%) 1= = 4.4 3= 2.2 0= = = 0.0 3= = = = = 4.4 3= 0.0 0= = = = 6.7 0= =

61 Electronic (%) Race (%) Sexual (%) Disability (%) 2= 0.0 3= 4.4 0= = 4.4 2= 0.0 3= 0.0 0= = 2.2 2= 0.0 3= 0.0 0= = 2.2 2= 0.0 3= 4.4 0= = 0.0 2= 0.0 3= 4.4 2= = = = 8.9 2= 0.0 3= 0.0 0= = 2.2 2= 0.0 3= 0.0 0= = 4.4 2= 0.0 3= 4.4 0= = = 6.7 3= 2.2 Note: 0= never; 1= once or twice; 2= three or four times; 3= more than four times. Student Performance on the RME and BarOn EQ-i:YV (S) The RME and BarOn EQ-i:YV (S) were examined to determine student performance in the areas of ToM and EI. Performance on the RME ranged from 10 to 25 with a mean score of (SD = 3.34). On the BarOn EQ-i:YV (S), performance ranged from 65 to 128, with a mean score of (SD = 14.89). Student performance on the RME and BarOn EQ-i:YV (S) can be seen in Table 6. Table 6. Student performance on RME and BarOn EQ-i:YV (S) Mean (SD) Range RME (3.34) BarOn EQ-I YV (S) (14.89)

62 Discriminant Function Analysis Discriminant function analysis (DFA) is a statistical procedure that allows for the prediction of group classification based on performance on independent variables; it indicates the extent to which continuous independent variables contribute to differences between the groups (Pelham, 2013; Stevens, 2007). DFA is intended as a follow-up procedure to significant group differences identified using a Multivariate Analysis of Variance (MANOVA), which is a statistical procedure that examines whether a categorical independent variable differs based on continuous dependent variables. When significant group differences are identified via MANOVA, a DFA is conducted to determine the extent to which the variables contribute to such group differences (Norman & Streiner, 2008). In the context of the present study, DFA was intended to determine whether peer victimization prevalence (victim, non-victim) was predicted by ToM and/or EI, and to what extent ToM and/or EI abilities contribute to the differences between groups (victim, non-victim). As a prerequisite to the DFA, a MANOVA was performed to identify significant group differences (victim, non-victim) on ToM and/or EI. To perform the MANOVA, student and parent responses to the prevalence of victimization on the PREVNet BEST were categorized into victim and non-victim and inputted as the categorical independent variable. Two separate MANOVAs were conducted: prevalence according to students and prevalence according to parents, with student performance on the RME and BarOn EQ-i:YV(S) as the dependent variables. According to parent report, the victim (M = 18.42, SD = 3.5) and non-victim (M = 17.11, SD = 2.47) groups did not significantly differ on ToM, F(1, 45) = 1.100, p >.05, ( η =.025). Similarly, the victim (M = 95.44, SD = 15.11) and non-victim (M = 94.89, SD = 14.86) groups did not significantly differ on EI, F(1, 45) =.010, p >.05, ( η =.025). Additionally, the victim (M = 19.00, SD = 3.52) and 2 p non-victim (M = 17.69, SD = 3.21) groups did not significantly differ on ToM, F(1, 45) = 1.605, p > 2 p 62

63 .05, ( η =.036) according to student report. Finally, the parent-reported victim (M = 92.88, SD = 17.26) 2 p and non-victim (M = 96.69, SD = 13.55) groups did not significantly differ on EI, F(1, 45) =.672, p >.05, ( η =.015). 2 p Given that the MANOVA failed to identify any significant differences between the victim and non-victim groups, the DFA was not performed. Ordinal Regression Analysis Ordinal regression analysis (OR) is a statistical procedure designed to examine the predictive nature of two or more continuous independent variables on an ordinal outcome variable. Each independent variable is controlled statistically in terms of its association with the other independent variables, which allows researchers to compare the predictive strength of each independent variable on the dependent variable (Norman & Streiner, 2008; Pelham, 2013; Stevens, 2007). Frequency of peer victimization was ranked on a scale from never to more than four times in the past 4 weeks (never was given a value of 0; one to two times was given a value of 1; three to four times was given a value of 2; and four or more times was given a value of 3). Student responses to the frequency of peer victimization in the past four weeks ( how many times have you been bullied in the past 4 weeks? ), irrespective of the form of bullying (e.g., physical, verbal, social etc.), was used as the ordinal outcome variable, while student performance on the RME and BarOn EQ-i:YV (S) were used as the independent variables. Student report was used exclusively for this analysis, as parents were not asked questions regarding the frequency of bullying irrespective of the form of bullying. Prior to running this analysis, the four assumptions of OR were evaluated. While three out of four of the assumptions were met (dependent variable is ordinal; independent variables are continuous; and there is no multicollinearity), the fourth assumption, proportional odds, was violated according to the full likelihood ratio test. To further explore if the assumption of proportional odds was met, separate 63

64 binomial logistic regressions on cumulative dichotomous dependent variables were run. This process required creating three new dichotomous dependent variables, which were labeled SelfVictim1 (1= never; 0= 1-2x/month, 2-3x/month, 4+/month), SelfVictim2 (1= never and 1-2x/month; 0= 2-3x/month and 4+/month) and SelfVictim3 (1= never, 1-2, 3-4; 0= 4+/month), that represented the cumulative splits of the categories of the ordinal dependent variable. According to the results of the separate binomial logistic regressions, the odds ratios for SV1 and SV2 on ToM and EI were similar; however, SV3 was distinctly different, indicating that the assumption of proportional odds may not be met. Therefore, it is important to interpret the following results of the ordinal regression with caution. According to student report, the ordinal regression did not indicate any significant predictions between student ToM or EI and their frequency of peer victimization. Specifically, the final model does not significantly predict frequency of peer victimization over and above the intercept model, χ 2 (2) = 1.716, p >.05. As such, performance on the RME is not significantly associated with an increase in the frequency of peer victimization Wald X2 (1) = 1.039, p >.05, (95% CI, to.291). Similarly, performance on the BarOn EQ-i YV (S) was not significantly associated with an increase in the frequency of peer victimization, Wald X2 (1) =.426, p >.05, (95% CI, to.028). These results suggest that ToM and EI do not predict the frequency of peer victimization for students with HFASD. Results are included in Table 7. Table 7. Ordinal regression predicting frequency of peer victimization by ToM and EI. Estimate Std. Error Wald Df Sig. Lower Upper RME BarOn EQ-i:YV (S)

65 Chapter Five: Discussion The present study extends the current literature by examining the role of social cognition, specifically ToM and EI, as risk factors for peer victimization within the uniquely vulnerable population of students with HFASD. Variables were initially analyzed descriptively to examine the prevalence and frequency of victimization, as well as student performance on measures of ToM and EI. Subsequently, analyses pertaining to the research questions were conducted. Each of these analyses and their implications will be discussed in turn. Overall Prevalence of Victimization The PREVNet BEST data were examined to determine the prevalence of peer victimization according to student and parent participants. According to students, 35.6% reported being victimized in the past four weeks and 80.0% of parents reported that their child had been victimized in the past four weeks. Moreover, of the 35.6% of students who reported victimization in the past four weeks, 81.3% (13/16) of these students parents also indicated that their child was victimized within that time frame. Student Report. The present student-reported prevalence of victimization is consistent with the few studies reporting on victimization of students with ASD within a monthly timeframe. Specifically, Twyman et al. (2010) found that 29% of students with ASD reported being victimized, a rate that was three to four times higher than TD students in the same study. In addition, Rose, Simpson, and Ross (2015) found that 33.9% of students with ASD reported high levels of victimization, defined by the authors as at least one standard deviation above the total population mean score. As such, the prevalence of peer victimization of students with ASD in the past month reported in the current study and previous reports is much higher than that reported for TD students (Glew et al., 2010; Molcho et al., 2009; Solberg & Olweus, 2003). 65

66 In light of the limited studies providing self-reported prevalence of victimization within the past month, a comparison of the current student reported prevalence to studies using diverse reference periods (i.e., past 6 months, past year, lifetime) is warranted. Depending on the reference period used, self-reported prevalence rates of victimization among students with ASD range from 28-57%, further highlighting consistency with the victimization prevalence rate of the current study (35.6%). For example, Chen and Schwartz (2012) found that students with ASD reported prevalence rates of 28% over the past year, Rowley et al. (2012) found that 42% of students reported victimization over their lifetime, and Kowalski and Fedina (2011) reported a prevalence rate of 57% for students experiencing victimization within the past two months. In contrast, Wainscot et al. (2008) reported higher rates (90% of students with HFASD reporting victimization) which the authors attributed to diagnostic status as individuals with intact cognitive abilities and milder social impairments have been found to be victimized more than students with more severe ASD symptomatology (Cappadocia et al., 2012; Sterzing et al., 2012; Zablotsky et al., 2014). Moreover, Wainscot et al. (2008) did not specify the reference period used to measure victimization and as such, this may also have impacted the higher prevalence rates found in this study compared to other studies. Parent Report. The parent-reported prevalence of victimization (80.0%) from the current study is also consistent with parent-report from previous studies of students with ASD within the past month, with rates ranging from 38% (Zablotsky et al., 2014) to 77% (Cappadocia et al., 2012). Similar to the self-reported results in Wainscot et al. (2008) that highlighted elevated prevalence rates among individuals with milder social impairments and intact cognitive functioning (compared to individuals with more severe ASD symptomology), Zablotsky et al. (2014) found that parents of individuals with AS reported higher prevalence rates of victimization (48.7%) compared to individuals with Autism (19.3%) and other ASDs (24.9%). 66

67 Studies examining parent-report of victimization among students with ASD using distinct reference periods than the current study indicate prevalence rates ranging from 33-94%, depending on the reference period used (i.e., past 2 months, past 6 months, past year). For example, studies exploring parent-reported victimization of students with ASD have found prevalence rates ranging from 30-94% within the past year (Bear et al., 2015; Carter, 2009; Chen & Schwartz, 2012; Little, 2002; Sterzing et al., 2012), 33% within the past six months (Rowley et al., 2012), and 70% within the past two months (Kowalski & Fedina, 2011). The parent-reported prevalence found within the current study (80.0%) is in line with studies using a variety of reference periods to measure victimization. Moreover, the current findings overlap with multiple meta-analyses of peer victimization of the ASD population, highlighting that students with ASD are victimized at alarmingly high rates (Sreckovic et al., 2014, p. 1161) compared to students with other disabilities and students without disabilities (Humphrey & Hebron, 2015; Maiano et al., 2015; Schroeder et al., 2014). For example, across 15 studies using multiple informants and diverse reference periods, Mainano and colleagues (2015) stated an estimated pooled prevalence rate of 44% for overall victimization of students with ASD. Of these 15 studies, seven used the past year as the reference period, with 4 studies using a onemonth reference period, and the remaining studies not specifying a timeframe. Despite the variability in reference periods, Maiano et al. (2015) concluded that across these 15 studies, the risk for victimization among students with ASD was three times higher than TD peers. In contrast to the prevalence of victimization of the ASD student population, prevalence rates among TD students range from 10-33% (Bear et al., 2015; Glew et al., 2000; Nansel et al., 2001; Scheithauer et al., 2006; Solberg & Olweus, 2003), with 33% of students reporting occasional victimization (defined as once or more in the past couple months) and 10% of students reporting chronic victimization (defined as two or more times in the past couple months; Molcho et al., 2009). 67

68 Although there is considerable variability in prevalence rates across studies due to methodological differences such as definitions of bullying, reference periods to evaluate prevalence (e.g., one month, one year, lifetime), frequency cutoff scores (e.g., sometimes, often), informants (parents, child, teacher, peer), and data collection approaches (questionnaire, interview, observation; Schroeder et al., 2014), it is uniformly clear that peer victimization occurs at strikingly higher rates among students with ASD than TD peers. The current findings of student-reported (35.6%) and parent-reported (80.0%) overall peer victimization are consistent with studies reporting two to three times higher peer victimization rates compared to TD children (Cappadocia et al., 2012; Little, 2002; Twyman et al., 2010). Prevalence of Specific Forms of Peer Victimization The PREVNet BEST data were also examined to determine the prevalence of the students experience of seven specific forms of peer victimization. Student Report. Students endorsed verbal bullying the most (26.7%) within the past month, followed by physical (17.8%), social (15.6%), sexual (6.7%), disability (4.4%), electronic (4.4%), and racial forms of bullying (2.2%). Verbal bullying has emerged as one of the most common forms of victimization in the bullying literature. Specifically, Wainscot et al. (2008) found verbal bullying (i.e., called names/get teased) to be reported most by youth with HFASD (50%) at a rate three times more common than physical abuse (17%). Rowley et al. (2012) and Zeedyk et al. (2014) also found teasing and name calling to be self-reported most often by students with ASD (20.2% and 78.8%, respectively). Moreover, while students with ASD experienced significantly more verbal bullying than their peers with ID, students with ASD also reported significantly more physical bullying (51.5%) compared to students with ID (37.5%) and TD control children (16.2%; Zeedyk et al., 2014). Rose et al. (2015) found that 33.9% of students with ASD were victimized at high rates whereas only 14.5% of students without disabilities reported victimization at high rates. More specifically, high rates of relational aggression 68

69 (i.e., social exclusion) were endorsed more by students with ASD (22%) compared to TD students (13.4%; Rose et al., 2015). In contrast to the present results, Kloosterman, Kelley, Craig, Parker, and Javier (2013) found that students with HFASD self-reported relational exclusion as occurring most (45.8%), with verbal bullying following closely behind (41.7%). Physical (29.2%) and sexual (29.2%) forms of bullying were similarly reported in the sample, followed by religious (16.7%), racial (12.5%), and cyber (12.5%) forms of bullying. The high frequency of verbal victimization is also reported by TD students. Khamis (2015) found verbal bullying (12.5%) to be the most common form of victimization based on self-report from TD children, followed by social rejection from a group (10.4%). Similarly, Karlsson et al. (2014) found that TD adolescents reported verbal bullying most (22%), followed by social bullying (16.4%) and physical bullying (3.9%). Wang, Iannotti, Luk, and Nansel (2010) found that students reported verbal victimization most (36.9%), followed by rumor spreading (32.1%), social exclusion (25.8%), physical (13.2%), and cyber (10.1%) forms; however, it is evident that the prevalence rates of each form of bullying is higher compared to the current study. The higher prevalence rates in Wang et al. (2010) may be due to the nationally representative sample of 7000 students, the reference period used (i.e., past couple of months) to measure bullying prevalence, or the age range (grades 6-10) of student participants. Previous studies have further highlighted that verbal and social forms of victimization are more prevalent than physical and cyber forms of victimization (Wang et al., 2009). Parent Report. In comparison, social bullying of student participants was endorsed most by parents (57.8%) within the past month, followed by verbal (55.6%), disability (35.6%), physical (20.0%), electronic (8.9%), sexual (8.9%), and racial bullying (2.2%). Consistent with the current findings, parents in Cappadocia et al. (2012) reported that students with ASD experienced social bullying (69%) most in the past month, followed by verbal (68%), 69

70 physical (42%), and cyber (10%) forms of victimization. In contrast, Sofronoff et al. (2011) found verbal teasing (46%) to be reported most by parents, followed by physical (32%), verbal (16%), disability-focused (15%), social (10%) and cyber bullying (2%). Sofronoff et al. (2011) adopted a qualitative approach to capture key themes relevant to the victimization of individuals with ASD. Parent comments that were identified as verbal teasing included kids at school call him psycho and he/she is picked on for the way he speaks. Little (2002) found that 75% of parents reported that their child was emotionally victimized, defined as being called names, saying mean things, or being socially excluded. Carter (2009) found 50% of parents reported that their child with AS was scared by their peers, whereas 47% reported being hit by peers and 44% reported being picked on. In a comparison of parent report of victimization across students with ASD, ID, and a TD control group, Zeedyk et al. (2014) found that the prevalence of different forms of bullying (i.e., verbal, physical, relational) did not significantly differ across groups (i.e., ASD, ID, TD). As such, parents of students with ASD and TD reported verbal bullying most (71.4% and 66.7%, respectively). Other studies have similarly found that parents of TD children report verbal bullying as the most common form of peer victimization (Bear et al. 2015; Wainscot et al., 2008). Across student and parent report, irrespective of the reference period, the current findings are consistent with majority of the bullying literature that has identified the common occurrence of verbal and social forms of victimization among school-age children with and without ASD (Cappadocia et al., 2012; Craig & Pepler, 2007; Woods & White, 2005). Overall Frequency of Student Reported Victimization The PREVNet BEST data were further examined to determine the frequency of student reported victimization irrespective of the form of bullying. The majority of students (64.4%) reported that they were not victimized within the past month, while 17.8% reported being victimized one to two times in 70

71 the past month, 6.7% reported being victimized three to four times in the past month, and 11.1% reported being victimized four or more times in the past month. Although there is a paucity of studies exploring the frequency of student-reported victimization in the past month, the current findings are consistent with an available study showing that 17% of students with ASD reported having been victimized by peers more than once a month (van Roekel et al., 2010). For the purpose of comparing across studies, future research would benefit from exploring bullying in the past month. Frequency of Specific Forms of Victimization The PREVNet BEST data were also examined to determine the frequency of student s experience of the seven specific forms of peer victimization according to student and parent report. Across the seven forms of bullying, students reported that they experienced verbal bullying most frequently, with 15.6% of students reporting having experienced verbal bullying once or twice in the past month, and 11.1% of students having experienced verbal bullying more than four times in the past month. Physical bullying was the next most frequently reported form of bullying, with 11.1% of students reporting having experienced physical bullying one to two times in the past month, 4.4% reporting three or four times in the past month, and 2.2% reporting more than four times in the past month. Social bullying was the third most frequent form of bullying reported by students, with 11.1% of students reported having experienced social bullying one to two times in the past month and 4.4% reporting more than four times in the past month. Sexual bullying was reported by 2.2% of students as having been experienced one to two times in the past month and 4.4% reporting victimization four times in the past month. Disability bullying was reported by 4.4% of students as having occurred more than four times in the past month. The two least frequently reported forms of bullying include electronic and racial bullying, reported by 4.4% of students and 2.2% of students as having been experienced one to two 71

72 times in the past month, respectively. Consistent with student report, verbal bullying was reported most frequently by parents, with 37.8% of parents indicating that their child was victimized once or twice in the past month, 11.1% indicating that it occurred three or four times in the past month, and 15.6% indicating that it occurred more than four times in the past month. Social bullying was reported by parents as the second most frequent form of bullying, with 31.1% of parents indicating that their child was victimized once or twice in the past month, 11.1% indicating that it occurred three or four times in the past month, and 15.6% indicating that it occurred more than four times in the past month. Disability bullying was the third most frequent form of bullying according to parent report, with 26.7% of parents indicating that their child was victimized once or twice in the past month, 6.7% indicating that it occurred three or four times in the past month, and 2.2% indicating that it occurred more than four times in the past month. Physical bullying was reported by 15.6% of parents as occurring once or twice in the past month, while 4.4% of parents indicated that their child was physically victimized three or four times in the past month. Sexual bullying was the next most frequently reported form of bullying, with 4.4% of parents reporting that their child was sexually victimized one or two times in the past month, and another 4.4% of parents reporting sexual victimization more than four times in the past month. The two least frequent forms of bullying according to parent report include electronic bullying, which was reported by 8.9% of parents as having occurred one to two times in the past month, and racial bullying, which was reported by 2.2% of parents as having occurred one to two times in the past month. Although several studies in the literature have explored self and parent report of the prevalence of various forms of bullying (Cappadocia et al., 2012; Carter, 2009; Kloosterman et al., 2013; Rowley et al., 2012; Wainscot et al., 2008; Zeedyk et al., 2014), the frequency of each form of bullying is not reported in detail to the extent that the current study provides above. Instead, the majority of the existing 72

73 research reports the prevalence of victimization according to the form of bullying (i.e., verbal, social, physical). As such, self-reported frequency of the seven forms of victimization captured in the current study is a unique contribution to the literature. Student Performance on the RME and BarOn The RME measured student s ToM abilities. With a maximum possible score of 28, student performance on the RME ranged from 10 to 25 with a mean score of (SD = 3.34). While normed scores do not exist for the RME, a raw score of 9 or more is recognized as above chance (Baron-Cohen et al., 2001) and an average score of 18 for men (SD = 2.5) and 21 for women (SD = 1.8) has been found in the adult general population (Baron-Cohen et al., 1997). Studies examining ToM using the RME have found that adults with ASD perform lower on the RME, with scores ranging from 13 to 23 (M = 16.3, SD = 2.9) compared to 16 to 25 (M = 20.3, SD = 2.63) in the control group (Baron-Cohen et al., 1997). Moreover, Baron-Cohen, Wheelwright, Hill, Raste, and Plumb (2001) found that adults with HFASD performed more poorly (M = 21.9, SD = 6.6) than the general population (M = 26.2; SD = 3.6). Limited studies have assessed children with ASD s performance on the RME. Baron-Cohen, Wheelright, Hill, Raste, and Plumb (2001) found that children with ASD scored more poorly (M = 12.6, SD = 3.3) than TD controls (mean ranged from according to age groups). Moreover, Montgomery et al. (2012) found that adolescents and young adults with AS scored significantly lower on the RME than the normative group. In contrast to the above studies, the performance of the current sample of students with ASD is higher than existing findings. The BarOn EQ-i:YV (S) measured student s EI abilities. Student performance on the measure ranged from 65 to 128, with a mean score of (SD = 14.89). The BarOn is a normed measure with a mean standard score of 100 and a standard deviation of 15. According to Bar-On and Parker (2000), a standard score below 80 on the Total EQ scale indicates an underdeveloped capacity for emotionally and 73

74 socially intelligent behaviour (p.17). Of the students in the current sample, only 13% (6/45) obtained a standard score below 80, indicating that the majority of the sample was within the low average or higher range, and as such, comparable to the normative sample. The current findings challenge some existing literature suggesting that trait EI is a specific weakness that potentially underlies the social interaction challenges characteristic of individuals with HFASD (Montgomery et al., 2010; Montgomery et al., 2008). Instead, the current findings suggest that students with HFASD do not significantly differ on trait EI compared to TD controls, which is consistent with other studies that have identified EI as an area of personal relative strength for children (as opposed to adolescents or adults) with HFASD (McCrimmon, Matchullis, & Altomare, 2016). For example, McCrimmon et al. (2016) found similar performance on the Bar-On EQ-i:YV for children with HFASD (M = ) compared to age and gender matched TD controls (M = ). In light of these findings, McCrimmon and colleagues (2016) suggest that EI may be intact in childhood, as the sample ranged from 8-12 years old, and that impairments in trait EI may develop over time if direct intervention is absent. Taken together, it is evident that student performance on the RME and BarOn in the current sample was higher than hypothesized. Possible explanations for these results will be discussed below. Research Questions and Hypotheses Two research questions with corresponding hypotheses were posed. The first research question aimed to determine whether students with HFASD and poor ToM and EI, as denoted by poor performance on ToM and EI tasks, are be more likely to be bullied. As such, a DFA was planned to determine whether peer victimization status (victim, non-victim) was predicted by ToM and/or EI, and to what extent ToM and/or EI abilities contributed to the differences between groups (victim, nonvictim). As the MANOVA results failed to identify any significant differences between the victim and non-victim groups, the DFA was not performed and this hypothesis was not supported. The second 74

75 research question aimed to determine whether students with HFASD and poor ToM and EI experience more frequent peer victimization. As such, an OR was performed to examine the predictive nature of ToM and/or EI on student-reported frequency of peer victimization. The results did not indicate any significant predictions between student ToM or EI and frequency of peer victimization, and as such this hypothesis was not supported. Collectively, these results suggest that poor social cognition, specifically ToM and EI, is not predictive of peer victimization for students with HFASD. There are several possible explanations for the current results. First, student performance on the RME and BarOn EQ-i: YV(s) was better than hypothesized for this population based upon previous findings (Baron-Cohen, 1985; Baron-Cohen et al., 1989; Baron-Cohen et al., 2001; Happe, 1994; Montgomery et al., 2012; Montgomery et al., 2010; Montgomery et al., 2008). However, the performance of individuals with ASD on social cognition tasks has been shown to differ significantly according to cognitive functioning. Specifically, children with ASD and intact cognitive functioning perform better on social cognition tasks than children with ASD and comorbid cognitive impairments (Happe, 1994; White et al., 2009; Yirmiya et al., 1996). As such, the intact cognitive functioning of the students in the current study may explain the increased performance on the ToM and EI tasks. Additionally, the students in the current study may be more aware of being bullied and thus be more likely to report peer victimization, thereby explaining the higher prevalence of self-reported peer victimization. This rationale mirrors Rowley and colleagues (2012) finding that peer victimization was higher among students with ASD with higher social and communication abilities because this group of students were more likely to recognize and report bullying than children with greater challenges in social communication skills and, as such, have higher rates of victimization. Second, the results suggest that individuals with HFASD with stronger ToM and EI abilities may actually experience elevated prevalence of peer victimization, potentially due to their unique differences 75

76 that make them stand out from their TD peers. Compared to prevalence rates among TD students (10-33%; Bear et al., 2015; Glew et al., 2000; Molcho et al., 2009; Solberg & Olweus, 2003), student (35.6%) and parent (80%) report in the current study highlight the striking increase in peer victimization rates for students with ASD. While several studies have explored a variety of developmental, social, communicative, and diagnostic characteristics of students with ASD to better understand the heightened risk for victimization (Cappadocia et al., 2012; Rowley et al., 2010; Sterzing et al., 2012; Zablotsky et al., 2014), it is within reason that students with HFASD and intact social cognition are more likely to stand out from their TD peers and therefore be at an increased risk for victimization. For example, individuals with HFASD that possess intact social cognition may actually be insightful, emotionally aware, and in tune to the thoughts of oneself and others, but struggle to apply this knowledge in a socially appropriate and acceptable way with peers, and as such, these students are at a heightened risk for victimization. For example, a student with HFASD may recognize someone is upset and try to cheer them up, but may talk excessively, make inappropriate comments, and use intense eye contact, all of which signify social differences and place that child at risk for peer victimization. Lastly, it is possible that social cognition, specifically ToM and EI, is not a relevant risk factor for peer victimization of the HFASD population. Despite a considerable body of research highlighting the role of social cognition for peer victimization of TD children (Arsenio & Lemerise, 2001; Gini, 2006; Lomas et al., 2012; Kokkinos & Kipritsi, 2012; Mavroveli & Sanchez-Ruiz, 2012; Shakoor et al., 2011; Sutton et al., 1999), there is a paucity of research identifying a potential relation between social cognition and peer victimization within the HFASD population (Rieffe et al., 2012; van Roekel et al., 2010). The current findings support the notion that these specific constructs may not play a role in the victimization of students with HFASD. 76

77 Limitations The current study was not without its limitations. First, despite extensive recruitment efforts, the sample size was much smaller than anticipated and, as such, may have impacted the statistical analyses and results. Second, the sample consisted of mostly males which may restrict the generalizability of the findings of this study. Third, the exclusion of teacher report due to poor response rate further limits the generalizability of the results and fails to provide a third party perspective regarding the prevalence and frequency of peer victimization for students with HFASD. The poor response rate of teachers was likely due to the timing at which many of the questionnaires were received by a large number of teachers (i.e., toward the end of the school), and should be strategically addressed in future research. Fourth, the study exclusively used self-report measures of ToM and EI and thus relied on self-report to assess social cognition. Although the research supports the use of self-report with individuals with ASD as a reliable and valuable source of information across a variety of constructs (i.e., bullying, mental health, quality of life) (Adams et al., 2014; Begeer et al., 2015; Ozsivadjian et al., 2014; Rieffe et al., 2012; Van Roekel et al., 2010; Shipman et al., 2011), additional perspectives (i.e., parent or teacher) may have provided unique information related to the student s ToM and EI abilities; however, there are currently no existing validated parent or teacher-report measures of EI or ToM. Lastly, the absence of a matched TD control group limits comparison of the prevalence and frequency rates of victimization to the HFASD group as well as performance on the ToM and EI measures. A limitation of the data analysis and results was the violation of the assumption of proportional odds according to the full likelihood ratio test. This violation suggests that the results of the ordinal regression should be interpreted with caution. That being said, the results of the ordinal regression are non-significant, and thus this violation posed less of an issue for the current study. 77

78 Strengths Despite these limitations, this study benefited from several strengths. First, this study included a self-report measure of peer victimization and thus captured the personal experience of the student that other individuals (i.e., parents, teachers, peers) may not observe or be aware of (Blake et al., 2012). Moreover, the prevalence of bullying may be underestimated from parent-report due to limited opportunity to observe school-related victimization directly (Blake et al., 2012) and therefore self-report provides a critical perspective for comparison. Second, in addition to examining multiple forms of bullying (i.e., verbal, physical, sexual, religious etc.), the current survey included a broader variety of forms compared to existing studies that primarily focus on verbal, social, physical and cyber forms of bullying. Definitions and pictures of each form of bullying were included in the PREVNet BEST to remove ambiguity of interpretation for participants. Moreover, the frequency of experiencing the multiple forms of bullying uniquely contributes to the literature as no known existing studies have explored the frequency of specific forms of bullying within this at-risk population. Lastly, the reference period (i.e., past month) used to examine bullying experiences is likely to be more accurate and not impacted by memory as significantly as if the reference period had been longer (e.g., past year). However, it should be noted that a shorter time frame may also limit the ability to capture bullying experiences that have occurred prior to the past month. Additionally, the current study benefited from the measures that were used to confirm study inclusion. Specifically, the ADOS-2 was used to confirm the student s ASD diagnosis and the WASI-II was used to confirm the student s cognitive abilities. The use of these comprehensive standardized assessments allows for stronger conclusions relevant to the HFASD population. In addition, the use of the WASI-II to confirm cognitive functioning ensured that students were able to complete the bullying 78

79 and social cognition self-report measures. Lastly, the current study explored bullying of students with HFASD within a Canadian sample, representing a unique contribution to the bullying literature. Implications Limited research has explored the role of social cognition, specifically ToM and EI, as a risk factor for peer victimization within the HFASD population. In light of compelling evidence highlighting the adverse impact of peer victimization on children s psychological, interpersonal, and academic functioning, it is critical to identify risk factors that increase the prevalence of peer victimization with the intent to develop prevention and intervention efforts to avoid and reduce these harmful acts. Contrary to the hypotheses, the current results suggest that social cognition may not be a relevant risk factor for peer victimization for the HFASD population. As such, it may be more pertinent to further explore risk factors that are particularly relevant to students with HFASD in relation to bullying (e.g., social and communication deficits) to better understand the nature of the relation and how to effectively support this group of vulnerable students. This research has important implications for students, parents, teachers and clinicians interested in preventing victimization and promoting resilience to help students overcome peer victimization. Moreover, the results indicate that students with HFASD performed well on measures of ToM and EI, highlighting a potential strength to be capitalized on in intervention efforts to address the social interaction and interpersonal skill deficits of students with HFASD. In addition, emphasizing the role of protective factors holds promise for reducing the incidence of victimization as well as mitigating the negative effects often associated with bullying. For example, fostering friendships within inclusive classrooms, promoting education and acceptance of HFASD students among typically developing peers, and adopting school-wide inclusive practices to avoid potential social exclusion and peer victimization must be prioritized. Moreover, Karlsson et al. (2014) highlighted the importance of parental warmth and 79

80 teacher support as factors that reduced the risk of peer victimization among TD students. It is important for school psychologists to adopt a strengths-based approach to bullying prevention and intervention in hopes of reducing bullying and enhancing resilience among victimized students and, in turn, lessening the pervasive negative outcomes associated with peer victimization. Future Directions Given the results of the current study, there are several possible directions for future research. While the current results suggest that ToM and EI may not be relevant risk factors for victimization, this exploration would benefit from a larger sample size, inclusion of more females, and collection of teacher-report that will allow for greater strength in statistical analyses and generalization of results. In addition, inclusion of parent and teacher measures of social cognition may provide unique insight into the student s ToM and EI abilities. Furthermore, peer report has been identified as the gold standard for estimating the prevalence and frequency of victimization within the TD population (Blake et al., 2012, p. 211), and may provide an important and reliable perspective of bullying within the classroom. Moreover, incorporating a qualitative component to the methodology would provide a rich opportunity to gain insight into the quality of the student s victimization experience to allow for greater detail regarding prevalence and frequency of bullying and to provide specific examples of the nature of the various forms of bullying experienced by this population, so that prevention and intervention efforts may be better informed. Lastly, it will be important that future studies explore victimization within the HFASD population using a longitudinal design to elucidate causal relations between risk factors, peer victimization, and adverse outcomes. A TD control group should also be included to compare rates of peer victimization and performance on the social cognition measures utilized in the study. Future research would also benefit from including an additional component to ToM and EI tasks that require participants to explain their responses. In line with Bowler (1992) and Bauminger and 80

81 Kasari (1999), it is possible that even though students with HFASD perform comparably to TD peers on some aspects of ToM tasks, they struggle to accurately interpret and justify their ToM responses when required to verbally explain their response. As such, although individuals with HFASD may be able to equivalently respond to some aspects of ToM tasks as TD individuals, they will likely still struggle to recognize and apply the social context of the task in their explanation. This distinction is further evident in the performance of students with ASD on experimental tasks compared to using social cognition abilities in real-life social situations. Finally, it is important to mention that generalization across research exploring the prevalence and frequency of victimization is limited due to considerable variability in methodology. Specifically, studies differ according to definitions of bullying, the reference period under consideration (i.e., one month, one year, lifetime), frequency cutoff scores (i.e., sometimes, 1-2 times, 3-4 times), informants (parent, student, teacher, peer), and data collection approaches (questionnaire, interview, observation; Schroeder et al., 2014). For example, Hebron (2012) revealed that the proportion of victimized children with ASD considerably varied across studies according to the measures, informants, and reference periods used. As such, there is need for caution when interpreting prevalence and frequency rates of bullying across different studies. Future research would benefit from identifying methodological approaches that are most relevant and appropriate to evaluating peer victimization in students with HFASD. Despite these methodological inconsistencies, it is uniformly evident across studies that peer victimization is a common and detrimental problem for students, especially for students with HFASD. Conclusion The current study extended the literature by exploring the role of social cognition, specifically ToM and EI, as a risk factor for peer victimization within the HFASD population. A large body of research has shown the elevated rates of victimization among students with HFASD compared to 81

82 students with other disabilities and without disabilities (Humphrey & Hebron, 2015; Maiano et al., 2015; Schroeder et al., 2014) and the adverse effects across academic, behavioural, social, physical, and psychological domains (Baumeister et al., 2008; Brank et al, 2012; Chen & Schwartz, 2012; Craig, 2007; Gwen et al., 2000; Sterzing et al., 2012; Vivolo et al, 2011). As such, there is a critical need to identify factors that increase the risk of victimization among students with HFASD with the aim of informing prevention and intervention programs to address bullying. Consistent with this line of thinking, the present study intended to determine the relevance of social cognition to the risk for peer victimization of students with HFASD. Contrary to the anticipated outcomes, the results indicate that students with HFASD performed well on measures of ToM and EI, and that neither factor was significantly related to the prevalence or frequency of victimization among students with HFASD. Despite these findings, future research would benefit from a longitudinal study with a larger sample, use of third-party informants (i.e., teacher, peer), additional measures of ToM and EI, and inclusion of a TD control group. Although the current results do not support the hypotheses regarding social cognition as a risk factor for victimization for students with HFASD, the results are consistent with existing research regarding the prevalence and frequency of victimization among students with ASD as well as higher rates for students with HFASD than TD students and students with other disabilities. In light of the adverse impact of bullying, research efforts should continue to explore relevant risk factors for students with HFASD to inform policy and program development to effectively support this vulnerable group of students. Moving forward, it will be critical for schools, teachers, parents, and clinicians to emphasize the importance of interventions and the role of protective factors to reduce acts of bullying and to promote resilience among victimized students with HFASD, in turn enhancing the psychological, interpersonal, and academic functioning of this uniquely vulnerable population. 82

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100 Appendix A: Recruitment Flyer 100