School bullying and mental health in Autism Spectrum Disorder: a systematic review

Authors

• Thayná Pathyuara Chiquito Mendes Campos Centro Universitário de Ciências e Tecnologias do Maranhão (Unifacema), Presidente Dutra - MA/Brazil https://orcid.org/0009-0001-8293-5445
• Kalyandra Brandão de Carvalho Associação de Ensino Superior do Piauí (AESPI), Teresina - PI/Brazil https://orcid.org/0009-0007-9680-6891
• Raquel Furtado Conte Universidade de Caxias do Sul, Caxias do Sul, RS/Brazil https://orcid.org/0000-0002-2378-8772

DOI:

https://doi.org/10.17058/psiunisc.v9i.18525

Keywords:

autism spectrum disorder, bullying, inclusive education, mental health, psychology

Abstract

Introduction: Autism Spectrum Disorder (ASD) is characterized by persistent deficits in social communication and restricted, repetitive patterns of behavior. In the school context, autistic students present specific vulnerabilities to bullying, a phenomenon associated with severe emotional and academic impairments. Considering the increasing enrollment of autistic students in Brazilian inclusive education, understanding the effects of bullying on this population and the coping strategies adopted constitutes an emerging demand for psychology. Objective: To understand how school bullying affects the mental health of autistic children and adolescents, identify interventions used to minimize its impacts, and discuss the role of psychology, as a science and profession, in the development of preventive and inclusive practices. Method: This is a systematic literature review conducted according to the PRISMA guidelines. Searches were carried out in BVSalud, Medline, and CAPES Portal databases using the descriptors “autism” and “bullying,” covering the period from 2017 to 2023. Original studies and reviews addressing the relationship between ASD and bullying in school settings were included, resulting in 22 articles analyzed qualitatively. Results: The studies indicate that autistic students are up to seven times more likely to experience bullying than neurotypical peers. Main associated factors include difficulties in social interaction, internalizing symptoms, and lack of institutional support. The most effective interventions involved inclusion programs, peer-mediated strategies, psychoeducation for teachers and families, and psychosocial actions aimed at reducing anxiety and strengthening social skills. Conclusion: Bullying is a major predictor of psychological distress, isolation, and school dropout among autistic students. Psychology plays an essential role in preventing and mitigating these impacts, fostering inclusive and mentally healthy school environments.

References

Adams, R. E., Taylor, J. L., & Bishop, S. L. (2020). Brief report: ASD-related behavior problems and negative peer experiences among adolescents with ASD in general education settings. Journal of Autism and Developmental Disorders, 50(12), 4548–4552. https://doi.org/10.1007/s10803-020-04508-1

Altomare, A. (2017). A qualitative exploration of bullying experiences among adolescents on the autism spectrum: Self-reports and parent perspectives. Canadian Journal of School Psychology, 32(2), 122–136. https://doi.org/10.1177/0829573516683068

American Psychiatric Association. (2014). DSM-5: Manual diagnóstico e estatístico de transtornos mentais (5ª ed.). Porto Alegre: Artmed.

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). Porto Alegre: Artmed. American Psychiatric Association Publishing.

Asunción, M. M., Romero, R. M. M., Andrés, M. I. F., & Cerezuela, G. P. (2018). Influencia del sesgo de género en el diagnóstico de trastorno de espectro autista: Una revisión. Escritos de Psicología, 11(1), 42–54. https://dx.doi.org/10.5231/psy.writ.2018.2804

Bitsika, V., & Sharpley, C. F. (2021). Direct and inverse correlates of post-traumatic stress disorder among school-age autistic boys. International Journal of Environmental Research and Public Health, 18(10), 5285. https://doi.org/10.3390/ijerph18105285

Carmo, B. C. M., Fumes, N. D. L. F., Mercado, E. L. O., & Magalhães, L. D. O. R. (2019). Políticas públicas educacionais e formação de professores: Convergências e distanciamentos na área de educação especial. Revista Educação Especial, 32, 1–28. https://doi.org/10.5902/1984686X39223

Centers for Disease Control and Prevention. (2023).

Chou, W.-J., Liu, T.-L., Yen, C.-F., & Hu, H.-F. (2020). Bullying victimization and perpetration and their correlates in adolescents clinically diagnosed with autism spectrum disorder. Frontiers in Psychiatry, 11, 9. https://doi.org/10.3389/fpsyt.2020.00009

Coelho, V. A., Marchante, M., & Romão, A. M. (2019). Efeitos da transição para o 2º ciclo sobre o envolvimento dos alunos em bullying. INFAD Revista de Psicología. International Journal of Developmental and Educational Psychology, 5(1), 135–144. https://doi.org/10.17060/ijodaep.2019.n1.v5.1576

Cook, A., Ogden, J., & Winstone, N. (2020). The effect of school exposure and personal contact on attitudes towards bullying and autism in schools: A cohort study with a control group. Autism, 24(8), 2178–2189. https://doi.org/10.1177/1362361320937088

Decreto nº 3.956, de 8 de outubro de 2001. Promulga a Convenção Interamericana para a Eliminação de Todas as Formas de Discriminação contra as Pessoas Portadoras de Deficiência. Recuperado de https://www.planalto.gov.br/ccivil_03/decreto/2001/d3956.htm

Decreto nº 6.571, de 17 de setembro de 2008. Dispõe sobre o atendimento educacional especializado, regulamenta o parágrafo único do art. 60 da Lei nº 9.394, de 20 de dezembro de 1996, e acrescenta dispositivo ao Decreto nº 6.253, de 13 de novembro de 2007. Recuperado de https://www.planalto.gov.br/ccivil_03/_ato2007-2010/2008/decreto/d6571.htm

Decreto nº 7.611, de 17 de novembro de 2011. Dispõe sobre a educação especial, o atendimento educacional especializado e dá outras providências. Diário Oficial da União. Recuperado de https://www.planalto.gov.br/ccivil_03/_ato2011-2014/2011/decreto/d7611.htm

Decreto nº 7.612, de 17 de novembro de 2011. Institui o Plano Nacional dos Direitos da Pessoa com Deficiência – Plano Viver sem Limite. Recuperado de https://www.planalto.gov.br/ccivil_03/_ato2011-2014/2011/decreto/d7612.htm

Dorol-Beauroy-Eustache, O., & Mishara, B. L. (2021). Systematic review of risk and protective factors for suicidal and self-harm behaviors among children and adolescents involved with bullying. Preventive Medicine, 152, 106–131.

Falcão, C. S. N., Stelko-Pereira, A. C., & Alves, D. L. G. (2021). Envolvimentos de alunos com TEA em situações de bullying de acordo com múltiplos informantes. Educação e Pesquisa, 47, e217359. https://doi.org/10.1590/S1678-4634202147217359

Fernandes, C. S., Tomazelli, J., & Girianelli, V. R. (2020). Diagnóstico de autismo no século XXI: Evolução dos domínios nas categorizações nosológicas. Psicologia USP, 31, e200027. https://doi.org/10.1590/0103-6564e200027

Fredrick, S. S., J. McClemont, A., N. Jenkins, L., & Kern, M. (2021). Perceptions of emotional and physical safety among boarding students and associations with school bullying. School psychology review, 50(2-3), 441-453.

Globo. (2025, 15 de abril). Violência escolar mais do que triplica em 10 anos. G1. Recuperado de https://g1.globo.com/educacao/noticia/2025/04/15/violencia-escolar-mais-do-que-triplica-em-10-anos.ghtml

Grillo, M. A., & Santos, A. C. S. (2015). Bullying na escola. Colloquium Humanarum, 12(3), 61–74.

Grossi, P. K., & Santos, A. M. (2018). Desvendando o fenômeno bullying nas escolas públicas de Porto Alegre. Revista Portuguesa de Educação, 22(2), 249–267. https://doi.org/ 10.21814/rpe.13973

Hill, C., Keville, S., & Ludlow, A. K. (2021). Parents’ views of mainstream school inclusion for children with autism spectrum disorder in the United Kingdom: A qualitative study. International Journal of Environmental Research and Public Health, 18(16), 8374. https://doi.org/10.3390/ijerph18168374

Holden, R., Mueller, J., McGowan, J., Sanyal, J., Kikoler, M., Simonoff, E., Velupillai, S., & Downs, J. (2020). Investigating bullying as a predictor of suicidality in a clinical sample of adolescents with autism spectrum disorder. Autism Research, 13(6), 988–997. https://doi.org/10.1002/aur.2292

Hoover, D. W., & Kaufman, J. (2018). Adverse childhood experiences in children with autism spectrum disorder. Current Opinion in Psychiatry, 31(2), 128–132. https://doi.org/10.1097/YCO.0000000000000390

Hsiao, M. N., Tai, Y. M., Wu, Y. Y., Tsai, W. C., Chiu, Y. N., & Gau, S. S. (2022). Psychopathologies mediate the link between autism spectrum disorder and involvement with bullying: A follow-up study. Journal of the Formosan Medical Association, 121(9), 1739–1747. https://doi.org/10.1016/j.jfma.2021.12.030

Humphrey, N. (2015). Bullying of children and young people with autism spectrum disorder: A review of the literature. International Journal of Inclusive Education, 19(8), 845–862. https://doi.org/10.1080/13603116.2014.981602

Hunsche, M. C., Cervin, M., Storch, E. A., Kendall, P. C., Wood, J. J., & Kerns, C. M. (2022). Social functioning and the presentation of anxiety in children on the autism spectrum: A multimethod, multi-informant analysis. Journal of Psychopathology and Clinical Science, 131(2), 198–208. https://doi.org/10.1037/abn0000724

Hwang, S., Kim, Y. S., Koh, Y. J., & Leventhal, B. L. (2018). Autism spectrum disorder and school bullying: Who is the victim? Who is the perpetrator? Journal of Autism and Developmental Disorders, 48(1), 225–238. https://doi.org/10.1007/s10803-017-3285-z

Kong, C., Chen, A., Ludyga, S., Herold, F., Healy, S., Zhao, M., Taylor, A., Müller, N. G., Kramer, A. F., Chen, S., Tremblay, M. S., & Zou, L. (2023). Associations between meeting 24-hour movement guidelines and quality of life among children and adolescents with autism spectrum disorder. Journal of Sport and Health Science, 12(1), 73–86. https://doi.org/10.1016/j.jshs.2022.08.003

Lei nº 12.764, de 27 de dezembro de 2012. Institui a Política Nacional de Proteção dos Direitos da Pessoa com Transtorno do Espectro Autista. Recuperado de https://www.planalto.gov.br/ccivil_03/_ato2011-2014/2012/lei/l12764.htm

Libster, N., Knox, A., Engin, S., Geschwind, D., Parish-Morris, J., & Kasari, C. (2022). Personal victimization experiences of autistic and non-autistic children. Molecular Autism, 13(1), 51. https://doi.org/10.1186/s13229-022-00531-4

Liu, T. L., Wang, P. W., Hsiao, R. C., Ni, H. C., Liang, S. H., Lin, C. F., Chan, H. L., Hsieh, Y. H., Wang, L. J., Lee, M. J., Chou, W. J., & Yen, C. F. (2022). Multiple types of harassment victimization in adolescents with autism spectrum disorder: Related factors and effects on mental health problems. Journal of the Formosan Medical Association, 121(11), 2161–2171. https://doi.org/10.1016/j.jfma.2022.03.005

Maciel, A. L. B., & Rech, T. L. (2018). Educação inclusiva como direito fundamental: Desafios atuais. In M. C. H. Leal & A. V. Custódio (Orgs.), Fundamentos constitucionais das políticas públicas (pp. 83–93). Santa Cruz do Sul: EDUNISC.

Matthias, C., LaVelle, J. M., Johnson, D. R., Wu, Y. C., & Thurlow, M. L. (2021). Exploring predictors of bullying and victimization of students with autism spectrum disorder (ASD): Findings from NLTS 2012. Journal of Autism and Developmental Disorders, 51(12), 4632–4643. https://doi.org/10.1007/s10803-021-04907-y

Medida Provisória nº 1.025, de 31 de dezembro de 2020. Dispõe sobre medidas de estímulo à prestação de serviços de infraestrutura e dá outras providências. Recuperado de https://www.planalto.gov.br/ccivil_03/_ato2019-2022/2020/Mpv/mpv1025.htm

Ministério da Educação (2008). Política nacional de Educação Especial na perspectiva da Educação Inclusiva: documento síntese. Brasília: MEC. Recuperado de http://portal.mec.gov.br/seesp/arquivos/pdf/politicaeducacaoespecial.pdf

Morton, H. E., Gillis, J. M., Mattson, R. E., & Romanczyk, R. G. (2019). Conceptualizing bullying in children with autism spectrum disorder: Using a mixed model to differentiate behavior types and identify predictors. Autism, 23(7), 1853–1864. https://doi.org/10.1177/1362361318813997

Organização das Nações Unidas para a Educação, a Ciência e a Cultura. (1994). Declaração de Salamanca e linha de ação sobre necessidades educativas especiais. UNESCO. Recuperado de https://unescdoc.unesco.org/ark:/48223/pf0000098427

Organização Mundial da Saúde (2021). Claissificação Internacional de Doenças 11ª revisão (CID-11). Recuperado de https://icd.who.int/

Organização Mundial da Saúde (2025). Saúde Mental dos adolescentes. Organização Mudial da Saúde. Recuperado de https://www.who.int

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., ... & Moher, D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. bmj, 372.

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., ... & Moher, D. (2023). A declaração PRISMA 2020: diretriz atualizada para relatar revisões sistemáticas. Revista panamericana de salud publica, 46, e112.

Page et al. Material suplementar – Lista de checagem PRISMA 2020 expandida. Epidemiologia e Serviços de Saúde, Brasília, 31(2):e2022107, 2022

Park, I., Gong, J., Lyons, G. L., Hirota, T., Takahashi, M., Kim, B., Lee, S. Y., Kim, Y. S., Lee, J., & Leventhal, B. L. (2020). Prevalence of and factors associated with school bullying in students with autism spectrum disorder: A cross-cultural meta-analysis. Yonsei Medical Journal, 61(11), 909–922. https://doi.org/10.3349/ymj.2020.61.11.909

Petersson-Bloom, L., & Holmqvist, M. (2022). Supporting pupils with autism in the classroom: Parents’ and teachers’ views on what constitutes a good learning environment. International Journal of Environmental Research and Public Health, 19(22), 14886. https://doi.org10.3390/ijerph192214886

Schrooten, I., Scholte, R., Cillessen, A., & Hymel, S. (2018). Participant roles in bullying among Dutch adolescents with autism spectrum disorders. Journal of Clinical Child and Adolescent Psychology, 47(6), 874–887. https://doi.org10.1080/15374416.2016.1138411

Silva, L. O., & Borges, B. S. (2018). Bullying nas escolas. Direito e Realidade, 6(5), 27–40.

Silva, M. F. B. (2018). Diagnóstico de Transtorno do Espectro Autista – TEA: Definição de critérios e considerações sobre a prática. Diagnóstico, 1(15), 1-15.

Skafle, I., Nordahl-Hansen, A., & Øien, R. A. (2020). Short report: Social perception of high school students with ASD in Norway. Journal of Autism and Developmental Disorders, 50(2), 670–675. https://doi.org/10.1007/s10803-019-04281-w

Sreckovic, M. A., Hume, K., & Reavis, S. (2017). Peer-mediated interventions for students with autism spectrum disorder: A systematic review. Journal of Autism and Developmental Disorders, 47, 2224–2241. https://doi.org/10.1007/s10803-017-3120-5

Shaw KA, Williams S, Patrick ME et al. Prevalência e Identificação Precoce do Transtorno do Espectro Autista entre Crianças de 4 e 8 Anos — Rede de Monitoramento do Autismo e Deficiências do Desenvolvimento, 16 Locais, Estados Unidos, 2022. MMWR Surveill Summ 2025;74(Nº SS-2):1–22. DOI: http://dx.doi.org/10.15585/mmwr.ss7402a1

Tipton-Fisler, L. A., Rodriguez, G., Zeedyk, S. M., & Blacher, J. (2018). Stability of bullying and internalizing problems among adolescents with ASD, ID, or typical development. Research in Developmental Disabilities, 80, 131–141. https://doi.org/10.1016/j.ridd.2018.06.004

Tsou, Y. T., Kovács, L. V., Louloumari, A., Stockmann, L., Blijd-Hoogewys, E. M., Koutamanis, A., & Rieffe, C. (2024). School-based interventions for increasing autistic pupils’ social inclusion in mainstream schools: A systematic review. Review Journal of Autism and Developmental Disorders, 11, 45–62. https://doi.org/10.1007/s40489-024-00429-2

Wang, R. & Susumu, Y. (2024). Bullying victimization and internalizing problems among adolescents with autism spectrum disorder: A longitudinal study. Review Journal of Autism and Developmental Disorders, 11, 97–112. https://doi.org/10.1007/s40489-024-00478-7