7. Cyberbullying

With the increasing prevalence of internet and social media usage among children and adolescents, understanding cyberbullying as an adverse childhood experience…

Cyberbullying and Its Implications as an Adverse Childhood Experience (ACE): A Literature Review

Tori Lillestolen; Maria Aramburu de La Guardia; Hatim Omar

Lehigh Valley Reilly Children’s Hospital, Lehigh Valley Health Network, Allentown, PA

Correspondence: Maria G Aramburu de la Guardia. Email: maria.aramburu@lvhn.org  

Received: 31/05/2024; Revised: 10/6/2024; Accepted: 15/6/2024

Key words: Adverse childhood experiences, bullying, cyberbullying, media use, screen time, adolescents, mental health, social media.

[citation: Lillestolen, Tori; Aramburu de La Guardia, Maria; Omar, Hatim A. (2024). Cyberbullying and Its Implications as an Adverse Childhood Experience (ACE): A Literature Review. DHH, 11(1):https://journalofhealth.co.nz/?page_id=3099].


Cyberbullying, defined as the use of digital communication tools to harass, intimidate, or harm others, has emerged as a significant concern in contemporary society (Hinduja & Patchin, 2015). With the increasing prevalence of internet and social media usage among children and adolescents, understanding cyberbullying as an adverse childhood experience is paramount. Adverse childhood experiences (ACEs) refer to potentially traumatic events occurring in childhood, such as abuse, neglect, and household dysfunction, which have long-term effects on an individual’s health and well-being (Felitti et al., 1998). These experiences can encompass physical, emotional, or sexual abuse, as well as household challenges such as substance abuse, mental illness, or domestic violence.

The concept of ACEs stems from the landmark Adverse Childhood Experiences Study conducted by Felitti et al. (1998), which demonstrated the profound impact of childhood trauma on later-life health outcomes. The study identified ten types of ACEs, including physical abuse, emotional abuse, sexual abuse, physical neglect, emotional neglect, household substance abuse, household mental illness, parental separation or divorce, domestic violence, and incarcerated household member. Further research has continued to expand on the detrimental consequences of ACEs on various aspects of development, including physical health, mental health, and social functioning (Gao et al., 2023).

In recent years, scholars and practitioners have increasingly recognized cyberbullying as a form of ACE with significant implications for child and adolescent well-being. Cyberbullying shares many characteristics with traditional forms of bullying, including the intent to harm, power imbalance, and repetition, but occurs through electronic means such as social media, text messages, or online forums (Smith et al., 2008). Despite its distinct features, cyberbullying can have similar adverse effects on victims’ mental health, academic performance, and social relationships as traditional bullying (Bauman et al., 2013).

Social media platforms, such as Facebook, Instagram, Snapchat, and Twitter, offer avenues for bullying that are not limited by physical location or temporal constraints. Social media’s instantaneous nature facilitates the rapid dissemination of hurtful messages, rumors, or images, amplifying the harm inflicted on victims. Moreover, the anonymity afforded by certain social media platforms can increase the likelihood for offenders to engage in cyberbullying behavior without fear of accountability, exacerbating the distress experienced by victims (Kowalski et al., 2008).

A study carried out by the Pew Research Center in 2022 concluded that nearly half (46%) of 13-17 year old had experienced at least one cyberbullying behavior, with older teens being at even higher risk with an incidence of 49% in 15-17 year olds (Vogels et al., 2022).  This statistic gives a glimpse into the incidence of cyberbullying but has limitations on quantifying the repetitive nature of cyberbullying, and how many of these teens have experienced multiple or recurrent cyberbullying experiences. Given the severity and frequency of cyberbullying as an adverse childhood experience, there is a pressing need for research to explore its impact, risk factors, and implications within the broader framework of ACEs.

This literature review aims to synthesize existing evidence on the association between cyberbullying and adverse childhood experiences, with a focus on its prevalence, impact on victims, and preventive strategies that can have implications for clinical practice, policy and parenting.

Prevalence and Impact of Cyberbullying:

The prevalence of cyberbullying is alarming, with rates ranging from 10% to 40% worldwide (Tokunaga, 2010). This form of aggression takes various forms, including online harassment, spreading rumors, and sharing embarrassing or compromising photos or videos, and occurs across multiple digital platforms such as social media, messaging apps, and online gaming communities (Smith et al., 2008).

The impact of cyberbullying on adolescents is profound and multifaceted. Victims of cyberbullying experience a range of adverse outcomes, including psychological distress, academic difficulties, and social isolation (Bauman et al., 2013). Research indicates that adolescents who experience cyberbullying are at increased risk of developing internalizing problems such as anxiety and depression, as well as externalizing problems such as aggression and conduct disorder (Hinduja & Patchin, 2010).

Moreover, cyberbullying often co-occurs with other adverse childhood experiences (ACEs), such as physical or emotional abuse, further exacerbating the negative outcomes for victims (Chen et al., 2020). The cumulative effect of multiple ACEs and cyberbullying victimization can have profound and long-lasting implications for adolescent mental health and well-being.

It has been well-studied that ACEs have a substantial impact on the development of children and adolescents. ACEs have been shown to increase the risk of various mental health problems, including depression, anxiety, post-traumatic stress disorder (PTSD), substance abuse, non-suicidal self-injury and suicidal behaviors (Anda et al., 2006; Gao et al., 2023) of which we are seeing increasing incidence and prevalence in the last 10 years.


Understanding the prevalence of cyberbullying and its impact on adolescents is crucial for developing effective intervention and prevention strategies. Schools, parents, and policymakers must prioritize efforts to address cyberbullying and create safe online environments for adolescents. Comprehensive approaches to intervention should include educating adolescents about responsible digital citizenship, promoting empathy and bystander intervention, and providing support services for victims of cyberbullying.  Additionally, collaboration between schools, families, mental health professionals, and technology companies is essential for addressing the complex interplay between cyberbullying, ACEs, and adolescent mental health.

Cyberbullying poses significant challenges to adolescent well-being, with far-reaching implications for mental health and social functioning. By understanding the prevalence of cyberbullying and its impact on adolescents, stakeholders can develop holistic approaches to intervention and prevention that address the complex interplay between cyberbullying, ACEs, and adolescent mental health.

A recent study performed by Tozzo and colleagues discussed the optimal strategies to address cyberbullying and intervene to prevent these consequences. The study concluded that school is the most targeted setting for cyberbullying interventions to take place for several reasons (Tozzo et al., 2022). The school environment can help prioritize programs and stimulate emotional education for adolescents while promoting a positive learning environment. Teaching adolescents how to be active and responsible users of the internet and digital platforms was shown to be a much more effective intervention than merely relying on internet awareness campaigns and presentations. Finally, effective strategies also included focusing on improving teacher’s and parent’s training and education on cyberbullying, so that they can be more effective leaders and influencers on an appropriate internet presence.


Adverse Childhood Experiences are becoming increasingly recognized and studied as they relate to the development and well-being of children and adolescents, particularly regarding their mental health. Examples of ACEs studied in the past include physical abuse, emotional abuse, sexual abuse, all forms of neglect, parental separation/divorce, substance abuse, and violence among others. Cyberbullying is becoming one of the most common challenges adolescents face with the increasing incidence and prevalence of social media use and online presence. Children are being exposed at younger ages to online platforms which will only increase the prevalence of cyberbullying and its impact, thereby necessitating intervention and prevention strategies. Recent data from the CDC describes that children aged 8-18 spend, on average, 7.5 hours on screen time daily for entertainment alone (CDC, 2018).

There are still ample opportunities for further research in the field of cyberbullying as well as effective interventions and prevention strategies. It would be beneficial to continue to explore the utility of parent and teacher education on online platform usage and how this intervention impacts our adolescents. Furthermore, given the increased screen time use among children and teens, it would also be beneficial to expand research in the efficacy of recommendations regarding physical activity to limit screen time and its potential consequences. Due to the increasing prevalence of cyberbullying and increased awareness of ACE’s as a consequence, research is limited on effective prevention strategies and measurements of such. There is also an identified need to increase learning opportunities and training for clinicians interacting with adolescents such as therapists, medical providers and counselors to increase the reach of preventive strategies and create a consistent message and open space for adolescents to share their online experiences, get education on safety strategies and good citizenship while using platforms. This implies that the field is open for these strategies to be explored and any advances in research can impact the future and well-being of our children and teens. The goal of preserving the emotional, physical, and mental well-being of our children and adolescents is crucial, and moving forward, continued research, collaboration, and advocacy are essential for creating safer online environments and promoting the well-being of children and adolescents in the digital age.


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Centers for Disease Control and Prevention. (2018, January 29). Infographics – screen time vs. Lean Time. Centers for Disease Control and Prevention. https://www.cdc.gov/nccdphp/dnpao/multimedia/infographics/getmoving.html

Chen, Y., Qu, Y., Yang, Y., Zheng, X., & Fu, Y. (2020). Association of adverse childhood experiences with non-suicidal self-injury and suicidality: Baseline survey of the Chinese Adolescent Health Growth Cohort. Journal of Affective Disorders, 263, 692-700. [DOI: 10.1016/j.jad.2019.11.158]

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