Paeds SAQs · adolescent-and-young-adult-medicine
Digital media, gaming and cyberbullying — formative SAQs
Two formative short-answer questions on classifying digital-media risk, cyberbullying and suicidality, and assembling a domain-specific harm-reduction bundle with a safeguarding exit.
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Target exams
SAQ 1 — Cyberbullying, function and the harm-reduction plan (10 marks)
A 14-year-old presents with three months of declining school attendance and tearfulness. Seen alone, they disclose that a group chat has been mocking them daily for weeks, including a manipulated image; they have had thoughts of "not being here" but no plan. They sleep with the phone and check it through the night. [2] [1]
Questions
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How do you classify this presentation, and what is the single most important discriminator between normative and harmful digital-media use? (3 marks) [7]
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Outline your same-visit assessment and immediate safety actions, including your suicide-screening response. (4 marks) [2]
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Describe the harm-reduction plan and the family media plan you would negotiate. (3 marks) [1] [7]
Model answer
Classification and discriminator (3). This is harmful digital-media use, not normative: a cyberbullying crisis with functional impairment (school decline, sleep disruption) and emerging suicidality. The single discriminator is function, not hours of use — whether sleep, mood, school, weight or safety are affected. Here every domain is impaired, and the cyberbullying sits in the conduct and contact cells of the content-contact-conduct-compulsion frame. A systematic review shows cyberbullying victimisation is associated with roughly doubled odds of self-harm and suicidal behaviour, which is why this presentation is high-acuity. [7] [2]
Assessment and safety (4). Move immediately to a structured suicide risk assessment: ideation, plan, intent, prior attempts, access to means, protective factors, ability to keep safe. With suicidal ideation after cyberbullying, secure the means and do not leave the young person alone. Preserve evidence (screenshots), advise against replying, and plan blocking, reporting and takedown of the manipulated image. Explain that confidentiality is limited by serious risk of harm, involve the crisis or mental-health pathway, and engage school and safeguarding as indicated. Do not treat this as routine mental-health follow-up. [2]
Harm-reduction and media plan (3). Negotiate a sleep-protective schedule with the device out of the bedroom overnight; curate or mute the offending accounts and platforms; protect time for sleep, movement and in-person contact; and arrange mental-health support. Build a family media plan that is age-appropriate and negotiated, not imposed — screen-free mealtimes and bedrooms, agreed content boundaries, and a low-threshold way back for review. The stance is harm reduction and motivational interviewing, not an abstinence lecture that ends disclosure. [1] [7]
SAQ 2 — Sexting, exploitation and the safeguarding exit (10 marks)
A. A 15-year-old, seen alone, discloses that they sent an intimate image to a boyfriend; it has now been shared widely in their year group without consent. They are distressed but say "please don't tell anyone." B. Separately, a 13-year-old describes an online "friend" who sent gifts and is now asking for more images, threatening to expose earlier messages if refused. [5] [6]
Questions
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For scenario A, outline your management including the safeguarding and legal response. (5 marks) [5] [6]
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For scenario B, what is the likely phenomenon, and what are your immediate actions? (5 marks) [6] [4]
Model answer
Non-consensual image sharing (5). This is image-based abuse: a non-consensual sharing of an intimate image of a minor, which is both a safeguarding and a legal event. Distinguish the original consensual sharing (common and age-related) from the harm, which is the non-consensual forwarding. Act immediately: preserve evidence and seek takedown through the relevant e-safety authority and platform reporting tools rather than having the family delete material without advice; support the young person and screen for suicidality, because leaked-image crises carry acute mental-health risk; explain that confidentiality is limited by serious harm, and activate safeguarding and, where indicated, law-enforcement pathways. Engage the school, since the sharing is within a peer group. Frame the young person as a victim, not a perpetrator. [5] [6]
Online grooming and sextortion (5). The pattern — attention and gifts online, escalating requests for images, then threats to expose earlier material — is online grooming progressing to sextortion, a form of sexual exploitation of a minor. Minors rarely disclose spontaneously. Ask directly and without judgement, distinguish from consensual peer contact, and preserve evidence. Treat this as a safeguarding and legal event: follow local mandatory-reporting duties, do not have the family contact the perpetrator, and involve child-protection and law-enforcement pathways. Provide trauma-informed support and clear follow-up. The core teaching point is that exploitation hides behind "risk-taking behaviour" unless you ask. [6] [4]
References
- [1]Council on Communications and Media Media Use in School-Aged Children and Adolescents. Pediatrics, 2016.PMID 27940794
- [2]John A, Glendenning AC, Marchant A, Montgomery P, Stewart A, Wood S, Lloyd K, Hawton K Self-Harm, Suicidal Behaviours, and Cyberbullying in Children and Young People: Systematic Review. Journal of medical Internet research, 2018.PMID 29674305
- [3]Boers E, Afzali MH, Newton N, Conrod P Association of Screen Time and Depression in Adolescence. JAMA pediatrics, 2019.PMID 31305878
- [4]Livingstone S, Smith PK Annual research review: Harms experienced by child users of online and mobile technologies: the nature, prevalence and management of sexual and aggressive risks in the digital age. Journal of child psychology and psychiatry, and allied disciplines, 2014.PMID 24438579
- [5]Madigan S, Ly A, Rash CL, Van Ouytsel J, Temple JR Prevalence of Multiple Forms of Sexting Behavior Among Youth: A Systematic Review and Meta-analysis. JAMA pediatrics, 2018.PMID 29482215
- [6]Greene-Colozzi EA, Winters GM, Blasko B, Jeglic EL Experiences and Perceptions of Online Sexual Solicitation and Grooming of Minors: A Retrospective Report. Journal of child sexual abuse, 2020.PMID 33017275
- [7]Odgers CL, Jensen MR Annual Research Review: Adolescent mental health in the digital age: facts, fears, and future directions. Journal of child psychology and psychiatry, and allied disciplines, 2020.PMID 31951670
- [8]Schneider LA, King DL, Delfabbro PH Family factors in adolescent problematic Internet gaming: A systematic review. Journal of behavioral addictions, 2017.PMID 28762279