Aggressive behaviours in Autism

One of the most challenging aspects of autism is aggressive behaviours. It is estimated that 25%-50% of autistic children express aggressive behaviours.

What causes aggressive behaviours?

One study in 2014 found that aggressive behaviours were associated with the use of drugs, melatonin, lower ASD severity and lower cognitive functioning. It also found that sleep, attention problems and internalising also associated strongly with more aggressive behaviours. However, a more recent study in 2016 found no connection between aggression and low IQ or absence of language. It did conclude that aggression was most likely linked with severity of ASD.

Aggressive behaviour could also be triggered by stressful external situations. These situations trigger a sense of lack-of-control, stress sensory overload or strong emotions. The aggressive behaviour is a way to release this stress, in the absence of other coping skills. In neurotypical children, stress might be reduced through coping mental strategies, social interaction and verbal communication with others. However, as the 2016 study notes, autistic children often struggle with verbal communication so rely on other strategies such as physical aggression.

Examples of stressful external situations include:

  • a change in daily routines
  • transitioning from enjoyable activities
  • sensory overstimulation such as crowds, small spaces, bright lights, particular sounds, strangers
  • boredom such as sitting in a car
  • demands from an adult or too many instructions at once

Why do autistic children act aggressively?

Another study concluded that much aggression is due to communication difficulties. If an autistic child wants something, they may act aggressively to make another person show attention and help them. So, aggression is an effort to communicate and to solve immediate problems. The study suggests that children don’t want to make life difficult for adults, but have a small set of strategies (including aggression) that they have found to be successful in getting adult help in the past.

What are aggressive behaviours?

A 2018 study of over 100 autistic children found that aggression could be directed towards things, themselves or people. There wasn’t not much difference between males and females with autism, between different age groups, or between children with an intellectual disability and autism. Worryingly, this study found that aggression was mostly likely towards others, and less likely towards things or themselves. The aggression could take the form of

  • refusing to follow instructions
  • pinching other people when they felt angry
  • kicking, biting, pushing, screaming at or hitting other people
  • throwing themselves on the floor
  • hitting themselves, such as with their hand or banging their head on the wall
  • scratching themselves until they bleed
  • breaking furniture or tearing clothing

How do you to respond to aggression?

Functional Behaviour Assessment is recommended as the first non-drug intervention to aggressive behaviours.

This involves recording the triggers to aggressive behaviour over time. It might be looking for behavioural patterns in seeking attention, wanting access to preferred items or activities, or wanting to remove demands or unpleasant sensory stimuli.

While there are questionnaires that professionals can use to screen behaviours, direct observation and recording using a STAR behaviour tracking template are also effective in the home.

After a Functional Behaviour Assessment, using reinforcement strategies to change the response can be used to reduce aggressive behaviours. This might include providing reinforcement when you don’t see aggressive behaviours (rewarding what you want to see), or when children select better strategies to communicate their needs.

This can include training on communicating effectively. Such as, teaching a child to touch a picture of a parent to request attention rather than hitting the parent. This approach is called Functional Communication Training and over 2 decades remains once of the most effective approaches to reducing aggression.

There are also drugs available to reduce aggressive behaviours in autism. The study referred to here has an evaluation of different drugs and their effectiveness as reported in different studies.

Help now!

But what if you’re in the middle of an aggressive episode RIGHT NOW?!

Step 1. Stay calm. Yelling or fighting will only escalate the situation.

Step 2. Stay safe. Find a safe place for you and your child. Try to avoid damage to yourself or them by removing yourself or any objects being used to harm.

Step 3. Step back and think about the situation. What might they want to communicate and what might be the trigger? Provide steps to calm and help regulate them.

Step 4. When everyone is calm, try using Functional Communication Training to change the communication and reduce the triggers.

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