Aggression in Children and Adolescents with ASD: Prevalence and Risk Factors

  • Stephen M. KanneEmail author
  • Micah O. Mazurek
Original Paper


The prevalence of and risk factors for aggression were examined in 1,380 children and adolescents with autism spectrum disorders (ASD). Prevalence was high, with parents reporting that 68% had demonstrated aggression to a caregiver and 49% to non-caregivers. Overall, aggression was not associated with clinician observed severity of ASD symptoms, intellectual functioning, gender, marital status, parental educational level, or aspects of communication. Individuals who are younger, come from a higher income family, have more parent reported social/communication problems, or engage in repetitive behaviors were more likely to demonstrate aggression. Given the significant impact of aggression on individual and family outcomes, it is hoped that this knowledge will inform more targeted intervention efforts.


Autism Autism spectrum disorder Aggression Disruptive behaviors 



This work was supported by a grant from the Simons Foundation (SFARI award #26021565-08C000066 to Judith Miles). We are grateful to all of the families at the participating Simons Simplex Collection (SSC) sites, as well as the principal investigators (A. Beaudet, A. Klin, B. Peterson, C. Lord, C. Martin, C. Saulnier, C. Walsh, D. Geschwind, D. Grice, D. Ledbetter, D. Martin, E. Cook, E. Fombonne, E. Wijsman, J. Miles, J. Constantino, J. Piggot, J. Sutcliffe, M. State, O. Ousley, R. Bernier, R. Maxim, W. Stone). We appreciate obtaining access to phenotypic data on SFARI Base,[sfari_collection_v7]/ui:view().


  1. Achenbach, T. M., & Rescorla, L. A. (2001a). Manual for the ASEBA preschool forms and profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth, and Families.Google Scholar
  2. Achenbach, T. M., & Rescorla, L. A. (2001b). Manual for the ASEBA school-age forms and profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth, & Families.Google Scholar
  3. Baker, B. L., Blacher, J., Crnic, K. A., & Edelbrock, C. (2002). Behavior problems and parenting stress in families of three-year-old children with and without developmental delays. American Journal of Mental Retardation, 107(6), 433–444.PubMedCrossRefGoogle Scholar
  4. Broidy, L. M., Nagin, D. S., Tremblay, R. E., Bates, J. E., Brame, B., Dodge, K. A., et al. (2003). Developmental trajectories of childhood disruptive behaviors and adolescent delinquency: A six-site, cross-national study. Developmental Psychology, 39(2), 222–245.PubMedCrossRefGoogle Scholar
  5. Bromley, B. E., & Blacher, J. (1991). Parental reasons for out-of-home placement of children with severe handicaps. Mental Retardation, 29(5), 275–280.PubMedGoogle Scholar
  6. Calkins, S. D. (1994). Origins and outcomes of individual differences in emotion regulation. Monographs of the Society for Research in Child Development, 59(2–3), 53–72; 250–283.Google Scholar
  7. Campbell, S. B., Spieker, S., Vandergrift, N., Belsky, J., & Burchinal, M. (2010). Predictors and sequelae of trajectories of physical aggression in school-age boys and girls. Development and Psychopathology, 22(01), 133–150.PubMedCrossRefGoogle Scholar
  8. Card, N. A., & Little, T. D. (2006). Proactive and reactive aggression in childhood and adolescence: A meta-analysis of differential relations with psychosocial adjustment. International Journal of Behavioral Development, 30(5), 466–480.CrossRefGoogle Scholar
  9. Chalfant, A. M., Rapee, R., & Carroll, L. (2007). Treating anxiety disorders in children with high functioning autism spectrum disorders: A controlled trial. Journal of Autism and Developmental Disorders, 37(10), 1842–1857.PubMedCrossRefGoogle Scholar
  10. Coie, J. D., Dodge, K. A., Damon, W., & Eisenberg, N. (1998). Aggression and antisocial behavior. In Handbook of child psychology: Vol 3. Social, emotional, and personality development (5th ed., pp. 779–862). Hoboken, NJ: Wiley.Google Scholar
  11. Constantino, J. N., Davis, S. A., Todd, R. D., Schindler, M. K., Gross, M. M., Brophy, S. L., et al. (2003). Validation of a brief quantitative measure of autistic traits: Comparison of the social responsiveness scale with the autism diagnostic interview-revised. Journal of Autism and Developmental Disorders, 33(4), 427–433.PubMedCrossRefGoogle Scholar
  12. Constantino, J. N., & Todd, R. D. (2003). Autistic traits in the general population: A twin study. Archives of General Psychiatry, 60(5), 524–530.PubMedCrossRefGoogle Scholar
  13. Cuccaro, M. L., Shao, Y., Bass, M. P., Abramson, R. K., Ravan, S. A., Wright, H. H., et al. (2003). Behavioral comparisons in autistic individuals from multiplex and singleton families. Journal of Autism and Developmental Disorders, 33(1), 87–91.PubMedCrossRefGoogle Scholar
  14. Dimitropoulos, A., Feurer, I. D., Butler, M. G., & Thompson, T. (2001). Emergence of compulsive behavior and tantrums in children with Prader-Willi syndrome. American Journal on Mental Retardation, 106(1), 39–51.PubMedCrossRefGoogle Scholar
  15. Dionne, G., Tremblay, R., Boivin, M., Laplante, D., & Perusse, D. (2003). Physical aggression and expressive vocabulary in 19-month-old twins. Developmental Psychology, 39(2), 261–273.PubMedCrossRefGoogle Scholar
  16. Dominick, K. C., Davis, N. O., Lainhart, J., Tager-Flusberg, H., & Folstein, S. (2007). Atypical behaviors in children with autism and children with a history of language impairment. Research in Developmental Disabilities, 28(2), 145–162.PubMedCrossRefGoogle Scholar
  17. Dunn, L. M., & Dunn, D. M. (2007). Peabody picture vocabulary test, Manual (4th ed.). Minneapolis, MN: Pearson Assessments.Google Scholar
  18. Einfeld, S. L., Tonge, B. J., & Rees, V. W. (2001). Longitudinal course of behavioral and emotional problems in Williams syndrome. American Journal on Mental Retardation, 106(1), 73–81.PubMedCrossRefGoogle Scholar
  19. Elliot, C. (2007). Differential abilities scale (DAS-II) Manual (2nd ed.). San Antonio, TX: Harcourt Assessment, Inc.Google Scholar
  20. Emerson, E., Kiernan, C., Alborz, A., Reeves, D., Mason, H., Swarbrick, R., et al. (2001). The prevalence of challenging behaviors: A total population study. Research in Developmental Disabilities, 22(1), 77–93.PubMedCrossRefGoogle Scholar
  21. Finucane, B., Dirrigl, K. H., & Simon, E. W. (2001). Characterization of self-injurious behaviors in children and adults with Smith-Magenis syndrome. American Journal on Mental Retardation, 106(1), 52–58.PubMedCrossRefGoogle Scholar
  22. Fite, P. J., Colder, C. R., Lochman, J. E., & Wells, K. C. (2008). Developmental trajectories of proactive and reactive aggression from fifth to ninth grade. Journal of Clinical Child and Adolescent Psychology, 37(2), 412–421.PubMedCrossRefGoogle Scholar
  23. Ganz, M. L. (2007). The lifetime distribution of the incremental societal cost of autism. Archives of Pediatric and Adolescent Medicine, 16, 343–349.CrossRefGoogle Scholar
  24. Gardner, W. I., & Moffatt, C. W. (1990). Aggressive behaviour: Definition, assessment, treatment. International Review of Psychiatry, 2(1), 91–100.CrossRefGoogle Scholar
  25. Gillham, J. E., Carter, A. S., Volkmar, F. R., & Sparrow, S. S. (2000). Towards a developmental operational definition of autism. Journal of Autism and Developmental Disorders, 30, 269–278.PubMedCrossRefGoogle Scholar
  26. Gotham, K., Pickles, A., & Lord, C. (2009). Standardizing ADOS scores for a measure of severity in autism spectrum disorders. Journal of Autism and Developmental Disorders, 39(5), 693–705.PubMedCrossRefGoogle Scholar
  27. Hartley, S. L., Sikora, D. M., & McCoy, R. (2008). Prevalence and risk factors of maladaptive behaviour in young children with Autistic Disorder. Journal of Intellectual Disability Research, 52(10), 819–829.PubMedCrossRefGoogle Scholar
  28. Hartup, W. W. (1974). Aggression in childhood: Developmental perspectives. American Psychologist, 29(5), 336–341.PubMedCrossRefGoogle Scholar
  29. Hay, D. F. (2007). The gradual emergence of sex differences in aggression: Alternative hypotheses. Psychological Medicine: A Journal of Research in Psychiatry and the Allied Sciences, 37(11), 1527–1537.Google Scholar
  30. Holden, B., & Gitlesen, J. P. (2006). A total population study of challenging behaviour in the county of Hedmark, Norway: Prevalence, and risk markers. Research in Developmental Disabilities, 27(4), 456–465.PubMedCrossRefGoogle Scholar
  31. Holland, A. J., Whittington, J. E., Butler, J., Webb, T., Boer, H., & Clarke, D. (2003). Behavioural phenotypes associated with specific genetic disorders: Evidence from a population-based study of people with Prader-Willi syndrome. Psychological Medicine: A Journal of Research in Psychiatry and the Allied Sciences, 33(1), 141–153.Google Scholar
  32. Lahey, B. B., Schwab-Stone, M., Goodman, S. H., Waldman, I. D., Canino, G., Rathouz, P. J., et al. (2000). Age and gender differences in oppositional behavior and conduct problems: A cross-sectional household study of middle childhood and adolescence. Journal of Abnormal Psychology, 109(3), 488–503.PubMedCrossRefGoogle Scholar
  33. Lahey, B. B., Waldman, I. D., & McBurnett, K. (1999). The development of antisocial behavior: An integrative causal model. Journal of Child Psychology and Psychiatry, 40(5), 669–682.PubMedCrossRefGoogle Scholar
  34. Lakin, K. C. (1983). New admissions and readmissions to a national sample of public residential facilities. American Journal of Mental Deficiency, 88(1), 13–20.PubMedGoogle Scholar
  35. Lam, K. S. L., & Aman, M. G. (2007). The repetitive behavior scale-revised: Independent validation in individuals with autism spectrum disorders. Journal of Autism and Developmental Disorders, 37(5), 855–866.PubMedCrossRefGoogle Scholar
  36. Lecavalier, L., Leone, S., & Wiltz, J. (2006). The impact of behaviour problems on caregiver stress in young people with autism spectrum disorders. Journal of Intellectual Disability Research, 50(Pt 3), 172–183.PubMedCrossRefGoogle Scholar
  37. Lochman, J. E., & Wayland, K. K. (1994). Aggression, social acceptance, and race as predictors of negative adolescent outcomes. Journal of the American Academy of Child and Adolescent Psychiatry, 33(7), 1026–1035.PubMedCrossRefGoogle Scholar
  38. Lord, C., DiLavorne, P. C., & Risi, S. (2002). Autism diagnostic observation schedule. Los Angeles, CA: Western Psychological Services.Google Scholar
  39. Lord, C., & Rutter, M. (1994). Autism diagnostic interview-revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24(5), 659–685.PubMedCrossRefGoogle Scholar
  40. Matson, J. L., & Rivet, T. T. (2008). The effects of severity of autism and PDD-NOS symptoms on challenging behaviors in adults with intellectual disabilities. Journal of Developmental and Physical Disabilities, 20(1), 41–51.CrossRefGoogle Scholar
  41. McClintock, K., Hall, S., & Oliver, C. (2003). Risk markers associated with challenging behaviours in people with intellectual disabilities: A meta-analytic study. Journal of Intellectual Disability Research, 47(6), 405–416.PubMedCrossRefGoogle Scholar
  42. McIntyre, L. L., Blacher, J., & Baker, B. L. (2002). Behaviour/mental health problems in young adults with intellectual disability: The impact on families. Journal of Intellectual Disability Research, 46(3), 239–249.PubMedCrossRefGoogle Scholar
  43. Moffitt, T. E. (1993). Adolescence-limited and life-course-persistent antisocial behavior: A developmental taxonomy. Psychological Review, 100(4), 674–701.PubMedCrossRefGoogle Scholar
  44. Mullen, E. M. (1995). Mullen scales of early learning. Circle Pines, MN: American Guidance Service, Inc.Google Scholar
  45. Murphy, G., Macdonald, S., Hall, S., & Oliver, C. (2000). Aggression and the termination of “rituals”: A new variant of the escape function for challenging behavior? Research in Developmental Disabilities, 21(1), 43–59.PubMedCrossRefGoogle Scholar
  46. Nagin, D. S., & Tremblay, R. E. (2001). Parental and early childhood predictors of persistent physical aggression in boys from kindergarten to high school. Archives of General Psychiatry, 58(4), 389–394.PubMedCrossRefGoogle Scholar
  47. NICHD Early Child Care Research Network. (2004). Trajectories of physical aggression from toddlerhood to middle childhood: I. Introduction. Monographs of the Society for Research in Child Development, 69(4), 1–25.CrossRefGoogle Scholar
  48. Prinstein, M. J., Boergers, J., & Vernberg, E. M. (2001). Overt and relational aggression in adolescents: Social-psychological adjustment of aggressors and victims. Journal of Clinical Child Psychology, 30(4), 479–491.PubMedCrossRefGoogle Scholar
  49. Reese, R. M., Richman, D. M., Belmont, J. M., & Morse, P. (2005). Functional characteristics of disruptive behavior in developmentally disabled children with and without autism. Journal of Autism and Developmental Disorders, 35(4), 419–428.PubMedCrossRefGoogle Scholar
  50. Rubin, K. H., Burgess, K. B., & Hastings, P. D. (2002). Stability and social-behavioral consequences of toddlers’ inhibited temperament and parenting behaviors. Child Development, 73(2), 483–495.PubMedCrossRefGoogle Scholar
  51. Rutter, M., Le Couteur, A., & Lord, C. (2003). Autism diagnostic interview-revised. Los Angeles, CA: Western Psychological Services.Google Scholar
  52. Shoham-Vardi, I., Davidson, P. W., Cain, N. N., Sloane-Reeves, J. E., Giesow, V. E., Quijano, L. E., et al. (1996). Factors predicting re-referral following crisis intervention for community-based persons with developmental disabilities and behavioral and psychiatric disorders. American Journal on Mental Retardation, 101(2), 109–117.PubMedGoogle Scholar
  53. Sparrow, S. S., Cicchetti, D. V., & Balla, D. A. (2005). Vineland adaptive behavior scales (2nd ed.). Circle Pines, MN: American Guidance Service.Google Scholar
  54. Stevenson, J., Richman, N., & Graham, P. J. (1985). Behaviour problems and language abilities at three years and behavioural deviance at eight years. Journal of Child Psychology and Psychiatry, 26(2), 215–230.PubMedCrossRefGoogle Scholar
  55. Stith, S. M., Liu, T., Davies, L. C., Alder, M. C., Som, A., Dees, J. E. M. E. G., et al. (2009). Risk factors in child maltreatment: A meta-analytic review of the literature. Aggression and Violent Behavior, 14(1), 13–29.CrossRefGoogle Scholar
  56. Stone, R. K., Alvarez, W. F., Ellman, G., & Hom, A. C. (1989). Prevalence and prediction of psychotropic drug use in California developmental centers. American Journal on Mental Retardation, 93(6), 627–632.PubMedGoogle Scholar
  57. Stormshak, E. A., Bierman, K. L., Bruschi, C., Dodge, K. A., & Coie, J. D. (1999). The relation between behavior problems and peer preference in different classroom contexts. Child Development, 70(1), 169–182.PubMedCrossRefGoogle Scholar
  58. Tomanik, S., Harris, G. E., & Hawkins, J. (2004). The relationship between behaviours exhibited by children with autism and maternal stress. Journal of Intellectual and Developmental Disability, 29(1), 16–26.CrossRefGoogle Scholar
  59. Tremblay, R. E. (2000). The development of aggressive behaviour during childhood: What have we learned in the past century? International Journal of Behavioral Development, 24(2), 129–141.CrossRefGoogle Scholar
  60. Tremblay, R. E., Nagin, D. S., Seguin, J. R., Zoccolillo, M., Zelazo, P. D., Boivin, M., et al. (2004). Physical aggression during early childhood: Trajectories and predictors. Pediatrics, 114(1), e43–e50.PubMedCrossRefGoogle Scholar
  61. Tsakanikos, E., Costello, H., Holt, G., Sturmey, P., & Bouras, N. (2007). Behaviour management problems as predictors of psychotropic medication and use of psychiatric services in adults with autism. Journal of Autism and Developmental Disorders, 37(6), 1080–1085.PubMedCrossRefGoogle Scholar
  62. Veenstra-Vanderweele, J., Christian, S. L., & Cook, E. H., Jr. (2004). Autism as a paradigmatic complex genetic disorder. Annual Review of Genomics and Human Genetics, 5, 379–405.PubMedCrossRefGoogle Scholar
  63. Wechsler, D. (1999). The Wechsler abbreviated scale of intelligence. San Antonio, TX: The Psychological Corporation.Google Scholar
  64. Wechsler, D. (2003). Wechsler intelligence scale for children (4th ed.). San Antonio, TX: Psychological Corporation.Google Scholar
  65. Zahn-Waxler, C., Park, J.-H., Essex, M., Slattery, M., & Cole, P. M. (2005). Relational and overt aggression in disruptive adolescents: Prediction from early social representations and links with concurrent problems. Early Education and Development, 16(2), 259–282.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of Health Psychology and Thompson Center for Autism and Neurodevelopmental DisordersUniversity of MissouriColumbiaUSA

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