Behind Closed Doors: Exploring the Dark Side of Autism and Aggression

Angry outbursts, tantrums, or even physical violence directed at oneself or others is a behavioral challenge that some individuals with autism face. Autism and aggression can be extremely concerning and stressful for caregivers, families, and the individuals themselves.

So what causes the combination of autism and aggression? According to experts, there is no single root cause of autism and aggression as a co-occurring condition. Rather, multiple factors likely play a role in increasing an autistic individual’s risk for aggressive meltdowns and outbursts.

There are a number of factors that can contribute to autism and aggression. 

6 Factors May Contribute to the Co-Occurring Condition of Autism and Aggression

1. Communication Challenges
   Many people with autism have difficulties communicating their wants, needs, discomfort, emotions or thoughts effectively through speech. This is especially true for those who are nonverbal or have limited verbal skills. Their inability to communicate about things bothering them or to be understood by others can lead to mounting frustration, anxiety, and agitation. This creates a pressure cooker effect that can eventually erupt into aggressive behaviors like hitting, biting, kicking or throwing objects.

   Read more about how to conquer ostracism.

2. Sensory Overload
   A high percentage of autistic individuals experience sensory processing issues and sensitivities to things like noises, lights, textures, and more. Their brains have trouble filtering and making sense of all the sensory stimuli around them. When overstimulated by too much sensory information, an autistic person can feel overwhelmed and lash out aggressively in response. For example, loud noises from a classroom or restaurant can overload their system and cause a fight-or-flight reaction.

   Read more about sensory sensitivities.

3. Need for Sameness
   Many people on the spectrum thrive on routine, structure, order and sameness. They feel most secure when their environment and schedule is predictable. Sudden changes to their routines or surroundings can cause major distress, leading to autism and aggression.

   Life is full of changes big and small—a canceled doctor appointment, a disrupted dinnertime routine, a friend moving away. An autistic person’s severe need for sameness makes it hard for them to flexibly handle or adapt to these changes. Their anxiety and resistance against any change, coupled with their communication challenges, may result in aggressive behavioral meltdowns.

   Read more about mastering the art of calming down autism meltdowns.

4. Co-Occurring Conditions
   Autism frequently co-occurs with other diagnoses like attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), anxiety, depressive disorders, and intellectual disabilities. The symptoms of these other conditions can increase a likelihood of having autism and aggression, keeping in mind that every individual on the spectrum is unique. For example, individuals with autism and ADHD may act more impulsively and have lower frustration tolerance.

   Anxiety may heighten emotions and emotional dysregulation. Autism and aggression often fulfills a certain need, whether it be escaping an unpleasant task, getting attention, or soothing themselves through self-injury.

5. Learned Behavior
   In some cases, aggression becomes an ingrained behavior pattern for autistic individuals, children as well as adults. They learn that aggressive acts like hitting or biting can help them escape situations they want to avoid, can draw immediate attention from caregivers, or provide an outlet for their emotions.

   Well-meaning parents and teachers may even reinforce autism and aggression behaviors inadvertently by giving the child what they want when they have an outburst. With consistent reinforcement, either positive or negative, aggression becomes an entrenched part of the person’s behavioral repertoire. It’s something they know gets results. This learned behavior is no different than with any child who realizes tantrums or meltdowns can result in them getting what they want.

6. Other Medical Factors
   Various medical issues are also more common in autistic individuals and can contribute to aggressive tendencies. Gastrointestinal disorders like acid reflux, constipation, and abdominal pain are widespread in this population and the discomfort can put individuals on edge.

   Sleep disturbances like insomnia and sleep apnea prevent restful sleep necessary for stable moods and optimum functioning. Seizure disorders, headaches, and other pain sources also commonly co-occur with autism. The inescapable pain and discomfort understandably fuels irritability and could lead to autism and aggression. To rule out underlying medical factors, a thorough physical exam by a doctor is recommended.

   Read more about autism and sleep issues.

Multiple Interacting Factors Can Be At Play With Autism and Aggression

Autism and aggression usually stems from multiple interacting factors including communication impairments, sensory sensitivities, need for consistency, comorbid psychiatric issues, ingrained learned behaviors, and potential medical issues like pain or GI problems.

The multitude of possible reasons underscores why a one-size-fits-all approach rarely succeeds in addressing aggression in this population.

When a child or adult with autism struggles with aggressive behavior, it causes great stress and concern for those around them as well as the individual themselves. While it may seem at times nearly impossible to control in the heat of the moment, there are evidence-based strategies families and treatment providers can utilize to decrease the frequency and intensity of aggressive outbursts over time. It requires commitment, consistency, and often professional help to see lasting improvement. 

Here are some of the most effective approaches for autism and aggression.

Strategies to Reduce Aggression in Autism

1. Foster Communication
   Helping autistic children and adults develop better communication abilities to express their wants, needs, and feelings in safe, appropriate ways should be a top priority.

   For nonverbal individuals, try picture cards, written notes, posters with visual cues, or electronic communication devices as alternatives to physical aggression. Model and teach them how to appropriately get someone’s attention or ask for a break.

   Work on identifying emotions and triggers for meltdowns. Provide abundant positive reinforcement when they communicate properly instead of acting out. Supplementing communication is key to help minimize autism and aggression.

2. Use Visual Supports
   Visual schedules, calendars, timers, lists, and other supports help make routines and expectations clear while reducing anxiety around changes. Post lists of coping strategies and calming activities they can refer to.

   Provide visual warnings well in advance of transitions to new activities. Visual supports empower an autistic individual to prepare for and understand daily events and changes, lowering their stress levels and reducing aggressive reactions.

3. Adopt Proactive Sensory Strategies
   Customizing the home and school environments to accommodate autistic sensory needs can head off meltdowns before they start. For example, provide noise-canceling headphones, sunglasses or low lighting to prevent sensory overload.

   Make sure high stimulation areas like classrooms have calming spaces the person can retreat to. Build in sensory breaks during the day—things like jumping on a mini-trampoline, taking a walk around the block, or even just squeezing a stress ball.

   If you can tell they are getting overstimulated, redirect them to a sensory calming activity before aggression erupts.

4. Reinforce Alternate Behaviors
   When aggressive behavior happens, do not inadvertently reinforce it by giving in to the demands. Instead immediately redirect them to an appropriate replacement behavior or activity. Reward positive behavior.

   For example, if autistic individuals seek attention through hitting, instead direct them to appropriately ask for a hug or friend to play with and provide praise. Or if a child throws toys when angry, teach them to do counting breaths instead or another calming technique that works.

   Frequently reinforce the acceptable behaviors so the person learns they produce the same or better results than through autism and aggression.

5. Make Environments Safer
   During severe behavioral episodes, the safety of the autistic individual and those around them is paramount. Create a safe space where the person can go to calm down away from potential physical altercations.

   Limit access to objects that can be easily thrown or used to inflict harm. Provide protective gear like helmets for head banging, if the autism and aggression is extreme or could cause harm. Make the environment as safe as possible until the crisis passes, then look for triggers to avoid the situation recurring. Having emergency plans in place is crucial.

6. Medication
   For individuals with severe autism and aggression not responsive to other interventions, medication may provide needed relief. Anti-psychotics, antidepressants, anti-anxiety drugs, beta blockers, or mood stabilizers are sometimes prescribed in careful consultation with a doctor and oversight.

   Medication helps control emotions and impulse control to reduce aggressive outbursts when combined with other management strategies. A doctor can best advise if pharmaceutical intervention should be considered.

   (As always, please remember, I am not a medical expert and do not provide any medical advice, so be sure to check with your own physician and/or therapist about this option.)

7. Get Expert Input
   Seeking help from professionals trained in autism intervention, like applied behavior analysts, should be an integral part of any aggression reduction plan. Experts can investigate the purpose behind unwanted behaviors, identify triggers, create a behavior intervention plan, and provide much needed guidance to families and schools struggling to manage these significant issues.

   Many times getting to the root of aggressive actions requires professional assessments and ongoing collaboration.

Autism and Aggression Takeaways

Just like with any neurotypical individual, autism and aggression is a possible combination that must be managed to keep the person and others safe and healthy.  You’ve probably seen videos (or perhaps were a witness to one in person) incidents of children or adults having extreme temper tantrums. The damage and harm those out-of-control behaviors can be pretty scary to deal with.

Caregivers need to be brave to deal with this behavior properly, and face the challenge head on, and may even seek professional help if needed  for best options. It can be scary and difficult at first, but like many things, once effective practices are put into place, autism and aggression can be easier to navigate.

Autism can be complicated and challenging for individuals with the disorder, parents, caregivers, and loved ones and friends alike. But through compassion, teamwork, and evidence-based strategies tailored to the individual, major improvements are possible events involving autism and aggression can be managed.

With consistent implementation of practices like improving communication, creating visual supports, addressing sensory needs, rewarding positive behavior, and consulting therapy professionals, the autistic person’s quality of life greatly increases. While more research on effective treatments is still needed, there is hope through proper intervention and support for those facing autism and aggression.

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