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Understanding aggression in autism

by ,  /  5 December 2014

Jennifer Richler; Katherine Gotham.

Two new studies explore the link between autism and aggression — a controversial connection that weighs heavily on individuals with the disorder and their families.

One study, published 1 September in Research in Autism Spectrum Disorders, found that one in four children with autism shows aggressive behavior, such as hitting others, destroying property or throwing temper tantrums. In this study, aggression was more common among children with mild autism symptoms and low intelligence quotients. Children with significant aggressive behavior also tended to have mood and anxiety symptoms, and difficulty sleeping and paying attention.

The second study, published 11 September in Autism, explored possible pathways to aggressive behavior in undergraduate students who do not have autism. It found that social anxiety and anger rumination — the tendency to dwell on negative, hostile feelings — predict verbal and physical aggression. People who tend to think or talk about the same things over and over again — a feature of autism dubbed cognitive perseveration — are more likely to dwell on negative feelings.

The studies are timely, given the media attention surrounding Kelli Stapleton, a Michigan mother who pleaded guilty to the attempted murder of her 14-year-old daughter, Issy, in September. Issy had autism and a history of aggression that was at times extreme. Coverage of the case generated considerable controversy, particularly among autism rights advocates, who felt some media reports painted the mother as a victim of her daughter’s aggression.

In reality, the case was much more complicated. Stapleton was abused as a child. At her trial, psychiatric experts suggested that she had a personality disorder that made her ill-suited to face the challenges of raising a child with autism and aggressive behavior.

Putting aside these particulars, the case provides an opportunity to consider aggression in autism. While extreme, the behaviors that Issy displayed are consistent with those seen in some people with autism: They lash out, often in moments of anger or frustration, often at caregivers and family members.

This is a major source of stress for families. Some parents worry about their safety and that of their other children. There is also misplaced concern among the general public, particularly in light of another high-profile case: that of Adam Lanza.

Lanza, who in 2012 shot and killed his mother, 20 elementary school children and 6 school staff members before killing himself, reportedly had a diagnosis of Asperger syndrome. As a result, much of the media attention surrounding the tragedy focused on a possible connection between autism and violence.

There is little empirical evidence for such a connection. In fact, aggression in children with autism tends to be impulsive, vastly different from the premeditated murders Lanza carried out.

Though some people with autism are aggressive to themselves and to their caregivers, we have no reason to think that autism leads to intentional violent behavior. However, given that individuals who dwell on anger may be more prone to aggressive behavior,it is worth considering whether the relationship between anxiety, anger rumination and aggression might also extend to violence in some individuals with autism.

It’s also important to consider that autism is not the only vehicle to social isolation and anger rumination. People with depression, schizoaffective disorder and social phobia also experience these phenomena. In fact, aggression has been more consistently linked to these types of psychiatric disorders than to autism.

Rather than focusing on whether autism and violence are connected, we believe that it is far more useful to look for ways to ease aggression in individuals with the disorder. These new studies suggest that alleviating problems with sleep, attention or anger rumination might be a first step.

Katherine Gotham is assistant professor of psychiatry at Vanderbilt University in Nashville, Tennessee. Jennifer Richler is a freelance science writer based in Bloomington, Indiana, who holds a Ph.D. in clinical psychology.


22 responses to “Understanding aggression in autism”

  1. Seth Bittker says:

    I totally agree with the authors that it makes sense to try to treat the causes of aggression. I believe the factors underlying it are almost always biochemical. Unfortunately most practitioners either take a psychological approach or a pharmacological approach when in fact there are many supplements with fewer side effects that are effective for some.

    One place to start is fatty acids. Fatty acid deficits tend to exacerbate aggressive behavior and fatty acid deficits are very common in those with autism. In addition there has been a double blinded placebo controlled trial showing improvement in behavior with omega 3 fatty acids in autism. See: http://www.sciencedirect.com/science/article/pii/S0006322306005919.

    Omega 3 fatty acids are not the only ones that are low in autism. Typically omega 6s and omega 9s are also deficient and often the level of deficiency among gamma linolenic (an omega 6) and oleic (an omega 9) are much greater relative to controls than the deficiencies in omega 3 fatty acids. See: http://www.lipidworld.com/content/10/1/62. This suggests that supplementation with borage oil (mostly omega 6) and olive oil (mostly omega 9) could be helpful and perhaps even more helpful than supplementation with omega 3s. In fact as the father of a child affected by autism, I think supplementation with these is effective based on experimentation. It would be nice if somebody would consider running a double blind trial to see if this holds for others.

    • Lisalt says:

      Hi. We have tried Omega 3 Fatty Acids for more than a year now. I do not see that much improvement though. We have also been using Olive Oil only for like 10 years and it still does not make a difference. What we notice though is that, it comes with age, meaning, there comes a point in one’s life that aggression is lessened as he grows older. Also, we are doing time-outs if he gets angry over the fact that the youtube.com is taking a long time to load the video or the video is stalling or he is not yet done watching the video or he is losing/dying in Minecraft. We ask him to go to bed and just rest and behave there. Last year (12 years old), was his notorious year of aggression. This year, it has subsided significantly.

      • Seth Bittker says:

        It might be a good idea to get an organic acid test as this can give some insight into an individual’s biochemistry and biochemical dysfunction frequently leads to behavioral dysfunction.
        Some other ideas for aggression:
        1) Probiotics. If your child’s autism seems to be related to digestion, probiotics can help.
        2) Prunes. If your child has constipation, he or she will be irritable and this can lead to aggression. Prunes are great sources of fiber and the sorbitol in them also helps clear ammonia which can cause irritability and aggression.
        3) Methylfolate. This may sound counterintuitive but methylation deficits can lead to significant dysfunction including aggression.
        4) N-acetyl-cysteine. Sulfation deficits are common in autism and a placebo controlled trial found that NAC which is a sulfur containing amino acid decreased irritability.
        5) Decrease intake of vitamin D from supplementation or fortification. Vitamin D upregulates dopamine production and excessive dopamine production seems to be a factor in a number of cases of autism and irritability. In fact the drug risperidone works on the principal of down regulating the affect of dopamine.
        I have included these ideas and some others in an ebook that is available here: http://www.amazon.com/Autism-Getting-Biomedical-Protocol-Biochemistry-ebook/dp/B00R298YNW/.
        Admittedly it is quite possible that none of these supplements will work. I wish you and others who commented here all the luck in the world in getting a favorable resolution.

  2. ASD Dad says:

    Aggression in autism is a complex set of factors that needs to be addressed in an ecological framework as does Autism itself.

    The list of possible causes and pathology range from neurological injury , psychological stress, or to underlying disease ie gastrointestinal disease (IBD as one example).

    So taking the last example aggression to self and others can be ameliorated by correction of the underlying disease as outlined by gastroenterologists in the late 1990’s. Further research in the gut has indicated probiotics may also address key autism symptoms and one could conclude aggression.

    In regards to psychological stress, mindfulness,a modern meditative practice, Harvard researchers found considerable changes to brain function and structural differences in cerebral cortex relating to attention and emotional integration.

    It is an imperative that carers, parents and the varying medical personnel that interact with autistic children and parents are aware of a range of causations and possible treatment options.

  3. Amanda says:

    Honestly I find this post disturbing. Aggression is not a psychiatric issue in autism as much as it is simply an expression of pain. The majority of ASD kids with aggression problems have untreated GI disease. They are in terrible pain with either chronic constipation or diarrhea. Migraines are also a problem in this sub population as well as chronic infections, such a Strep, which is intensely painful.
    Please let’s move beyond autism circa 1980 and see the aggression not a a genetic or psychiatric issue but as a physical manifestation of biological pain.
    For severely affected ASD people CNT training will be highly challenging. Please do a through medical history, possible allergies, GI problems, immune dysfunctions before diagnosing aggression. See works of Rossingnol and Frye on biological underpinnings of aggressive behavior.

    • Dale says:

      Yes. Amanda is correct. This post IS disturbing. Aggression is another way of communicating and expressing self. It seems like every new set of parents talk about autism as though it’s just been invented. Ignoring the work and progress since the 80’s.

  4. Dadvocate says:

    Aggressive behavior is triggered by many things and takes many forms, of course. I’d like to see more research on the type of aggression in autism that looks to me to be a typical and completely involuntary fight or flight response triggered by overstimulation.

  5. Candi says:

    I have a 17 year old daughter. She was diagnosed at 3 with autism, 4 with epilepsy and along the way ADHD, OCD, Destructive Behavior disorder, Optional Defience disorder, Severe anxiety and last MR. Ok so over the years we have tried many things: diets, allergy test, natural pathics, speech therapists, OT, medications, early intervention programs, IBI(intensive behavior intervention). Many doctors. A few different children’s hospitals in differnt states. Different test ran on my daughter to figure how to help her…..NOTHING…..at the age of 3 we got her in early intervention was in that program for 3 years. Did well for learning had behavior outburst frequently but managable being little. At 4 started Grand Mal seizures. So he went through the public school system ( great school) we had behavior along the way there but still managable hard but managable she would hit herself and walls but seldom anyone else. 12 year old she starts puberty and that’s when the real aggression begins now!! Hit, kicks, pulls hair, throws objects all this to whomever is in her line of fire when the behavior starts. Could be a complete stranger on the street from a few minutes to 6 hours of rage. She could be completely happy hugs and loves one minute the next out of control no explaintion? Very unpredictable!! She weighed 200lb cause of the sezure meds and behavior meds it got to the point we could not control the behavior any longer. We put her in a behavior intervention place for a short stay to get her meds figured out. Well that happend on 3 occations. Couldn’t get her meds figured out or behavior. We have a son too which is 4 years younger than his sister so the state we live in told us the last time we removed her from the behavior program that if our daughter hurts our son in a physical manner that we need to get medical attention for we can have him taken away. In the mean time this has taken a mental toll on our son her constantly hitting him, throwing things at him. We decided to put her in a group home 2 years ago. The plan was for one year to get her meds under control. Here we are still with behavior and severe anxiety which brings on the behavior. Anxiety rules her life. It’s very sad!!! I wish I could find something/someone to help her:( . Any suggestions here is my email would love to hear anything!!!! Candibuell@gmail.com. Thank You!!

    • AutismDadd says:

      Very frustrating. It must be difficult to know what’s best. Seems you’ve tried it all. My experience would say be watchful of diet, stay optimistic and patient and as she grows some calming may occur. Its impossible to avoid meds when seizures are included. Also sad a group home was necessary, but I imagine you knew its was a must do.

  6. FLORENCE says:

    Mystery gene uncovered in autism studies may steer neurons. ANK2 may be a so-called ‘hot gene,’ meaning that it organizes the other genes in the network. Others are: SCN2A encodes a calcium channel, which binds to ANK3, another member of the ankyrin family. ANK3 has been linked to schizophrenia and bipolar disorder.

    If you’ve done 23andMe or AncestryDNA tests:
    HERE ARE THE LINKS TO CHECK YOUR RESULTS FOR THE GENES IDENTIFIED UN THIS RESEARCH ARTICLE:

    ANK2(Part 1): https://livewello.com/snps/library?action=preview&index=351542&for=demo

    ANK2(Part 2): https://livewello.com/snps/library?action=preview&index=962944&for=demo

    SCN2A: https://livewello.com/snps/library?action=preview&index=939601&for=demo

    PTEN: https://livewello.com/snps/library?action=preview&index=920917&for=demo
    ANK3 Gene (Part 1): https://livewello.com/snps/library?action=preview&index=110252&for=demo

    ANK3 Gene (Part 2): https://livewello.com/snps/library?action=preview&index=422042&for=demo

    ( Livewello gives results for about 600,000 genes. As long as the gene is in your raw data with rsID and minor allele Livewello will give you, your report for it. Livewello also comes with 8 Learning Resources linked directly to each of the Genes in your Variance Report. The major tools that come with the App are the SNP Sandbox tool, the Gene library and the Health Conditions tool.
    They are free features and well worth learning about here:
    https://www.facebook.com/notes/livewello/about-livewellos-gene-app/863565933654629 )

    Link to article: http://sfari.org/news-and-opinion/news/2014/mystery-gene-uncovered-in-autism-studies-may-steer-neurons

  7. Dee C says:

    Our autistic son is 30 and he has had lots of meds and therapy. His aggression is not gut pain as he is very verbal and can tell us what the problem is. He has so much fear and anxiety, on which he ruminates constantly, that he reacts to changes and problems with yelling and hitting. He creates rules that he wants the world to obey so he can be in control of everything. Yes, we need research on this! He will commit suicide or be killed by police if we can’t help him change.

  8. Payman says:

    Kids on autism, can not express themselves, difficulty sleeping, when they get sick they can not communicate it and they have host of health issues ignored by the science put forward by the world of psychiatry. These kids are left alone in a world of their own: How do you want not to get agressive.

  9. Heart-broken says:

    I am with Dee C. Our 24 year old son iOS very verbal (hyper verbal) and it’s his rules and we will go until he finally is exhausted. Nothing work. No redirecting, compromise, nada and it’s just heartbreaking. As our sons become adults society is very difficult on them and it scare the bgeegues out of me! He is still this boy trapped in a mans body who can’t recongnize how life is and we are scared for him! Personally, this Momma is worn out too 😞😞

  10. mom in the trenches says:

    This is a ridiculous situation. My adult son suffers. He is like a man without a country. He goes to a psychiatrist who doesn’t listen and refuses 2 talk 2 parents. It’s hard 2 find a decent dr in this field. Their job is to listen and help not harm. Very few shrinks r familar with autism .they would rather use psciatric terms..2 dehumanize.We r disgusted ..

    • AutismDadd says:

      Psychiatry is useless for most issues. They will charge you for listening to their blah blah opinions but actual help will not come from this source.

  11. gregboustead says:

    If someone you know exhibits warning signs of suicide, please call the U.S. National Suicide Prevention Lifeline at 800-273-TALK (8255).

    You can also visit their website: http://www.suicidepreventionlifeline.org

    Greg Boustead
    community manager, SFARI.org

  12. Questioning your response says:

    Mr. Boustead, Do you really think a hotline helps prevent suicide? Maybe for functional people, but autism, many times is not a reasonable thing. It isn’t the “cry for help”. I feel so bad for these people. Maybe you need to just tell them “we’re trying to find answers for you.” I wish so much that I would have focused my schooling on this type of research because I have the drive to find the answers. I don’t have super deep pockets like Mr. Simon, either, but love him for his willingness to use his money to look for answers for the rest of us.

  13. Lauren says:

    My son has been aggressive since he was little. He has continued, he went from aggression towards others and property destruction to just property destruction (his own things by the way). He usually gets aggressive when he can’t control things and doesn’t get he wants immediately. We have worked with CBA’s and believe me we have learned to a lot but have not been able to stop the aggression. We know when he is anxious and what sets him off so we do all we can avoid his meltdowns. He takes psychotropics but they do help only a little. At this point we feel like we are walking on eggshells so we don’t provoke his aggression. We aren’t trying to “fix” him he is a sweetheart when he is calm. Any suggestions would be appreciated. Thank you.

    • AutismDadd says:

      He hates his life. Have you looked into food allergies? Food allergies can affect behavior by affecting the brain. Start to research it online and research anything that occurs to you or others. You never know where you will end up finding. Wheat, cows milk etc are common allergens

  14. Joanne says:

    It’s not “just his autism”–This past April, our 17 year old high-functioning autistic son became aggressive and the incidents were prolonged and scary to us as parents. After repeated occurrences, we sought help from a pediatric psychiatrist. He advised us to put our son on Abilify and assured us that these aggressive incidents were “just part of his autism.” Because the aggression seemed to come on suddenly and didn’t start until age 17, my husband and I felt there was very likely a treatable cause. For the time being, we put our son on Abilify to counter the aggression.

    Prior to the onset of this aggression, our son had been suffering from depression and OCD. It turned out that he had a severe Vitamin D deficiency and once that problem was treated, his depression seemed to go away (but not the OCD) Around this time, we heard that the supplement, Turmeric, was helpful for depression and also inflammatory issues. We started giving him a daily Turmeric supplement (500mg). Around the time the aggression developed and Abilify was prescribed, my son started complaining that the turmeric (and other dense) tablets were too hard to swallow, so we stopped giving him the supplement. His aggression seemed under control and we assumed the Abilify was the answer.

    About six weeks later, I found turmeric in an easier-to-swallow capsule form, so we resumed giving our son the supplement. All of a sudden, the aggressive attacks resumed. The Abilify made the attacks less severe, but did not prevent them from occurring.

    It seemed too much of a coincidence that the aggression returned at the same time that we resumed giving our son the Turmeric supplement. The psychiatrist also mentioned something about food sensitivities that made me think my son might have a problem with the supplement. After about 10-15 minutes of computer research, I learned about sensitivities to phenols. It turns out that turmeric has a high phenolic content. When we stopped giving my son the turmeric, the aggression stopped (except for one day when we gave my son chicken seasoned with Old Bay, which contains paprika, also high in phenols). Many foods (fruits, vegetables, nuts, spices) contain phenols. If you suspect that your child’s aggression might be related to the food he/she eats, you might want to look at a list of high phenol foods. We only figured out the cause of our son’s aggression due to several seemingly unlikely coincidences.

  15. AutismDadd says:

    Its not complicated folks. Aggression comes from frustration. Try appreciating how hard it is to be autistic and try to imagine NOT being frustrated and bored. Not understanding your existence and what it means is frightening. We all have experience with this in certain instances, but we can think it through. But some can’t which must be frustrating.

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