A checklist for identifying sources of aggression

One of the most frequent and difficult parental concerns that we see in the autism community is that of aggressive behavior on the part of a child or teenager.  Caring parents are often frustrated at not being able to discern the source of their child’s distress, or worry that while they can handle the physical outbursts of a small child, they won’t know what to do when a child is older and larger.

Several of us at We Are Like Your Child have personal experience with anger and aggression, or with children who do.

The following is a checklist of questions to address when trying to identify the source of and alleviate aggression on the part of an autistic child or adult.  It does not necessarily include every possibility, but is a preliminary checklist of, in our experience, some major primary issues that are likely to be related to behavior observed as aggression on the part of an autistic person.  (To some extent, many of these issues can be related to self-injury as well.)

These are presented in no rigid order of likelihood or importance—they are all important factors to consider and investigate, and may affect different individuals in different ways and different combinations.

1.  Make sure that they are not being abused or mistreated in any way—At home, at school, in therapy or other activities…by parents, by teachers, by classmates, by siblings (including what might seem like “normal” taunting)…physically, sexually, emotionally or psychologically.

1a.  If they are being subjected to therapy intended to normalize their appearance, behavior, or mannerisms, to extinguish stimming, or ensure compliance or indistinguishability, they are being abused.

1b.  Do teachers at school engage in group punishment for the misbehavior of individual students?  If so, it can feel like there’s no point to behaving well or not lashing out, since they’ll be punished anyway for what they didn’t do.  Extreme anxiety can also result from feeling like you can’t ever know what the right thing to do is, since punishment is seemingly random.

2.  Do they have a reliable and safe mode of communication?  If not, what is being done to address that?

2a.  Is gaining speech being prioritized over developing a mode of communication that works better for them?

3.  Is their communication, in whatever form it occurs, being acknowledged as such and honored?  Do people take seriously what they say, in whatever way they are able to say it?  Can they get their needs met by non-aggressive means?

4.  Is their competence being presumed?  Is their autonomy and right to self-direction being honored to the greatest extent possible?  Is their right to bodily autonomy or personal space being violated?  Are they being forced, pushed, tricked, or coerced into activities or modes of social interaction that they are not ready for?  Are they being put into situations where they feel unsupported or unsafe?  Are they being allowed to do academic work at their level of capability?  Are their strengths being recognized and supported?  Are they trusted to know and assert their own limits?  Are they being included to the greatest extent possible in plans regarding their welfare, education, and activities?

5.  Is something wrong in their sensory environment, whether at home or at school?  Is their home or classroom environment too loud, chaotic, claustrophobic, or unpredictable?  Are they trapped in an environment with other kids they find overwhelming, hostile, or threatening?

5a.  If they are intense sensory seekers in any way (and remember that someone can be sensory-defensive in some regards, and also sensory-seeking in others), do they have an outlet for intensive physical input and focus, such as a martial art, sport, hiking, swimming, or horseback riding?

6.  Are they allowed to say ‘no’ and have it mean something?  This does not mean that they never have to do something they don’t want to do (like go to the doctor or dentist), but if the matter at hand is not a matter of life, health, or immediate safety, are they allowed to refuse activities or situations that they find uncomfortable or have no interest in?

If an unpleasant situation is truly unavoidable, is everything possible being done to identify and address their discomfort?

7.  Is sadness, grief, or anxiety being expressed as anger or irritability?  (This is VERY common in autistic people.)  Have they experienced a loss of a family member, friend or favorite classmate, pet, or member of their support staff recently?

8.  Have their plans, routines, or need for ritualization been disrupted?  Has something changed recently in their environment, family life, or social milieu?

9.  Have they had a full medical checkup and blood panels recently?  Is it possible that they’re in pain or discomfort from a treatable medical condition or food allergy/sensitivity that they lack verbal means to communicate?  (Even in verbal individuals, alexythymia, body awareness issues, effects of compliance training, and atypical pain perception can make communication about illness or pain difficult.)  Nutritional, dietary, and metabolic issues can also wreak havoc with our ability to self-regulate.

10.  Are they being allowed sufficient down time and privacy?  Or does their school and therapy schedule mean that they’re working the equivalent of two full-time jobs?  Is their ability to multi-task or process being overwhelmed?  We are very vulnerable to sensory, information, and emotional overload.  Do they have truly free time to spend as they choose or be alone?  Do they have a space that is their own?

Finally, something that we very strongly recommend, if you are looking for further guidance or input, is to find an autistic adult or mentor local to you, who can meet you and your child, observe their environment and interactions, and give feedback on what kinds of changes or interventions might be helpful.