A CHECKLIST FOR IDENTIFYING SOURCES OF AGGRESSION

One of the most frequent and difficult parental concerns I see in the autism community is 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 bigger..

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 the behavior observed as aggression on the part of an autistic person. (To some extent, many of these issues can also be related to self-injury.)

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

1. Make sure that they are not being abused or mistreated in any way—At home, at school, in therapy, or in 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, 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 in behaving well or not lashing out since they’ll be punished for what they didn’t do. Extreme anxiety can also result from feeling like you can’t ever know the right thing to do 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 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 seriously take what they say in whatever way they can? 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 freedom 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 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, home or 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. Can they say ‘no’ and have it mean something? This does not imply 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?

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

7. Is sadness, grief, or anxiety 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 complete medical checkup and blood panels recently? Is it possible 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, alexithymia, body awareness issues, effects of compliance training, and atypical pain perception can make communication about illness or pain difficult.) Nutritional, dietary, and metabolic problems can also wreak havoc with our ability to self-regulate.

10. Are they being allowed sufficient downtime and privacy? Or does their school and therapy schedule mean 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 genuinely free time to spend as they choose or be alone? Do they have a space that is their own?