Children with ASD (Autism Spectrum Disorder) often exhibit aggressive behaviors. Some argue that aggressive behaviors in ASD-children should be interpreted differently from those exhibited by typically developing children. Atypical empathic development is often seen in children with ASD, but little research has been done to assess the association with their aggressive behavior.
What is known about aggression in ASD-children?
Previous studies have shown that children with ASD exhibit several aggressive behaviors (self-harm, vandalizing the belongings of others , tantrums). One study showed that 68% of over 1300 participants demonstrated aggressive behavior towards caregivers and 49% towards others. These studies, however, assessed aggressive behavior in mostly intellectual disabled ASD-children. Little is known about aggressive behavior in high functioning young adolescents.
There are two categories of aggressive behavior: proactive and reactive aggression. Proactive aggression (also known as instrumental aggression) is directed at reaching a certain goal without being provoked. Reactive aggression is shown in defense to a provocation (no personal gain motive).
Poor emotion regulation is common in ASD-children, resulting into the expectation that ASD-children show higher levels of reactive aggression. Earlier studies showed that adolescents and children with ASD exhibit more reactive aggression and physical aggression in comparison to TD-children. However, these studies involved low functioning participants, while a higher intelligence is associated with less reactive aggression. Little is known about ASD-children and proactive aggression. Bullying is considered a type of proactive aggression, which is reported more often in ASD-children. Unfortunately, research on this topic is lacking.
What is known about empathy in ASD-children?
Empathy concerns the ability to recognize and comprehend the emotions of others and being able to provide an appropriate response to these emotions. Affective empathy reflects emotional arousal when seeing others’ distress. ASD-children do not differ from TD-children on this matter. Cognitive empathy refers to perceiving and understanding the emotions experienced by someone else. It is common for ASD-children to have impairments regarding cognitive empathy.
Empathy is considered the precursor of prosocial behaviors (comforting, helping, sharing). These behaviors are often limited or absent in ASD-children. Some argue that these children can’t regulate their empathic arousal because they fail to comprehend why someone is distressed (poor emotion regulation and impaired cognitive empathy cause a lack of prosocial behaviors). Witnessing the emotions of other people can be distressing for ASD-children, which prevents the emergence of empathic behavior.
What is the relationship between aggression and empathy?
In typically developing children, there is an association between reactive aggression and decreased levels of affective empathy. Children’s distress caused by seeing someone else experiencing negative emotions, tends to stop them harming that person in order to minimize their own distress. There is also an association between reactive aggression and decreased levels of cognitive empathy. A child that can perceive and understand the other’s situation, tends to behave less aggressively. An association between reactive aggression and ASD-children was never examined.
In typically developing adolescents, there is an association between proactive aggression and decreased levels of affective empathy. The relation between cognitive empathy and proactive aggression is unclear, in ASD-children it was never examined.
What are the aims of this study?
This study aims to assess to which extent cognitive and affective empathy are related to proactive and reactive aggression, and whether this relation differs between children with ASD (Autism Spectrum Disorder) and TD (typically developing) children.
Examined were:
- Differences between TD-children and ASD-children in the level of self-reported proactive and reactive aggression and parent-reported externalizing behavior.
- Differences in the level of empathy (understanding, personal distress, contagion), emotion regulation (anger on a daily basis) and ToM capacity.
- The association between proactive and reactive aggression, and empathy and anger on a daily basis.
Who were the participants and what procedure was followed?
The ASD-group consisted of 67 high functioning children diagnosed with ASD, aged between 9 and 15 years. The TD-group consisted of 66 children aged between 9 and 15 years. No differences between the groups were found regarding gender, IQ and SES scores.
The participants were visited at their institutions or home and were asked to answer questions. Parents were asked to complete questionnaires.
Participants rated their aggressive behavior through self-reports. They had to report how often and why they experienced it.
Regarding externalizing behaviors, Anger, ToM and Empathy, parents reported higher scores in the ASD group. No differences between the groups were observed regarding self-reports for Anger Mood, Proactive and Reactive Aggression, Personal Distress and Contagion. ASD-children reported lower scores on the Understanding-scale and the ToM-task compared to TD-children.
The results show an correlation between Proactive and Reactive Aggression, Contagion, Understanding, ToM, Anger Mood and Personal Distress. Contagion was negatively correlated with Reactive Aggression in TD-children. In ASD-children, all empathy scales were positively correlated with both types of aggression (one exception: understanding with proactive aggression). The correlation between Reactive and Proactive Aggression and Contagion differed significantly between both groups. In ASD-children, there was a negative correlation between ToM and Proactive and Reactive Aggression. In TD-children, there was a negative correlation between ToM and Proactive Aggression. A positive correlation between anger mood and the two types of aggression was found in both groups.
ASD-children did not report more aggressive behaviors than the TD-children. Parents of ASD-children mentioned more symptoms of externalizing behavior compared to the parents of TD-children. While aggressive behavior in low functioning ASD-children is considered common, this is less evident in high functioning ASD-children. ASD-children reported less cognitive empathy (ToM and understanding). Scores of personal distress and contagion (affective empathy) showed no differences between both groups. This indicates that ASD-children have impaired cognitive empathy, but no impaired affective empathy.
In the ASD-group, it was found that higher levels of self-reported personal distress, contagion and anger mood, and a lower ToM capacity were related to more proactive and reactive aggression. Both anger mood and personal distress indicate an impaired capability of emotion regulation, which could mean that both forms of aggression in ASD-children may be explained by impaired emotion regulation.
In accordance with previous studies, impaired emotion regulation (anger mood and personal distress) was related to more reactive aggression in typically developing children. Contagion was, however, related to less reactive aggression in TD-children. The positive association of contagion with reactive aggression proves that all kinds of arousal can trigger aggressive behaviors in ASD-children. The relation between a lower capacity to ToM and more reactive aggression illustrates that issues with social cognitions could provoke aggressive behaviors towards other people.
The findings of this study indicate that cognitive empathy (ToM) is problematic for ASD-children, it prevents them from responding empathically. Not being able to handle their own arousal makes it difficult to response adaptively to the feelings of others.
Surprisingly, a lack of empathy was not related to proactive aggression in typically developing children. In ASD-children, some participants exhibited more proactive aggression and reported more arousal when seeing someone else in distress or pain. In both groups, higher levels of anger and a lower level of ToM were predictive of proactive aggression.
The findings of this study demonstrate that reactive aggression in ASD-children should be interpreted differently from that in TD-children. Reactive aggression in ASD-children seems related to impaired emotion regulation. Future programs for these children should include improving their ability to differentiate and regulate emotions.
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