Early Childhood Aggression in Autistic and Non-Autistic Preschoolers: Prevalence, Topography, and Relationship to Emotional Reactivity

Abstract

Objective

Despite heightened rates of aggressive behaviors among older autistic youth relative to non-autistic peers, less is known about these behaviors during early childhood. This study included 3 objectives to address this gap: (1) to establish the prevalence and topography (frequency, severity, type, context) of aggressive behaviors in a large sample of preschool-aged children using a developmentally sensitive parent-report measure; (2) to identify clinical correlates of aggression; and (3) to investigate whether different subgroups of autistic children can be identified based on their profiles of aggression, emotional reactivity, and autism traits.

Method

Data were analyzed from parents of 1,199 children 2 to 5 years of age (n = 622 autistic children) who completed the Multidimensional Assessment Profiles Scales (MAPS) aggression subscale and the Emotion Dysregulation Inventory–Young Child (EDI-YC) reactivity subscale.

Results

Autistic preschoolers had 2 to 6 times higher odds of experiencing frequent aggression (more days than not) compared with non-autistic preschoolers. Hierarchical multiple regression analyses revealed that autism diagnosis, traits, and suspected and diagnosed attention-deficit/hyperactivity disorder (ADHD) were positively associated with aggression; however, heightened emotional reactivity explained the greatest degree of added variance in aggression total scores. Machine learning clustering techniques revealed 3 distinct subgroups of autistic preschoolers, with cluster membership driven primarily by aggression and reactivity scores, and less so by autism traits.

Conclusion

Autistic preschoolers display more frequent parent-reported aggressive behaviors, and emotional reactivity may play an important role in aggressive behavior presentation. Future developmental screening and early intervention tailoring for aggression may benefit from assessing reactivity early in development.

Plain language summary

In this study of 1,199 children aged 2 to 5 years of age (n = 622 autistic children), parents completed validated questionnaires quantifying disruptive behaviors and emotion dysregulation to evaluate prevalence and topography of aggressive behaviors, identifying clinical correlates of aggression, and determining distinct subgroups of children with autism based on patterns of aggression, reactivity, and autism traits. The authors found that preschoolers with autism had higher rates of frequent aggressive behaviors compared to non-autistic children. Although more aggression was associated with having an autism diagnosis, greater levels of autism traits, and attention-deficit/hyperactivity disorder, high levels of aggression were most strongly associated with heightened emotional reactivity. Subgroups of preschoolers with autism emerged principally on their aggression and emotional reactivity scores, rather than on their levels of autistic traits.

Diversity & Inclusion Statement

One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper self-identifies as living with a disability. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.