Autistic children sometimes express their emotions through aggressive behaviour towards others. Sometimes their aggressive behaviour can be directed towards themselves. This is called self-injurious behaviour. They might hit, kick, throw objects or hurt themselves – for example, by head-banging.
Aggression in autism can involve severe tantrums, anger, hostility, sudden-onset violent outbursts including self-harm and rage 'episodes'.
High-functioning autism and the rage cycle
The rage cycle consists of three stages: The rumbling stage or the anger build-up stage includes repetitive behaviors such as rocking and pacing, covering ears with hands, suddenly becoming very tense, and threatening others.
Adults diagnosed with autism spectrum disorder (ASD), including Asperger's and autism, are prone to anger outbursts. An 'on-off' quality during which individuals may be calm one second and then have an autism outburst in the next is common.
In addition, underlying problems can trigger aggression. Among those with autism, common triggers include disturbing breaks in routine, lack of sleep, jarring “sensory stimuli” (noises, lights, or smells) or even undiagnosed mental health problems.
If a person with autism says something that appears rude or offensive, it is most likely a result of missing or not being able to read typical social cues. You can kindly and calmly say, “Please don't say 'You have spots on your face. ' People think that is rude.” That's all it takes.
Risperdal is an antipsychotic medication given to kids who have extreme behavior problems like being very aggressive or angry. It's sometimes used for kids with autism, ADHD or ODD (oppositional defiant disorder) who are acting out in dangerous ways.
The only medications approved by the FDA for children with autism are Abilify and Risperdal. Both are antipsychotic medications that can help with irritability and aggression. Medication can also be helpful for kids who also have another diagnosis.
Signs of High-Functioning Autism in Children
May appear more mature for their age and have above-average intelligence. A tendency to avoid eye contact. Trouble deviating from a routine or adapting to changes. Trouble making friends and maintaining social relationships or not “fitting in” with peers.
In the general population, young children often become less aggressive as they get older and learn better ways to express themselves. But for some with autism, aggression persists through the teen years into adulthood.
During a meltdown, we found that most autistics described feeling overwhelmed by information, senses, and social and emotional stress. They often felt extreme emotions, such as anger, sadness, and fear, and had trouble with thinking and memory during the meltdown.
In previous studies of children with ASD, the term 'irritability' was often used to describe severe behavioral difficulties, e.g., verbal and physical aggression, self‐injury or property destruction.
Many autistic children love to argue and need to have the last word. Autistic children often find it distressing to not be 'right'; this is due in part to the need to look 'perfect' to protect their self-esteem. It's not important to get the final word as the adult; don't get into a downward cycle of arguing.
Mood stabilizing autism medication
Lithium, Lamictal, Depakene, Depakote, Tegretol, Topamax, Trileptal, and Keppra are options to explore with your child's pediatrician.
Some autism research shows that differential reinforcement is highly effective when treating violence in children on the spectrum. This strategy involves providing reinforcement when the problem behavior is not performed. It contains some different subtypes: Reinforcement whenever the problem behavior is absent.
While cognitive empathy can be lower in people with autism, affective empathy—which is based on instincts and involuntary responses to the emotions of others—can be strong and overwhelming. In fact, newer research suggests that some people with autism may actually feel other people's emotions more intensely.
In a patient with autism and agitation, consider drug-induced causes like akathisia. Start by reducing sensory stimulation and then establish a set routine and structure to the day. Consider short-term benzodiazepines or beta-blockers, however, keep in mind the effect beta-blockers on sleep.
One particularly rich indicator of social differences in autism is the voice. Children with autism often sound different from other people. Some may speak in a flat, monotone voice; others may use unusual modulation or stress different words or parts of words in their speech; and some may speak at an increased volume.
Remain calm. Remember that your child's behavior may be kindled if you “give in” to their aggression. Prevent your child from making contact with you by moving out of the way. If this is not possible, you may need to protect vulnerable parts of your body.