Reactive/Proactive Aggression, Emotion Regulation, and Empathy in Children with ASD

Background:  Aggressive behavior has been frequently observed in children with Autism spectrum disorder (Farmer & Aman, 2010). It could be expected that this mainly concerns aggression in response to negative or overwhelming situations, which is (at least partly) caused by impaired emotion regulation skills. Emotion regulation skills are also important concerning empathy. For an adaptive empathic reaction, one needs to be able to regulate the own emotion arousal caused by witnessing another person in pain or upset. It could therefore be expected that impairments in controlling the own level of arousal evoked by witnessing a negative emotion in someone else, will be positively related to reactive aggression.

Objectives:  The purpose of the study was to examine the unique contribution of affective and cognitive empathy, and emotion regulation (anger mood) to reactive and proactive aggression in children with an Autism Spectrum Disorder (ASD) and typically developing (TD) children.

Methods:  The study included 136 children and young adolescents (68 with ASD, 68 TD, Mage = 139 months).In order to compare the groups, self-report and parent questionnaires concerning empathy, anger mood, and aggression were used.

Results:  The outcomes showed that affective empathy was negatively associated with reactive aggression in de TD group, but positively in the ASD group. However, in the ASD group, the link between affective empathy and reactive aggression was mediated by anger dysregulation. Personal distress was positively and uniquely related to reactive aggression in de TD group, over and above anger dysregulation. Proactive aggression was associated with affective empathy in the ASD group, but not in the TD group. Again, the link between proactive aggression and affective empathy was mediated by anger dysregulation in the ASD group.

Conclusions:  These outcomes support previous findings that in TD children, a lack of empathy is related to proactive aggression, suggesting a cold blooded urge to achieve their means. In contrast, emotion dysregulation is related to both reactive and proactive aggression in children with ASD, showing a different origin for these behavioral problems in this clinical group.