Aggressive behavior problems in children with autism spectrum disorders: Prevalence and correlates in a large clinical sample

Alison Presmanes Hill, Katharine E. Zuckerman, Arlene D. Hagen, Daniel J. Kriz, Susanne W. Duvall, Jan Van Santen, Joel Nigg, Damien Fair, Eric Fombonne

Research output: Contribution to journalArticlepeer-review

171 Scopus citations


Aggressive behavior problems (ABP) are frequent yet poorly understood in children with autism spectrum disorders (ASD) and are likely to co-vary significantly with comorbid problems. We examined the prevalence and sociodemographic correlates of ABP in a clinical sample of children with ASD (N = 400; 2-16.9 years). We also investigated whether children with ABP experience more intensive medical interventions, greater impairments in behavioral functioning, and more severe comorbid problems than children with ASD who do not have ABP. One in four children with ASD had Child Behavior Checklist scores on the Aggressive Behavior scale in the clinical range (T-scores ≥ 70). Sociodemographic factors (age, gender, parent education, race, ethnicity) were unrelated to ABP status. The presence of ABP was significantly associated with increased use of psychotropic drugs and melatonin, lower cognitive functioning, lower ASD severity, and greater comorbid sleep, internalizing, and attention problems. In multivariate models, sleep, internalizing, and attention problems were most strongly associated with ABP. These comorbid problems may hold promise as targets for treatment to decrease aggressive behavior and proactively identify high-risk profiles for prevention.

Original languageEnglish (US)
Pages (from-to)1121-1133
Number of pages13
JournalResearch in Autism Spectrum Disorders
Issue number9
StatePublished - Sep 2014
Externally publishedYes

Bibliographical note

Funding Information:
This research was conducted using data collected as part of the Autism Treatment Network (ATN). The ATN is funded by Autism Speaks and a cooperative agreement ( UA3 MC 11054 ) from the Health Resources and Services Administration to Massachusetts General Hospital. Dr. Zuckerman's effort was funded by K23MH095828 from the U.S. National Institute of Mental Health .


  • Aggression
  • Attention problems
  • Autism spectrum disorders
  • Internalizing problems
  • Psychotropic drugs
  • Sleep


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