Aggression and Risk Behaviors in a Group of Adolescents with High-Functioning Autism

Aggression in adolescents with autism, particularly those with high-functioning autism (HFA), presents a unique clinical profile. The aim of this study was to assess and compare anger expression and regulation in adolescents with HFA, those diagnosed with conduct disorder (CD), and a control group with no psychiatric diagnoses.

A total of 120 adolescents aged 14-17 were divided into three equal groups: 40 with HFA, 40 with CD, and 40 controls. Participants were assessed using the State-Trait Anger Expression Inventory (STAXI-2), which measures emotional intensity, trait predisposition, and modes of anger expression and control. Non-parametric statistical analyses were conducted to examine group differences.

Statistically significant differences were found across most STAXI-2 scales. Adolescents with CD exhibited the highest scores on anger intensity and expression, followed-at a lower level-by those with HFA. The autism group showed significantly elevated levels of verbal anger expression and frustration reactivity compared to controls, but lower tendencies for physical aggression. Trait anger was also higher in the HFA group, particularly in response to frustration or criticism. No significant differences were found between the HFA and control groups on anger control scales individually; however, the overall Anger Expression Index was significantly elevated in HFA, reflecting a global imbalance between anger expression and regulation.

Adolescents with high-functioning autism exhibit a distinct profile of emotional dysregulation, characterized by increased verbal anger and frustration sensitivity, despite lower levels of overt aggression. This comparative pilot study contributes to a better understanding of emotional dysregulation and anger expression in adolescents with HFA. These findings highlight the need for tailored emotion regulation interventions. School-based programs focused on emotional awareness and verbal anger management could offer meaningful benefits for this population. Future research should expand sample diversity, explore gender differences, include common comorbidities like ADHD, and investigate longitudinal and neurobiological patterns of anger regulation in ASD.