Anxiety and aggression in adolescents with autism spectrum disorders attending mainstream schools

• Adolescents with ASDs are more physically aggressive at school than typically developing peers.
• Adolescents with ASDs are more likely to be suspended from school than typically developing peers.
• In adolescents with ASDs, physical aggression increases as severity of social anxiety increases.
• High anger control reduces physical aggression in adolescents with ASDs.

This study investigated the link between anxiety and aggression in adolescents with autism spectrum disorders (ASDs) using self-report measures of anxiety and anger and teacher ratings of behaviour. Participants were 104 high school students aged 12–18: 52 students with ASDs, without intellectual disability, and their typically developing peers matched for age and gender. Students with ASDs who attend mainstream high schools reported higher levels of anxiety and reactive anger than their peers, were reported by their teachers to engage in more aggressive behaviours, and were at higher risk of being suspended from school. The results further suggested that social anxiety is a significant moderator of the relationship between autism and physical aggression. For ASD students, but not for the control students, there was a strong, positive relationship: higher levels of anxiety were associated with higher levels of physical aggression. However, ASD students with high anger control did not display physical aggression. Our results have implications for screening students for anxiety, the provision of interventions for managing anxiety and the development of anger management skills, and for the appropriateness of suspension as a mandatory response to incidents of physical aggression in schools.