Predictors of Aggression in Children and Adolescents With Autism Spectrum Disorder: A Systematic Review

Aggression is a common and impairing co-occurring behavior among children and adolescents with autism spectrum disorder (ASD), negatively affecting developmental outcomes, family functioning, and social participation. Although numerous studies have examined factors associated with aggression in ASD, findings remain inconsistent, limiting efforts to improve early identification and intervention. This systematic review synthesized current evidence on predictors of aggression in children and adolescents with ASD. The review protocol was registered in PROSPERO (CRD42023416081). A systematic search of PubMed, Web of Science, Embase, Scopus, and the Cochrane Library was conducted from database inception to 4 April 2024. Eligible studies were evaluated using the Joanna Briggs Institute Checklist for cross-sectional designs and the Newcastle-Ottawa Scale for cohort studies, and findings were narratively synthesized. Thirteen studies met inclusion criteria and were of generally satisfactory methodological quality. Across studies, six categories of predictors were identified: demographic, caregiver, core symptom, comorbidity, psychological, and biological factors. Social communication deficits and poor sleep quality showed relatively consistent associations with aggression, although these findings were based on only three and two studies, respectively, whereas evidence for other factors-including age, IQ, caregiver characteristics, and sensory or biological markers-was mixed. Overall, aggression in ASD appears to arise from interacting individual, familial, and contextual influences. These findings highlight the importance of assessing communication skills and sleep problems when evaluating aggression risk and suggest that interventions targeting these domains may reduce aggressive behavior. Future research should employ longitudinal and cross-cultural designs to clarify developmental pathways and strengthen the evidence base for personalized intervention strategies.