Reactive/proactive aggression and affective/cognitive empathy in children with ASD

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Abstract

The main aim of this study was to examine the extent to which affective and cognitive empathy were associated with reactive and proactive aggression, and whether these associations differed between children with an Autism Spectrum Disorder (ASD) and typically developing (TD) children. The study included 133 children (67 ASD, 66 TD, Mage = 139 months), who filled out self-report questionnaires. The main findings showed that the association between reactive aggression and affective empathy was negative in TD children, but positive in children with ASD. The outcomes support the idea that a combination of poor emotion regulation and impaired understanding of others’ emotions is associated with aggressive behavior in children with ASD.

Highlights

► Reactive aggression was negatively associated with affective empathy in TD children, but this association was positive for children with ASD. ► Observation of others’ distress is associated with anger and aggressive behavior in children with ASD.

Introduction

Aggressive behaviors have been frequently observed in children with Autism Spectrum Disorder (ASD) (Bronsard et al., 2010, Farmer and Aman, 2011, Kanne and Mazurek, 2011), which are also related to more frequent mental health referrals (Mash & Barkley, 2003). Clinicians sometimes argue that aggressive behaviors in children with ASD should not be interpreted the same way as in typically developing (TD) children (Matson & Nebel-Schwalm, 2007). In fact, despite the high prevalence of aggressive behaviors in young and/or intellectual disabled children with ASD, little research has been done to examine aggressive behavior in high-functioning young adolescents with ASD. In TD children, a lack of empathy is associated with higher levels of aggression (e.g., Jolliffe & Farrington, 2006). Although children with ASD are known for their atypical empathic development (Jones, Happe, Gilbert, Burnett, & Viding, 2010), it has never been studied in relation to their aggressive behavior. Therefore, in this study, the main aim was to examine the relationship between empathy (affective and cognitive) and aggression in children and young adolescents with ASD, as compared to their TD peers.

Research is suggesting that aggression is a common problem in children with ASD (Farmer and Aman, 2011, Kanne and Mazurek, 2011). For example, young and older children with ASD exhibit various externalizing behaviors such as damaging others’ belongings, tantrums, and self-injurious behaviors (Horner, Carr, Strain, Todd, & Reed, 2002). Kanne and Mazurek (2011) investigated 1380 children with ASD from 4 to 17 years old and found that 68% displayed aggressive behavior toward a caregiver and 49% toward non-caregivers. However, these studies examining aggressive behavior in children with ASD mainly include intellectual disabled children with ASD. Despite this high prevalence of aggressive behaviors in this population of children with ASD, to date, little research is done on aggressive behavior in high functioning young adolescents with ASD. Furthermore, not much is known about possible causes or motives of these behaviors.

Aggressive behavior can be divided into reactive and proactive aggression. Reactive aggression is seen as defensive behavior in reaction to real or perceived external provocation without thought to personal gain (Crick & Dodge, 1996). It is a response to poor emotion regulation, feelings of anger, and hostile (mis)attributions or misunderstandings (Marsee & Frick, 2007). Proactive aggression refers to instrumental aggression, which children engage in to reach a certain goal (e.g., material or territorial gain or social control), without being provoked (Crick & Dodge, 1996). It has been argued that proactive aggression is not necessarily anger-driven (e.g., Crick & Dodge, 1996). However, Hubbard et al. (2002) showed that children who display higher levels of proactive aggression also report higher levels of anger. Yet, these children appear to be particularly skilled in controlling their anger expressions.

Since children with ASD are known for their poor emotion regulation especially in social situations (Laurent & Rubin, 2004), one would expect higher rates of reactive aggression in this group. Farmer and Aman (2011) analyzed parent reports on different subtypes of aggression in children and adolescents with ASD (from 3 to 20 years old) and indeed found higher instances of behaviors linked to reactive aggression, such as hot-headedness, impulsive reactions, and difficulties with cooling off (Farmer & Aman, 2011). Children and adolescents with ASD are also reported to use more physical aggression, such as pinching, biting, and throwing objects toward others, compared to children without ASD (Farmer & Aman, 2011). These behaviors are especially seen in stress-evoking situations further emphasizing the intent of reactive aggression (Bronsard et al., 2010). Note, however, that a higher intelligence is related to less reactive aggression (Brereton et al., 2006, Nas et al., 2005), and that the presently cited studies examined low functioning individuals with ASD.

There is not much known about whether children with ASD display more proactive aggression than TD children. However, there are some studies examining bullying behavior in children with ASD, which could be seen as a form of proactive aggression, because bullies initiate aggressive behavior in order to dominate others (Camodeca, Goossens, Terwogt, & Schuengel, 2002). Furthermore, bullies show and report high rates of proactive aggression (Salmivalli & Nieminen, 2002). A study of Farmer and Aman (2009) investigated different subtypes of aggressive behavior in children with ASD and other intellectual/developmental disabilities and found that parents of children with ASD score their children higher on bullying, compared to children without ASD. Yet, other studies based on parent or self-report showed no differences in the frequency of bully behaviors between children with ASD and TD children (Montes and Halterman, 2007, Rieffe et al., 2012, Twyman et al., 2010). Conclusively, there are no clear study results supporting children with ASD would display more proactive aggression compared to TD children.

Empathy refers to the ability to accurately perceive and understand another person's emotions and to react to these emotions appropriately (Rieffe, Ketelaar, & Wiefferink, 2010). It is an important feature of human interpersonal behavior, necessary to interact effectively in the social world. Furthermore, empathy is a complex construct that exists of lower order (affective empathy) and higher order processes (cognitive empathy) (Leiberg & Anders, 2006).

Affective empathy, or contagion (Hoffman, 1987), is linked to mirror neurons in the parietal-frontal region of the brain. These mirror neurons are activated whilst observing another's goal directed action (Cattaneo & Rizzolatti, 2009), also creating arousal in the observer. Although earlier studies suggested mirror neuron abnormalities in children with ASD (Dapretto et al., 2006), recent studies indicate that the mirror neuron system in children with ASD is intact (Fan et al., 2010, Press et al., 2010). Children with ASD are as emotionally aroused (based on skin conductance activity) when witnessing another's distress as TD children (Blair, 1999), and did not score lower than TD children on a self-report questionnaire measuring affective empathy (Jones et al., 2010). Furthermore, children with ASD have been found to score equally to TD children on affective empathy tasks (Dziobek et al., 2008).

Additionally, for an adaptive empathic response, the focus of concern should be other-oriented rather than self-oriented (Eisenberg et al., 1996). In other words, observers should recognize that their own arousal is a consequence of the other's emotion and not their own. When observers are unable to locate the source of the arousal and misinterpret its cause, this will cause personal distress in the observers. In TD children, personal distress can be observed in very young children, but it decreases naturally with age when children's skills for emotion regulation develop (Rieffe et al., 2010). Furthermore, a certain level of cognitive empathy is required to decrease personal distress. Cognitive empathy refers to the ability to adopt another's point of view, and represent the other's thoughts, intentions, beliefs, and knowledge, which facilitates the observer to interpret and understand others’ emotions. The ability to infer mental states, also known as Theory of Mind (ToM) (Blair, 2005), is the capacity to understand or predict others’ behaviors based on the subjective desires and/or beliefs of that person (Gordon, 1992). A ToM is typically established around the age of four. Children with ASD are known for their impairments in this domain (Baron-Cohen et al., 1985, Dziobek et al., 2008, Jones et al., 2010, Rogers et al., 2007), and in fact, seem well aware of this impairment and also score lower than TD children on self-report items that measure understanding others’ emotions (Dziobek et al., 2008, Jones et al., 2010).

Empathy is supposed to cause prosocial behaviors, such as helping, sharing, comforting, in attempt to alleviate the other person's distress. Especially these kinds of behaviors seem overly absent or limited in children with ASD (Sigman, Kasari, Kwon, & Yirmiya, 1992). It is argued that the lack of prosocial behaviors is mainly caused by impaired cognitive empathy and poor emotion regulation. In other words, children with ASD are unable to regulate their own empathic arousal (contagion) because they fail to understand why the other person is upset. It appears that emotions of others are confusing and unpredictable for children with ASD, which causes distress and prevents them from behaving empathically (Blair, 1999, Jones et al., 2010, Smith, 2009).

In TD children, reactive aggression is associated with lower levels of affective empathy (contagion). Children who become distressed by witnessing the negative state of another person, usually stop harming the other in order to reduce their own (empathic) distress (Mayberry & Espelage, 2007). Reactive aggression is also linked to lower levels of cognitive empathy. Rieffe and Meerum Terwogt (2006) argue that children who are more able to take another's perspective, react less aggressively. In contrast, personal distress could be expected to be positively related to reactive aggression, because personal distress is indicative for poor emotion regulation (Eisenberg, 2000). Whereas it is clear in TD children that reactive aggression is inhibited by both affective and cognitive empathy (Mayberry and Espelage, 2007, Rieffe and Meerum Terwogt, 2006), no studies have yet examined this linkage of reactive aggression and empathy in children with ASD.

Proactive aggression is associated with lower levels of affective empathy in TD adolescents (Lovett & Sheffield, 2007). Yet, the relation between proactive aggression and cognitive empathy is less clear. It has been argued that proactive aggression in the form of bullying is associated with higher levels of cognitive empathy compared to reactive aggression (Sutton, Smith, & Swettenham, 1999). However, others could not support this claim and found a negative association between bullying and cognitive empathy instead (Gini et al., 2007, Mayberry and Espelage, 2007, Rieffe et al., 2012). To our knowledge, no studies examined how proactive aggression is related to affective and cognitive empathy in children with ASD.

This study was a first attempt to examine the link between empathy and aggression in children with ASD. We focused on the relationship of reactive and proactive aggression with affective and cognitive empathy. We chose to examine this relationship in middle childhood because from the age of nine, children's cognitive and emotional functioning develops fast and children are increasingly able to reflect upon their own emotions and behaviors (Harris, 1989). Self-reports were used to measure aggression and empathy. Additionally, children's ToM capacity was also indexed through an age-appropriate false belief task (Theunissen, Rieffe, Kouwenberg, Soede, Briaire, & Frijns, 2011). We added the level of self-reported daily anger as an index for emotion regulation.

First, differences between children with ASD and TD children in the level of self-reported reactive and proactive aggression and parent-report of externalizing behavior (CD and ODD) were examined. Differences in the level of empathy (contagion, personal distress, and understanding), ToM capacity, and emotion regulation (daily anger) were also examined. Based on previous studies, we expected to find higher rates of reactive but not proactive aggression in children with ASD compared to TD children (Farmer & Aman, 2011). We did not expect differences in rates of affective empathy between the two groups. However, we expected higher rates of personal distress and daily anger, and lower rates of cognitive empathy and their ToM ability in children with ASD compared to TD children, based on previous discussed literature (Baron-Cohen and Wheelwright, 2004, de Vignemont and Singer, 2006, Jones et al., 2010, Laurent and Rubin, 2004).

Second, the relations of reactive aggression and proactive aggression with the different aspects of empathy and daily anger were examined, using group (ASD/TD) as a moderator. We expected negative associations of reactive aggression with affective and cognitive empathy and a positive association of reactive aggression with personal distress and daily anger. However, we expected a moderating effect of group on the relation between affective empathy and reactive aggression, in a way that the negative relation between affective empathy and reactive aggression is evident in TD children, but not in children with ASD. Previous studies indicate that the empathic arousal created by affective empathy, is not well regulated in children with ASD because of impaired cognitive empathy and emotion regulation (Blair, 1999, Smith, 2009). Therefore, it was expected that affective empathy does not have that inhibiting role in aggressive behavior, as it does in TD children.

Although literature is contradictive regarding proactive aggression (Crick and Dodge, 1996, Hubbard et al., 2002, Mayberry and Espelage, 2007, Rieffe et al., 2012, Sutton et al., 1999), we expected a negative association with affective and cognitive empathy, and a positive association with daily anger. We were unable to formulate expectations concerning moderating effects of group on the link between proactive aggression and empathy.

Section snippets

Participants and procedure

The ASD sample included 67 high functioning children (8 girls, 59 boys) diagnosed with ASD (Mage = 139 months, SD = 15.1, age range: 109–176 months) based on the Autism Diagnostic Interview-Revised (Lord, Rutter, & Lecouteur, 1994) by child psychiatrists. The ASD participants met the inclusion criteria (i) IQ scores above 80, (ii) diagnosed with ASD of the DSM-IV (Association, 1995). Participants were recruited from (1) Center for Autism, Leiden, The Netherlands; (2) Dr. Leo Kannerhuis, Doorwerth,

Differences between groups in externalizing behaviors, empathy, ToM, and anger

The mean scores in Table 3 show higher scores on parent reports ODD, t(109) = 6.433, p  .001 and CD, t(109) = 4.192, p  .001 in the ASD group compared to the TD group. The groups did not differ on the self-report measures for reactive and proactive aggression, anger mood, or the empathy scales contagion, and personal distress. Yet, children with ASD reported lower scores than their TD peers on the empathy scales of understanding t(131) = −3.866, p  .001 and on the ToM task t(131) = −1.993, p  .05.

Relations between reactive and proactive aggression with empathy, ToM, and anger

Table 4

Discussion

Should we interpret aggressive behaviors in children with ASD the same as in their TD peers? The main aim of this study was to examine the extent to which affective and cognitive empathy are associated with reactive and proactive aggression, and whether these associations are moderated by group.

Before interpreting the outcomes of this study, it should be noted that the self-report questionnaires used in this study showed moderate to good internal consistencies in both groups, supporting

Conflict of interest

The authors declare that they have no conflict of interest.

Acknowledgments

This research was supported by the Innovational Research Incentives Scheme (a VIDI grant) by The Netherlands Organisation for Scientific Research (NWO), no. 452-07-004 to Carolien Rieffe. The authors thank all participating children, parents, and schools. In addition, the authors thank Makoto Miller for correcting our English.

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