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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\u2013Ottawa 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\u2014including age, IQ, caregiver characteristics, and sensory or biological markers\u2014was 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.<\/jats:p>","DOI":"10.1177\/00332941261501045","type":"journal-article","created":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T11:35:45Z","timestamp":1792323345000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Predictors of Aggression in Children and Adolescents With Autism Spectrum Disorder: A Systematic Review"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9614-0611","authenticated-orcid":false,"given":"Yahui","family":"Yang","sequence":"first","affiliation":[{"name":"Yangzhou University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fang","family":"Wang","sequence":"additional","affiliation":[{"name":"Yangzhou Wenhe Primary School"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Zhang","sequence":"additional","affiliation":[{"name":"Yangzhou Wenhe Primary School"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aiguo","family":"Chen","sequence":"additional","affiliation":[{"name":"Nanjing Sport Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fengshu","family":"Zhu","sequence":"additional","affiliation":[{"name":"Yangzhou University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,18]]},"reference":[{"key":"e_1_3_7_2_1","volume-title":"Parenting stress index","author":"Abidin R. 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