# Introduction his study looks to relate the hostile attribution bias present in children with autism spectrum disorder (ASD) and link it to the regulatory flexibility model (Bonanno et al., 2013), to understand better the emotion regulation process that goes through autistic children and ultimately try to find out why children with ASD are perceived to display more aggressiveness than their typically developing peers (Mazefsky et al., 2013;Samson et al., 2015). This knowledge is critical in better understanding children with ASD and providing better care. I hypothesize that autistic individuals will have difficulty understanding social cues and enacting reappraisal as an emotion regulation strategy. Their misunderstandings will lead to an inflexible emotion regulation model becoming more rigid as the regulatory flexibility model moves on. Finally, this will make them more prone to choose idiosyncratic emotion regulation strategies, ultimately leading to aggression, all because of misunderstanding/miscommunication. First, I will examine the current understanding of autism, summarize the diagnostic criteria, and define how I will deal with outdated diagnoses/terms such as Asperger's or "high-functioning." Then I will apply that knowledge and previous research to create a model of how individuals with autism face stressors using the regulatory flexibility model. I will talk about interpersonal regulation, and finally, I will apply this knowledge to literature that deals with hostile attribution bias in children with ASD. # II. # Definition of Autism Autism Spectrum Disorder (ASD) is an increasingly common neurodevelopmental condition that occurs in 1 in 44 children (Centers for Disease Control and Prevention, 2022). The DSM 5 diagnoses autism in people who have "persistent de ficits in social communication and social interaction across multiple contexts," "restricted, repetitive patterns of behavior, interests, or activities," and sensory deficits (American Psychiatric Association, 2022). The deficits in social communication extend to difficulties communicating and engaging in back-toback conversations. They might also have deficits in nonverbal communication, for example, lack of facial expressions and abnormalities in eye contact and body language. Repetitive behaviors might be similar to an adherence to schedule (and distress at changes) but also can be highly restricted and fixated interests. Sensory deficits mean that people with autism might be more sensitive to loud noises or certain textures (American Psychiatric Association, 2022). 71-80% of people with autism also have a co-occurring condition, such as intellectual disability, anxiety, or verbal apraxia (Leyfer et al., 2006), but they might be overdiagnosed. A study of 35 low-support adolescents with ASD found that the majority (~60%) of prior diagnoses were not supported by a psychiatric interview modified to take the ASD-related impairment into account (Mazefsky et al., 2012). However, this research failed to have control groups, or test for other psychiatric ailments, so it is possible that this procedure is reasonable. Autism is diagnosed four times more often in males than females (Simantov et al., 2021). The analysis of the reasons for and accounting for this are outside the scope of this study. However, this fact remains useful while examining behavioral differences in aggression across genders. Autism exists on a spectrum, with people showing different levels of behavior. Tim might have difficulty keeping eye contact and become upset with changes in their schedule but have a large friend group and have the same type of autism as Jenna, who finds it difficult to venture out to public spaces due to her aversion to loud noises and has difficulty communicating with people outside her immediate family. The variety of experiences has led to terms such as "Asperger's syndrome," which was discontinued and incorporated into the Autism Spectrum family in 2013. In many ways, Asperger's has been replaced by the term "high-functioning autism," which is a misnomer as it does not correspond with intelligence, just societal competence (Alvares 2020). However, most studies increasingly focus on individuals with high-functioning autism. Alvares found that most publications focused/ relied on high-functioning individuals on the spectrum. A graph from her article is below. As we examine studies and try to make generalizations, this fact is important to note, as what we conclude might not apply to everyone on the spectrum. The term "high-functioning" also presents a negative connotation for those who have "lowfunctioning autism." For this paper, I will treat studies of participants with Asperger's as individuals with ASD and use the terms low support autism and high support autism instead of the terms high-functioning or lowfunctioning autism. # III. Aggression and Autism Emotion dysregulation is not a core feature of ASD but is hypothesized to cause irritability, poor anger control, temper tantrums, self-injurious behavior, aggression, and mood dysregulation (Samson et al., 2014). Idiosyncratic strategies such as avoidance, venting, or crying are used more frequently by children with ASD (Samson et al., 2012). Individuals with autism are significantly more self-injurious than those without ASD, especially those with intellectual disabilities (Kaartinen et al., 2012;Green et al., 2000, McClintock et al., 2003;Tsakanikos et al., 2007). Individuals with autism might be overrepresented among violent adult offenders, and aggression in childhood is a strong predictor of the use of antipsychotic medications and seeking psychiatric services in adulthood (Tsakanikos et al., 2007). Aggressive behavior is seen in 35-50% of autistic children and is the strongest predictor of parental stress and the number one reason for seeking treatment. Kaartinen (2014) found that dysfunctional emotion regulation was principally associated with impulsive reactions to a real or perceived threat. She found that boys with autism were significantly more aggressive than their typically developing counterparts when faced with minor attacks. Aggression was measured using a Pulkkinen aggression machine, and the participants displayed aggression in a video game. Deficits in emotion regulation are prevalent in children with autism and may result in anger or anxiety being experienced more frequently and intensively than in TD children (Mazefsky et al., 2013;Kirst et al., 2021), leading to anger in some cases. Inaccurate interpretations of social situations promote aggressive behaviors, also known as the hostile attribution bias. The hostile attribution bias occurs when individuals are more likely to interpret ambiguous situations as hostile rather than harmless. # IV. The Regulatory Flexibility Model and Emotion Regulation Emotion regulation is required to process emotions and act within the context of the situation. It is the processing of external/internal stimuli and the subsequent actions that maintain wellbeing (Mazefsky et al., 2013). The two main emotion regulation strategies are reappraisal and suppression. Reappraisal is reevaluating the situation and being able to think about Volume XXII Issue IX Version I 42 ( ) the situation differently to change its impact. In comparison, suppression inhibits the behavior of the emotion (Gross, 2001). There is also expressive suppression which is inhibiting the facial expressions associated with the emotion. Keeping in mind the variety of different behaviors people with autism display and the unique way their mind works, it is reasonable to assume that the typical regulatory flexibility model (image below) by Bonanno and Burton (2013) looks different for them. There will be individual differences between people in the spectrum, just as there are individual differences in neurotypical people. However, I suggest there will be some common differences in people with autism. In this section, I will describe the model and hypothesize how the model would look different to those with an autism spectrum disorder. # a) Context Sensitivity The regulatory flexibility model starts when a person faces a stressor. The first step they do is to evaluate it according to the context it is present. The efficacy of any behavior or strategy will tend to depend on context. This evaluation occurs over a background of ongoing appraisal processes involving general monitoring of goals (Carver & Scheier, 1982), mood and affect (Russell & Barrett, 1999), motivation (Ryan & Deci, 2000), and social interactions (Taylor, Wayment, & Carrillo, 1996). The perception is only as accurate as the context allows, and that is why there is room for flexibility as the model progresses. The individual evaluates the demands and opportunities in the situational context to find the ideal regulatory strategy. People who are more sensitive to a context will be able to deploy more emotion regulation strategies later on as they can sense the feedback more acutely. In contrast, people who are less sensitive to the context will have less flexibility in their emotion regulation ( Bonnano et al., 2013). People with autism are more likely to be in the latter group as they are less skilled at dealing with social situations and often lack the emotional insight to identify the strategy required. Prior research has found that autistic individuals show a less positive and a more negative affect (Samson et al., 2012) which also impacts their context sensitivity. Their overuse of maladaptive emotion regulation strategies that are universally applied suggests poor motivation for ER and poor emotional insight and self-monitoring (Mazefsky et al., 2013). People with autism might also have differences in information processing and heightened sensitivity to environmental influences (e.g, sensory sensitivity, resistance to change), which might also affect context processing and make the emotions felt more intense (Mazefsky et al., 2013). A study by Keating (2021) looking at the differences between autistic individuals and non-autistic individuals in recognizing emotions and controlled alexithymia (difficulty in identifying and describing emotions), found that autistic participants were significantly less effective at recognizing anger, and recognized it more often than TD participants. The study made participants interact with expressions seen on a computer screen and rank them based on how angry/sad/happy the expression was. Using only 22 participants for the autistic criterion and having static faces might have limited the study in its ability to measure the skill of autistic participants in recognizing emotions accurately. # b) Repertoire The next step is selecting a regulatory strategy. This is done from the repertoire of strategies available to the individual. As prior studies have shown, although children with autism use fewer emotion regulation strategies in general, they use more expressive suppression and less cognitive reappraisal than their typically developing counterparts (Samson et al., 2012, Jahromi et al., 2013). This finding persisted even after controlling for differences in emotional experiences and alexithymia (Samson et al., 2012). The same study showed that the efficacy of these strategies was equivalent in children and adolescents with autism and TD kids. Two charts from Samson's 2012 study below show the differences between autistic and typically developing adolescents and children in their emotion regulation techniques. As children with autism have difficulty with theory of mind, it makes sense that they have difficulty evaluating situations from different perspectives (Baron-Cohen, 1997), and as a lack of facial expressions is part of the diagnostic criteria of autism, the fact expressive suppression is common makes logical sense as well. Adaptive emotion regulation strategies are contextually dependent and applied selectivity in contrast to maladaptive strategies that tend to be universally applied (Alado et al., 2010;Mazefsky et al., 2013). With the problems of cognitive flexibility and modulating behavior in people with ASD, a greater use of maladaptive strategies follows logically. Samson (2014) has found that restrictive and repetitive behaviors are the best predictors of emotion dysregulation in children with ASD. Samson hypothesizes this might be due to individuals with autism being less able to regulate their emotions due to difficulties inhibiting ongoing behavior, or emotion dysregulation in ASD triggers compensatory control mechanisms expressed by restricted and repetitive behaviors. # c) Responsiveness to feedback People will not always choose the ideal emotion regulation strategy. Feedback monitoring is important to see the efficacy of the emotion regulation strategy and for the individual to adjust to a better strategy if required. The feedback stage involves the individual evaluating if the strategy was effective and similar to the repertoire stage; it is dependent on the strategies available to the person (Bonanno et al., 2013). There are two types of feedback, internal and social. Internal relies on the participant's emotions and whether they can evaluate if the strategy was effective in upregulating or downregulating their emotions. Children with low-support autism tend to rely on overt cues to describe their emotions (e.g., I was happy because I was laughing, I was sad because I was crying) and provide nonspecific accounts of their emotional experiences (Losh et al., 2006). This suggests that they might have difficulty in recognizing their emotions and, therefore, difficulty in adjusting their emotional strategy in response to that. Social feedback is the external feedback of a regulatory strategy. This mainly comes from interpersonal interactions, which I will discuss further in the next section. Depending on how other people react to the situation or how they respond to your emotion regulation, people will either cease, adjust, or maintain their regulation strategy or select a new strategy from their repertoire, reevaluating the demands and opportunities given to them. As discussed before, people with autism might have difficulty changing their behavior and moving through the interactions with the flexibility needed. V. # Interpersonal Interactions Interpersonal interactions allow for societal feedback and may also be one of the major stressors that cause the regulatory-flexibility model to be required in the first place. This facet is especially important to cover in the research on autistic children who struggle with understanding social cues. Zaki and Williams discuss how the different types of interpersonal emotion regulation affects our affect (2013). Individuals seek support from stress and conversely attempt to regulate others' emotions through empathetic, supportive, and prosocial behaviors (Zaki et al., 2013). Zaki defines interpersonal interaction as events occurring in the context of live social interaction and representing the pursuit of a regulatory goal. Under interpersonal interactions, there are two categories of emotions, intrinsic and extrinsic, and response independent and response-dependent. I have created a diagram below to illustrate each type. There is very little research on the different types of interpersonal emotion regulation and the effect it has on autistic individuals. It would be interesting to see if, for example, children with autism rely on responsedependent regulation or how effective extrinsic regulation is to them. With the current knowledge we have, however, we hypothesize the difficulty in recognizing emotions in themselves and others (Keating et al., 2021) might make autistic participants worse at response-dependent extrinsic emotions than neurotypical people. # VI. Communication and the Hostile Attribution Bias Due to the difficulty people with autism have in enacting the regulatory flexibility model, it makes sense why they sometimes respond aggressively to social engaged more in emotion-related conversations when opportunities and resources to talk about emotions were promoted, resulting in the child showing more engagement while using their AAC system. However, critics argue whether this is the right way to teach autistic individuals to communicate and if we are molding them to fit our society's definition of "normal" (Grunsven et al., 2022). Although some autistic patients report feeling understood, others argue that people's perception of them changes as soon as they pull out their devices. The perception of incompetence and pity is replaced with the feeling that they are "normal" and worthy to be heard comes in. Grunsven (2022) states, "The design space of assistive technologies for autism . . . can and should include technologies that involve both interlocutors in the communication process ................. For example, in addition to an augmentative communication device that helps autistic children to approach their peers in 'socially appropriate ways, it could be helpful to create tools that help NT children to approach their autistic peers in 'autistically appropriate' ways." This suggests a different way to see augmentative and alternative communication and a way to reexamine the previous studies on AAC. # VII. # Conclusion There is still a lot to be understood about interpersonal regulation within children with autism, but this article aimed to provide a model to understand better how aggression might occur as a factor of the difficulty in regulating the emotions people with autism face. This article has shown how the regulatory flexibility model differs for autistic children with the different regulation strategies children with autism access and how it influences them in the feedback and repertoire stages. It describes the current knowledge about emotion regulation for autistic children and relies on studies to show how the processing might differ. There is still much research to be done on interpersonal regulation and understanding of the ways we can counteract or help people with autism. However, this framework offers a base for further research. itations ![situations they do not understand. This aggression may stem from the helplessness or confusion they face due to misunderstanding the situation. With a worse theory of mind, children are more likely to trust what others tell them (Palmquist et al., 2022). They might not understand what is meant to be a joke and are aggressive as well. As many autistic individuals struggle with communication, augmentative and alternative devices have become a good resort. These devices come in various types but allow individuals to communicate through symbols (whether online or physical). Augmentative and alternative communication (AAC) has been proven to decrease the communication handicap and have a great psychological impact on voiceless patients (Xin-Xing Ju et al., 2021). It is also adaptable for patients' needs, such as eye-tracking for patients with locked-in syndrome. Rangel-Rodríguez (2021) found that children with communication difficulties © 2022 Global Journals Volume XXII Issue IX Version I 45 ( )](image-2.png "") ![](image-3.png "") ![](image-4.png "") Miscommunication in Interpersonal Interactions Exacerbates Perceived Levels of Aggression in Childrenwith Autism * Data and Statistics on Autism Spectrum Disorder | CDC 2022. March 2. August 5, 2022 Centers for Disease Control and Prevention. * Diagnostic and Statistical Manual of Mental Disorders American Psychiatric Association 2022 Amer Psychiatric Pub Inc Text Revision Dsm-5-tr 5th ed. * The role of emotion regulation in autism spectrum disorder CAMazefsky JHerrington MSiegel AScarpa BBMaddox LScahill SWWhite 10.1016/j.jaac.2013.05.006 Journal of the American Academy of Child & Adolescent Psychiatry 52 7 2013 * Maladaptive behavior in autism spectrum disorder: The role of emotion experience and emotion regulation ACSamson AYHardan IALee JMPhillips JJGross 10.1007/s10803-015-2388-7 Journal of Autism and Developmental Disorders 45 11 2015a * Regulatory flexibility: An individual's perspective on coping and emotion regulation GABonanno CLBurton 10.1177/1745691613504116 Perspectives on Psychological Science 8 6 2013 * Medical symptoms and conditions in autistic women TSimantov APohl ATsompanidis EWeir MVLombardo ARuigrok ..Uzefovsky F 10.1177/13623613211022091 Autism 26 2 2022 * Comorbid psychiatric disorders in children with autism: interview development and rates of disorders OTLeyfer SEFolstein SBacalman NODavis EDinh JMorgan HTager-Flusberg JELainhart 10.1007/s10803-006-0123-0 Journal of autism and developmental disorders 36 7 2006 * Differences between autistic and nonautistic adults in the recognition of anger from facial motion remain after controlling for alexithymia CTKeating DSFraser SSowden JLCook 10.1007/s10803-021-05083-9 Journal of Autism and Developmental Disorders 52 4 2021 * Subtypes of aggressive behavior in children with autism in the context of emotion recognition, hostile attribution bias, and dysfunctional emotion regulation SKirst KBögl VLGross RDiehm LPoustka IDziobek 10.1007/s10803-021-05387-w Journal of Autism and Developmental Disorders 2021 * Brief report: Emotional picture and language processing in adults with autism spectrum disorder TY QWong MJYap TObana CLAsplund EJTeh 10.1007/s10803-021-04920-1 Journal of Autism and Developmental Disorders 52 1 2022 * Disruption to the core self in autism, and its care JDelafield-Butt PDunbar CTrevarthen 10.1080/07351690.2022.2007031 Psychoanalytic Inquiry 42 1 2022 * Emotion Dysregulation and the Core Features of Autism Spectrum Disorder ACSamson JMPhillips KJParker 10.1007/s10803-013-2022-5 J Autism Dev Disord 44 2014 * without autism spectrum disorder 10.1007/s10803-012-1743-1 J Autism Dev Disord 44 2014 * A systematic review on voiceless patients' willingness to adopt high-technology augmentative and alternative communication in intensive care units, Intensive and Critical Care Nursing Xin-XingJu JieYang Xiao-XinLiu 10.1016/j.iccn.2020.102948 2021 63 * JannaVan Grunsven & Sabine Roeser 10.1080/02691728.2021.1897189 Autism, and the Empathic Turn, Social Epistemology 36 1 2022 AAC Technology * Encouraging Emotional Conversations in Children With Complex Communication Needs: An Observational Case Study GARangel-Rodríguez MBadia SBlanch Front Psychol 2021 * 10.3389/fpsyg.2021.674755 34295286 PMC8290146 Jul 6 12 674755 * Emotion regulation in children and adolescents with autism spectrum disorder ACSamson AYHardan RWPodell JMPhillips JJGross 10.1002/aur.1387 Autism Research 8 1 2015 * Emotion regulation in asperger's syndrome and high-functioning autism ACSamson OHuber JJGross 10.1037/a0033839 Emotion 12 4 2012 * Interpersonal emotion regulation JZaki WCWilliams 10.1037/a0033839 Emotion 13 5 2013 * Emotion Regulation in Adulthood: Timing Is Everything JJGross Current Directions in Psychological Science 10 6 2001 * Control theory: A useful conceptual framework for personality-social, clinical, and health psychology CSCarver MFScheier doi: 10.1037/ 0033-2909.92.1.111 Psychological Bulletin 92 1982 * Core affect, prototypi-cal emotional episodes, and other things called emotion: Dissecting the elephant JARussell LFBarrett 10.1037/0022-3514.76.5.805 Journal of Personality and Social Psychology 76 1999 * Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being RMRyan ELDeci American Psychologist 55 2000 * Social com-parison, self-regulation, and motivation SETaylor HAWayment MCarrillo Handbook of motivation and cognition RM S E THiggins New York, NY Guilford Press 1996 3 The interpersonal context * The importance of self-regulation for the school and peer engagement of children with high-functioning autism LBJahromi CIBryce JSwanson Res Autism Spectrum Dis 7 2 2013 * The misnomer of 'high functioning autism': Intelligence is an imprecise predictor of functional abilities at diagnosis GAAlvares KBebbington DCleary KEvans EJGlasson MTMaybery SPillar MUljarevi ? KVarcin JWray AJWhitehouse 10.1177/1362361319852831 Autism: the international journal of research and practice 24 1 2020 * Social and psychiatric functioning in adolescents with asperger syndrome compared with conduct disorder JGreen AGilchrist DBurton ACox Journal of Autism and Developmental Disorders 30 4 2000 * Risk markers associated with challenging behaviors in people with intellectual disabilities: A meta-analytic study KMcclintock SHall COliver Journal of Intellectual Disability Research 47 6 2003 * Behaviour management problems as predictors of psychotropic medication and use of psychiatric services in adults with autism ETsakanikos HCostello GHolt PSturmey NBouras Journal of Autism and Developmental Disorders 37 6 2007 * ASD, a psychiatric disorder, or both? Psychiatric diagnoses in adolescents with high-functioning ASD CAMazefsky DPOswald TNDay SMEack NJMinshew JELainhart J Clin Child Adol Psychol 41 4 2012 * Emotionregulation strategies across psychopathology: A meta-analytic review AAldao SNolen-Hoeksema SSchweizer Clin Psychol Rev 30 2 2010 PubMed: 20015584 * Mindblindness: An essay on autism and theory of mind SBaron-Cohen 1997 * Understanding of emotional experience in autism: Insights from the personal accounts of high-functioning children with autism MLosh LCapps Dev Psychol 42 5 2006 PubMed: 16953688 * Social cognition and trust: Exploring the role of theory of mind and hostile attribution bias in children's skepticism of inaccurate informants CMPalmquist AFloersheimer KCrum JRuggiero 10.1016/j.jecp.2021.105341 Journal of Experimental Child Psychology 215 15 2022 * MKaartinen KPuura MHelminen Reactive aggression among children with and