Autistic Camouflaging: Who Does It and Why It Matters

Musician David Byrne watched TV as a young man to learn how neurotypicals behave (see Compensation below)

More autistic traits means more camouflaging

Background

Camouflaging is masking autistic traits to pass as neurotypical. It contributes to diagnostic delays and worse mental health outcomes.

The Study

• Analysis of 50 studies (N = 16,895; ages 10–90, 61% female)
• All included continuous measures of autistic traits and camouflaging
• The aim was to test what influenced the relationship between camouflaging and autistic traits in autism

Results

The more autistic traits a person had, the more camouflaging behaviors, with a moderate association (r = 0.34). Masking (actively hiding traits) had the weakest link (r = 0.10), while these two camouflaging rose the most with autistic traits:

1. Assimilation (trying to fit in and appear normal) (r = 0.50)
2. Compensation (eg, scripting conversations, mimicking body language, or studying social cues from media to appear neurotypical (r = 0.37)

Those with more depression were more likely to camouflage, but anxiety and social anxiety did not influence it, surprisingly.

When researchers looked at autistic traits in the general population, there was more camouflaging (stronger association, r = 0.42) than in formally diagnosed groups (r = 0.26). Why? Possibly those who do not camouflage are more likely to get diagnosed, or those who have the diagnosis don’t feel as much need to camouflage.

Contrary to prior assumptions about a uniquely female camouflaging profile, gender didn’t influence the results, nor did age.

Limitations: Samples were predominantly from the UK, female, and White, limiting generalizability.

Practice Implications

1. Camouflaging may explain why some patients scores high on self-report autistic trait measures but don’t appear autistic.
2. The Camouflaging Autistic Traits Questionnaire (CAT-Q) can identify camouflaging, adding to other screening instruments like the the Autism Symptom Dimensions Questionnaire.
3. Talking Heads frontman David Byrne has come public with having autism, and talks about how watched TV as a young man to learn how people behave. Listen for the camouflaging in his songs, like I Should Watch TV, Seen and Not Seen, and Make Believe Mambo.

— Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report

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