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Camouflaging/Masking in Autism Spectrum Disorder

September 7, 2021 by Maria Hays in Uncategorized


Author: Meredith Cola, B.A.

Autism spectrum disorder (ASD) is a complex neurodevelopmental condition characterized by social communication difficulties and the presence of restricted or repetitive behaviors (American Psychiatric Association, 2013). ASD affects 1 in 54 children, with a male-to-female ratio of 4:1 (Maenner et al., 2020). Girls are diagnosed with ASD less often than boys, even when they have comparable symptom profiles (Dworzynski et al., 2012), which may be due to minimally understood sex differences in the way ASD manifests (Loomes et al., 2017). Recently, researchers have suggested that the discrepancy in diagnostic prevalence could be due, in part, to the fact that some autistic girls and women may camouflage their symptoms (Bargiela et al., 2016; Bernardin, Mason, et al., 2021; Cook et al., 2021; Hull et al., 2017; Jorgenson et al., 2020).

Camouflaging or masking refers to strategies that individuals with ASD use to mask social difficulties and enable them to “pass” as non-autistic in social situations (Hull et al., 2017; Livingston et al., 2020). Camouflaging consists of complex copying behaviors, compensation, and/or masking of some personality traits or autistic characteristics, with an adaptive purpose that promotes functioning in response to specific environmental or situational demands (Hull et al., 2019; Tubío-Fungueiriño et al., 2020). Examples of camouflaging include mimicking facial expressions of a conversation partner, forcing oneself to make eye contact or stop talking about a specific interest, and using social scripts in everyday interactions.

Although masking and camouflaging behaviors may be common amongst people with autism, they often come at a cost. Research has shown that engaging in camouflaging or masking behaviors over long periods of time can negatively impact mental health outcomes. One study of adults found that individuals who reported masking in professional or interpersonal settings tended to have higher levels of stress (Cage & Troxell-Whitman, 2019). Results also indicated that autistic women may be more likely to engage in camouflaging or masking, possibly due to gendered cultural norms for social interaction. Research with adolescents has shown a similar pattern of results, with autistic girls reporting higher levels of camouflaging than autistic boys (Bernardin, Lewis, et al., 2021; Bernardin, Mason, et al., 2021). In addition, adolescents reported that the desire to avoid teasing or bullying was the most common motivation for engaging in camouflaging or masking behaviors.

Taken together, these findings highlight the importance of providing mental health services beyond the diagnosis for both adults and adolescents on the autism spectrum, and the special attention that should be paid to those who may be camouflaging or masking their behaviors across different settings to avoid negative social outcomes.

References

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5 (5 edition). American Psychiatric Publishing.

Bargiela, S., Steward, R., & Mandy, W. (2016). The experiences of late-diagnosed women with autism spectrum conditions: An investigation of the female autism phenotype. Journal of Autism and Developmental Disorders, 46(10), 3281–3294. https://doi.org/10.1007/s10803-016-2872-8

Bernardin, C. J., Lewis, T., Bell, D., & Kanne, S. (2021). Associations between social camouflaging and internalizing symptoms in autistic and non-autistic adolescents. Autism. https://doi.org/10.1177/1362361321997284

Bernardin, C. J., Mason, E., Lewis, T., & Kanne, S. (2021). “You Must Become a Chameleon to Survive”: Adolescent Experiences of Camouflaging. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-021-04912-1

Cage, E., & Troxell-Whitman, Z. (2019). Understanding the reasons, contexts and costs of camouflaging for autistic adults. Journal of Autism and Developmental Disorders, 49(5), 1899–1911. https://doi.org/10.1007/s10803-018-03878-x

Cook, J., Crane, L., Bourne, L., Hull, L., & Mandy, W. (2021). Camouflaging in an everyday social context: An interpersonal recall study. Autism, 1362361321992641. https://doi.org/10.1177/1362361321992641

Dworzynski, K., Ronald, A., Bolton, P., & Happé, F. (2012). How different are girls and boys above and below the diagnostic threshold for autism spectrum disorders? Journal of the American Academy of Child & Adolescent Psychiatry, 51(8), 788–797.

Hull, L., Mandy, W., Lai, M.-C., Baron-Cohen, S., Allison, C., Smith, P., & Petrides, K. V. (2019). Development and validation of the Camouflaging Autistic Traits Questionnaire (CAT-Q). Journal of Autism and Developmental Disorders, 49(3), 819–833. https://doi.org/10.1007/s10803-018-3792-6

Hull, L., Petrides, K. V., Allison, C., Smith, P., Baron-Cohen, S., Lai, M.-C., & Mandy, W. (2017). “Putting on my best normal”: Social camouflaging in adults with autism spectrum conditions. Journal of Autism and Developmental Disorders, 47(8), 2519–2534. https://doi.org/10.1007/s10803-017-3166-5

Jorgenson, C., Lewis, T., Rose, C., & Kanne, S. (2020). Social Camouflaging in Autistic and Neurotypical Adolescents: A Pilot Study of Differences by Sex and Diagnosis. Journal of Autism and Developmental Disorders, 50(12), 4344–4355. https://doi.org/10.1007/s10803-020-04491-7

Livingston, L. A., Shah, P., Milner, V., & Happé, F. (2020). Quantifying compensatory strategies in adults with and without diagnosed autism. Molecular Autism, 11(1), 15. https://doi.org/10.1186/s13229-019-0308-y

Loomes, R., Hull, L., & Mandy, W. P. L. (2017). What Is the Male-to-Female Ratio in Autism Spectrum Disorder? A Systematic Review and Meta-Analysis. Journal of the American Academy of Child & Adolescent Psychiatry, 56(6), 466–474. https://doi.org/10.1016/j.jaac.2017.03.013

Maenner, M. J., Shaw, K. A., Baio, J., Washington, A., Patrick, M., DiRienzo, M., Christensen, D. L., Wiggins, L. D., Pettygrove, S., Andrews, J. G., Lopez, M., Hudson, A., Baroud, T., Schwenk, Y., White, T., Rosenberg, C. R., Lee, L.-C., Harrington, R. A., Huston, M., … Dietz, P. M. (2020). Prevalence of autism spectrum disorder among children aged 8

years—Autism and developmental disabilities monitoring network, 11 Sites, United States, 2016. MMWR Surveillance Summaries, 69(4), 1–12. https://doi.org/10.15585/mmwr.ss6904a1

Tubío-Fungueiriño, M., Cruz, S., Sampaio, A., Carracedo, A., & Fernández-Prieto, M. (2020). Social camouflaging in females with autism spectrum disorder: A systematic review. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-020-04695-x

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