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.
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