Autistic traits are associated with frequent psychological distress and everyday functional challenges. Some individuals with autistic traits “camouflage” these traits during social interactions by effortfully engaging in “typical” social behaviors. Camouflaging seems to be especially common in autistic girls and women. Emerging evidence proposes a role for camouflaging behaviors in poorer mental health and daily functioning. Furthermore, camouflaging efforts may delay receipt of a proper diagnosis and access to appropriate mental health care. Despite their clinical significance, camouflaging efforts remain difficult to quantify, and the mechanisms and impacts of camouflaging are poorly understood. This study aimed to compare multiple methods of quantifying camouflaging, investigate potential mechanisms of camouflaging, and describe mental health implications of camouflaging behaviors.The sample included 66 women (M age = 25:2 years, SD = 6:4; M IQ = 114, SD = 11) who reported social challenges and scored high on a measure of broad autistic traits. A minority (n = 22) had previously received an autism diagnosis. A majority reported significant anxiety, depression, or suicidality. Camouflaging was quantified using three methods: one self-report questionnaire (CAT-Q), and two discrepancy-based methods that contrasted presentation of autistic traits during the ADOS-2 with measures of less-visible autistic traits (AQ, TASIT-S). Analyses showed that the discrepancy-based measures agreed with each other, but not with the self-report measure of camouflaging. Regression analyses showed camouflaging scores were poorly predicted by age, IQ, performance on executive functioning tasks, and self-reported social cognitive abilities. Regression models including clinician-rated and self-reported autistic traits showed that autistic traits on the SRS-2, and camouflaging efforts on the CAT-Q, modestly but significantly predicted psychological distress and functional challenges. Finally, clinician-administered and self-report diagnostic measures demonstrated only fair or poorer agreement with each other in this unique sample that includes women with elevated self-reported camouflaging.Results emphasize the clinical significance of the camouflaging construct, which may predict mental health difficulties in individuals with autistic traits better than conventional autism measures. Quantifying camouflaging remains challenging as various proposed measures disagree with each other. Disagreement on diagnostic classification between measures underscores the importance of comprehensive, multi-method assessment of mental health in women who report difficulties fitting into social situations and who may be camouflaging significant autistic traits.



College and Department

Family, Home, and Social Sciences; Psychology



Date Submitted


Document Type





autism, camouflaging, female, women, mental health, diagnosis