Quantifying and exploring camouflaging in men and women with autism

TLDR

Some autistic individuals, especially females, camouflage social communication difficulties, which may require cognitive effort and increase stress, anxiety, and depression. The study investigates the constructs, measurement, mechanisms, consequences, and heterogeneity of camouflaging in autism. The authors quantified camouflaging in 60 age‑ and IQ‑matched autistic adults by comparing external behavior on the Autism Diagnostic Observation Schedule with internal traits from the Autism Spectrum Quotient and Reading the Mind in the Eyes Test. Camouflaging scores were unrelated to age or IQ, were higher in women than men (Cohen’s d = 0.98), varied widely, correlated with depressive symptoms in men and better signal‑detection sensitivity in women, and showed a sex‑dependent neuroanatomical association in women linked to emotion and memory.

Abstract

Autobiographical descriptions and clinician observations suggest that some individuals with autism, particularly females, ‘camouflage’ their social communication difficulties, which may require considerable cognitive effort and lead to increased stress, anxiety and depression. Using data from 60 age- and IQ-matched men and women with autism (without intellectual disability), we operationalized camouflaging in adults with autism for the first time as the quantitative discrepancy between the person’s ‘external’ behavioural presentation in social–interpersonal contexts (measured by the Autism Diagnostic Observation Schedule) and the person’s ‘internal’ status (dispositional traits measured by the Autism Spectrum Quotient and social cognitive capability measured by the ‘Reading the Mind in the Eyes’ Test). We found that the operationalized camouflaging measure was not significantly correlated with age or IQ. On average, women with autism had higher camouflaging scores than men with autism (Cohen’s d = 0.98), with substantial variability in both groups. Greater camouflaging was associated with more depressive symptoms in men and better signal-detection sensitivity in women with autism. The neuroanatomical association with camouflaging score was largely sex/gender-dependent and significant only in women: from reverse inference, the most correlated cognitive terms were about emotion and memory. The underlying constructs, measurement, mechanisms, consequences and heterogeneity of camouflaging in autism warrant further investigation.