The Masking Was Measured as a Gap

What the research found

Camouflaging is the term researchers use for masking. It describes the effort some autistic people make to hide their autistic traits and appear to fit in. A child might rehearse conversations, suppress the urge to move or stim, force eye contact, or copy the expressions of the people around them. It is exhausting, and it is often invisible. That last point is the difficulty: if masking works, the people watching do not see it.

This study, published in Autism Research in 2023 by Alice Ross, Rachel Grove and John McAloon, set out to measure that hidden effort in young people and to ask whether it was linked to their mental health. The sample was large for this kind of work: 733 autistic children and adolescents, aged 4 to 17, split almost evenly by sex (359 girls and 374 boys).

The clever part is how the researchers estimated camouflaging, because you cannot simply ask a young child how hard they are masking. They used a discrepancy. For each child, they compared how many difficulties a clinician observed during assessment against how many difficulties the child’s parent reported from daily life at home. When a parent described far more struggle than the clinician saw in the room, the researchers read that gap as camouflaging: the child was, in effect, holding it together for the appointment in a way they could not sustain at home.

The headline finding was consistent. Higher camouflaging scores were associated with more pronounced internalising symptoms, meaning higher levels of anxiety, depression and related distress. This link held even after the researchers accounted for the child’s age, sex and IQ, so it was not simply an artefact of older or more able children masking more. A single reliable pattern emerged from a large group: the bigger the gap between the public performance and the private reality, the more distress the child carried.

Two further patterns are worth noting. Parents reported more difficulties in girls than in boys, yet clinicians observed no such sex difference in their assessments. And adolescents over 13 showed more pronounced camouflaging than younger children. Both findings fit a picture in which masking grows with age and social pressure, and in which girls in particular may present very differently at home and in the clinic.

It is important to be precise about what this study does not establish. The design is cross-sectional: it photographs children at one moment rather than following them over time. That means it cannot tell us the direction of the relationship. We do not know whether the effort of camouflaging wears children down into anxiety and depression, or whether children who are already anxious mask more to protect themselves, or whether some third factor drives both. The authors are candid about this. They also worked from data collected for other purposes rather than assessing the children themselves, and their measure of camouflaging is an indirect estimate, not a direct read of a child’s inner effort.

What it means for you and your child

If you have ever collected a seemingly composed child from school only to watch them come apart the moment the front door closes, this study will feel familiar. It gives a name to something many parents already sense. The child who performs well in front of teachers and clinicians, and then unravels at home, is not being manipulative or inconsistent. They may be spending their whole day masking, and home is simply the one place safe enough to stop.

The practical value here is in how you interpret that gap. Professionals naturally weight what they observe directly, and a child who masks well can look, in a 90-minute appointment, as though they are coping fine. This study suggests the opposite may be true: a large gap between the calm clinic presentation and the struggle you see at home is itself worth taking seriously. It may be a signal of hidden distress rather than a sign that things are going well. You are not exaggerating when you report difficulties the clinician did not witness. You are describing the part of your child’s life where the mask comes off.

For girls especially, this matters. The finding that parents saw more difficulty in girls than clinicians did echoes a wider concern that autistic girls are under-identified precisely because they mask so effectively. If your daughter’s assessment does not match your daily experience of her, that mismatch is information, not a contradiction to be explained away.

Be careful, though, not to read more into the study than it can bear. It does not prove that masking causes mental illness, so it would be wrong to conclude that simply telling a child to stop masking will lift their mood. Masking is often a survival strategy, and it may be doing something protective as well as costly. The sensible response is not to strip it away but to reduce the need for it: environments where a child feels safe enough to be openly autistic, where stimming is not punished, where the social demands are dialled to a level they can actually meet.

One study, however large and well designed, is a single data point. This one is genuinely useful because its sample is big, its finding is stable across age, sex and IQ, and its authors are honest about its limits. Treat it as a well-supported reason to watch the gap between how your child presents in public and how they cope in private, and to raise that gap explicitly with the professionals who support them. It is a strong clue, not a verdict, and it points attention exactly where a masking child most needs it.