There Is Only One Ruler for This Trait

What the research found

Social camouflaging is the effort some autistic people make to hide their autistic traits and pass as non-autistic. It includes rehearsing conversations, forcing eye contact, copying other people’s gestures, and suppressing the urge to talk about a favourite subject. This 2023 paper by Cremone and colleagues, published in the journal Brain Sciences, is a narrative literature review. It gathers and summarises the existing research on how camouflaging is measured. It is not a new experiment, and it does not report a single group of participants. It is a survey of the field.

The review’s first and most practical finding is about measurement itself. Across all the work the authors examined, there is essentially one validated instrument built specifically for this purpose: the Camouflaging Autistic Traits Questionnaire, or CAT-Q. It asks people to rate statements about their own behaviour across three areas the authors call compensation (developing strategies to get around social difficulties), masking (hiding autistic characteristics), and assimilation (trying to fit in with others). That the entire field rests on a single self-report questionnaire is not a minor detail. It means camouflaging is measured by asking people what they think they do, and there is no independent yardstick to check that against.

The second finding is the most consistent one in the paper. Higher camouflaging is linked to worse mental health. Studies reviewed here found that greater camouflaging scores predicted higher anxiety, depression, and social anxiety, and that this held even after accounting for how many autistic traits a person had. One study cited found camouflaging to be an even stronger predictor of suicide risk than a delayed autism diagnosis. Participants described mental, physical, and emotional exhaustion, and a blurred sense of their own identity. The authors are careful, though, to say the direction of this relationship is unclear. Camouflaging might cause distress, distress might drive camouflaging, or a third factor might drive both. A review of correlations cannot settle that.

The third finding is the one to read most cautiously. The popular claim is that girls and women camouflage more, and that this hides them from diagnosis. The review shows the evidence is genuinely mixed. Some studies found autistic females scored higher on the masking and assimilation subscales. Others did not. One study of 164 adults found no difference between autistic men and women at all. The authors describe the gender findings as varying by sample and environment, and elsewhere call the literature “controversial, and sometimes even opposite.” What is better established is the diagnostic gap itself: the male-to-female ratio may exceed 5.5 to 1 among people without intellectual disability, but narrows to roughly 2 to 1 among those with an IQ below 70. Camouflaging is offered as one plausible reason girls are diagnosed later or missed, but the review treats it as a candidate explanation, not a proven one.

What it means for you and your child

If your daughter or son is bright, socially motivated, and seems to “hold it together” at school only to fall apart at home, this research gives that pattern a name and some legitimacy. Camouflaging is real, it is effortful, and the studies gathered here connect that effort to anxiety, low mood, and exhaustion. The child who is exemplary in the classroom and depleted by the car ride home is not being difficult. They may be spending the whole day performing.

It also explains a frustrating experience many families have. A school or even a clinician may say a child “can’t be autistic” because they make eye contact, have a friend, or answer questions politely. This review is a useful corrective. The whole point of camouflaging is that it conceals the very traits an assessor is looking for. A polished surface is not evidence against autism, and this is especially worth holding in mind for girls, who this literature suggests are diagnosed later or overlooked more often.

Be equally clear about what this paper does not prove. It does not show that girls always camouflage more than boys; the evidence there is contradictory, and one study found no sex difference at all. It does not show that camouflaging causes depression or suicidality, only that they travel together. And because everything rests on a single self-report questionnaire, the field cannot yet tell you how much a given child is camouflaging with any precision. This is honest, early-stage science that has identified a real phenomenon before it has fully learned to measure it.

The sensible response is neither to dismiss camouflaging nor to over-diagnose from it. If you recognise your child in this description, it is worth raising with a clinician who understands the concept, and worth asking about it specifically during assessment. The practical takeaway is gentler and more immediate than any diagnosis: a child who masks all day needs a genuine, low-demand release afterwards. Reducing the daily performance cost, and not expecting the same social effort at home that school demands, is something you can act on now, whatever the eventual label.