A comparison of methods for measuring camouflaging in autism

Abstract

Interest in social camouflaging has led to a multiplicity of measurement methods of uncertain validity. This two-part investigation first used a systematic review ("Study 1") to identify and appraise methods used to quantify camouflaging of autistic traits, using the Consensus-based Standards for the Selection of Health Status Measurement Instruments checklist. A total of 16 distinct measurement tools were identified; all are in the preliminary phases of psychometric evaluation. The systematic review highlighted: (1) the need for parent-report tools which specifically measure camouflaging; and (2) a lack of studies looking at associations between different methods of camouflaging, which limits understanding of their validity. "Study 2" aimed to begin to address these gaps in knowledge. We created a parent-report version of the Camouflaging Autistic Traits Questionnaire (CAT-Q) and evaluated its concurrent validity in autistic young people by examining associations with the self-report CAT-Q and a discrepancy measure. Discriminant validity was investigated by comparing all three methods of measuring camouflaging to a measure of social skills, to test whether they assess a construct distinct from social ability. The self-and parent-report CAT-Q were significantly related (r = 0.47, 95% CI = 0.24-0.65), and were related weakly (r = 0.20, 95% CI = À0.06 to 0.43) and strongly (r = 0.46, 95% CI = 0.23-0.64), respectively, to the discrepancy approach. No measure was associated with social skills. Improving the psychometric properties of these methods, and introducing a novel parentreport measure, may help selection of appropriate methods in future research and integration into clinical practice. Lay SummaryThe first study looked at published research to evaluate tools used to measure camouflaging in autism; showing that there is still much to learn about whether existing measures are accurate, and that there are no parent-report tools designed to measure camouflaging. The second study started to fill these gaps in knowledge, by developing and testing a parent-report camouflaging measure, and comparing it to other common ways of measuring camouflaging. This showed that, for teenagers, a new parent-report questionnaire can be useful for measuring camouflaging.

Measuring Social Camouflaging in Individuals with High Functioning Autism: A Literature Review

“…Moreover, we recognize the presence of two previous reviews assessing camouflaging in the frame of ASD [ 40 , 91 ]. While the first is a systematic review on the whole autism spectrum and camouflaging strategies [ 40 ], the second aims to compare different methods for measuring camouflaging in autism [ 91 ].…”

“…Moreover, we recognize the presence of two previous reviews assessing camouflaging in the frame of ASD [ 40 , 91 ]. While the first is a systematic review on the whole autism spectrum and camouflaging strategies [ 40 ], the second aims to compare different methods for measuring camouflaging in autism [ 91 ]. Unlike these previous works, our article aims to give a detailed narrative description of the actual literature available on camouflaging in individuals with high functioning autism and proposes a modern spectrum approach to the topic that could help to achieve a consensus on many aspects of this controversial topic.…”

Exploring camouflaging by the Chinese version Camouflaging Autistic Traits Questionnaire in Taiwanese autistic and non-autistic adolescents: An initial development

“…The translated version was then back translated into English independently by another study-team member/psychiatrist (P.-J.C.), which was then checked and approved by the original CAT-Q developers (Drs Hull and Mandy). For the caregiver-report version, based on the recommendation of the original CAT-Q developers, the pronouns were changed from "I" or "myself" to "my child" or "him or her" without any other content change (Hannon et al, 2023). The caregiver-reported CAT-Q-Ch elicits caregiver's observation on adolescent's social behaviors.…”

“…The caregiver-reported CAT-Q-Ch elicits caregiver's observation on adolescent's social behaviors. The English parent-report version of CAT-Q has been published recently (Hannon et al, 2023). Both versions of the CAT-Q-Ch are available via the corresponding authors.…”

Understanding Camouflaging and Identity in Autistic Children and Adolescents Using Photo-Elicitation

“…The CAT-Q, the only self-report measure available to assess camou aging behaviour, was developed for use with autistic adults, and has yet to be validated for use with children and adolescents (Hull et al, 2019). A caregiver-report version of the CAT-Q has been developed (Hannon et al, 2022); however, observational and proxy reports are limited to measuring behaviours that are visible to others, while not capturing camou aging as an internal psychological process. It is important to collect information from autistic children and adolescents themselves, who have unique insight into their own thoughts and behaviours.…”