Associations between social camouflaging and internalizing symptoms in autistic and non-autistic adolescents

Abstract

Autistic individuals experience higher rates of psychiatric comorbidities than their peers. Camouflaging, the process through which individuals hide autistic traits, can be detrimental to mental health. This may be particularly true for autistic females, although research on sex differences in the relationship between camouflaging and mental health has focused on adults. The purpose of this study was to extend previous research on camouflaging and mental health through examining age, sex, autism diagnosis, and camouflaging as predictors of depression, anxiety, and stress levels in autistic and non-autistic adolescents. One hundred forty adolescents ages 13–18 years (62 non-autistic, 58 female) completed an online survey including measures of camouflaging, autistic traits, and internalizing symptoms. Hierarchical linear regression was used to examine age, sex, diagnosis, and camouflaging as predictors of internalizing symptoms. Findings suggest that level of camouflaging is an important predictor of depression, anxiety, and stress in autistic and non-autistic adolescents and that camouflaging may be particularly distressing for females, regardless of diagnosis. These findings inform our understanding of camouflaging and its consequences and point to future directions for support for autistic and non-autistic adolescents. Clinicians may consider interventions targeting social skills, self-acceptance, and self-esteem to reduce possible negative effects of camouflaging. Lay abstract Autistic individuals have more mental health difficulties than non-autistic individuals. It is important to understand why this might be. Research has shown that camouflaging, or strategies used to hide autistic traits, might contribute to mental health difficulties in autistic adults. We examined whether this was also the case for autistic adolescents. This study included 140 adolescents ages 13–18 years (62 non-autistic, 58 female). All participants answered questions about camouflaging, autistic traits, and mental health difficulties. We found that autistic and non-autistic adolescents who reported higher levels of camouflaging also reported higher levels of depression, anxiety, and stress. We also found that camouflaging might be particularly stressful for females. These findings improve our understanding of camouflaging during adolescence and point to potential ways to support autistic adolescents, such as help with social skills, self-acceptance, and self-esteem. The findings also support the importance of increasing autism acceptance in the general population.

CAT-Q MSCS BASC2 Pre-Print

“…These results replicate previous findings that non-autistic people engage in camouflaging 4,14,17 and that camouflaging in non-autistic people is related to social competence 15 . Further, these results are consistent with previous studies indicating that camouflaging is associated with internalizing behaviours among autistic and non-autistic adolescents 17 and autistic adults 18 . The current research extends these findings in a sample of non-autistic adults, taking into consideration their social competence.…”

“…For example, autistic adults have reported that camouflaging is necessary to procure and maintain employment 3 . However, despite the possible advantages, there is emerging evidence that camouflaging may be a risk factor for internalizing behaviour 17,18 . Internalizing behaviour is a broad category of psychological behaviours that are directed inwards and create psychological distress within the individual, including anxiety and depression 19 .…”

“…Autistic adults commonly describe their experience of camouflaging as having a negative impact on their mental health [20][21][22] . Indeed, camouflaging has been quantitatively associated with anxiety and depression among autistic adults 18,20,23 , adolescents 17 , and children 24 . Among non-autistic people, camouflaging has similarly been associated with anxiety and depression among adults 25 and adolescents 17 .…”

Camouflaging in autism: A systematic review

“…Table 2 provides an overview of participant characteristics for participants with autism diagnoses or high autistic traits. There were four sets of studies in which samples were partially or fully duplicated (Hull et al, 2019;Hull, Lai, et al, 2020;Hull, Levy, et al, 2021;Jorgenson et al, 2020;Bernardin et al, 2021;Lai et al, 2017Lai et al, , 2019Livingston, Shah, & Happé, 2019;Livingston et al, 2020). In these instances, only information from one study (the study with the largest N) was counted when calculating aggregated participant characteristics.…”

Gender Differences in Misdiagnosis and Delayed Diagnosis among Adults with Autism Spectrum Disorder with No Language or Intellectual Disability

“…It has been suggested that ASD might both share a common etiopathological root with other disorders and be itself the ground where other disorders flourish [ 8 , 9 ]. The role of ASD as a psychopathological risk factor is confirmed by a number of studies, especially when focusing on the high level of distress in everyday life due to the lack of interpersonal and communication skills and leading to anxiety, depression, trauma/stress-related symptoms and suicidal thoughts [ 10 , 11 , 12 , 13 , 14 ]. This might be especially critical for mild forms of ASD, which often remain unknown through childhood and make their first appearance during adolescence or adulthood, when social demands exceed the individual coping ability [ 1 ].…”