Camouflaging in Autism: Examining Sex‐Based and Compensatory Models in Social Cognition and Communication

Abstract

Camouflaging refers to behavioral adaptations that individuals with autism spectrum disorder (ASD), especially females, use to mask symptoms during social situations. Compensation is a component of camouflaging in which an individual's observed behavior is considerably better than actual ability. The study explored diagnostic, sex‐based, and compensatory differences using the Contextual Assessment of Social Skills (CASS). The sample included 161 youth 10:0‐to‐16:11 years (115 males, 46 females). T‐tests were performed based on sex (female, male) or High (good ADOS + poor Theory of Mind (TOM)) compared to Low (poor ADOS + poor TOM) Compensation groups. Comparisons were examined for Social Affect (SA), Restricted Repetitive Behavior, (RRB), IQ, social behavior (Positive Affect, Overall Involvement) and communication (Vocal Expression, Gestures). Females exhibited fewer RRB t(158) = 3.05, P = 0.003, d = 0.54. For the CASS, females evidenced more Vocal Expressiveness t(157) = −2.03, P = 0.05, d = 0.35, which corroborates sex‐based differences in the literature. Compensation group differences indicated the High compared to Low group showed stronger Social and Communication behaviors on the CASS for Vocal Expression t(72) = 2.56, P = 0.01, d = 0.62, and overall rapport t(72) = 2.36, P = 0.02, d = 0.56. Several differences were observed when the groups were stratified based on level of compensation, with the High compensation participants showing stronger social engagement and communication behaviors. Findings may inform efforts to understand camouflaging, compensation, and clinical practices for male and female adolescents with ASD. A more nuanced consideration of camouflaging alongside compensation models reveals subtle differences in cognition, behavior, and affect that may reflect underlying profiles of challenge and strength in youth with ASD. Lay Summary Camouflaging refers to ways individuals with autism spectrum disorder (ASD), especially females, mask symptoms. Compensation occurs when a person's observed behavior appears more typical than what would be expected based on underlying ability and symptoms. The study explored camouflaging and compensation differences in 161 youth with ASD. Findings suggest sex‐based differences with females showing better vocal expression. However, several compensation differences were observed with the High compensators showing stronger social communication and rapport. A more nuanced consideration of camouflaging using compensation models reveal subtle differences in underlying challenge and strength.

Self-reported camouflaging behaviours used by autistic adults during everyday social interactions

“…One line of research, using an existing diagnostic observational measure, has demonstrated that in clinical settings, some autistic individuals are rated as appearing less autistic and more normatively socially skilled than would be expected given their autistic traits and social cognition differences (Corbett et al, 2021;Lai et al, 2017Lai et al, , 2019Livingston, Colvert, et al, 2019;Schuck et al, 2019). However, this approach, based on an observational assessment designed to measure the presence or absence of behaviours for the expressed purpose of an autism diagnostic assessment, is limited in describing the full range of camouflaging behaviours exhibited by autistic people in more naturalistic social environments.…”

How to Measure Camouflaging? A Conceptual Replication of the Validation of the Camouflaging Autistic Traits Questionnaire in Dutch Adults.

“…Since the discrepancy approach has been used in scientific research before (e.g. Corbett et al, 2021;Lai et al, 2016;Livingston, Colvert, et al, 2019;Parish-Morris et al, 2017;Ratto et al, 2018;Rynkiewicz et al, 2016;Schuck et al, 2019;Wood-Downie, 2021), it is important that we better understand how this approach measures camouflaging behavior.…”

Greater Social Competence Is Associated With Higher Interpersonal Neural Synchrony in Adolescents With Autism

“…We hypothesized that the magnitude of neural synchronization with a social partner will: (1) increase during the active interaction compared to the baseline; and (2) correlate with autism symptom severity, caregiver reports of social functioning, and theory of mind skills. In addition, given recent evidence that females with ASD may be more successful than males at masking their social difficulties (Halladay et al, 2015;Corbett et al, 2020), we predicted greater interpersonal neural synchrony in females than males with ASD.…”