Gender differences in self-reported camouflaging in autistic and non-autistic adults

Abstract

Social camouflaging describes the use of strategies to compensate for and mask autistic characteristics during social interactions. A newly developed self-reported measure of camouflaging (Camouflaging Autistic Traits Questionnaire) was used in an online survey to measure gender differences in autistic ( n = 306) and non-autistic adults ( n = 472) without intellectual disability for the first time. Controlling for age and autistic-like traits, an interaction between gender and diagnostic status was found: autistic females demonstrated higher total camouflaging scores than autistic males (partial η2 = 0.08), but there was no camouflaging gender difference for non-autistic people. Autistic females scored higher than males on two of three Camouflaging Autistic Traits Questionnaire subscales: Masking (partial η2 = 0.05) and Assimilation (partial η2 = 0.06), but not on the Compensation subscale. No differences were found between non-autistic males and females on any subscale. No differences were found between non-binary individuals and other genders in either autistic or non-autistic groups, although samples were underpowered. These findings support previous observations of greater camouflaging in autistic females than males and demonstrate for the first time no self-reported gender difference in non-autistic adults.

Intrinsic excitation-inhibition imbalance affects medial prefrontal cortex differently in autistic men versus women

“…rsfMRI H in autistic adults was also relevant in a sex-specific manner to a clinical behavioral phenomenon known as 'camouflaging'. Camouflaging relates to a set of compensatory or masking strategies or mechanisms that allows individuals to cope with their socialcommunicative difficulties in everyday social situations 16,17,45 . It is known that cognitively able adult autistic females tend to engage in more camouflaging behavior than males [16][17][18] and the extent to which individual females engage in camouflaging is linked to vMPFC function 19 .…”

“…Camouflaging relates to a set of compensatory or masking strategies or mechanisms that allows individuals to cope with their socialcommunicative difficulties in everyday social situations 16,17,45 . It is known that cognitively able adult autistic females tend to engage in more camouflaging behavior than males [16][17][18] and the extent to which individual females engage in camouflaging is linked to vMPFC function 19 . One of the most important known functions of vMPFC has to do with self-representation 46 and simulating others based on information about the self 47 .…”

“…In prior task-evoked fMRI work we found a similar sex-by-diagnosis interaction in vMPFC self-representation response and a female-specific brain-behavioral correlation with camouflaging ability 19 . Given that adult autistic females engage more in camouflaging on-average [16][17][18] , we next tested the hypothesis of whether H as an index of intrinsic E:I balance, would be related to camouflaging in a sex-specific manner. In autistic females, increased camouflaging was strongly associated with increased H in vMPFC (r = 0.60, p = 0.001).…”

“…Sex/gender heterogeneity may also lead to differing clinical presentations and compensatory mechanisms in autism. It is known that many cognitively able adult autistic women engage in camouflaging behaviors that tend to compensate or mask their social-communicative difficulties more so than males [16][17][18] . Prior work has shown that whereas autistic males show reduced ventral MPFC (vMPFC) self-representation neural response, autistic females show intact vMPFC function.…”

The Female Autism Phenotype and Camouflaging: a Narrative Review

“…Cassidy et al 2018 Score on four self-report questions of camouflaging Dean et al 2017 Observed social behaviours in the playground Hull et al 2017a Self-reported behavioural examples Hull et al 2018 Score on self-report measure of camouflaging behaviours (CAT-Q). Hull et al 2019 Score on self-report measure of camouflaging behaviours (CAT-Q).…”