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# "Putting on My Best Normal": Social Camouflaging in Adults with Autism Spectrum Conditions

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Camouflaging of autistic characteristics in social situations is hypothesised as a common social coping strategy for adults with autism spectrum conditions (ASC). Camouflaging may impact diagnosis, quality of life, and long-term outcomes, but little is known about it. This qualitative study examined camouflaging experiences in 92 adults with ASC, with questions focusing on the nature, motivations, and consequences of camouflaging. Thematic analysis was used to identify key elements of camouflaging, which informed development of a three-stage model of the camouflaging process. First, motivations for camouflaging included fitting in and increasing connections with others. Second, camouflaging itself comprised a combination of masking and compensation techniques. Third, short- and long-term consequences of camouflaging included exhaustion, challenging stereotypes, and threats to self-perception. Electronic supplementary material The online version of this article (doi:10.1007/s10803-017-3166-5) contains supplementary material, which is available to authorized users.
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Vol.:(0123456789)
1 3
J Autism Dev Disord (2017) 47:2519–2534
DOI 10.1007/s10803-017-3166-5
ORIGINAL PAPER
“Putting onMy Best Normal”: Social Camouﬂaging inAdults
withAutism Spectrum Conditions
LauraHull1,6 · K.V.Petrides2· CarrieAllison3· PaulaSmith3·
SimonBaron‑Cohen3· Meng‑ChuanLai3,4,5· WilliamMandy1
Published online: 19 May 2017
Second, camouﬂaging itself comprised a combination of
masking and compensation techniques. Third, short- and
long-term consequences of camouﬂaging included exhaus-
tion, challenging stereotypes, and threats to self-perception.
Keywords Autism· Camouﬂaging· Coping· Sex·
Introduction
Autism Spectrum Conditions (ASC)1 are atypical devel-
opmental conditions characterised by impairments in
social interaction and communication, alongside unusu-
ally restricted/repetitive behaviours and interests, need
for sameness, and atypical sensory processing (APA
2013). ASC is generally viewed as dimensional, with
traits found amongst the general population and a speci-
ﬁed cut-oﬀ point, when present with concurrent func-
tional impairments, used to identify the clinical diagno-
sis (Baron-Cohen et al. 2001; Constantino 2011). One
behaviour associated with ASC that has recently attracted
interest is the development of camouﬂaging or coping
strategies for use in social situations (Attwood 2007;
Gould and Ashton-Smith 2011; Kopp and Gillberg 2011;
Lai etal. 2011; Wing 1981). These strategies may include
hiding behaviours associated with their ASC, using
explicit techniques to appear socially competent, and
ﬁnding ways to prevent others from seeing their social
Abstract Camouﬂaging of autistic characteristics in
social situations is hypothesised as a common social cop-
ing strategy for adults with autism spectrum conditions
(ASC). Camouﬂaging may impact diagnosis, quality of life,
and long-term outcomes, but little is known about it. This
qualitative study examined camouﬂaging experiences in
92 adults with ASC, with questions focusing on the nature,
motivations, and consequences of camouﬂaging. Thematic
analysis was used to identify key elements of camouﬂaging,
which informed development of a three-stage model of the
camouﬂaging process. First, motivations for camouﬂaging
included ﬁtting in and increasing connections with others.
Meng-Chuan Lai and William Mandy are joint senior authors for
this paper.
Electronic supplementary material The online version of this
article (doi:10.1007/s10803-017-3166-5) contains supplementary
material, which is available to authorized users.
* Laura Hull
laura.hull.14@ucl.ac.uk
1 Research Department ofClinical, Educational & Health
Psychology, University College London, London, UK
2 London Psychometric Laboratory, University College
London, London, UK
3 Autism Research Centre, Department ofPsychiatry,
University ofCambridge, Cambridge, UK
4 Child andYouth Mental Health Collaborative attheCentre
forAddiction andMental Health andThe Hospital forSick
Children, Department ofPsychiatry, University ofToronto,
5 Department ofPsychiatry, National Taiwan University
Hospital andCollege ofMedicine, Taipei, Taiwan
6 Department ofPsychology, University College London, 26
Bedford Way, LondonWC1H0AP, UK
1 We use the term ‘Autism Spectrum Condition’ (ASC) when refer-
ring to a diagnosis of Autism Spectrum Disorder, to be respectful
to those on the spectrum who feel that the term ‘disorder’ is stig-
matising, whereas ASC is compatible with the presence of both the
strengths and diﬃculties of people on the spectrum.
2520 J Autism Dev Disord (2017) 47:2519–2534
1 3
diﬃculties. In this paper we will refer to these behaviours
as ‘camouﬂaging’.
While many neurotypical people, of all genders, man-
age the way others perceive them in social situations
(Izuma et al. 2011), research suggests that individuals
with ASC have a reduced ability to do so (Cage et al.
2013). However, the research in this area has focused on
the manipulation of typical social behaviours, rather than
how individuals with ASC may want and be able to adapt
their ASC-related characteristics. Camouﬂaging is likely
to exist on a spectrum (similar to autistic traits) in those
who have an ASC diagnosis and those who are subclini-
cal. However, self-reported evidence suggests possible
categorical diﬀerences between autistic and non-autistic
camouﬂaging. For instance, camouﬂaging by ASC indi-
viduals has been reported as extremely eﬀortful and chal-
lenging to one’s identity (Bargiela et al. 2016), unlike
ordinary reputation management in typically developing
individuals.
Camouﬂaging has also been proposed as an explana-
tion for the missed or late diagnosis of females with ASC,
as part of the female phenotype or behavioural presen-
tation (Gould and Ashton-Smith 2011; Kirkovski et al.
2013; Lai et al. 2015). Amongst clinical samples, male
to female gender ratios for ASC diagnosis are generally
around 4:1 (Fombonne 2009), but when active case ascer-
tainment is used within the general population, the ratio
lowers to around 3:1 (Sun etal. 2014). This discrepancy
suggests that there are biases that work against females
with ASC receiving accurate, timely diagnoses from clin-
ical services. Females are less likely to receive a diag-
nosis of ASC than males with similar levels of autistic
traits (Dworzynski etal. 2012; Russell et al. 2011), and
those who receive a diagnosis on average are more likely
than males receiving the same diagnosis to be older and
have more additional needs, including increased intel-
lectual disability (Shattuck etal. 2009) and behavioural-
emotional challenges (Duvekot et al. 2016). Clinical
experience suggests that females with ASC may be more
likely than males with ASC to have been previously mis-
diagnosed with other mental health conditions, such as
personality disorders or eating disorders (Lai and Baron-
Cohen 2015; Mandy and Tchanturia 2015).
In addition to camouﬂaging, there are other gender
diﬀerences in autistic characteristics which may contrib-
ute to late diagnosis or misdiagnosis of females. While
few signiﬁcant quantitative sex diﬀerences in the core
symptoms have been found (Hull etal. 2016; Lai etal.
2015; Mandy et al. 2012; Van Wijngaarden-Cremers
et al. 2014), comparisons of associated characteristics
have shown diﬀerences between the female and male
presentations (Kreiser and White 2014; Rivet and Mat-
son 2011). For instance, males with ASC are more likely
to experience externalising diﬃculties such as hyperac-
tivity and conduct problems, whereas females with ASC
are more likely to experience internalising problems such
as anxiety and depression (May etal. 2012; Oswald etal.
2016).
These ‘qualitative’ diﬀerences between male and
female presentation, including camouﬂaging behaviours,
need to be included in measures used to assess ASC, as
sex diﬀerences at a nosological level are likely to have an
impact on diagnosis (Lai et al. 2015). Current diagnos-
tic practices focus on the core ASC characteristics that
have been historically established from the behavioural
presentation in males, and so do not necessarily reﬂect
the areas in which females with ASC may display diﬀer-
ent behaviours to males. As a result, current assessments
of females with ASC are restricted to the areas in which
females are most similar to males, and those females who
do not meet the male-typical behavioural descriptions
are likely to be missed (Van Wijngaarden-Cremers etal.
2014). Diagnostic biases may lead to biased sampling in
studies of sex diﬀerences in ASC, such that only male-
typical ASC behaviours are expected, and therefore only
these behaviours are found when looked for. It has hence
been argued that diagnostic assessments of ASC should
include female-typical behaviours to more accurately
assess ASC prevalence and characteristics across genders
(Kreiser and White 2014).
Camouﬂaging in certain settings may lead to the percep-
tion that individuals function well and do not experience
any problems, even though those individuals still experi-
ence diﬃculties as a result of the interaction of their ASC
and the context. For example, it is suggested that girls with
ASC may mimic other socially successful individuals to
give the impression that they too are socially successful,
but when placed in unknown environments they are not
prepared for, they struggle to socialise (Attwood 2006).
This may reﬂect both a stronger motivation to mimic, and
itself be the result of a stronger motivation to ‘systemize
social behaviour, than is seen in males with ASC. Teach-
ers or clinicians may therefore be unaware of the diﬃculties
being faced by girls and women with ASC, whereas family
members may see their loved one in a range of situations
and so realise the extent of their diﬃculties. Alternatively,
women who receive an ASC diagnosis later on in life may
have spent years feeling diﬀerent and attempting to mini-
mise this diﬀerence, until their children receive a diagnosis
and they recognise the symptoms within themselves (Hol-
liday Willey 2015).
There is a variety of anecdotal evidence of camouﬂaging
amongst women with ASC. For instance, Liane Holliday
Willey describes how she spent her life pre-diagnosis ‘pre-
tending to be normal’, yet knowing that something was dif-
ferent about her (Holliday Willey 2015). In case studies of
2521J Autism Dev Disord (2017) 47:2519–2534
1 3
girls with ASC, researchers have suggested that the use of
social imitation strategies may lead to missed, late, or ques-
tioned diagnoses (Kopp and Gillberg 1992). Essentially,
social imitation may be a form of acting, whereby girls
with undiagnosed ASC may be coping without receiving
a diagnosis or even needing a diagnosis because their act-
ing is relatively successful. Success here may be deﬁned as
simply not having overt functional impairments or raising
concerns of teachers or other professionals, even though
under the surface or behind maintaining such appearances,
females may report high levels of subjective stress, anxiety
and exhaustion, and a need to withdraw from social inter-
action to ‘re-set’. These observations have not yet been
systematically tested, despite extensive interest in gender
diﬀerences in ASC and the female phenotype (Gould and
Ashton-Smith 2011; Kopp and Gillberg 1992; Lai et al.
2015; Robinson etal. 2013).
Individuals with ASC also display signiﬁcant variation
in their outcomes across the lifespan, especially concern-
ing their social functioning. Some adults with ASC form
friendships and relationships, and have fulﬁlling careers
that enable them to remain independent (Farley etal. 2009;
Strunz etal. 2016). Others, however, struggle to maintain
social relationships and may remain unemployed, despite
having the motivations and capabilities to work (Baldwin
and Costley 2015; Shattuck et al. 2012). While some of
this variation is due to individual diﬀerences in cognitive
abilities, language ability, and personal preference (Howlin
et al. 2000; Shattuck et al. 2012; Van Bourgondien et al.
1997), it is possible that an individual’s ability to cam-
ouﬂage their ASC contributes to them achieving socially
desirable outcomes. Individuals who are better able to cam-
ouﬂage their ASC characteristics might feel more able to
make friends, improve their social support, and perform
better in job interviews.
However, many individuals with ASC also report exten-
sive anxiety and depression, especially those with average-
to-high levels of IQ and language abilities (Lugnegård etal.
2011). Anecdotal evidence suggests that an individual’s
camouﬂaging can impact their mental health (Holliday-
Willey 2015). Where camouﬂaging is unsuccessful, stren-
uous, or if the person feels forced to camouﬂage, it may
be associated with high stress level, low mood and low
self-esteem. In addition, the pressure to maintain success-
ful camouﬂaging may lead to anxiety for individuals with
ASC. Camouﬂaging is not necessarily a beneﬁcial behav-
iour, and should not be regularly expected or encouraged
for individuals with ASC, as this may risk increasing men-
tal health problems. It is therefore important to study cam-
ouﬂaging in order to better understand the individual dif-
ferences predicting long-term wellbeing and outcomes for
individuals on the autism spectrum.
A small number of studies have recently emerged which
directly examine social camouﬂaging behaviours in indi-
viduals with ASC. Tierney, Burns, and Kilbey (2016)
experiences of camouﬂaging, and revealed some com-
mon themes including the uncertain, exhausting nature of
the social environment; the desire to make friends which
motivated camouﬂaging attempts; and using explicit tech-
niques to mask ASC-related diﬃculties. Similar themes
were also found during qualitative interviews with late-
diagnosed women with ASC (Bargiela etal. 2016). In par-
ticular, the idea of pretending to be normal, which could
be achieved through both learned and automatic strategies,
and the extensive costs of such strategies, were identiﬁed.
Recently, some empirical operationalisation of camouﬂag-
ing behaviours in both children and adults with ASC has
also been developed. Behavioural observations suggest
that girls camouﬂage their social diﬃculties (e.g. by stay-
ing in close proximity to peers and weaving in and out of
activities) to a greater extent on the playground than boys,
and therefore are less likely to be identiﬁed as struggling
socially (Dean etal. 2016). Camouﬂaging, operationalised
as the discrepancy between (a) interpersonal behavioural
presentation and (b) self-reported autistic traits and objec-
tively measured social cognitive abilities, was found to be
on-average higher in women with ASC than in men with
ASC, although was associated with more symptoms of
depression in men (Lai etal. 2016). These important initial
studies suggest that camouﬂaging is a real and meaningful
experience in the lives of people with ASC, and directly
impacts on their social functioning and mental wellbeing.
Despite these encouraging ﬁrst steps, key questions
how common camouﬂaging is within the ASC population,
whether it varies across the lifetime, and whether individ-
ual diﬀerences in camouﬂaging are related to long-term
outcomes in functioning, achievement and quality of life. In
addition, the majority of those diagnosed with ASC iden-
tify as male, and a signiﬁcant number of ASC individu-
als experience non-binary gender identities (Glidden etal.
2016; Kim etal. 2011). It is therefore important to examine
camouﬂaging behaviours across all genders, as research so
far has focused on female experiences.
Most importantly, studies of camouﬂaging in ASC can-
not progress until a conceptual model of camouﬂaging has
been produced, so that subsequent research has strong theo-
retical grounding. Such a model is best developed from a
qualitative analysis of the camouﬂaging experiences of
individuals with ASC. This will ensure that the construct of
camouﬂaging reﬂects the real-life experiences of individu-
als with ASC rather than the preconceptions of research-
ers or clinicians, and that our understanding of camouﬂag-
ing is representative of a broad range of individuals with
2522 J Autism Dev Disord (2017) 47:2519–2534
1 3
ASC. Inductive (i.e. data-driven) research resulting in a
comprehensive model of the camouﬂaging process will
enable hypothesis generation and form the basis of meas-
urement development to further explore camouﬂaging
quantitatively.
The present qualitative study examined camouﬂaging in
a large sample of adults of all self-identiﬁed genders who
had been diagnosed with ASC, using internet-based survey
and thematic analysis. Emphasis was placed on the moti-
vations for camouﬂaging, techniques used, the impact that
camouﬂaging has for the individual, and their overall atti-
tudes to camouﬂaging. The aim of the study was to derive
a conceptual model of camouﬂaging to inform future
research.
The following research questions were addressed:
1. What is camouﬂaging?
2. What are the techniques used and what do people with
ASC think camouﬂaging is?
3. Why do people camouﬂage their ASC?
4. What are the consequences of camouﬂaging?
Methods
Participants
Participants were 92 adults of 15 diﬀerent nationalities
(55% British). They were eligible to take part in the study
if they were over the age of 16 years and had received a
DSM-IV or DSM-V diagnosis from a psychiatrist or clini-
cal psychologist in a recognized specialist clinic of an
ASC, including Autism/Autistic Disorder, Asperger Syn-
drome/Asperger’s Disorder, Autism Spectrum Disorder,
Atypical Autism, and Pervasive Development Disorder
Not Otherwise Speciﬁed. Participants were recruited via
the Cambridge Autism Research Database (CARD) and
through adverts placed on social media. Whilst it was not
possible for this study to independently verify the diagnos-
tic status of participants, several measures were taken to
check diagnostic status and establish the generalisability of
ﬁndings from this sample. Participants were asked to report
what age and from which type of healthcare professional)
or whether they were self-diagnosed. Those who reported
self-diagnosis, or who reported receiving an ASC diagnosis
from someone other than a medical professional, clinical
psychologist, or healthcare team, were excluded from cur-
rent analysis (n = 3). Demographic characteristics of par-
ticipants are included in Table1. Participants were asked to
identify their gender as ‘female’, ‘male’ or ‘other’, and give
more details if they wished.
Materials
A newly designed questionnaire of camouﬂaging was
developed by the researchers, in consultation with other
experts in ASC, including clinicians, researchers, and
adults with ASC. The questionnaire included 23 closed and
20 open questions, and examined participants’ motivations
for camouﬂaging, the characteristics of their camouﬂag-
ing experiences, the consequences of camouﬂaging (posi-
tive and negative), and their attitudes towards camouﬂaging
(see online Appendix1). Closed questions were developed
from predicted behaviours and observations raised during
the development process, although participants were able
Open questions were designed to elicit new insights from
participants and identify experiences not anticipated by the
researchers.
Demographic information about the participants, includ-
ing details of their ASC diagnosis, was also obtained. Other
measures, including those of quality of life, social anxiety,
Table 1 Demographic
characteristics of participants
and whether they reported
camouﬂaging
Three male participants reported their natal sex as female. All participants who identiﬁed their gender as
‘Other’ reported their natal sex as female
Female Male Other gender
N 55 30 7
Age (mean years) 40.71 (SD 14.14) 48.03 (SD 16.62) 40.71 (SD 14.29)
Age (range) 18–68 22–79 27–69
Age at diagnosis (mean years) 36.98 (SD 14.21) 41.03 (SD 18.08) 32.67 (SD 9.25)
Camouﬂage? (yes/no) 51/4 28/2 7/0
Nationality
British 30 17 4
North American 12 3 1
Western European 7 6 2
Other 6 4 0
2523J Autism Dev Disord (2017) 47:2519–2534
1 3
and depressive symptoms, were administered, but not
included in the current analysis.
Procedure
Participants were emailed an online link to ‘a study look-
ing at experiences of coping behaviours in social situations’
(which was hosted by Qualtrics) or followed a link posted
on social media. They were reminded that they could with-
draw at any point and were under no obligation to answer
any question. Participants completed the survey at their lei-
sure and were able to stop and start their responses as they
chose, to minimise stress or discomfort from completing
the survey.
Early in the questionnaire after demographic data had
been ascertained, participants were asked the following
question: “Have you ever had the experience of ‘camou-
ﬂaging’ your autism? A reminder: in this survey we use
the term ‘camouﬂaging’ to refer to ‘coping skills, strate-
gies, and techniques that function to “mask” features of
ASC during social situations’.” Those who responded ‘no’
were directed to the end of the questionnaire, where they
could leave their thoughts on camouﬂaging if they wished.
These responses were included in the ﬁnal analysis. Those
who responded ‘yes’ completed the full questionnaire. Four
females (7% of total number of females) and two males (6%
of total males) reported that they had never camouﬂaged
their ASC in social situations. All seven participants who
identiﬁed their gender as ‘Other’ reported camouﬂaging
their ASC. Responses were saved securely on the Qualtrics
server in anonymised format.
Ethical approval for this study was obtained from the
University of Cambridge Psychology Research Ethics
Committee, reference number Pre.2015.036. Informed con-
sent was obtained from all individual participants included
in the study.
Analysis
Analysis followed the six phases of thematic analysis rec-
ommended by Braun and Clarke (2006) with the aim of
identifying patterns of information within the data which
answered the research questions. This inductive (i.e., data
driven) analytic approach was chosen because it does not
rely on a rigid theoretical framework for interpretation,
and so enables researchers to examine alternative perspec-
tives and identify new information within developing areas
of psychology (Willig 2013). Guidelines for good qualita-
tive research (Barker and Pistrang 2005; Elliott etal. 1999;
Ritchie etal. 2014) were followed to ensure that interpre-
tations were credible and could be generalised beyond the
existing sample. A consensus approach was taken with
data extracts read thoroughly by one author (LH) and
codes addressing the research questions identiﬁed. Initial
codes were audited by an independent researcher to con-
ﬁrm that interpretations reﬂected the data accurately. These
codes were then checked by the two senior authors (MCL
and WM), and the ﬁnalised set of codes was grouped into
themes and subthemes. All authors discussed and reﬁned
themes until a consensus was reached. Member validation
was used as a further credibility check: themes and sub-
themes were sent to six participants (ﬁve female, one male)
who had expressed interest in the ﬁndings to ensure these
accurately reﬂected their experiences.
Results
Seven themes, comprising 16 subthemes, were clustered
into three stages of the camouﬂaging process, as detailed
in Fig. 1. Motivations (Assimilation and “To know and
be known”) describe the reasons why respondents cam-
ouﬂaged their ASC, including the aims they hoped to
achieve as a result. What is Camouﬂaging? (Masking and
Compensation) describes the concept of camouﬂaging
itself, including the techniques used. Finally, the short- and
long-term consequences of camouﬂaging are described
through the themes “I fall to pieces”, “People have a stereo-
typed view”, and “I’m not my true self”. Names of themes
and subthemes are taken directly from quotations from
respondents. The number of participants who referenced
each theme at least once is displayed in Table2.
Motivations forCamouﬂaging
Assimilation: “Hide inPlain Sight”
Respondents described wanting to camouﬂage in order to
‘blend in with the normals’. Most respondents reported a
social expectation from the general population that indi-
viduals with ASC need to change in order to be accepted
by others. Respondents’ social and communication dif-
ﬁculties, and their unique behaviours and interests,
meant that they stood out from the crowd during social
situations. It was felt that the general population viewed
this as unacceptable, and so respondents felt a pressure
to change their behaviours in order to seem ‘normal
enough’.
[I camouﬂage] to reduce the threat of feeling uncom-
fortable through being unable to measure up to social
expectations. (Male, 62)
I don’t want to draw attention to myself by appearing
to be diﬀerent. (Female, 30)
However, a few respondents suggested that their moti-
vations to camouﬂage were similar to those of the general
2524 J Autism Dev Disord (2017) 47:2519–2534
1 3
population; camouﬂaging was simply seen as the way in
which everyone tries to ﬁt in or hide less desirable aspects
of their personality:
Most neurotypicals are camouﬂaging nearly all the
time they are in public. (Male, 79)
A more pragmatic aspect of this motivation was the
desire to obtain jobs and qualiﬁcations, which respond-
ents felt were less accessible when they were more visibly
‘autistic’. Many respondents described how they would not
ASC characteristics. Camouﬂaging during these situations
was thought to improve employment opportunities, and so
enable them to become a ‘functioning member of society’.
I’m pretty sure no-one would ever hire me if I didn’t
camouﬂage in job interviews. (Other, 27)
Camouﬂaging helps to survive in school and college
and it is important for keeping jobs. (Female, 27)
The desire for assimilation was also prompted by con-
cerns for their own safety and wellbeing. Many described
being ostracised, verbally or emotionally attacked, and
some even reported physical assaults when they had not
camouﬂaged their ASC:
Fig. 1 Thematic map of the three stages (motivations, camouﬂaging, and consequences) of the camouﬂaging process. Themes are indicated by
rectangles; subthemes by ovals
Table 2 Number of participants
who referenced each theme Theme Number of participants
Female
(n = 55)
Male
(n = 30)
Other
gender
(n = 7)
Assimilation: “hide in plain sight” 49 20 7
“To know and be known” 42 24 5
Compensation: “to exceed what nature has given” 45 22 7
Masking: “I’m hiding behind what I want people to see” 38 18 7
“I fall to pieces” 44 21 7
“People have a stereotyped view” 32 6 4
“I’m not my true self” 31 15 3
2525J Autism Dev Disord (2017) 47:2519–2534
1 3
When I was younger and more obviously odd and
strange I was thought of as stupid and also badly
physically and mentally bullied. I also lost employ-
ment. I want to avoid the bullying mostly. I have even
been spat at in the street. (Female, 49)
Most attributed this to their perceived diﬀerences com-
pared to others, and used camouﬂaging techniques to mini-
mise these diﬀerences and hence reduce the threat. This
was particularly the case when describing their experiences
in childhood and adolescence; respondents often reported
that relations with others improved as they got older and
were better able to camouﬂage their ASC.
If I had known how to camouﬂage earlier, perhaps I
wouldn’t have been such an outcast as a child. (Other,
41)
“I Want toKnow andBe Known”
The other key motivation for camouﬂaging was to increase
connections and relationships with others. Due to their
inherent social diﬃculties, many respondents reported
struggling to make friends and form romantic attachments,
despite this being a strong desire. Camouﬂaging was seen
as one way to overcome the initial obstacles to connection
and allow for future relationships to develop.
Many respondents wanted to be accepted by others and
be able to socialise, but recognised that they lacked the
skills needed to make small talk, interact comfortably with
strangers, and relax in social situations. This limited their
ability to get to know people better. As will be discussed
further in the theme ‘Compensation’, camouﬂaging oﬀers
solutions to some of these issues. The payoﬀs in terms of
easier social interaction were a strong motivation for many
respondents to camouﬂage their ASC with others. How-
ever, several respondents felt camouﬂaging was only nec-
essary for the initial stages of a friendship or relationship;
once a connection was established, the respondent felt more
comfortable showing their ‘true’ ASC characteristics.
I know it is necessary when I am ﬁrst getting to know
someone. After I have known them for a while and
they know I have Asperger’s and they are accepting
of my quirks, then I can let my guard down more.
Connections have to be made initially on neurotypical
terms. Then, hopefully, on my terms as well. (Female,
46)
For some, the risk of failure and associated embarrass-
ment created severe anxiety during social interactions; by
camouﬂaging and using structured techniques, respondents
could reduce some of this uncertainty and so were more
conﬁdent in their ability to socialise. Respondents felt that
camouﬂaging would lead to success in a variety of social
situations, when compared to their default behaviours or
responses.
It enables me to be with other people in a way that
is relatively comfortable for me and for them. I avoid
looking like a socially clumsy idiot. It avoids the
embarrassment and awkwardness of getting things
wrong. (Female, 56)
What isCamouﬂaging?
Masking: “I’m Hiding Behind What I Want People toSee”
Masking encompasses the aspects of camouﬂaging that
focus on hiding one’s ASC characteristics and developing
diﬀerent personas or characters to use during social situ-
ations. Both of these emphasise a distinction between the
respondent’s ‘true’ or ‘automatic’ behaviours, and what
they present to the rest of the world.
Camouﬂaging was partly performed through suppress-
ing, hiding, or otherwise controlling behaviours associated
with ASC that were seen as inappropriate in the situation.
The extent to which this happened could vary depending
on who the person was with; camouﬂaging tended to occur
less often with close friends and family members, although
some respondents described camouﬂaging at all times.
Respondents described attempting to minimise their
self-soothing or ‘stimming’ behaviours, and their responses
to sensory overstimulation, in order to make their condition
less obvious to others. These techniques included using
objects as ‘props’ to meet sensory needs in a subtle way,
and giving themselves regular excuses to leave overstimu-
lating environments and calm down.
I prevent myself from doing any particularly visible
or otherwise noticeable stims: I still ﬁnd myself doing
things like shaking my leg repeatedly without notic-
ing, but don’t make any noises people would think are
weird, don’t full-body shake (like with the leg but…
all of me), or do any ﬁnger movements or tapping etc.
that would annoy people. (Female, 20)
Masking enabled respondents to present a diﬀerent iden-
tity to the outside world, one that covered up those parts
of themselves they were not happy with. The combination
of controlled behaviour and appropriate conversation pro-
duced through camouﬂaging was often described as essen-
tial during social interactions, even though this meant con-
cealing one’s actual personality.
I don’t think I’ll ever completely stop wearing the
mask. It’s a defence mechanism really. It is easier
to have people you’re friendly with, than taking
2526 J Autism Dev Disord (2017) 47:2519–2534
1 3
the mask of[f] and revealing the real broken you.
(Female, 18)
In some cases, this went as far as portraying an entirely
diﬀerent character, and several respondents likened it to
acting or performing a role, complete with costumes. The
character or aspects of the role could change across diﬀer-
ent situations:
I camouﬂage by putting on a character… I treat my
clothes rather like costumes, and certain items of
clothing help me to uphold certain personality char-
acteristics of which character I am on that occasion.
I have a repertoire of roles for: cafe work, bar work,
uni, various groups of friends, etc. They are all me at
the core, but they are edited versions of me, designed
to not stand out for the ‘wrong’ reasons. (Female, 22)
One way to easily identify the appropriate role to play
was to mimic the behaviours of others during a social inter-
action. Behaviours could be copied directly from the person
in front of them, or could be identiﬁed and learned from
observing others interacting, and even from watching tel-
evision and ﬁlms. Some respondents went as far as to copy
clothing style, mannerisms, and even interests from others.
I try to copy socially successful people by trying to
imitate their speech and body language and trying to
understand their interests. (Male, 71)
Compensation: “To Exceed What Nature hasGiven”
The other aspects of camouﬂaging centre around develop-
ing explicit strategies to meet the social and communica-
tion gaps resulting from an individual’s ASC, which we
call compensation. These camouﬂaging techniques include
speciﬁc non-verbal communication strategies and guide-
lines for successful conversations with others. Respondents
often described these techniques as ‘rules’ or expectations
from others that had to be met, even if they themselves felt
these rules were not necessary.
Explicit, compensatory strategies were reported by many
respondents as a vital way to improve non-verbal communi-
cation with others. These strategies aimed to help the indi-
vidual perform behaviours used in typical social encoun-
ters, which they would not necessarily perform naturally.
Respondents described how these camouﬂaging techniques
required intensive monitoring of the way they presented
themselves, in order to ensure they were being performed
as correctly as possible.
Forcing and maintaining appropriate eye contact, or
attempting to look as close to another’s eyes as possible,
was a common compensatory technique reported. Respond-
ents also made an eﬀort to display facial expressions of
emotion or interest, even if they didn’t feel this inside. Dif-
ferent expressions were identiﬁed as important for diﬀer-
ent situations, and so many respondents described keeping
a mental list of how to behave depending where they were.
I look in people’s eyes when I ﬁrst meet them/or in
formal/professional situations even though I wouldn’t
naturally, because I know you’re supposed to.
(Female, 26)
I try to look people in the eye and make faces that ﬁt
the situation. (Other, 27)
Many respondents noted that their preferred levels of
emotional expression and body language did not match
those of others around them, and so over-emphasised these
behaviours in order to communicate better. This included
non-verbal and verbal signs of interest in the interaction,
which were also used to encourage others to continue
speaking and so take the pressure oﬀ the ASC individual to
respond appropriately.
My autistic lack of non-verbal signals are read as hos-
tility, arrogance or indiﬀerence by people, so I have to
act the good will that I genuinely feel. (Female, 45)
I’m not good at knowing when it’s my turn and I also
tend to just blurt out things or keep talking when I
should have stopped, so I prep myself always in social
situations to have a reminder or tag or internal buzzer
about not speaking too much and trying to do more
listening, nodding, agreeing. (Female, 49)
In addition to these non-verbal techniques, respond-
ents reported developing rules or guidelines to compen-
sate for some of the social diﬃculties they experienced
during conversations. These were more generalised and
so could be prepared ahead of time and applied to diﬀer-
ent situations. These camouﬂaging strategies were used
to help the ASC individual get through ‘small talk’ or
more in-depth conversations with minimal stress, and to
make the chat more enjoyable for their social partners.
One rule was to ask questions of the other people.
Explanations for this varied between respondents, but
included minimising the amount of time they had to
speak, giving them more time to prepare things to say,
and ensuring the ASC individual did not take over the
conversation by talking about themselves or their own
interests.
more “you” questions - how did that make you feel,
what did you do next, what do you think about a given
thing - instead of “me” or “I” statements. (Male, 29)
My issue is talking too much or saying the wrong
things. I tend to think of one or two questions to
ask the person and most people are so happy just
2527J Autism Dev Disord (2017) 47:2519–2534
1 3
to talk about themselves that it stops them shining
a spotlight on me. I ﬁnd asking questions is the best
deﬂection and camouﬂage ever. (Female, 49)
Respondents were often aware that talking only about
themselves and their interests was not socially acceptable
and so developed strict rules to control their self-focused
talk. For some, camouﬂaging also involved not divulg-
ing personal details about themselves, whether to protect
themselves from being taken advantage of, or to maintain
privacy.
I say as little about myself as possible as the more I
say, the more likely it is that I say something inap-
propriate OR give away too much information about
myself which can then be used against me. (Other,
31)
I remain silent when I might otherwise have spoken,
knowing that I can’t always tell whether or not my
comments would be welcome. I make generic com-
ments rather than oﬀering speciﬁc ones that might
reveal my more unusual traits. (Male, 29)
Respondents also described spending time before
an interaction to prepare topics of conversation, includ-
ing questions to ask, anecdotes to relate, and poten-
tial responses to others. These made them feel more in
control of the interaction, and reassured them that they
would have structured ‘scripts’ to follow rather than hav-
ing to spontaneously ‘chat’:
I usually also think up stories and how whole con-
versations might go before I have them so I have
responses practiced as well as potential things to
say if the conversation ‘dries up’. (Female, 20)
However, it is important to emphasise that not all
respondents developed such structured rules for conversa-
tion; some simply had the goal of speaking as little as pos-
sible in order to get out of the interaction quickly.
In these social situations, I do not talk about any-
thing of interest to me, I avoid talking much and just
pretend to be interested in what people are saying.
(Female, 42)
Consequences ofCamouﬂaging
“I Fall toPieces”
By far the most consistent consequence of camouﬂaging
described by respondents was exhaustion. Camouﬂaging
was frequently described as being mentally, physically, and
emotionally draining; requiring intensive concentration,
self-control, and management of discomfort. The longer
a camouﬂaging session continued, the harder it became
to maintain the intended level of camouﬂaging. Many
respondents reported needing time to recover after cam-
ouﬂaging, where they could be alone and release all of the
It’s exhausting! I feel the need to seek solitude so I
can ‘be myself’ and not have to think about how I am
perceived by others. (Other, 30)
In addition to this exhaustion, after a camouﬂaging ses-
sion was over some respondents would experience extreme
anxiety and stress. Respondents felt signiﬁcant pressure,
whether from themselves or others, to camouﬂage suc-
cessfully, but many were uncertain of how eﬀective their
camouﬂaging strategies were. Twenty-one respondents (10
male, 11 female) reported being unsuccessful in their cam-
ouﬂaging attempts or reported that they had not achieved
the outcomes they intended.
after question, to keep conversation going but some-
times it doesn’t work and they leave me. (Female, 27)
Camouﬂaging therefore often involved a constant moni-
toring of the situation, as if training oneself in self-monitor-
ing, self-awareness, and monitoring others’ reactions, both
during and after the interaction occurred, which induced
stress and even greater anxiety.
My head will be racing as if I’m interpreting another
language. I will be incredibly anxious. It’s like study-
ing for an exam, constantly on edge trying to predict
what others will say and do. (Female, 49)
I hate it. I go over and over and over what they said
and what I said. Did I understand them correctly, did
I respond appropriately, did I make a gaﬀe? Have I
oﬀended anyone? (Female, 45)
In contrast, a minority of respondents reported feel-
ing satisﬁed and relieved after camouﬂaging, particularly
if they felt as though it went well. For these individuals,
camouﬂaging was rewarding because it enabled them to
achieve what they wanted with minimal eﬀort, whether that
was getting through a necessary social situation, or being
able to make a connection with someone. Interestingly,
60% of those who reported feeling positive or relieved after
camouﬂaging were male (n = 9, compared to six females),
in contrast to the majority female total sample.
Small sense of achievement and relief that it is over.
(Male, 69)
I am glad that the camouﬂaging enables me to survive
within myself and accomplish any necessary tasks.
(Male, 62)
2528 J Autism Dev Disord (2017) 47:2519–2534
1 3
“People Have aStereotyped View”
Many respondents felt that, because their camouﬂag-
ing changed the way they presented themselves to others,
they did not meet the stereotype of ‘an autistic person
when they camouﬂaged. In many ways this was construed
as positive, since it allowed them to get on in life, succeed
in jobs and relationships, and achieve many of the aims
they wanted. Some also reported that this enabled them to
challenge commonly held views of autism, especially for
women. By demonstrating good social skills and educating
others about their conditions, respondents hoped to change
the public perception of autism and make others more
understanding.
People don’t always realise that I have AS, more
likely to be socially accepted, more likely to get a job.
(Male, 28)
I feel that I’m showing the people I work with that
autistic people can have people skills and be good
role models (Female, 28)
Some female respondents (n = 7) suggested that others
were surprised that they had an ASC, since they diﬀered so
much from the public perception of an ASC man with high
maths skills, poor eye contact, and uncommon interests.
So many people have a stereotyped view of what
ASC looks like. They think people with AS are all
geeky, and have little empathy and little insight. They
think people with ASC bore on and on about their pet
subject and make tactless remarks. They don’t realise
that women with ASC tend to internalise things much
more and do have empathy and insight, and are very
careful not to make hurtful remarks. (Female, 56)
However, there were also negative consequences to not
appearing autistic to others. The most striking was that
for some respondents their camouﬂaging, even if it was
involuntary, resulted in a delay or questioning of their
ASC diagnosis. Respondents reported that parents, teach-
ers, and even clinical professionals refused to believe
they could have an ASC, especially if they were female:
The amount of girls that aren’t diagnosed because
they are more likely to camouﬂage than boys is
really bad. I went for so long without being diag-
nosed because they didn’t know that I could pretend
to be normal! (Female, 20)
In addition to this, respondents described failing to
diﬃculties, because these diﬃculties were often hidden
behind the mask of camouﬂaging. Others would therefore
give them more responsibilities or expectations than the
respondent was comfortable with, because of a perceived
level of capability that did not always actually exist.
After beginning graduate school, a lot of issues
arose because I was camouﬂaging to the point that
my support needs weren’t being met. So, in that
instance, it was detrimental to camouﬂage. (Female,
24)
I am an SEN teacher and my boss doesn’t know
when I am camouﬂaging. Currently highly stressed
because she keeps giving me more work and not
realising the stress it is causing. (Female, 44)
For some respondents, this reﬂected the idea that cam-
ouﬂaging was not a conscious choice; they described
wanting to control when and how they camouﬂage to a
greater degree, in order to access support when they
needed it:
People need to learn how to drop the camouﬂage
when in situations such as medical assessments or
dealing with support professionals otherwise they
may be under assessed for support as they appear to
be coping. (Female, 28)
For others, however, camouﬂaging was seen as a delib-
erate technique to avoid detection. Thus, increasing gen-
eral awareness of camouﬂaging strategies by the public,
and particularly by employers, was seen as ‘outing’ an
ASC individual without their consent. These respond-
ents feared that by giving others the tools to identify their
camouﬂaging, the negative consequences they were try-
ing to avoid would still happen.
If they [employers] can identify camouﬂaging, then
they will “ﬁnd us out” and reject us. (Female, 68)
“I’m Not My True Self”
The ﬁnal consequence reported by respondents was that
camouﬂaging aﬀected their perception of themselves, in
particular how they represented themselves to the outside
world and their sense of authenticity. For many respond-
ents, by camouﬂaging their ‘true’ or natural behaviours
they were lying about who they were. This was often
regretted by the respondents, who wanted to be happy as
they were, but felt that the pressures of the typical social
world meant this was not possible.
I don’t care about being diﬀerent, I like my diﬀer-
ences (apart from things feeling really stressful and
no conﬁdence) but I don’t want to deal with peo-
ples’ negative and sometimes evil reactions. I feel
2529J Autism Dev Disord (2017) 47:2519–2534
1 3
like the weight of a black cloud is hanging on me
having to be this fake version of me. (Female, 48)
In an extension of this, for some respondents their
camouﬂaging behaviours contradicted the important role
they attributed to ASC in shaping their identity. Despite
feeling proud of their ASC diagnosis, and the community
they were a part of, they still deliberately camouﬂaged
the behaviours associated with this diagnosis. These indi-
viduals felt that by hiding their ASC characteristics, they
were betraying the ASC community as a whole.
It’s mentally exhausting constantly having to be
something else, literally never being able to be
myself, and kind of sad too I guess? I even stop
myself doing certain tics and things automatically
when I’m by myself and that kinda sucks, that I’m
not even me on my own. I guess I’m letting down
the side a bit by hiding my autism; I am very vocal
about stigmas and stereotypes with mental illness,
and do talk about my anxiety openly, so I don’t
know why autism is diﬀerent. (Female, 20)
Some respondents felt that the relationships they
formed through camouﬂaging were based on deception,
and therefore the relationships themselves were false.
This reinforced experiences of loneliness and isolation,
as they felt no one truly knew them or understood them.
Some also felt bad for deceiving their friends and even
loved ones.
I feel sad because I feel like I haven’t really related
to the other people. It becomes very isolating
because even when I’m with other people I feel like
I’ve just been playing a part. (Female, 30)
I was married for 15 years and was camouﬂaging
in high gear during that time… My husband would
occasionally say to me that he wondered if I was
really who I was. I think he would get glimpses of
the real me. I didn’t even know who the real me
was… The marriage ended in divorce. (Female, 64)
The situations in which respondents camouﬂaged were
so extensive for some, they felt that they were losing sense
of who they truly were. Respondents often felt they were
playing so many diﬀerent roles, it was hard to keep track of
their authentic sense of identity. This increased the anxiety
and stress associated with camouﬂaging, as individuals lost
a sense of grounding and security in who they were.
Sometimes, when I have had to do a lot of camou-
ﬂaging in a high stress environment, I feel as though
I’ve lost track of who I really am, and that my actual
self is ﬂoating somewhere above me like a balloon.
(Female, 22)
Discussion
This study identiﬁed key themes underlying the motiva-
tions, techniques, and consequences associated with social
camouﬂaging amongst adults with ASC. The vast major-
ity of participants (male, female, and of other genders)
reported camouﬂaging to some degree, although there
was signiﬁcant variation in individual experiences of cam-
ouﬂaging. The results were combined into a model of the
camouﬂaging process, which we hope will contribute to
the generation of testable hypotheses and identiﬁcation of
avenues for future research.
The themes revealed two key motivations for camouﬂag-
ing; assimilation and connection. This suggests that cam-
ouﬂaging behaviours come from multiple sources. They
may be internally driven by the individual to accomplish
speciﬁc goals such as friendships, but they may also be pro-
duced as a response to external demands placed on how a
person should behave in society. The diﬀerential inﬂuence
of each of these motivations varies between individuals,
but our ﬁndings suggest that people are strongly motivated
by wanting to avoid discrimination and negative responses
from others. This conclusion is supported by a recent study
demonstrating that non-autistic individuals judge autistic
people more negatively, and are less willing to interact with
them, even after only brief exposure to the autistic individ-
ual (Sasson etal. 2017). Several participants suggested that
improved education and acceptance of ASC amongst the
general public would improve their social experiences sig-
niﬁcantly, and would allow them to both ﬁt in and increase
their connections without the need to camouﬂage.
Respondents described a wide variety of techniques
used as part of their camouﬂaging behaviours, and further
research is needed to determine the extent to which speciﬁc
techniques can be generalised to all people who camou-
ﬂage. The two main themes found here, masking and com-
pensation, appear to relate to the motivations of ﬁtting in
and forming connections respectively; respondents used
techniques to mask their ASC in order to appear like other
people around them, and compensated for their social com-
munication diﬃculties in order to make better connections
with others. However, it remains to be seen whether these
two goals of camouﬂaging are entirely separate, or whether
the same techniques can be used to further both aims.
There was extensive variation in the consequences of
camouﬂaging reported, but one of the most striking ﬁnd-
ings was that the vast majority of participants reported
some unpleasant and unwanted consequences of camou-
ﬂaging. These included the exhaustion experienced during
and after camouﬂaging, which has been identiﬁed in pre-
vious research (Tierney etal. 2016). Our ﬁndings suggest
that, if people with ASC want to continue camouﬂaging
in the ways reported in our study, those supporting them
2530 J Autism Dev Disord (2017) 47:2519–2534
1 3
should be aware of the associated strains. Time alone to
recover was identiﬁed as an important tool to help par-
ticipants continue camouﬂaging, and could be utilised by
employers and schools to make these environments more
accessible for ASC individuals.
In addition, a profound consequence of camouﬂaging
was a change in self-perceptions, as detailed by the theme
‘I’m not my true self’. Camouﬂaging appears to challenge
many participants’ views towards themselves, and produce
negative emotions and attitudes, such as being a ‘fake’ or
losing their identity. It may be that the rigidity of thinking
and scrupulous honesty that are present in many individuals
with ASC leads them to view any change in self-presenta-
tion as false (Chevallier etal. 2012). Regular camouﬂaging
would consequently increase the individual’s perception of
themselves as a ‘liar’ or inauthentic person, and could lead
to long-term negative impacts on self-esteem. This could
account for the ﬁnding that some participants viewed cam-
ouﬂaging as lying, in contrast to those who viewed it as a
performance.
We can only speculate whether diﬀerences in partici-
pants’ attitudes towards camouﬂaging, including the moti-
vations and techniques used, may lead to diﬀerences in
the consequences of camouﬂaging. Interestingly, positive
consequences were reported more frequently by males than
females or those of other genders. This could suggest that
camouﬂaging is more likely to be a satisfying process for
males with ASC given present gendered social-cultural
contexts; alternatively, it may reﬂect gender diﬀerences
in the actual camouﬂaging techniques used, which pro-
duce diﬀerent consequences. However, some participants
reported that their camouﬂaging strategies were not always
performed successfully; a relatively large proportion of
these participants were male, in contrast to the gender
ratio of the overall sample. There may be a discrepancy
between desire to camouﬂage and ability to do so, and this
too should be investigated in diﬀerent genders and across
the entire autism spectrum. The potential gender diﬀerence
corresponds well with a recent study showing on-aver-
age lower level of camouﬂaging and stronger association
between camouﬂaging and depressive symptoms (i.e. the
more camouﬂaging, the higher level of depression) in men
with ASC, compared to women with ASC (Lai etal. 2016).
It may be that females with ASC who camouﬂage tend to
do so more successfully than males.
Previous researchers have suggested that camouﬂaging
by females with ASC might account for the gender dispar-
ity in diagnosis (Gould and Ashton-Smith 2011; Kreiser
and White 2014; Lai etal. 2015). Our study is not designed
to directly test this idea, or to compare the extent of camou-
ﬂaging between diﬀerent groups. We found that relatively
equal numbers of males and females, and all individuals
of other genders, reported camouﬂaging, and no consistent
patterns of diﬀerences in camouﬂaging behaviours between
males and females were identiﬁed. However, some female
and other-gender participants argued that camouﬂaging was
a speciﬁc reason for their own or others’ late diagnosis, sug-
gesting that society places higher demands on social ability
and assimilation for people perceived as female. Indeed, a
recent study in elementary school children shows that the
gendered, female social landscape supports ASC girls for
camouﬂaging (e.g., staying in close proximity to peers) and
therefore if clinicians and teachers rely on a male landscape
to detect ASC characteristics (e.g., social isolation on the
playground), females will tend to be left unidentiﬁed (Dean
etal. 2016). Further examination of the impact of camou-
ﬂaging behaviours in all genders is essential to understand
the diﬃculties in accessing support by those who do not
show a ‘typical’ ASC presentation.
One explanation for the similarities in camouﬂaging
between males and females found here is that our sample
was self-selecting, in response to a call for participants for
‘a study looking at experiences of coping behaviours in
social situations’. Although previous experience of camou-
ﬂaging was not required to take part in the study, potential
this way. It is therefore possible that our sample comprised
only those people who had experienced camouﬂaging,
which might include a substantial number of ASC females,
but a smaller proportion of ASC males. The majority of
those who did not take part, because they had never or only
rarely experienced camouﬂaging, may have more likely
been male. This would account for the high proportion of
female participants in our study, in contrast to previous
research into ASC. Further investigation of camouﬂaging
behaviours across the entire ASC population would shed
more light on this.
An alternative explanation is that camouﬂaging is
equally common in males and females with ASC. Previ-
ous research has either theorised that camouﬂaging is more
common in females (Lai etal. 2011; Wing 1981), has only
included female samples (Bargiela et al. 2016; Tierney
etal. 2016), or has observed on-average more evident cam-
ouﬂaging in females than males (Dean etal. 2016; Lai etal.
2016). If camouﬂaging does indeed lead to not receiving
the diagnosis, there may, in fact, be a signiﬁcant number
of both males and females with ASC missing out on the
support they might need. Future research could test this
possibility by comparing camouﬂaging levels in males and
females with high ASC traits, but who have not received
an ASC diagnosis. However, this also leads to a point that
was raised by some of the participants who reported not
camouﬂaging—the concept that if people are camouﬂaging
so successfully that they are not diagnosed, they may not
need a diagnosis or related support. While this may seem
plausible to those who view camouﬂaging as a successful,
2531J Autism Dev Disord (2017) 47:2519–2534
1 3
low-impact strategy, the signiﬁcant diﬃculties and uncer-
tainty reported by our participants tell us that people who
camouﬂage still need to be able to access appropriate
support.
This issue reﬂects a concern voiced by some partici-
pants, viz. that increasing the awareness of camouﬂaging in
the general public might actually lead to worse outcomes
for some individuals with ASC. Those participants who
used camouﬂaging to hide their ASC, especially at work,
often viewed their camouﬂaging as a defensive strategy
protecting them from discrimination. They worried that if
other people were able to identify camouﬂaging, the ASC
individual might lose this protection and be treated unfairly.
It remains to be seen how much camouﬂaging in ASC can
be identiﬁed by others. Many participants felt their cam-
ouﬂaging was at times unsuccessful, or reported occasions
where another person had commented on their techniques.
This concern suggests that research and public education
regarding camouﬂaging needs to be performed in consulta-
tion with a range of people from the ASC community to
ensure that increasing information helps rather than harms.
More crucially, this concern voiced by some participants
once again emphasises that the outcome of individuals with
ASC does not solely rely on personal characteristics—it
can more fundamentally rely on how the social contexts
treat them. A better person-environment ﬁt is the key, and
this involves ‘treating the environment’ to reduce stigmati-
zation attached to autism and barriers to social life (Lai and
Baron-Cohen 2015).
Strengths andLimitations
One strength of this study was the high proportion of
females and those of non-binary gender, many of whom
were diagnosed later in life. This is an under-represented
population, and it is important to include their voices and
insights, which may be diﬀerent to those of the majority
male, younger samples included in previous research. How-
ever, because of this our sample was not fully representa-
tive of the entire ASC community. Intellectual ability was
not measured, although it can be assumed that participants
should have had close to or average cognitive abilities in
order to be able to complete the online, text-based survey.
The cognitive and self-reﬂecting abilities required to com-
plete the survey may also mean that our sample were better
able to perform successful camouﬂaging behaviours than
others on the autism spectrum.
As a result, our ﬁndings cannot be said to represent the
views of those with ASC who also have intellectual disabil-
ity, or who cannot express themselves in written English.
Developing more accessible measures of camouﬂaging,
such as self-report questionnaires that can be orally or visu-
ally administered, or measures to identify camouﬂaging
behaviours, would improve our ability to understand cam-
ouﬂaging across the whole ASC community. This study
was not designed to measure camouﬂaging behaviours
across the ASC population, but to identify the component
parts of the construct of camouﬂaging. We hope that with
these results, future research can investigate the functional
and demographic characteristics of those individuals with
ASC who do or do not camouﬂage, including those with
non-binary gender identities and/or gender dysphoria, char-
acteristics that may also contribute to the need for camou-
ﬂaging, and should be explored in their own right. Larger
and more varied samples of individuals from across the
autism spectrum should be included to further reﬁne our
understanding of camouﬂaging in the future.
As previously mentioned, our sample only included
adults with a conﬁrmed diagnosis of ASC; it is therefore
possible that those who are most likely to camouﬂage were
not included in our study as they would not have met the
diagnostic criteria. A typically developing comparison
group was not included in this study due to the diﬃculty of
operationalising camouﬂaging for individuals with limited
ASC-related characteristics. However, several participants
reported having camouﬂaged for years before receiving a
diagnosis later in life, suggesting that our ﬁndings have rel-
evance for undiagnosed ASC individuals. Using the behav-
iours and themes identiﬁed in this study, descriptions of
camouﬂaging suitable for the general population can now
be developed. Future research in individuals with high lev-
els of ASC traits, regardless of their diagnosis, may reveal
more about how camouﬂaging varies between those who
ther qualitative and quantitative research comparing the
camouﬂaging experiences of individuals from diﬀerent age
groups may reveal more about how camouﬂaging develops
and changes across the lifespan.
The inductive nature of this study has resulted in novel
avenues for research, such as focusing on the impact of
camouﬂaging on identity, which may not have otherwise
been considered. In addition, although camouﬂaging has
previously been described as mainly a female expression
of ASC, we found that many males and individuals of
other genders also reported camouﬂaging. A recent study
operationalising camouﬂaging using existing ASC-related
measures also shows wide variability of the level of cam-
ouﬂaging in both men and women with ASC, indicating
that camouﬂaging is not a female-speciﬁc phenomenon
(Lai etal. 2016). In the present study, no statistically tested
gender diﬀerences in camouﬂaging behaviours or outcomes
were presented due to the qualitative nature of the data,
and no analysis of the subjective or objective success of
camouﬂaging attempts was made. However, our ﬁndings
have produced the ﬁrst known conceptual model of camou-
ﬂaging, with key themes and components as identiﬁed by
2532 J Autism Dev Disord (2017) 47:2519–2534
1 3
individuals who camouﬂage. We hope that future research
in this area will use the themes identiﬁed here to develop
precise, testable hypotheses for qualitative or quantita-
tive research into camouﬂaging and the sex- and gender-
informed phenotypes of ASC.
The next stage of research requires the development of
measures of camouﬂaging behaviours, in order to stand-
ardise and compare camouﬂaging experiences between
autistic and non-autistic individuals and allow for follow-
up quantitative research. We hope that the model presented
in this paper, and in particular the behaviours described in
the ‘masking’ and ‘compensation’ themes, will provide a
framework for the development of such a measure. Fur-
thermore, studies delineating component psychological
constructs and interpersonal-contextual processes underly-
ing the themes identiﬁed here will deepen our understand-
ing of the mechanisms underlying camouﬂaging. Eventu-
that maximise the positive consequences and minimise the
negative consequences of camouﬂaging—and to attain the
most appropriate person-environment ﬁt for each individual
with ASC.
Conclusions
This study demonstrates that camouﬂaging of ASC-related
characteristics in social situations may be a common behav-
iour amongst adults with ASC. Camouﬂaging is motivated
by the desire to ﬁt in with others and to make connections.
The behaviours themselves can be grouped into masking
and compensation strategies. In the short term, camouﬂag-
ing results in extreme exhaustion and anxiety; although
the aims of camouﬂaging are often achieved, in the long-
term there are also severe negative consequences aﬀecting
support. Our ﬁndings demonstrate that camouﬂaging is an
important aspect in the lives of many individuals with ASC.
Future research is needed to quantitatively measure camou-
ﬂaging and compare techniques in individuals with ASC of
all genders, to identify demographic and ASC characteris-
tics associated with individual variation in camouﬂaging
and its outcomes, to uncover underlying psychological and
interpersonal/contextual processes, and to devise strategies
that minimise negative impacts of camouﬂaging and facili-
tate the realization of maximal individual potential.
Acknowledgments The authors express their thanks to Holly
Walton for auditing the initial analyses. The authors would also like
to thank all those who took part in the study, especially those who
provided comments on the ﬁndings. During the period of the study
Meng-Chuan Lai was supported by the O’Brien Scholars Program
within the Child and Youth Mental Health Collaborative at the Centre
for Addiction and Mental Health and The Hospital for Sick Children,
Toronto, Canada; Simon Baron-Cohen was supported by the Autism
Research Trust, Autistica, the MRC and Wellcome Trust, and by
the National Institute for Health Research (NIHR) Collaboration for
Leadership in Applied Health Research and Care East of England at
Cambridgeshire and Peterborough NHS Foundation Trust. The views
expressed are those of the author(s) and not necessarily those of the
NHS, the NIHR or the Department of Health.
Author Contributions LH participated in the design and coordina-
tion of the study, interpreted the data and drafted the manuscript. KVP
participated in the interpretation, and revised the manuscript. CA and
PS conceived of the study, and participated in its design and coordina-
tion. SBC, MCL and WM conceived of the study, participated in its
design, coordination, and interpretation, and revised the manuscript.
All authors read and approved the ﬁnal manuscript.
Compliance with Ethical Standards
Conﬂict of interest The authors declare that they have no conﬂict
of interest.
Ethical Approval All procedures performed in studies involving
human participants were in accordance with the ethical standards of
the institutional and/or national research committee and with the 1964
Helsinki declaration and its later amendments or comparable ethical
standards.
use, distribution, and reproduction in any medium, provided you give
appropriate credit to the original author(s) and the source, provide a
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## Supplementary resource (1)

Data
January 2017
... This was also found by Bargiela et al. (2016) who spoke to 14 autistic women and found that these women, who had all received a diagnosis in late adolescence or adulthood, reported camouflaging their autistic behaviours, which was implicated in poor recognition of their need for help. Similar findings were reported by Hull et al. (2017), who interviewed 55 autistic females, 30 autistic males and 7 autistic people who identified as a different gender. Participants in this study commented that females often 'pretend to be normal' and therefore are often overlooked for autism diagnosis. ...
... In terms of possible motivations or predictors for camouflaging behaviour, research has shown both conventional (such as success in the workplace) and relational (such as fitting in with friends) factors may be the driving force (Cage & Troxell-Whitman, 2019). Similarly, Hull et al. (2017) found motivations for camouflaging reported by late-diagnosed autistic women included assimilation and a desire to build relationships. Sex differences have been observed in terms of the motivations for camouflaging, with females citing conventional factors more often than males. ...
... Cook et al., 2021). There is evidence to suggest that camouflaging behaviour is associated with increased self-reported stress and anxiety (Cage & Troxell-Whitman, 2019;Hull et al., 2017). Camouflaging behaviour has also been linked to increased exhaustion for those engaging in this often-effortful strategy (Bargiela et al., 2016). ...
Article
Full-text available
Lay abstract: Many autistic people use strategies that help them adapt in social situations and hide behaviours that may seem different to non-autistic individuals - this is called camouflaging. Camouflaging may help autistic people fit in socially; however, it might also lead to poorer well-being. It has been suggested that autistic females camouflage more than autistic males. This article explored differences between males and females who have an autism diagnosis, have characteristics of autism but no diagnosis and those with few autistic characteristics. It is important to include these groups as camouflaging may make it more difficult to get an autism diagnosis and therefore make it less likely a person will receive support. We found that autistic women camouflaged more than all other groups. The group with few autistic characteristics (males and females) camouflaged the least. Loneliness was found to be a possible reason for camouflaging for the diagnosed autistic group only. In terms of outcomes related to camouflaging, it was found that those who camouflaged most had a lower quality of life; this was true of all groups. This tells us that there may be different reasons to camouflage, and different outcomes related to camouflaging for those with many characteristics of autism (including those with a diagnosis), and those with few. It is important that clinicians, teachers, parents and other stakeholders are aware of the negative outcomes associated with camouflaging so that more support can be provided for those who need it.
... Finally, despite dif culties in social awareness and understanding others' mental states, autistic adults often do experience subjective feelings of judgment and lack of social acceptance related to their symptoms and behaviors (Kapp et al., 2019a). Research investigating the phenomenon of "camou aging," in which autistic individuals mask, hide, or otherwise compensate for their autism features in social interactions, has clearly demonstrated their awareness of the need to change one's behavior to achieve various aims (Hull et al., 2017). ...
... Adults perceive stigma related to autism features and mental health problems, resulting in a heightened desire to "camou age" (Crane et al., 2019;Kapp et al., 2019a). However, these camou aging behaviors come at a high emotional cost, with reports of exhaustion, identity loss, depressive symptoms, and suicidality (Cage & Troxell-Whitman, 2019; Cassidy et al., 2018;Hull et al., 2017). Further, the construct of collective self-esteem, or one's beliefs about how autistic individuals as a group are viewed by society and by oneself, has been linked to personal selfesteem, anxiety, and depressive symptoms in autistic adults (Cooper et al., 2017), further compounding the potential negative effects of perceived stigma. ...
... Whilst this might resemble maladaptive behaviors presented in neurotypical groups, such as difficulties with social functioning precipitates a negative sense of self and disordered eating as proposed by the interpersonal model of binge eating (Wifley et al., 2000), CC serves as a "scaffold" for social behavior (socially adapted behaviors which are achieved through conscious CC strategies; Ullman and Pullman, 2015;Livingston and Happé, 2017). For example, autistic individuals may engage in masking/social camouflaging (suppressing AP behaviors) in an attempt to appear neurotypical (Lai et al., 2016;Hull et al., 2017). Although these strategies potentially facilitate social navigation, they are susceptible to rapid decline and/or maladaptation when faced with stressors (e.g., mental fatigue), and are inflexible to novel or ambiguous situations (Hull et al., 2017;Livingston and Happé, 2017). ...
... For example, autistic individuals may engage in masking/social camouflaging (suppressing AP behaviors) in an attempt to appear neurotypical (Lai et al., 2016;Hull et al., 2017). Although these strategies potentially facilitate social navigation, they are susceptible to rapid decline and/or maladaptation when faced with stressors (e.g., mental fatigue), and are inflexible to novel or ambiguous situations (Hull et al., 2017;Livingston and Happé, 2017). As a result, an individual may "mask" in way which adopts external, socio-cultural influences (e.g., copying anorexic values; Brede et al., 2020). ...
... Some of the participants reported being overwhelmed when presented with these scenarios, and still wanting to come across as 'polite'. Studies have suggested that many autistic adults 'camouflage' their autistic traits by trying to hide behaviour that might be viewed as socially undesirable to seem socially confident and is often motivated by a desire to make friends (Hull et al., 2017;Tierney et al., 2016). ...
Article
Full-text available
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... 5 Background 'Masking' (sometimes called 'camouflaging') is an experience frequently reported for many autistic people within multiple different contexts. [1][2][3][4] Masking involves blending in with the neurotypical majority, using intentional or unintentional ways to get by in social situationssuch as developing scripts for conversations, suppressing stimming, or forcing oneself to make eye contact. 5,6 Due to ongoing conceptual discussions, 6,7 we use the term masking in this paper, to respect the term which the autistic community tends to use most often. ...
... These interests are less likely to be perceived as a fixation which increase the risk for under identification of females with ASD (Hiller et al., 2014(Hiller et al., , 2016Mandy et al., 2012;Sutherland et al., 2017). A related aspect is camouflaging (i.e. the use of coping strategies to fit in) which is reported to be more common in females without intellectual disability and has been proposed to contribute to the under identification of females with ASD (Hull et al., 2020;Hull et al., 2017;Lai et al., 2017). Furthermore, the choice of responders may influence the way sex differences are captured by a screening instrument. ...
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... As such, his social impairments associated with ASD would not be apparent. In order to hide their impairments or difficulties, research has shown that some individuals with ASD may engage in social camouflaging, masking, or compensation (Cook et al., 2021;Hull et al., 2017;Lai et al., 2017;Perry et al., 2022). ...
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... Future work should examine how a focus on social skills can be embedded within the screening and intervention process of a multi-tiered systems of support approach for autistic children. However, school-based professionals should ensure that any social skills support is driven by students' own social goals and are affirming of neurodiversity, authenticity, and self-determination (Bottema-Beutel et al., 2018;Cage & Troxell-Whitman, 2019) to avoid reinforcing stigma and ableism, inhibiting authenticity, or enforcing masking, which have negative mental health implications (Hull et al., 2017). ...
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... It would seem that women are more able to use camouflage, even though the desire to do so can concern either gender. People with ASD have suggested that improving the general public's awareness and acceptance of their symptoms would improve their social experiences, their integration and relationships, without having to resort to camouflage to reach these objectives [44]. ...
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Social performances pervade human interactions. Some autistic people describe their social performances as ‘camouflaging’ and engage in these performances to mitigate social challenges and survive in the neurotypical world. Here, we reconsider autistic camouflaging under the unifying framework of impression management (IM) by examining overlapping and unique motivations, neurocognitive mechanisms, and consequences. Predictive coding and Bayesian principles are synthesized into a computational model of IM that applies to autistic and neurotypical people. Throughout, we emphasize the inherently transactional, context-dependent nature of IM, the distinct computational challenges faced by autistic people, and the psychological toll that compelled IM can take. Viewing camouflaging through this lens highlights the pressing needs to change societal attitudes, destigmatize autism, refine social skills-building programs for autistic individuals, and integrate these programs with environment-focused support.
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Autobiographical descriptions and clinician observations suggest that some individuals with autism, particularly females, ‘camouflage’ their social communication difficulties, which may require considerable cognitive effort and lead to increased stress, anxiety and depression. Using data from 60 age- and IQ-matched men and women with autism (without intellectual disability), we operationalized camouflaging in adults with autism for the first time as the quantitative discrepancy between the person’s ‘external’ behavioural presentation in social–interpersonal contexts (measured by the Autism Diagnostic Observation Schedule) and the person’s ‘internal’ status (dispositional traits measured by the Autism Spectrum Quotient and social cognitive capability measured by the ‘Reading the Mind in the Eyes’ Test). We found that the operationalized camouflaging measure was not significantly correlated with age or IQ. On average, women with autism had higher camouflaging scores than men with autism (Cohen’s d = 0.98), with substantial variability in both groups. Greater camouflaging was associated with more depressive symptoms in men and better signal-detection sensitivity in women with autism. The neuroanatomical association with camouflaging score was largely sex/gender-dependent and significant only in women: from reverse inference, the most correlated cognitive terms were about emotion and memory. The underlying constructs, measurement, mechanisms, consequences and heterogeneity of camouflaging in autism warrant further investigation.
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Autobiographical descriptions and clinician observations suggest that some individuals with autism, particularly females, ‘camouflage’ their social-communication difficulties, which may require considerable cognitive effort and lead to increased stress, anxiety and depression. Using data from 60 age- and IQ-matched men and women with autism (without intellectual disability) we operationalized camouflaging in adults with autism for the first time, as the quantitative discrepancy between the person’s ‘external’ behavioural presentation in social-interpersonal contexts (measured by the Autism Diagnostic Observation Schedule) and the person’s ‘internal’ status (dispositional traits measured by the Autism Spectrum Quotient and social cognitive capability measured by the ‘Reading the Mind in the Eyes’ Test). We found that the operationalized camouflaging measure was not significantly correlated with age or IQ. On average, women with autism had higher camouflaging scores than men with autism (Cohen’s $\textit{d}$=0.98), with substantial variability in both groups. Greater camouflaging was associated with more depressive symptoms in men, and better signal-detection sensitivity in women with autism. The neuroanatomical association with camouflaging score was largely sex/gender-dependent and significant only in women: from reverse inference the most correlated cognitive terms were about emotion and memory. The underlying constructs, measurement, mechanisms, consequences, and heterogeneity of camouflaging in autism warrant further investigation.
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We used Framework Analysis to investigate the female autism phenotype and its impact upon the under-recognition of autism spectrum conditions (ASC) in girls and women. Fourteen women with ASC (aged 22–30 years) diagnosed in late adolescence or adulthood gave in-depth accounts of: ‘pretending to be normal’; of how their gender led various professionals to miss their ASC; and of conflicts between ASC and a traditional feminine identity. Experiences of sexual abuse were widespread in this sample, partially reflecting specific vulnerabilities from being a female with undiagnosed ASC. Training would improve teachers’ and clinicians’ recognition of ASC in females, so that timely identification can mitigate risks and promote wellbeing of girls and women on the autism spectrum.
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This study examined the extent to which gender-related social behaviors help girls with autism spectrum disorder to seemingly mask their symptoms. Using concurrent mixed methods, we examined the social behaviors of 96 elementary school children during recess (autism spectrum disorder = 24 girls and 24 boys, typically developing = 24 girls and 24 boys). Children with autism spectrum disorder had average intelligence (IQ ⩾ 70), a confirmed diagnosis, and were educated in the general education classroom. Typically developing children were matched by sex, age, and city of residence to children with autism spectrum disorder. The results indicate that the female social landscape supports the camouflage hypothesis; girls with autism spectrum disorder used compensatory behaviors, such as staying in close proximately to peers and weaving in and out of activities, which appeared to mask their social challenges. Comparatively, the male landscape made it easier to detect the social challenges of boys with autism spectrum disorder. Typically developing boys tended to play organized games; boys with autism spectrum disorder tended to play alone. The results highlight a male bias in our perception of autism spectrum disorder. If practitioners look for social isolation on the playground when identifying children with social challenges, then our findings suggest that girls with autism spectrum disorder will continue to be left unidentified.