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The Association Between Self-Reported Camouflaging of Autistic Traits and Social Competence in Nonautistic Young Adults
Abstract
Background:
Autistic individuals often experience difficulties in social settings. Although autistic individuals may not intuitively know the "typical" way to behave in social settings, many autistic individuals have a desire to fit in so they develop techniques to "camouflage" their autistic traits. Although camouflaging may help individuals to navigate social environments, camouflaging has also been shown to produce negative psychological outcomes. This study aims to explore whether this "camouflaging" strategy is associated with poor social competence, an aspect of the autism diagnosis.
Methods:
In this study, 247 nonautistic adults completed the Multidimensional Social Competence Scale (MSCS) to assess their social competence, and the Camouflaging Autistic Traits Questionnaire (CAT-Q) to assess the extent to which they used strategies to compensate or mask behaviors characteristic of autism in social settings.
Results:
We found that over and above IQ, gender, and executive functioning scores, social competence (MSCS) scores reliably predicted the extent to which nonautistic individuals camouflaged, accounting for 25% of the variance in CAT-Q scores. Importantly, even when autistic traits were controlled for, social competence was still able to account for additional variance in CAT-Q scores.
Conclusion:
These results suggest that low social competency in nonautistic adults predicts camouflaging as a strategy in social situations. Given these camouflaging behaviors are being performed in an attempt to comply with an environmental demand to behave in a particular manner, these results also highlight the importance of conceptualizing the social challenges that autistic and nonautistic individuals face in a bidirectional manner, where the onus is not solely on the individual to comply with social conventions but also on society to accommodate diverse behavioral traits.
Lay summary:
Why was this study done?: Some autistic individuals try to hide their autistic traits to "fit in" with others, referred to as "camouflaging." Nonautistic adults also report camouflaging, but it is unclear whether this camouflaging is related to social difficulties that are not specific to autism. No research has been conducted to examine the relationship between social competence and camouflaging in nonautistic adults.What was the purpose of this study?: To further understand the factors that are related to camouflaging behaviors. More specifically, whether social abilities, and/or autism characteristics, are related to whether nonautistic adults camouflage.What did the researchers do?: We had 257 nonautistic adults complete various questionnaires, including ones that asked them about their camouflaging behaviors and social abilities. We examined the relationships between the scores from these questionnaires and the influence of other factors such as gender, intelligence, and executive functioning.What were the results of the study?: We found that both social abilities and autistic traits were related to camouflaging behaviors. Indeed, nonautistic adults who had poor social skills, and more autistic traits, engaged in more camouflaging. Social skills were associated with camouflaging even after we considered factors such as gender, intelligence, and executive functioning.What do these findings add to what was already known?: These findings help us understand camouflaging by demonstrating that it may be a common response to social difficulties in nonautistic, as well as autistic, adults. These results also indicate that camouflaging is related to low social competency, not just autism characteristics.What are the potential weaknesses in the study?: The participants in our study completed questionnaires through which they were required to pick from set answers, rather than describe their experiences. We may be missing important qualitative differences in the way nonautistic adults camouflage compared with autistic adults.How will these findings help autistic adults now or in the future?: By comparing what is shared and what is unique with nonautistic people who share traits with autistic people, a more precise definition and study of camouflaging behavior are possible. Rather than see camouflaging as a phenomenon that occurs exclusively in autistic people because of their disability, it may be that both autistic and nonautistic people use camouflaging when they perceive themselves to lack the necessary social competencies that are expected within their social contexts. Because both autistic traits and social competency are related to camouflaging behavior, we can begin to think about how to tease apart which characteristics are more likely to evoke camouflaging in autistic individuals and how this may be similar or different in nonautistic individuals. This knowledge will ultimately contribute to the development of more tailored approaches to prevent and/or reduce the negative impact of camouflaging behaviors for autistic adults.
... 1,2 It is a well-established phenomenon in autistic* populations, [2][3][4][5][6] which is associated with a range of indicators of psychological distress or poor psychological health. 3,[6][7][8][9][10][11][12][13] Recent evidence suggests that social camouflaging use is also reported by non-autistic adults, 1,11,[14][15][16][17] indicating that social camouflaging is used more broadly by the general population. However, explanations about the mechanisms that drive social camouflaging by non-autistic individuals are less clear. ...
... 3,8,9,11,13,31,32 In some cases, autistic individuals may also use social camouflaging strategies to avoid the stigma, ostracization, and victimization that can occur in response to being ''out as autistic.'' 2,3 In non-autistic populations, social camouflaging has been linked to autistic traits, 1,4,16,17,33,34 which may suggest that social camouflaging by non-autistic individuals is motivated by the same desire to disguise ''undesirable'' autistic traits during social interactions. Alternatively, that social camouflaging is not exclusively used by autistic populations implies that something other than autistic traits may motivate, or at least contribute to, the use of social camouflaging. ...
... The ''camouflage'' hypothesis, as it has been coined, has been linked to claims that autism presents differently in males and females and may help to explain why autistic females who successfully camouflage are less readily diagnosed by current diagnostic means. 7 To date, social camouflaging has primarily been examined in non-autistic samples as a single (i.e., total score) construct 17,40,[43][44][45] via the Camouflaging Autistic Traits Questionnaire (CAT-Q), a self-report measure of social camouflaging behaviors. 1 Despite this, Hull et al. 1 differenti-ated three related, yet distinct, components of social camouflaging behavior, which make up the subscales of the CAT-Q: compensation, masking, and assimilation. ...
... Det gjenspeiler seg i at det eneste standardiserte måleverktøyet hittil, eksplisitt omtaler det som kamuflering av autistiske trekk . Imidlertid fant en nylig publisert studie en signifikant sammenheng mellom sosial kompetanse og kamuflering hos personer uten ASD (Scheerer et al., 2020). Personer med lav sosial kompetanse kamuflerer mer enn personer med høy sosial kompetanse, og personenes skåre på sosial kompetanse forklarer 25% av variasjonen (Scheerer et al., 2020). ...
... Imidlertid fant en nylig publisert studie en signifikant sammenheng mellom sosial kompetanse og kamuflering hos personer uten ASD (Scheerer et al., 2020). Personer med lav sosial kompetanse kamuflerer mer enn personer med høy sosial kompetanse, og personenes skåre på sosial kompetanse forklarer 25% av variasjonen (Scheerer et al., 2020). Studien antyder at kamuflering ikke er spesifikt for personer med ASD, men heller et allmennmenneskelig fenomen som eksisterer i ulik grad hos alle mennesker. ...
... fant eksempelvis at kamuflering er assosiert med økte symptomer på sosial angst og lavere velvaere hos personer uten ASD. Sammen med studien av Scheerer et al. (2020), som viste en sammenheng mellom lav sosial kompetanse og økt bruk av kamuflering hos personer uten ASD, tyder våre resultater på at kamuflering er relevant ved andre kliniske tilstander. Tolkningen er imidlertid usikker da vi ikke har noe informasjon om omfanget av kliniske vansker blant deltakerne i denne studien. ...
... Social competence is a broad term referring to (neurotypically-defined) skills used to establish social relations with peers and adults, to form friendships, and to understand the needs of others (Hoffman et al., 2015). It includes a range of cognitive skills and processes such as social motivation, social inferencing, empathy, social knowledge, verbal conversation skills, nonverbal communication skills, and emotional regulation (Scheerer et al., 2020). It is important to acknowledge that the concept of social competence is defined by neurotypical norms rather than by autistic people themselves. ...
... Additionally, non-autistic people experience challenges in social competence (e.g. Scheerer et al., 2020). ...
Anxiety is one of the most frequently reported co-occurring conditions for autistic children and adolescents. The relationship between anxiety and social outcomes in autistic youth has been the focus of a range of studies, with mixed results. This meta-analysis aimed to identify the strength of the association between anxiety and a frequently researched social outcome (social competence) in autistic young people and whether that association is influenced by individual or research design factors. A previous preregistered systematic review was updated with a search of the same three databases (CINAHL, ERIC, and PsycINFO) as the original review. Through this, 20 studies with sufficient data on a neurotypically-defined measure of social competence and anxiety were identified. Results were synthesised using a mixed effects model. The meta-analysis on 2,321 participants (from 22 samples) highlighted wide heterogeneity in results. The findings show that anxiety has a significant, small negative impact on social competence (d = − 0.48; 95% CI = − 0.71, − 0.26), meaning that as scores on measures of anxiety increase, scores on measures of social competence decrease. This relationship between anxiety and social competence was moderated by age, becoming weaker as age increased. Whilst this is an important finding for supporting mental health and well-being of autistic young people, the large amount of variance left unexplained suggests that multiple factors, including the use of measures designed for neurotypical people and the potential impact of camouflaging on such measures, need to be considered in future designs.
... Quantitative data were analyzed for number and percentage of respondents. Qualitative data, specifically student open-ended responses to why they do and do not disclose mental health conditions and their experiences with accommodations and supports, were coded for themes using an open coding approach (Saldana, 2009). Responses were reviewed in full, then re-read with emerging codes compared for similarities leading to themes. ...
... With the increasing prevalence of neurodivergent students attending college, this finding is of utmost concern. Neurodivergent students have been found to camouflage their disability often due to lack of understanding of others leading to negative mental health outcomes (Scheerer et al., 2020). It is imperative that universities center neurodiversity in diversity initiatives and eliminate barriers faced by neurodivergent students, for example through the establishment of disability cultural centers, faculty and staff training and comprehensive supports . ...
Preparing special education teacher candidates in an authentic learning environment is challenging, but case studies provide effective practice-based learning opportunities. Unfortunately, there are limited case studies available that focus on students with intellectual and developmental disabilities (IDD) and moderate to extensive support needs (M-ESN). Furthermore, the quality of case studies varies. We conducted a document analysis of the literature and resources to (1) identify case studies that included students with IDD and M-ESN, (2) examine the components/features of case studies that included students with IDD and M-ESN, and (3) create a list of existing case studies on this population that EPPs can use in their programs. Using recommendations from Chabon and Cohn (2011), we analyzed 14 case studies that met inclusion criteria. Results indicated that most case studies for this population are narratives about secondary level students and included varied components of the case studies. Implications, limitations, and future suggestions are discussed.
... The present finding of increased social monitoring in cognitively able children with ASD is consistent with recent findings on camouflaging behaviour in youth with ASD. Camouflaging refers to the way people with ASD (or nonautistic people with low social competency -Scheerer et al., 2020) carefully monitor and modify their behaviour in order to conform to normative social behaviour (Hull et al., 2017;Lai et al., 2017;Livingston et al., 2019;Scheerer et al., 2020). In order to camouflage, they often observe, mimic and copy the social behaviour of their typical peers (Cresswell et al., 2019;Tierney et al., 2016). ...
When two participants perform a go/no go task, sharing the same display but responding to different targets, their responses show a spatial compatibility effect. A shape on the side of a participant is responded to faster than that on the neighbour’s side. This is called the Joint Simon effect (JSE), and it vanishes when participants perform the same task alone. JSE has been taken as evidence that humans automatically monitor the actions of others. Here we compare the JSE in adults, typically developing (TD) children, and children with autism spectrum disorder (ASD). Contrary to our expectations, we found a robust JSE in children with ASD. Ex-Gaussian analyses of the distributions of correct responses revealed that the JSE is later-acting in children with ASD. This implies more deliberate social processing, consistent with social camouflaging, which is a behavioural modulation undertaken by people with ASD in an attempt to conform to social norms. These findings support a social interpretation of the JSE while also revealing the unique nature of social processing in children with ASD.
... A three-step procedure was used whereby the first step contained the independent variables of age, sex, and IQ in order to control for their potential influence on social competence. Given social competence has been shown to vary with autistic traits (Scheerer et al., 2020), the second step contained AQ scores to parse out the variance in social competence accounted for by autistic traits. The third step contained CAM scores to determine how much additional variance in the dependent variable, MSCS scores, could be accounted for by alexithymia traits. ...
Alexithymia is characterized by difficulties identifying and describing one's own emotions and the emotions of others. These challenges with understanding emotions in people with alexithymia may give rise to difficulties with social interactions. Given that alexithymia frequently co‐occurs with autism spectrum disorder (ASD), and that both populations have difficulties with social interactions, it is of interest to determine whether alexithymia can help to parse some of the heterogeneity in social competence in autistic and nonautistic individuals. The caregivers of 241 children (6–14 years old), including 120 autistic, and 121 nonautistic, rated their child's social competence using the Multidimensional Social Competence Scale (MSCS), autism traits using the Autism Spectrum Quotient (AQ), and alexithymia traits using the Children's Alexithymia Measure (CAM). Regression analyses indicated that age, IQ, sex, AQ, and CAM scores accounted for 40.2% of the variance in autistic children's, and 68.2% of the variance in nonautistic children's, parent‐reported social competence. Importantly, after controlling for age, IQ, sex, and AQ scores, CAM scores alone accounted for an additional 16.2% of the variance in autistic children's, and 17.4% of the variance in nonautistic children's social competence. These results indicate that higher alexithymia traits predict lower levels of social competence, suggesting that increased difficulty in identifying and describing one's own emotions and the emotions of others is associated with poorer social competence. Furthermore, CAM scores were found to partially mediate the relationship between autistic traits and social competence, suggesting that comorbid alexithymia traits may be partially responsible for poor social competence in individuals with high autistic traits. This research contributes to the understanding of the factors associated with the development of social competence and highlights alexithymia as a potential target for identification and intervention to improve social competence.
Lay Summary
Alexithymia is a condition where people find it hard to think and talk about their (and others') feelings. About 50% of autistic people have alexithymia. This might be why they have social and emotional difficulties. Parents answered questions about alexithymia and social difficulties their children have. Children with more alexithymia problems had poorer social skills. Thus, alexithymia may be related to social problems faced by autistic and nonautistic children.
Introduction
Although autism inclusion and acceptance has increased in recent years, autistic people continue to face stigmatization, exclusion, and victimization. Based on brief 10-second videos, non-autistic adults rate autistic adults less favourably than they rate non-autistic adults in terms of traits and behavioural intentions. In the current study, we extended this paradigm to investigate the first impressions of autistic and non-autistic children by non-autistic adult raters and examined the relationship between the rater's own characteristics and bias against autistic children.
Method
Segments of video recorded interviews from 15 autistic and 15 non-autistic children were shown to 346 undergraduate students in audio with video, audio only, video only, transcript, or still image conditions. Participants rated each child on a series of traits and behavioural intentions toward the child, and then completed a series of questionnaires measuring their own social competence, autistic traits, quantity and quality of past experiences with autistic people, and explicit autism stigma.
Results
Overall, autistic children were rated more negatively than non-autistic children, particularly in conditions containing audio. Raters with higher social competence and explicit autism stigma rated autistic children more negatively, whereas raters with more autistic traits and more positive past experiences with autistic people rated autistic children more positively.
Discussion
These rapid negative judgments may contribute to the social exclusion experienced by autistic children. The findings indicate that certain personal characteristics may be related to more stigmatised views of autism and decreased willingness to interact with the autistic person. The implications of the findings are discussed in relation to the social inclusion and well-being of autistic people.
We present this article as a testament to Ed Zigler's commitment to science in the service of humanity and to policy based on conceptually compelling theory and methodologically rigorous science. In doing so, we highlight ways that Ed's universal and inclusive developmental world view, early training as a behaviorist, exacting scientific standards, concern for others, and appreciation of his own roots and upbringing all transformed the way that many different groups of people of all ages and backgrounds are studied, viewed, and intervened with by researchers, policy makers, and society at large. Ed's narrative of development rather than defect, universality rather than difference, and holistic rather than reductionist continues to compel us in the quest for a kinder, more inclusive, and enabling society. Conversely, Ed's behaviorist training as a graduate student also influenced him throughout his career and was essential to his career-long commitment to systemic action in the service of improving the lives of others. We cite the lessons that we, as his descendants, learned from Ed and apply them to our own areas of research with populations that Ed did not study, but had considerable interest in – persons with autism spectrum disorder and Indigenous youth.
Despite average or above cognitive and verbal abilities, many children with autism spectrum disorder (ASD) experience difficulties in functional and social communication. Executive functioning (EF) may be the cognitive and regulatory mechanism that underlies these difficulties. Parents rated 92 children with ASD as demonstrating significantly more challenges than 94 typically developing children on measures of EF (Behavior Rating Inventory of Executive Function; BRIEF), functional communication (FC), and verbal conversation (VC) skills. For both groups, the BRIEF metacognition scale emerged as a strong predictor of FC, while the BRIEF behavior regulation and the inhibit scale were predictive of VC skills. These findings suggest that targeting EF domains specifically may improve FC and VC skills in children with ASD.
'Stereotyped or repetitive motor movements' are characterised as core features in the diagnosis of autism, yet many autistic adults (and the neurodiversity movement) have reclaimed them as 'stimming'. Supported by a growing body of scientific research, autistic adults argue that these behaviours may serve as useful coping mechanisms, yet little research has examined stimming from the perspective of autistic adults. Through interviews and focus groups, we asked 32 autistic adults to share their perceptions and experiences of stimming, including the reasons they stim, any value doing so may hold for them and their perceptions of others' reactions to stimming. Using thematic analysis, we identified two themes: stimming as (1) a self-regulatory mechanism and (2) lacking in social acceptance, but can become accepted through understanding. Autistic adults highlighted the importance of stimming as an adaptive mechanism that helps them to soothe or communicate intense emotions or thoughts and thus objected to treatment that aims to eliminate the behaviour.
The current study contributes to previous work on measuring the social phenotype in Autism Spectrum Disorder (ASD) by validating a multidimensional test of social competence developed for use with individuals with and without ASD. The “Multidimensional Social Competence Scale” (MSCS) was previously validated as a parent-rating scale with youth 11–18 years with ASD without intellectual disability and typically developing adolescents of comparable age. The current study presents a validation of a self-report version of the MSCS in a non-clinical young adult population (N = 1178, males = 360, females = 817, age range = 17–25 years). The MSCS consists of seven domains that represent social competence: social motivation, social inferencing, demonstrating empathic concern, social knowledge, verbal conversation skills, nonverbal sending skills, and emotion regulation. These domains are theorized to be indicative of the higher-order construct of social competence. A second higher-order theorization of the MSCS structure posits that 3 of these factors are indicative of social responsiveness, and the remaining 4 factors are indicative of social understanding and emotion regulation. Our findings indicated support for each of the theorized multidimensional factor structures. Reliability, optimal scoring, convergent and discriminant validity of the measure, as well as implications for future research are discussed.
There currently exist no self-report measures of social camouflaging behaviours (strategies used to compensate for or mask autistic characteristics during social interactions). The Camouflaging Autistic Traits Questionnaire (CAT-Q) was developed from autistic adults’ experiences of camouflaging, and was administered online to 354 autistic and 478 non-autistic adults. Exploratory factor analysis suggested three factors, comprising of 25 items in total. Good model fit was demonstrated through confirmatory factor analysis, with measurement invariance analyses demonstrating equivalent factor structures across gender and diagnostic group. Internal consistency (α = 0.94) and preliminary test–retest reliability (r = 0.77) were acceptable. Convergent validity was demonstrated through comparison with measures of autistic traits, wellbeing, anxiety, and depression. The present study provides robust psychometric support for the CAT-Q.
Prior work has revealed sex/gender-dependent autistic characteristics across behavioural and neural/biological domains. It remains unclear whether and how neural sex/gender differences are related to behavioural sex/gender differences in autism. Here, we examined whether atypical neural responses during mentalizing and self-representation are sex/gender-dependent in autistic adults and explored whether 'camouflaging' (acting as if behaviourally neurotypical) is associated with sex/gender-dependent neural responses. In total, N = 119 adults (33 typically developing males, 29 autistic males, 29 typically developing females and 28 autistic females) participated in a task-related functional magnetic resonance imaging paradigm to assess neural activation within right temporo-parietal junction and ventromedial prefrontal cortex during mentalizing and self-representation. Camouflaging in autism was quantified as the discrepancy between extrinsic behaviour in social-interpersonal contexts and intrinsic status. While autistic men showed hypoactive right temporo-parietal junction mentalizing and ventromedial prefrontal cortex self-representation responses compared to typically developing men, such neural responses in autistic women were not different from typically developing women. In autistic women only, increasing camouflaging was associated with heightened ventromedial prefrontal cortex self-representation response. There is a lack of impaired neural self-representation and mentalizing in autistic women compared to typically developing women. Camouflaging is heightened in autistic women and may relate to neural self-representation response. These results reveal brain-behaviour relations that help explain sex/gender-heterogeneity in social brain function in autism.
This mixed-methods study examined gender differences in the friendships and conflict experiences of autistic girls and boys relative to their neurotypical peers. In total, 102 adolescents (27 autistic girls, 26 autistic boys, 26 neurotypical girls, and 23 neurotypical boys), aged between 11 and 18 years completed the Friendship Qualities Scale, the Revised Peer Experiences Questionnaire and were interviewed about their friendships. Results demonstrated that in many ways, the friendships and social experiences of autistic girls are similar to those of neurotypical girls. Autistic girls, however, have significantly more social challenges than their neurotypical peers, experiencing more conflict and finding that conflict harder to manage successfully. Autistic boys showed quantitatively different friendship patterns to all other groups. There were consistent gender differences in the type of conflict which boys and girls experienced, regardless of diagnostic status. These findings suggest that gender, rather than diagnosis per se, plays a critical role in the way that autistic adolescents perceive and experience their social relationships.
Within research into neurodevelopmental disorders, little is known about the mechanisms underpinning changes in symptom severity across development. When the behavioural presentation of a condition improves/symptoms lessen, this may be because core underlying atypicalities in cognition/neural function have ameliorated. An alternative possibility is ‘compensation'; that the behavioural presentation appears improved, despite persisting deficits at cognitive and neurobiological levels. There is, however, currently no agreed technical definition of compensation or its behavioural, cognitive and neural characteristics. Furthermore, its workings in neurodevelopmental disorders have not been studied directly. Here, we review current evidence for compensation in neurodevelopmental disorders, using Autism Spectrum Disorder as an example, in order to move towards a better conceptualisation of the construct. We propose a transdiagnostic framework, where compensation represents the processes responsible for an observed mismatch between behaviour and underlying cognition across development. Further, we explore potential cognitive and neural mechanisms underlying compensation and discuss the broader relevance of the concept within research and clinical settings.
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.
Individuals with autism spectrum disorder (ASD), including those who otherwise require less support, face severe difficulties in everyday social interactions. Research in this area has primarily focused on identifying the cognitive and neurological differences that contribute to these social impairments, but social interaction by definition involves more than one person and social difficulties may arise not just from people with ASD themselves, but also from the perceptions, judgments, and social decisions made by those around them. Here, across three studies, we find that first impressions of individuals with ASD made from thin slices of real-world social behavior by typically-developing observers are not only far less favorable across a range of trait judgments compared to controls, but also are associated with reduced intentions to pursue social interaction. These patterns are remarkably robust, occur within seconds, do not change with increased exposure, and persist across both child and adult age groups. However, these biases disappear when impressions are based on conversational content lacking audio-visual cues, suggesting that style, not substance, drives negative impressions of ASD. Collectively, these findings advocate for a broader perspective of social difficulties in ASD that considers both the individual’s impairments and the biases of potential social partners.
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.
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.
College students with autism may be negatively impacted by lack of understanding about autism on college campuses. Thus, we developed an online training to improve knowledge and decrease stigma associated with autism among college students. Participants (N = 365) completed a pre-test, online training, and post-test. Women reported lower stigma towards autism than men. Participation in the training was associated with decreased stigma and increased knowledge about autism. Although participants exhibited relatively high baseline knowledge of autism, misconceptions were common, particularly in open-ended responses. Participants commonly confused autism with other disorders, such as learning disabilities. This study suggests that online training may be a cost-effective way to increase college students’ understanding and acceptance of their peers with autism.
Four times as many males are diagnosed with high functioning autism compared to females. A growing body of research that focused on females with autism spectrum disorder (ASD) questions the assumption of gender invariance in ASD. Clinical observations suggest that females with ASD superficially demonstrate better social and emotional skills than males with ASD, which may camouflage other diagnostic features. This may explain the under-diagnosis of females with ASD.
We hypothesised that females with ASD would display better social skills than males with ASD on a test of friendship and social function. One hundred and one 10- to 16-year-olds (ASD females, n = 25; typically developing (TD) females, n = 25; ASD males, n = 25; TD males, n = 26) were interviewed (using the friendship questionnaire (FQ)) with high scores indicating the child has close, empathetic and supportive relationships. One parent of each child completed the FQ to assess whether there are differences in perception of friendships between parents and children.
It was found that, independent of diagnosis, females demonstrated higher scores on the FQ than males. Further, regardless of gender, children with ASD demonstrated lower scores than TD children. Moreover, the effect of ASD was independent of gender. Interestingly, females with ASD and TD males displayed similar scores on the FQ.
This finding is supported by clinical reports that females with ASD have more developed social skills than males with ASD. Further research is now required to examine the underlying causes for this phenomenon in order to develop gender-appropriate diagnostic criteria and interventions for ASD.
Previous research has reported that autistic adults do not manage their reputation, purportedly due to problems with theory of mind [Izuma, Matsumoto, Camerer, & Adolphs]. The current study aimed to test alternative explanations for this apparent lack of reputation management. Twenty typical and 19 autistic adults donated to charity and to a person, both when alone and when observed. In an additional manipulation, for half of the participants, the observer was also the recipient of their donations, and participants were told that this observer would subsequently have the opportunity to donate to them (motivation condition). This manipulation was designed to encourage an expectation of a reciprocal "tit-for-tat" strategy in the participant, which may motivate participants to change their behavior to receive more donations. The remaining participants were told that the person watching was just observing the procedure (no motivation condition). Our results replicated Izuma et al.'s finding that autistic adults did not donate more to charity when observed. Yet, in the motivation condition, both typical and autistic adults donated significantly more to the observer when watched, although this effect was significantly attenuated in autistic individuals. Results indicate that, while individuals with autism may have the ability to think about reputation, a reduced expectation of reciprocal behavior from others may reduce the degree to which they engage in reputation management. Autism Res 2013, ●●: ●●-●●. © 2013 International Society for Autism Research, Wiley Periodicals, Inc.
According to self-determination theory, well-being and healthy personality development depend on the fulfillment of three basic psychological needs: autonomy, relatedness, and competence. However, various contextual features can interfere with need satisfaction and undermine well-being. We hypothesized that fashion models, who are often valued for superficial reasons (i.e., their looks) and who may not have regular opportunities to cultivate deep relationships or exercise personal control on the job, might experience lower psychological need satisfaction, less well-being, and less optimal personality adjustment. Two studies were conducted in which professional fashion models (N = 56 in Study 1; N = 35 in Study 2) were compared to approximately equally large groups of non- models. Fashion models reported slightly lower need satisfaction and well-being but greater personality maladjustment ( personality disorder features). Mediation analyses in Study 1 suggested that the lower well-being among models was explained via unfulfilled basic needs. These findings further substantiate the importance of basic need satisfaction for well-being and optimal adjustment.
Currently there are no brief, self-administered instruments for measuring the degree to which an adult with normal intelligence has the traits associated with the autistic spectrum. In this paper, we report on a new instrument to assess this: the Autism-Spectrum Quotient (AQ). Individuals score in the range 0–50. Four groups of subjects were assessed: Group 1: 58 adults with Asperger syndrome (AS) or high-functioning autism (HFA); Group 2: 174 randomly selected controls. Group 3: 840 students in Cambridge University; and Group 4: 16 winners of the UK Mathematics Olympiad. The adults with AS/HFA had a mean AQ score of 35.8 (SD = 6.5), significantly higher than Group 2 controls (M = 16.4, SD = 6.3). 80% of the adults with AS/HFA scored 32+, versus 2% of controls. Among the controls, men scored slightly but significantly higher than women. No women scored extremely highly (AQ score 34+) whereas 4% of men did so. Twice as many men (40%) as women (21%) scored at intermediate levels (AQ score 20+). Among the AS/HFA group, male and female scores did not differ significantly. The students in Cambridge University did not differ from the randomly selected control group, but scientists (including mathematicians) scored significantly higher than both humanities and social sciences students, confirming an earlier study that autistic conditions are associated with scientific skills. Within the sciences, mathematicians scored highest. This was replicated in Group 4, the Mathematics Olympiad winners scoring significantly higher than the male Cambridge humanities students. 6% of the student sample scored 327plus; on the AQ. On interview, 11 out of 11 of these met three or more DSM-IV criteria for AS/HFA, and all were studying sciences/mathematics, and 7 of the 11 met threshold on these criteria. Test—retest and interrater reliability of the AQ was good. The AQ is thus a valuable instrument for rapidly quantifying where any given individual is situated on the continuum from autism to normality. Its potential for screening for autism spectrum conditions in adults of normal intelligence remains to be fully explored.
Autism spectrum conditions (ASC) affect more males than females in the general population. However, within ASC it is unclear if there are phenotypic sex differences. Testing for similarities and differences between the sexes is important not only for clinical assessment but also has implications for theories of typical sex differences and of autism. Using cognitive and behavioral measures, we investigated similarities and differences between the sexes in age- and IQ-matched adults with ASC (high-functioning autism or Asperger syndrome). Of the 83 (45 males and 38 females) participants, 62 (33 males and 29 females) met Autism Diagnostic Interview-Revised (ADI-R) cut-off criteria for autism in childhood and were included in all subsequent analyses. The severity of childhood core autism symptoms did not differ between the sexes. Males and females also did not differ in self-reported empathy, systemizing, anxiety, depression, and obsessive-compulsive traits/symptoms or mentalizing performance. However, adult females with ASC showed more lifetime sensory symptoms (p = 0.036), fewer current socio-communication difficulties (p = 0.001), and more self-reported autistic traits (p = 0.012) than males. In addition, females with ASC who also had developmental language delay had lower current performance IQ than those without developmental language delay (p<0.001), a pattern not seen in males. The absence of typical sex differences in empathizing-systemizing profiles within the autism spectrum confirms a prediction from the extreme male brain theory. Behavioral sex differences within ASC may also reflect different developmental mechanisms between males and females with ASC. We discuss the importance of the superficially better socio-communication ability in adult females with ASC in terms of why females with ASC may more often go under-recognized, and receive their diagnosis later, than males.
Restricted and repetitive behaviors (RRBs) are a core feature of autism spectrum disorders. They constitute a major barrier to learning and social adaptation, but research on their definition, cause, and capacity for change has been relatively neglected. The last decade of research has brought new measurement techniques that have improved the description of RRBs. Research has also identified distinctive subtypes of RRBs in autism spectrum disorders. Research on potential causal origins and immediate triggers for RRBs is still at an early stage. However, promising new ideas and evidence are emerging from neurobiology and developmental psychology that identify neural adaptation, lack of environmental stimulation, arousal, and adaptive functions as key factors for the onset and maintenance of RRBs. Further research is needed to understand how these factors interact with each other to create and sustain atypical levels of RRB. The literature indicates that RRBs have the potential to spontaneously reduce across time, and this is enhanced for those with increased age and cognitive and language ability. Research on interventions is sparse. Pharmacological treatments can be helpful in some children but have adverse side effects. Behavioral intervention methods provide the better intervention option with positive effects, but a more systematic and targeted approach is urgently needed. Evidence suggests that we will learn best from the last decade of research by taking a developmental perspective, by directing future research toward subtypes of RRBs, and by implementing early intervention targeted to improve RRBs before these behaviors become entrenched.
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 η ² = 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 η ² = 0.05) and Assimilation (partial η ² = 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.
Background: Peer relationships can be especially difficult for autistic adolescents, given their marked social communication difficulties. The purpose of this systematic review is to synthesise reported qualitative findings on how autistic adolescents experience peer relationships, including the rewards and challenges, from their perspective. The review includes the perspectives of others (e.g. parents, support workers), from included papers where these were reported in addition to the adolescent viewpoint. Method: PRISMA guidelines and the Joanna Briggs Institute meta-aggregative approach to qualitative synthesis informed this review process. Articles included were published in the last ten years, specific to autistic adolescents between the ages of 10 and 19. Of the 75 articles meeting eligibility for full-text review, ten matched the final inclusion criteria. Results: Findings relating to four main themes emerged from the qualitative synthesis: understanding friendship, having and wanting friends, challenges of peer relationships and overcoming challenges. Fourteen sub-topics are described in detail, for example, that autistic adolescents do have and want friends, though this is often not easily achieved, leading to feelings of loneliness. Findings also revealed experiences of peer rejection and victimisation, and specific factors that might make building positive peer relationships difficult, such as group settings. Conclusions: Autistic adolescents face a number of difficulties with understanding social rules and conventions, which seem to make peer relationships difficult. However, due to many autistic adolescents having a desire for friendship, some have developed ways of overcoming these challenges. This review highlights that additional support is needed to support the development of autistic adolescents' social skills and awareness; further research is needed to establish how this could be done most effectively.
The socio-communication deficits of individuals on the autistic spectrum are well documented. However, this has largely been based on the male population and less is known about how females with autism manage social relationships across the developmental period. Ten adolescent female participants with a diagnosis of autism were interviewed and Interpretative Phenomenological Analysis used to explore their experiences of managing their social relationships. The results showed that participants were motivated to develop and maintain friendships, but during adolescence this became increasingly difficult. Consequently, they developed explicit strategies to manage these relationships, including masking and imitation. The use of such strategies was both advantageous and disadvantageous, and such findings should be considered in developing gender sensitive assessment and developmentally appropriate support.
Autism spectrum conditions comprise a set of early-onset neurodevelopmental syndromes with a prevalence of 1% across all ages. First diagnosis in adulthood has finally become recognised as an important clinical issue due to the increasing awareness of autism, broadening of diagnostic criteria, and the introduction of the spectrum concept. Thus, the idea of a lost generation of people who were previously excluded from a diagnosis of classic autism has arisen. Making a first diagnosis of autism spectrum conditions in adults can be challenging for practical reasons (eg, no person to provide a developmental history), developmental reasons (eg, the acquisition of learnt or camouflaging strategies), and clinical reasons (eg, high frequency of co-occurring disorders). The diagnostic process includes referral, screening, interviews with informants and patients, and functional assessments. In delineating differential diagnoses, true comorbidities, and overlapping behaviour with other psychiatric diagnoses, particular attention should be paid to anxiety, depression, obsessive-compulsive disorder, psychosis, personality disorders, and other neurodevelopmental disorders. Possible misdiagnosis, especially in women, should be explored. The creation of supportive, accepting, and autism-friendly social and physical environments is important and requires a coordinated effort across agencies and needs support from government policies.
Autism and its related disorders are commonly described as lying along a continuum that ranges in severity and are collectively referred to as autism spectrum disorders (ASDs). Although all individuals with ASD meet the social impairment diagnostic criteria outlined in the DSM-IV-TR, they do not present with the same social difficulties. The variability in the expression and severity of social competence is particularly evident among the group of individuals with "high-functioning" ASD who appear to have difficulty applying their average to above average intelligence in a social context. There is a striking paucity of empirical research investigating individual differences in social functioning among individuals with high-functioning ASD. It is possible that more detailed investigations of social competence have been impeded by the lack of standardized measures available to assess the nature and severity of social impairment. The aim of the current study was to develop and evaluate a parent rating scale capable of assessing individual differences in social competence (i.e. strengths and challenges) among adolescents with ASD: the Multidimensional Social Competence Scale (MSCS). Results from confirmatory factor analyses supported the hypothesized multidimensional factor structure of the MSCS. Seven relatively distinct domains of social competence were identified including social motivation, social inferencing, demonstrating empathic concern, social knowledge, verbal conversation skills, nonverbal sending skills, and emotion regulation. Psychometric evidence provided preliminary support for the reliability and validity of the scale. Possible applications of this promising new parent rating scale in both research and clinical settings are discussed. Autism Res 2013, ●●: ●●-●●. © 2013 International Society for Autism Research, Wiley Periodicals, Inc.
Biological factors are strongly emphasized in the actualization theories of Maslow and Rogers. Despite this emphasis, functionally nothing is known about the composition of the inherent potentialities of actualization. This study was intended to provide specific information about such potentialities. Toward that end, the study focused on the construct of the personality temperament, a trait having a significant genetic foundation. Using the temperaments of emotionality, activity level, and sociability, it was hypothesized that if these organismic potentialities were not actualized, then maladjustment would result, a deduction from Rogers's theory of personality. Degree of actualization was operationally defined by the discrepancy between retrospective parental recall of the participant's temperament profile as a young child and the college-aged participant's current self-perceptions of these temperaments. All temperament and maladjustment measures were taken by paper-and-pencil inventories, and the hypothesis was confirmed: The greater the child/adult temperament discrepancy, the greater were levels of current maladjustment. The results point to the personality temperament as a useful theoretical construct for understanding inherent potentialities of actualization. The findings are integrated into Maslow's and Rogers's theories, and the relevance of this research to the current crisis of general actualization theory in humanistic psychology is discussed.
The idea that social motivation deficits play a central role in Autism Spectrum Disorders (ASD) has recently gained increased interest. This constitutes a shift in autism research, which has traditionally focused more intensely on cognitive impairments, such as theory-of-mind deficits or executive dysfunction, and has granted comparatively less attention to motivational factors. This review delineates the concept of social motivation and capitalizes on recent findings in several research areas to provide an integrated account of social motivation at the behavioral, biological and evolutionary levels. We conclude that ASD can be construed as an extreme case of diminished social motivation and, as such, provides a powerful model to understand humans' intrinsic drive to seek acceptance and avoid rejection.
Authors examined the combined effects of descriptive and explanatory information on peers' perceptions and behavioral intentions toward an unfamiliar child with autism. Children (N = 576; M age = 10.06) were randomly assigned to view two videotapes of a boy engaging in typical and autistic behaviors receiving either descriptive (AUT-D) or descriptive and explanatory information (AUT-D + E). Children responded to measures of attitudes (Adjective Checklist) and behavioral intentions (Shared Activities Questionnaire). Children rated the typical boy more favorably than the boy showing autistic symptoms. When compared to descriptive information alone, the combination of descriptive and explanatory information resulted in improved third- and fourth-graders' but not fifth-graders' attitudes toward the child with autism. Combined information improved behavioral intentions across grades; however, girls (vs. boys) were more responsive to information as evidenced by differences in academic intentions. The combination of descriptive and explanatory information about autism appears to have a positive effect on children's attitudes and behavioral intentions. Implications of the findings are briefly discussed as well as study limitations and recommendations for future research.
Behaviour Rating Inventory of Executive Function-Adult Version Manual. Lutz, FL: Psychological Assessment Resources
- R M Roth
- P K Isquith
- G A Gioia
Roth RM, Isquith PK, Gioia GA. Behaviour Rating Inventory of Executive Function-Adult Version Manual. Lutz,
FL: Psychological Assessment Resources; 2005.