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Camouflaging and delayed diagnosis in Autism

Christiana Goetz, M.A., Clinical Psychology Doctoral Intern, is discussing camouflaging and delayed diagnosis in Autism.
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Christiana Goetz, M.A., Clinical Psychology Doctoral Intern.

Christiana Goetz, M.A., Clinical Psychology Doctoral Intern

Camouflaging in Autism Spectrum Disorder (ASD) is the use of behaviours and strategies to mask autistic features to adapt to the non-autistic social world. Examples of camouflaging are forcing eye contact, rehearsing social scripts, or feeling like one must perform to fit in. 

According to a recent publication in Clinical Psychology Review, higher camouflaging for children and adults with autistic traits is associated with more mental health problems. Masking can be exhausting, causing stress, sadness, and identity confusion. Self-reported camouflaging has also predicted suicidality.

Conscious or unconscious camouflaging can occur at any age, yet it predominantly stands out for autistic individuals diagnosed as adults. Individuals with a delayed diagnosis are likely to have socially compensated, closely studying people or fictional characters (such as in movies or media) to imitate expected social behaviours. Compensation strategies may not just conceal abnormal behaviours but overtly depict excellent social skills. 

Beyond the age of diagnosis, autistic females and autistic gender-diverse individuals have revealed the highest levels of camouflage. Autistic females may learn and present more socially acceptable behaviours due to the cultural expectations of girls and women. Females often fall off the autism radar, requiring more difficulties than males to receive an autism diagnosis. 

The expression of autism in females (known as the female autism phenotype) comprises high levels of social motivation despite difficulties with friendships. Females often have special interests that are socially acceptable and relational in nature, such as animals, fictional characters, or psychology (compared to typical male special interests of a mechanical nature). Internalizing mental health or emotional difficulties are also common with autistic females, which can overshadow autistic characteristics.  

Keep in mind that there is a discrepancy with camouflaging—the outward performance differs from the always present autistic traits and social communication struggles. This adaptive, yet detrimental, masking of autistic traits can impact whether a diagnosis is given and hidden needs are met.

So, what can be done? We need to break the stigma around autism and showing autistic traits. Just because one can act “normal” does not mean one should be expected or pressured to act in such a way. Moreover, extra attention should be given to females and gender-diverse individuals in diagnostic assessments, which might require adapted tools or thresholds. 

Ultimately, if you have masked or felt different your whole life, you deserve understanding and for your needs to be met. 

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