By Emma Hinze, Professor Tony Attwood and Dr. Michelle Garnett.
Camouflaging behaviours in autistic individuals have received increasing attention in research and clinical practice. These behaviours often begin in childhood, continue through adolescence, and often persist into adulthood as individuals experience increasing social pressures and developmental changes. Understanding and assessing camouflaging in autistic adolescents is essential for practitioners, especially as this age group experiences significant challenges during this critical period. This guide draws on existing research and clinical experience and offers key considerations for assessing camouflaging in autistic teenagers.
Understanding Camouflaging in Autism
Camouflaging refers to the strategies that autistic individuals employ to adapt to predominantly nonautistic social environments. These strategies may include concealing and suppressing autistic characteristics, mimicking neurotypical behaviours, and engaging in superficial social interactions to avoid negative judgments or misunderstandings. While camouflaging can facilitate short-term social success, it often comes at a significant cognitive and emotional cost, contributing to mental health challenges such as anxiety, depression, and burnout (Hull et al., 2017; Cassidy et al., 2019).
Autistic adolescents often camouflage to avoid negative social experiences, such as bullying or being perceived as “weird” or “different.” This contrasts with neurotypical adolescents, who typically camouflage to fit in and make friends (Bernardin et al., 2021). These protective motivations can indicate deeper social vulnerabilities in autistic adolescents, highlighting the need for interventions targeting bullying and peer rejection. Furthermore, the heightened social expectations and pressures of adolescence—such as navigating complex peer relationships and conforming to societal norms—may intensify camouflaging behaviours.
Key Considerations for Practitioners
The Double-Edged Nature of Camouflaging
Camouflaging can be adaptive in certain situations, allowing autistic teens to integrate socially and avoid immediate negative consequences. However, it is important for practitioners to recognise that this social “success” may come with significant long-term costs. Research indicates that camouflaging is cognitively and emotionally taxing, contributing to exhaustion, increased anxiety, and even a heightened risk of mental health difficulties such as depression (Cook et al., 2022; Hull et al., 2017). Practitioners should carefully balance recognising the benefits of camouflaging in social contexts with the potential harm it may cause to the adolescent’s overall well-being.Gender Differences in Camouflaging
Research suggests that autistic girls are more likely to engage in camouflaging than boys (Lai et al., 2017). However, it is essential to recognise that camouflaging occurs across all genders, including non-binary and gender-diverse individuals. Historically, research has focused on binary gender differences, often overlooking gender-diverse experiences. Consequently, individuals across the gender spectrum may have their autism under-recognised due to their ability to “blend in” socially, masking their internal struggles.
Autistic girls tend to demonstrate both behavioural and compensatory camouflaging more frequently than boys. Behavioural camouflaging involves mimicking social behaviours, while compensatory camouflaging enables them to mask underlying social cognitive difficulties, such as challenges in understanding social cues and norms. This can obscure their social difficulties, making it critical for practitioners to assess both behavioural and internal cognitive dimensions (Wood-Downie et al., 2021). Additionally, autistic girls often show greater social reciprocity than boys, which can further delay recognition of their social challenges (Wood-Downie et al., 2021).
This delay in diagnosis often limits access to timely support and can exacerbate mental health issues (Wood-Downie et al., 2021). Practitioners should assess beyond surface-level social interactions, recognising that camouflaging reflects broader variations in autism presentation. The internal experiences of autism, including social anxiety and sensory sensitivities, can motivate camouflaging, and these internal struggles may not be immediately visible. A gender-inclusive approach is crucial to avoid missed or delayed diagnoses, particularly for those whose camouflaging efforts mask their true needs and stress levels.
Autistic females may also camouflage to conceal their autism diagnosis due to fears of stereotyping or being treated differently. This adds another layer of complexity to camouflaging for females, who may feel compelled to hide their true identity to avoid stigma (Bernardin et al., 2021). It is important to note that while research often highlights differences in camouflaging behaviours between girls and boys, these behaviours are not inherently tied to gender. Autistic individuals across the gender spectrum may engage in camouflaging to varying degrees, and practitioners should be careful not to make assumptions based on gender when using camouflaging behaviours.Developmental Considerations
Adolescence is marked by significant neurological and psychological changes, and increased social expectations during this period can exacerbate camouflaging behaviours. The transition to high school often coincides with increased peer pressure, making this a critical time for assessment. As adolescents mature, their camouflaging strategies may become more sophisticated, often involving heightened self-awareness of how they are perceived by others. This can lead to more deliberate attempts to mask autistic traits, making it difficult for practitioners to detect camouflaging.
Executive function abilities have been linked to more frequent and effective camouflaging, especially in terms of compensation strategies. Assessing these cognitive abilities can help practitioners understand the adolescent’s capacity to manage social interactions but may also indicate an increased cognitive and emotional burden (Hull et al., 2020). Notably, IQ does not consistently predict camouflaging, suggesting that camouflaging behaviours can occur across the intellectual spectrum (Hull et al., 2020). However, some evidence indicates that higher IQ may influence the extent of compensatory camouflaging, with adolescents of higher cognitive abilities potentially presenting better social skills despite underlying social challenges (Wood-Downie et al., 2021).
Additionally, gender differences in the ease of camouflaging are evident, with autistic males often describing it as straightforward, while autistic females report it as more difficult and emotionally taxing (Bernardin et al., 2021). These differences may reflect the additional social pressures on females to conform to more intricate social norms, greater use of camouflaging by females across more settings, and /or use of camouflaging techniques that require increased cognitive and emotional load, for example, compensation.Assessing Beyond Surface-Level Social Competence
One of the key challenges in assessing camouflaging is that autistic adolescents may appear socially competent at first glance, leading to a misjudgement of their actual difficulties. Camouflaging often involves not only masking autistic characteristics but also actively engaging in behaviours perceived as socially normative, such as maintaining eye contact, smiling, or using scripted conversation. However, these competencies may not reflect the individual’s true comfort or ability in social situations (Cook et al., 2022).
To address this, practitioners should combine self-report measures with observational methods. Tools such as the Camouflaging Autistic Traits Questionnaire (CAT-Q; Hull et al., 2019) provide insight into an individual’s internal experiences of masking. Additionally, gathering qualitative data through interviews or reflective exercises allows adolescents to describe situations where they feel the need to camouflage, revealing the discrepancies between external competence and internal struggles.
It is also important to note that not all camouflaging is conscious. Some individuals may not be fully aware of their camouflaging behaviours, which underscores the importance of including parent or teacher reports to gain a more complete understanding (Hull et al., 2020). Moreover, while camouflaging can help autistic adolescents build friendships, it often comes at the cost of feeling emotionally drained or inauthentic (Bernardin et al., 2021).Impact on Mental Health and Well-Being
Camouflaging is strongly associated with negative mental health outcomes, including increased anxiety, depression, and suicidality (Cassidy et al., 2019). Practitioners must assess not only the presence of camouflaging but also the emotional toll it takes on the adolescent. Direct inquiries into feelings of exhaustion, social anxiety, and burnout may reveal the hidden costs of camouflaging.
Autistic females often report feeling emotionally drained and inauthentic after camouflaging, while autistic males are more likely to report feeling neutral or even positive. These gender differences underscore the importance of considering the emotional costs of camouflaging, particularly for females, who may face greater internal conflict because of masking their autistic characteristics (Bernardin et al., 2021). The cognitive load involved in camouflaging—especially in terms of deliberate compensation—can significantly affect mental health, leading to long-term emotional burnout and fatigue (Hull et al., 2020).Family and School Contexts
Autistic adolescents may experience different pressures to camouflage across various social contexts. For instance, the expectations placed on them at school, home, or with peers can differ significantly. Practitioners should adopt a contextual approach when assessing camouflaging, exploring how the adolescent’s behaviours may change depending on their environment. Engaging parents, teachers, and peers in the assessment process can provide valuable insights into the adolescent’s social behaviour across contexts. In particular, teachers often have a unique perspective on how adolescents manage peer relationships and social dynamics in structured settings.
A Holistic Approach to Camouflaging Assessment
Assessing camouflaging in autistic adolescents requires a comprehensive and multi-dimensional approach. Practitioners should consider the complex interplay between the adolescent’s internal experiences, their social environment, and the potential long-term consequences of camouflaging. By combining self-report tools, observational techniques, and in-depth interviews, clinicians can better understand the adolescent’s social functioning and well-being. As the field evolves, future research will likely provide more targeted assessments for this population. However, for now, it is crucial to recognise and address the hidden challenges that camouflaging can pose for autistic adolescents.
Given that camouflaging behaviours appear to develop early in adolescence and remain relatively stable throughout this period (Hull et al., 2020), early identification of camouflaging is critical. Timely assessments can help mitigate the mental health consequences that often accompany prolonged camouflaging.
Next Steps for Professionals in Understanding Autism and Teens:
We have created a two-day Masterclass:
Diagnosis, Support, and Therapy for Autistic Teenagers is for professionals and those interested in increasing their understanding of autism and ADHD within the framework of the neurodiversity-affirming model. We will present our course live in the room and live on the webcast in London on January 16th and 17th, 2025.
References
Bernardin, C.J., Mason, E., Lewis, T. et al. “You Must Become a Chameleon to Survive”: Adolescent Experiences of Camouflaging. J Autism Dev Disord 51, 4422–4435 (2021). https://doi.org/10.1007/s10803-021-04912-1
Cassidy SA, Bradley L, Bowen E, Wigham S, Rodgers J. Measurement properties of tools used to assess suicidality in autistic and general population adults: A systematic review. Clin Psychol Rev. 2018 Jun;62:56-70. doi: 10.1016/j.cpr.2018.05.002. Epub 2018 May 5. PMID: 29778930.
Hull L, Petrides KV, Mandy W. Cognitive Predictors of Self-Reported Camouflaging in Autistic Adolescents. Autism Res. 2021 Mar;14(3):523-532. doi: 10.1002/aur.2407. Epub 2020 Oct 13. PMID: 33047869.
Hull, L., Petrides, K.V., Allison, C. et al. “Putting on My Best Normal”: Social Camouflaging in Adults with Autism Spectrum Conditions. J Autism Dev Disord 47, 2519–2534 (2017). https://doi.org/10.1007/s10803-017-3166-5
Hull, L., Mandy, W., Lai, MC. et al. Development and Validation of the Camouflaging Autistic Traits Questionnaire (CAT-Q). J Autism Dev Disord 49, 819–833 (2019). https://doi.org/10.1007/s10803-018-3792-6
Lai, M.-C., Lombardo, M. V., Auyeung, B., Chakrabarti, B., & Baron-Cohen, S. (2015). Sex/Gender Differences and Autism: Setting the Scene for Future Research. Journal of the American Academy of Child and Adolescent Psychiatry, 54(1), 11–24. https://doi.org/10.1016/j.jaac.2014.10.003
Wood-Downie, H., Wong, B., Kovshoff, H. et al. Sex/Gender Differences in Camouflaging in Children and Adolescents with Autism. J Autism Dev Disord 51, 1353–1364 (2021). https://doi.org/10.1007/s10803-020-04615-z
