Camouflaging in autism spectrum disorder: Examining the roles of sex, gender identity, and diagnostic timing.
Late-diagnosed autistic females and gender-diverse adults self-report the most camouflaging—use the CAT-Q plus clinical judgment to catch hidden needs.
01Research in Context
What this study did
Gandhi et al. (2022) ran an online survey. They asked autistic adults to fill out the Camouflaging Autistic Traits Questionnaire. The team wanted to know who reports the most masking: females, males, or gender-diverse people. They also looked at whether late diagnosis changes scores.
What they found
Females and gender-diverse adults scored highest on the CAT-Q. People who learned they were autistic after age 18 also scored higher. In short, late-diagnosed women and non-binary clients say they hide their autism the most.
How this fits with other research
Arnold et al. (2026) looked at 389 studies and warn the CAT-Q may pick up social anxiety more than autism. They say most camouflaging data come from higher-functioning, late-diagnosed females—exactly the group A et al. studied.
Liu et al. (2024) give the CAT-Q a thumbs-up in Taiwanese teens. Autistic adolescents scored higher than peers, and scores rose with stress. This backs the idea that the tool spots real masking, not just adult female behavior.
Whaling et al. (2025) show online autism surveys always oversample higher-functioning, late-diagnosed people. Their finding explains why A et al. saw sky-high scores in that group; it is not a contradiction, just a sampling mirror.
Why it matters
If you assess adults who were diagnosed late, expect high CAT-Q scores. Pair the tool with clinical skill—watch for exhaustion, anxiety, and gender stress. A quick screen can stop years of missed support.
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02At a glance
03Original abstract
Camouflaging in autism spectrum disorder refers to behaviors and/or strategies that mask the presentation of autism spectrum disorder features in social contexts in order to appear "non-autistic" (Attwood, 2007). Camouflaging modifies the behavioral presentation of core autism spectrum disorder features (e.g. social and communication differences), but the underlying autistic profile is unaffected, yielding a mismatch between external observable features and the internal lived experience of autism. Camouflaging could be an important factor in later diagnosis of individuals without co-occurring intellectual disability, especially among those designated female sex at birth. Little research to date has examined how gender identity impacts camouflaging, however. Furthermore, no study has compared groups that differ in diagnostic timing to directly investigate if later-diagnosed individuals show elevated camouflaging relative to those receiving an earlier diagnosis. We used the Camouflaging Autistic Traits Questionnaire subscales (Assimilation, Compensation, and Masking) and investigated the roles of sex, gender identity (gender diverse vs cisgender), and diagnostic timing (childhood/adolescent-diagnosed vs adult-diagnosed), and the interactions of these factors, in autistic adults (N = 502; ages 18-49 years). Main effects of sex, gender identity, and diagnostic timing were revealed. Autistic females reported more camouflaging across all three Camouflaging Autistic Traits Questionnaire subscales compared to males. Gender diverse adults reported elevated camouflaging on the Compensation subscale compared to cisgender adults. Adulthood-diagnosed individuals reported elevated Assimilation and Compensation compared to childhood/adolescence-diagnosed individuals. We discuss how the aspects of camouflaging may have unique implications for later diagnostic timing and for the intersection of neurodiversity and gender diversity.
Autism : the international journal of research and practice, 2022 · doi:10.1177/13623613211042131