The relationship between camouflaging and mental health in autistic children and adolescents.
The more autistic youth camouflage, the more anxiety and depression they report—so screen for masking and treat the stress, not just the behaviors.
01Research in Context
What this study did
Ross et al. (2023) asked 733 autistic kids and teens to fill out rating scales. Ages ranged from 4 to 17. The team measured how much each child camouflaged their autism and how many anxiety, depression, and body-stress symptoms they showed.
What they found
More camouflaging went hand-in-hand with more internalizing problems. The link held for both boys and girls, but the strength changed with age. In plain words, the harder a child worked to mask autism, the more worry, sadness, and stomach-aches they reported.
How this fits with other research
Ferron et al. (2023) and Riebel et al. (2025) extend the same idea to adults. They show that self-compassion can soften the autism-anxiety path. Their work adds a protective skill you can teach after you spot the camouflaging risk.
Hedley et al. (2006) is an earlier cousin. They found that feeling left out predicted depression in Asperger teens. Ross et al. (2023) updates that risk factor: today we call it camouflaging, not just poor group fit.
Andrews et al. (2024) looks like a contradiction. In a mixed group of psychiatric inpatients, autistic traits barely touched depression scores. The key difference is diagnosis. Alice studied youth with confirmed autism; M et al. studied mostly non-autistic inpatients who only screened high on traits. Different kids, different story.
Why it matters
When a client works overtime to look neurotypical, expect anxiety and depression to ride along. Add a quick camouflaging scale to your intake packet. If the score is high, build in breaks, teach self-compassion drills, and schedule mood checks. Catching the mask early may spare you a crisis later.
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Join Free →Hand the parent and teen a 10-item camouflaging checklist; if either circles often or very often on three or more items, add a mood-monitoring procedure to the behavior plan.
02At a glance
03Original abstract
Camouflaging involves the masking of autistic traits in social situations. While camouflaging may function as a potential barrier to the early diagnosis of autism, minimal research into camouflaging in autistic young people has been conducted. It is also important to evaluate the impact of camouflaging on the mental health of autistic children and adolescents. This study evaluated camouflaging in a sample of 359 female and 374 male autistic children and adolescents (4-17 years, 48.9% females). Findings indicated that camouflaging was a significant predictor of internalizing (i.e., anxiety, depression, somatic complaints) symptoms, when controlling for age, gender, and IQ. We also found evidence for some gender differences in camouflaging. Parents endorsed more autistic traits for females compared with males, whereas there were no differences in autistic traits across sex in the clinician-administered assessment. There was also evidence for a relationship between age and camouflaging, with adolescents showing a larger discrepancy between parent and clinician reported autistic traits. This has implications for clinical assessment and future research and is important for understanding how best to support the mental health of autistic children and adolescents.
Autism research : official journal of the International Society for Autism Research, 2023 · doi:10.1002/aur.2859