For Better or for Worse? Social Camouflaging, Mental Health and Wellbeing in Autistic Adults.

Background: Social camouflaging is the name given to the social coping strategies used by autistic people to cover up their autism in order to ‘pass’ as neurotypical (Tierney, Burns & Kilbey, 2016). Previous work on this phenomenon has been predominantly qualitative and focused on the experiences of autistic adults. In such studies, participants report benefits of social camouflaging, for example as a way of fitting in, ‘feeling normal’ and making connections. However, they also identify costs, stating that social camouflaging can be draining, stressful and can feel inauthentic (Hull et al., 2017). To date, only one published study has examined social camouflaging using quantitative methods (Lai et al., 2016), finding that higher levels of social camouflaging predicted higher levels of depression in men, but not women. Thus, whilst social camouflaging is common amongst autistic people, little is known about its associated costs and benefits.

Objectives: To investigate the costs and benefits of social camouflaging by investigating its links to internalizing disorders (social anxiety, generalized anxiety and depression) and wellbeing amongst autistic adults.

Methods: Participants (315 autistic adults aged 18-75; 177 female) were recruited online and via autism networks, and completed a series of well-validated self-report questionnaires measuring internalizing problems (social anxiety, generalized anxiety and depression) and wellbeing. A recently-developed, validated quantitative measure of social camouflaging, the Social Camouflaging in Autism Questionnaire (SCAQ) was used (Hull et al., 2017). In addition, demographic characteristics and autism severity were assessed.

Results: Females (mean=169) had higher average SCAQ scores than males (mean=102; p<.001, d=.56), though social camouflaging was common in both males and females. For males and females, SCAQ scores did not significantly differ based on either occupation status (in education, training or employment vs not in education, training or employment) or relationship status. In analyses controlling for autism symptom severity, higher SCAQ scores predicted higher scores on all measures of internalizing psychopathology; for social anxiety (p <.05; ϐ=.298), generalized anxiety (p <.001; ϐ=.331 ) and depression (p <.05; ϐ=.214 ). None of these effects were moderated by gender; they were observed in males and females. There was no significant association between SCAQ score and wellbeing score.

Conclusions: This is the most comprehensive quantitative study to date on mental health difficulties associated with social camouflaging. Preliminary findings suggest that on average, females engage in higher levels of camouflaging than males as measured by the SCAQ. Nevertheless, in this sample social camouflaging was widespread in both genders, challenging the idea that camouflaging is primarily a female phenomenon. Further, our findings accord with reports in the qualitative literature (Bargiela et al., 2016; Hull et al., 2017), that social camouflaging is a risk factor amongst autistic people for the development of internalizing problems. Further longitudinal work is needed to investigate whether social camouflaging really is a causal risk factor for internalizing problems of autistic people