Camouflaging Predicts Internalizing Problems in Young Adults without Autism

Background: Camouflaging refers to deliberate attempts made by individuals to hide or compensate for autistic symptoms in order to ‘fit in’ with their non-autistic peers (Hull et al., 2018; Lai et al., 2016). Reports from autistic individuals indicate that there may be a link between camouflaging and internalizing problems, including symptoms of depression and anxiety (Cage et al., 2018; Hull et al., 2017, 2018; Lai et al., 2017). Poor social competence in autistic youth has also been associated with increased internalizing problems (Johnston & Iarocci, 2017), as has older age and higher IQ (Vickerstaff et al., 2007). Given camouflaging appears to reflect an attempt to compensate for poor social skills, it is of interest to determine whether camouflaging is also associated with increased internalizing problems in individuals without autism.

Objectives: The aims of this study were: 1) to examine the relationship between camouflaging and social competence in young adults without autism, and 2) to investigate whether camouflaging was associated with internalizing problems after accounting for social competence and autistic traits (as well as age, IQ, and gender) in young adults without ASD.

Methods: We collected data from 76 university students (aged 17 to 23; 59 female). Participants completed questionnaires including the Autism-Spectrum Quotient (AQ; Baron-Cohen et al., 2001), the Multidimensional Social Competence Scale (MSCS; Yager & Iarocci, 2013), the Camouflaging Autistic Traits Questionnaire (CAT-Q; Hull et al., 2018), and the college-level Behavior Assessment System for Children (BASC2 SRP-COL; Kamphaus & Reynolds, 2004). Additionally, we assessed participants’ IQ using the Wechsler Abbreviated Scale of Intelligence (WASI-2; Wechsler, 2011).

Results: Pearson’s correlations indicate that total CAT-Q scores were significantly positively correlated with overall AQ scores (r=.47, p<.001) and significantly negatively correlated with overall MSCS scores (r=-.46, p<.001). Scores on the Internalizing Problems subscale of the BASC-2 were also significantly positively correlated with total CAT-Q (r=-.55, p<.001) and AQ scores (r=.51, p<.001), and significantly negatively correlated with total MSCS scores (r=-.48, p<.001). Age, IQ, and gender were not significantly correlated with any of the variables.

Results of a hierarchical multiple regression analysis indicated that the full model of total AQ scores, age, IQ, and gender to predict scores on the Internalizing Problems subscale of the BASC-2 (Model 1) was statistically significant (R² =.325, F(4,71)=8.535, p<.001). The addition of total MSCS scores (Model 2) accounted for an additional 5% of the variance in Internalizing Problems scores (ΔR²=0.054, ΔF_(1,70)=6.078, p=.016) and the addition of CAT-Q scores (Model 3) accounted for an additional 12% of the variance in Internalizing Problems scores beyond all previous predictor variables (ΔR²=0.116, ΔF_(1,69)=15.800, p<.001).

Conclusions: Results indicate that among non-autistic young adults, those with greater social skills reported less camouflaging, suggesting that increases in camouflaging behaviour is associated with poorer social competence. Additionally, camouflaging predicted internalizing problems over and above social competence, autistic traits, age, IQ, and gender. These results are consistent with previous reports that camouflaging is associated with poorer mental health outcomes in autistic individuals (e.g., Hull et al., 2018), and extends these findings to young adults without autism.