Being but Not Appearing to be Autistic: Qualitative Exploration of Social Compensation Strategies in Autism

Background: It has been proposed that some autistic people use strategies during social interaction to ‘compensate’ for core social cognitive difficulties (e.g., in theory of mind). By using social compensatory strategies, these individuals demonstrate ‘typical’ social behaviour, despite continued social cognitive difficulties. Whilst compensation might have several positive consequences (e.g., for gaining and maintaining employment, social relationships), evidence suggests it may come at a cost to mental health. Additionally, compensation might help explain why some autistic people do not receive a diagnosis, and therefore appropriate support, until adulthood. Very little, however, is known about the nature and type of social compensatory strategies used by autistic people, as well as the consequences for clinical outcomes.

Objectives: Using an exploratory qualitative approach, this study is the first to explore social compensatory strategies in autistic adults. Individuals with a clinical autism diagnosis were recruited, in addition to a group without a diagnosis but reporting high autistic traits, to explore how compensation operates across the diagnostic threshold.

Methods: 136 adults (58 with an independent autism diagnosis) completed an online questionnaire about their experiences using social compensatory strategies and a measure of autistic traits, AQ10 (Allison et al., 2012). Qualitative thematic analysis was conducted using Braun and Clarke’s (2006) procedure and data were analysed in an inductive (i.e., data-driven) manner.

Results: Eight themes and 19 subthemes were identified. The eight themes were: 1) ‘secondary route’, which depicts compensation as a secondary, slower route to social problem solving, when intuitive social understanding is limited, 2) ‘cognitive compensation’, which describes compensation as cognitive strategies supporting typical social interaction, 3) ‘behavioural masking’, which encompasses minor behavioural modifications that do not support social interaction, 4) ‘internal factors’, which are internally-driven mechanisms influencing compensation (e.g., social motivation), 5) ‘external factors’, which are externally-driven mechanisms (e.g., pressure to conform), 6) ‘diagnosis and support’, which outlines how lifetime compensatory strategy use may delay individuals receiving appropriate support, 7) ‘quality of life’, which depicts the (positive and negative) effects of compensation on health, employment and social relationships, and 8) ‘trajectories and attitudes’, which refers to individual differences in strategy success over the lifetime, ranging from “things have got better” to compensation being “an ongoing challenge”.

Conclusions: The results highlight important cognitive characteristics, drivers and clinical outcomes of social compensation in autism. They also suggest that social compensatory strategy use is not limited to diagnosed individuals. More broadly, the results highlight the importance of considering the phenomenon of social compensation when aiming to understand the mechanisms driving ‘typical’ social behaviour in autism, in both research and clinical settings.