Date Revised: August 19, 2020
When Juli Liske was a teenager years ago, she watched her sisters talk excitedly about how they would talk, dress, and act in social situations. “It was something they enjoyed talking about, but I didn’t,” she recalls. “It was misery to me.”
Unlike her sisters, Liske has autism spectrum disorder. Following the complex, unwritten rules of social situations can be difficult and stressful for people on the spectrum. To manage, she talked less and hid any habits that could attract attention that might be negative. “I was trying to fly under the radar,” she recalls now.
Liske may have been hiding her autistic traits to “fit in” — a behavior that autism experts call “camouflaging.” Some studies show that many adults on the spectrum, particularly women, camouflage in social situations.1-2 But what about teenagers?
For the first time, scientists studied camouflaging in teens who have autism and compared them to typically developing teens. This study, which included SPARK participants, “is going to help us better understand their social lives, and the positive and negative consequences of their social interactions,” explains Courtney Jorgenson, Ph.D., the University of Missouri researcher who led the study.
For the study, 140 teenagers, 78 of whom have autism, took two online surveys.3 One survey asked if they had certain traits common to autism. The other one, the Camouflaging Autistic Traits Questionnaire,4 measures behaviors such as:
- monitoring your body language to appear interested in someone else
- taking steps to improve your social skills
- copying the body language or facial expressions of another person, and
- thinking about the impression you make on others.
All teens took the same surveys, whether or not they have autism. Most of the autistic teens are SPARK members, and none have intellectual disability. The rest are “neurotypical” teens who neither have autism nor receive special education.
Some of the results were surprising. Unlike studies involving adults, neurotypical teens camouflaged as much as the autistic teens did, although possibly for different reasons. When the researchers dug deeper, they found differences based on age and sex.
Whether they had autism or not, girls camouflaged more than boys. But when age was considered, there was no difference between the sexes.
The researchers discovered trends when they divided the teens into two age groups. Autistic teens aged 13 to 15 camouflaged more than neurotypical teens that age. But the situation was reversed among the 16- to 18-year-olds: the neurotypical teens did the most camouflaging. That trend may have been influenced by the autistic boys; they reported less camouflaging than autistic girls their age, whom they also outnumbered. “By ages 16 to 18, the girls were looking a lot more similar to their peers than the males were,” Jorgenson says.
The findings suggest that there may be differences in the social development of autistic and neurotypical teens as they approach adulthood. But it’s hard to draw firm conclusions because this was a small, pilot study, with only 23 girls who have autism.
The researchers plan to use these results to launch another study on camouflaging next year, this time with more teens, particularly girls, Jorgenson says. The more people who take part in a study, the easier it will be to uncover differences by age, sex, and diagnosis that did not happen by chance.
It can be hard to find enough girls to take part in autism research. Boys outnumber girls by as much as 10 to 1 at the milder end of the autism spectrum.5
Does Camouflaging Affect Autism Diagnosis and Services?
Camouflaging may begin early, especially in girls, some researchers say. Several studies have found that young girls who have autism are more likely to imitate others in social situations and to want to “fit in” than boys on the spectrum.6-7 By adulthood, women report more camouflaging behaviors than men who have autism, according to other studies.2,8
Some researchers wonder if camouflaging, especially among girls and women, could make it harder to receive an autism diagnosis and services. Will people be referred for an autism evaluation if they are hiding their autism traits? If they are diagnosed, will they receive fewer services because others assume they don’t need the help?
“It’s important to study and understand social camouflaging because there is evidence — from people’s own experiences and from research — that camouflaging is associated with mental health difficulties, including anxiety and depression. It also might make it harder for autistic people’s needs to be assessed accurately, including getting access to autism assessments,” explains Laura Hull, Ph.D., who was not involved in the Jorgenson teen study. Hull, a research psychologist in the United Kingdom, helped create the camouflaging questionnaire for older teens and adults.
The Jorgenson teen study is the first to use that questionnaire with 13- to 15-year-olds; it has not been validated yet with that group, Hull says.
Components of Autism Camouflaging
The questionnaire breaks down camouflaging into three types: compensation, assimilation, and masking. People may compensate for social weaknesses by learning social skills from books or others. They can assimilate by using social support from other people or “pretending to be normal.” And they may mask by trying to appear interested in others and thinking about the impressions they make.
In research on older teens and adults, Hull’s team found significant differences between autistic and neurotypical adults on all three components of camouflaging, although the differences in masking were smallest. “Everyone tries to hide aspects of themselves that they aren’t happy with, or don’t think are appropriate for that situation. It may be that autistic people have to do this more often, or that it takes more effort to mask their autistic characteristics, than neurotypical people,” Hull says.
Social Lives of Teenagers
Jorgenson’s teen study found that typically developing teens were more likely to “mask” than autistic teens. She wonders if those results reflect typical social development during the teen years. “Teens are going through this process of what’s known as identity formation — figuring out who they are and how they want to act around others,” she explains. “Teens will engage in a kind of self-monitoring of the way they present themselves to others, which is really close to camouflaging.”
Liske, a member of the SPARK Community Advisory Council, remembers neurotypical teens doing a type of camouflaging while she was growing up. For example, when her family would travel from their Kentucky home, her siblings would pretend to be from England when meeting new people. “It was kind of done in sport,” she says. “It was masking for them,” a way of avoiding stereotypes about people from Appalachia.
Hull says, “I think adolescence is a time when everyone feels different and tries to fit in; some questions on the Camouflaging Autism Traits Questionnaire are picking up on those feelings which might be why neurotypical teens scored so high in this [teen] study.”
In Jorgenson’s teen study, the autistic teens worked harder on assimilation, which Hull describes as “feeling inauthentic and needing additional strategies to fit in with others.”
“This suggests that the ways neurotypical teens change their behaviors might not affect their sense of self in the same way that camouflaging can affect autistic people,” Hull says.
Jorgenson says that her team is currently working on another part of the teen study that will examine stress and mental health issues related to camouflaging.
And both she and Hull say they are looking forward to seeing a larger study on camouflaging that could shed more light on teens’ social lives, needs, and development.
- View the SPARK Summary Report: Camouflaging Autism: Do Autistic Teenagers Hide Their Autism Traits?
- Hull L. et al. J. Autism. Dev. Disord. 47, 2519–2534 (2017) PubMed
- Hull L. et al. Autism 24, 352-363 (2020) PubMed
- Jorgenson C. et al. J. Autism. Dev. Disord. Epub ahead of print (2020) PubMed
- Hull L. et al. J. Autism. Dev. Disord. 49, 819-833 (2019) PubMed
- Fombonne E. Pediatr. Res. 65, 591-598 (2009) PubMed
- Hiller R.M. et al. Autism 20, 75-84 (2016) PubMed
- Hiller R.M. et al. J. Abnorm. Child Psychol. 42, 1381-1393 (2014) PubMed
- Lai M.C. et al. Autism 21, 690‐702 (2017) PubMed