Update: Finding ASD in Girls who Camouflage

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that impacts the social communication abilities of individuals throughout their lifespan. For many individuals on the autism spectrum, these impairments are quite noticeable. For other individuals on the autism spectrum, they are more able to compensate and engage in behaviors that camouflages their autism symptoms.  For these individuals, the symptoms are still present and impact a person’s well-being, but may not be as visible to other people in their life. 

Presently, for approximately every 4 boys diagnosed with ASD, only 1 girl is diagnosed (Zeliadt, 2018). One reason to explain this sex/gender disparity is a concept known as camouflaging, a strategy individuals on the autism spectrum use to blend in with their social environment and conceal their autism symptoms to appear “non-autistic” (Attwood, 2007, as cited in, McQuaid et al., 2022). Some of the sex/gender disparity in the male to female ratio for diagnosed ASD can be accounted for by the misdiagnosis, delayed diagnosis, or no diagnosis of ASD in women or girls due to the fact that camouflaging makes it difficult to see ASD symptoms (Schuck et al., 2019).

This blog will outline what this camouflage phenomenon looks like in individuals with ASD, and the signs a parent can look out for if they think that their child may be camouflaging autism symptoms.

Defining Camouflage

Camouflage is an active, constant, and elaborate effort to conform to social norms. It gives the impression that the social challenges an individual with autism is facing are minimized or non-existent, when they can actually be quite impairing. Identifying individuals who are camouflaging their autism symptoms can be tricky, but when an individual is identified, it can be incredibly beneficial to their development over time.

Camouflaging can be split into three subcategories, as defined in a 2018 research study by Laura Hull et. al. The first two, compensation and masking, are explicit strategies used to mitigate the social deficits associated with ASD, while assimilation covers the internal thoughts or feelings an individual with ASD may have from engaging in camouflaging behaviors. 

Compensation – strategies used to compensate and navigate challenges in social situations 

• Learn social cues from television, films, or books
• Repeat others’ phrasing and tone
• Using learned phrases or pre-prepared jokes
• Imitating facial expressions and gestures
• Practicing smiling to initiate conversations
• Memorizing precreated anecdotes or scripts

Masking – strategies used to conceal autistic characteristic and appear “non-autistic”

• Monitor and adjust face and body to appear relaxed, such as disguising “stimming” behaviors
• Monitor and adjust body to appear interested in others, like feigning interest in a group’s topic of interest
• Pressure to make eye contact mean they may fake eye-contact by looking between a person’s eyes

Assimilation – strategies used to socially blend in with others

• Feel a need to put on an act
• Pretending to be normal
• Force self to interact with others
• Cannot be oneself while socializing

A more comprehensive list of camouflaging behaviors can be found in this article on the Social Camouflaging Model.

Impact of Camouflaging

Camouflaging can help individuals to make friends, find and maintain employment, meet romantic partners, and provide protection from being shunned. Camouflage is typically carried out due to the desire to be viewed as “normal”. While adaptability can be beneficial, camouflaging can also take a physical and emotional toll on the individual attempting to camouflage their behaviors. Identifying individuals camouflaging their symptoms can lead to a sense of relief and the possibility of receiving support from mental health professionals and from the ASD community.

Signs Your Child May be Camouflaging ASD Symptoms

As a parent, here are some signs you can look out for in a child who may be attempting to camouflage their symptoms:

1. Intense interests: Girls with ASD are often missed because their intense interests seem typical, such as an interest in animals, dolls, or celebrities. The key thing to notice is not what the interests are, but whether they tend to be repetitive or all encompassing.
2. Depression: While changing their outward appearance to fit in with their social environments, individuals camouflaging ASD symptoms may feel an increased sense of loneliness believing that their friendships feel fake. It is also possible that individuals feel they are hiding their true self and losing their identity, possibly leading to symptoms of depression.  
3. Disguising stimming behaviors: “Stimming” is a buzzword for stimulating behaviors, such as hand flapping and spinning. Instead of these more obvious behaviors, a child may be disguising it as sucking, clenching teeth, tensing and relaxing muscles, or other body movements, such as tapping a pen or doodling.
4. Using learned phrases, anecdotes, or pre-prepared jokes: For some individuals with ASD, despite having well developed formal language skills, using language to communicate with others can be challenging. One technique used to camouflage symptoms is pre-preparing phrases, anecdotes or jokes that they have heard from others or heard on the television.
5. Faking eye contact: Eye contact can be an important part of participating in social interactions with peers. While it may appear your child is making eye contact, some individuals are actually looking past your shoulder or staring between your eyes since they understand the importance of eye-contact, but it is not comfortable for them.
6. Imitating facial expressions or gestures: People often mimic the facial expressions and gestures of those that they are close with, but typically people can use their own spontaneous gestures and facial expressions. This imitation would likely be carried out after seeing another person’s response to a situation in the moment, taking their cues from others most of the time rather than spontaneously responding to a situation.
7. Practicing speaking more quietly: While volume control can be a challenge, some individuals with ASD learn that it is important to speak in a quieter voice, so they shift from using their usual loud speaking voice to a quieter speaking voice over time.

If you notice that your young child seems to be struggling socially, consider speaking with a professional. Early intervention for ASD is important in order to gain access to services and to provide the opportunity for the greatest improvement in symptoms over time.

References

Hull, L., Mandy, W., Lai, MC. et al. Development and Validation of the Camouflaging Autistic Traits Questionnaire (CAT-Q). J Autism Dev Disord 49, 819–833 (2019). https://doi.org/10.1007/s10803-018-3792-6

Kreiser, N. L., & White, S. W. (2014). ASD in females: are we overstating the gender difference in diagnosis?. Clinical child and family psychology review, 17(1), 67-84.

Lai, M. C., Lombardo, M. V., Ruigrok, A. N., Chakrabarti, B., Auyeung, B., Szatmari, P., … & MRC AIMS Consortium. (2017). Quantifying and exploring camouflaging in men and women with autism. Autism, 21(6), 690-702.

McQuaid, G. A., Lee, N. R., & Wallace, G. L. (2022). Camouflaging in autism spectrum disorder: Examining the roles of sex, gender identity, and diagnostic timing. Autism : the international journal of research and practice, 26(2), 552–559. https://doi.org/10.1177/13623613211042131

Ratto, A. B., Kenworthy, L., Yerys, B. E., Bascom, J., Wieckowski, A. T., White, S. W., … & Scarpa, A. (2018). What about the girls? Sex-based differences in autistic traits and adaptive skills. Journal of autism and developmental disorders, 48(5), 1698-1711.

Russo, Francine. (2018). The Costs of Camouflaging. https://www.spectrumnews.org/features/deep-dive/costs-camouflaging-autism/

Schuck, R. K., Flores, R. E., & Fung, L. K. (2019). Brief Report: Sex/Gender Differences in Symptomology and Camouflaging in Adults with Autism Spectrum Disorder. Journal of autism and developmental disorders, 49(6), 2597–2604. https://doi.org/10.1007/s10803-019-03998-y 

Wright, Jessica. (2017). Quantifying Camouflaging in Autism. https://www.spectrumnews.org/news/new-method-aims-quantify-camouflaging-autism/

Zeliadt, Nicholette. (2022, September 14). Autism’s sex ratio, explained. https://www.spectrumnews.org/news/autisms-sex-ratio-explained/