Autistic masking, also referred to as camouflaging, is the conscious or subconscious suppression of autistic behaviors and compensation of difficulties in social interaction by autistic people with the goal of being perceived as neurotypical. [1] [2] Masking is a learned coping strategy [3] [4] that can be successful from the perspective of autistic people, but can also lead to adverse mental health outcomes. [1] [5]
There is no universally agreed-upon terminology for the concept. [1] [5] : 16–17 [6] While some use the terms masking and camouflaging synonymously, [1] [2] [5] : 16–17 others distinguish between masking (the suppression of behaviors) and compensation (of social difficulties) as the two main forms of camouflaging. [1] [3] [7] Among autistic people, masking is the most commonly used umbrella term. [5] : 16 [8] Autistic researcher Wenn Lawson has proposed that adaptive morphing is a more fitting term. [9]
The process of consciously giving up masking, which some autistic people see as a desirable goal, is referred to as unmasking. [2] [10] [11] Motivations for unmasking include no longer hiding one's true identity and avoiding adverse mental health outcomes. [2] [8] [10]
Typical examples of autistic masking include the suppression of stimming and reactions to sensory overload. [3] To compensate difficulties in social interaction with neurotypical peers, autistic people might maintain eye contact despite discomfort or mirror the body language and tone of others. [1] [2] [3] [12]
Autistic people with conversational difficulties may also use more complex strategies such as scripting a conversation outline, developing conscious "rules" for conversations, carefully monitoring if these are being followed. [3] Many autistic people learn conversational rules and social behaviors by watching television shows and other media and by observing and mimicking a character's behavior. [12] Masking may also include refraining from talking about passionate interests. [2] [3]
Autistic people have cited social acceptance, the need to get a job, and the avoidance of ostracism or verbal or physical abuse as reasons for masking. [13]
Masking requires an exceptional effort [3] [14] and is a main cause of autistic burnout. [15] [16] It is linked with adverse mental health outcomes [17] [18] [19] [20] such as stress, [21] anxiety, depression, and other psychological disorders, [21] loss of identity, [21] and suicidality. [22] [23] [24] According to a recent meta analysis, the association between masking and depression, general anxiety, and social anxiety appear consistent across different age groups (children, adolescents, and adults). [20] Some studies find that compensation strategies are seen as contributing to leading a successful life. [1] [7] [14] Since many studies on masking focus on autistic adolescents or adults without cognitive impairments, the generalizability of such findings across the autism spectrum is uncertain. [1]
Masking may conceal the person's need for support. [13] It can complicate a diagnosis of autism spectrum disorder (ASD), particularly past childhood, as relevant symptoms are suppressed or compensated for. [25] : 60–62 The diagnostic criteria for ASD in the DSM-5 published in 2013 explicitly state that while symptoms "must be present in the early developmental period", these "may be masked by learned strategies in later life", allowing for a diagnosis even if autistic behaviors and difficulties are successfully masked. [25] : 57 [26] Addition of such a formulation was proposed to the workgroup drafting the criteria by representatives of the Autistic Self Advocacy Network including Ari Ne'eman and Steven Kapp. [26] The diagnostic criteria for ASD in the ICD-11 (2022) contain a similar provision. [27]
It has been hypothesized that masking may play an important role in explaining why autistic women and non-binary persons [2] are significantly less often recognized and diagnosed as autistic compared to men. [2] [3] [12] This hypothesis was put forward by Lorna Wing as early as 1981 [5] : 20 [28] : 134 and is recognized in the DSM-5-TR published in 2022. [25] : 65
While masking was written about and discussed among autistic people, it has only become a focus of academic research since the 2010s. [5] : 18 The Camouflaging Autistic Traits Questionnaire (CAT-Q), the first self-report measure for camouflaging, was published in 2018. [29] [30] Across 25 items, it measures the extent to which a person utilizes strategies to actively compensate for difficulties in social situations (Compensation, 9 items), uses strategies to hide autistic characteristics or portray a non-autistic persona (Masking, 8 items), and employs strategies to fit in with others in social situations (Assimilation, 8 items). [29] Other researchers have criticized the use of self-report measures, arguing that self-report may exclude understudied groups within autism, such as individuals with linguistic disabilities. [31]
In light of rising awareness of the adverse mental health outcomes of masking and insight into the double empathy problem, therapies and interventions with implicit or explicit targets of instilling neurotypical behavior and suppressing autistic traits in autistic people are controversial and often criticized by some researchers, neurodiversity proponents, and autistic self-advocates from the autism rights movement. [32] [33] [34] Some autistic adults who experienced applied behavior analysis therapy as children describe being forced to behave like neurotypical peers with detrimental effects on their mental and overall well-being. [35] [36] [37]
There are some research studies centered around the experiences of masking by comparing different groups of neurotypes. In 2021, researchers conducted an online survey comparing masking experiences between autistic, non-autistic neurodivergent, and neurotypical groups. [38] They found that the behavior of masking is shared across all types of people, but some aspects of masking are more specific to autism, such as sensory suppression and suppression of stimming. Researchers also recreated this study in a workplace context and examined workplace masking experiences for autistic, non-autistic, and neurotypical adults in the UK. They identified eight emerging themes from the survey and reported large overlap among three groups such as reasonings and perceptions of benefits and drawbacks: both neurodivergent and neurotypical people adopted masking strategies to achieve social goals, indicating that masking is more like a common rather exclusive experience. [31]
There has also been qualitative research focused on the autistic experiences of masking. A study in 2022 conducted semi-structured interviews with twenty autistic teenagers and observed that masking is associated with mental health (but not necessarily in linear relationship) and how both of them are affected by social and environmental factors. Researchers stressed the need to approach masking, authenticity, and mental health through the context of people's identities and the environment, providing implications for diagnostic services and interventions. [39] There have been comparisons between masking and passing. [31]
In addition to masking, researchers investigated the "authenticity" autistic people feel while socializing and observed that supportive environments, such as being around people who accept and understand them, can lead to self-awareness and create more positive socializing experiences than camouflaging. [40] However, this doesn't imply that autistic "masking" is equivalent to non-authenticity. Researchers proposed that the focus should not be encouraging masking but promoting autistic authenticity, creating a more positive self-image and better mental health. [39]
Asperger syndrome (AS), also known as Asperger's syndrome or Asperger's, was a diagnosis used to describe a neurodevelopmental condition characterized by significant difficulties in social interaction and nonverbal communication, along with restricted, repetitive patterns of behavior and interests. Asperger syndrome has been merged with other conditions into autism spectrum disorder (ASD) and is no longer a diagnosis in the WHO's ICD-11 or the APA's DSM-5-TR. It was considered milder than other diagnoses which were merged into ASD due to relatively unimpaired spoken language and intelligence.
Diagnoses of autism have become more frequent since the 1980s, which has led to various controversies about both the cause of autism and the nature of the diagnoses themselves. Whether autism has mainly a genetic or developmental cause, and the degree of coincidence between autism and intellectual disability, are all matters of current scientific controversy as well as inquiry. There is also more sociopolitical debate as to whether autism should be considered a disability on its own.
The neurodiversity paradigm is a framework for understanding human brain function that recognizes the diversity within sensory processing, motor abilities, social comfort, cognition, and focus as neurobiological differences. This diversity falls on a spectrum of neurocognitive differences. The neurodiversity paradigm argues that diversity in neurocognition is part of humanity and that some neurodivergences generally classified as disorders, such as autism, are differences and disabilities that are not necessarily pathological. Neurotypical individuals are those who fall within the average range of functioning and thinking.
The autism rights movement, also known as the autistic acceptance movement, is a social movement allied with the disability rights movement. It emphasizes the neurodiversity paradigm, viewing autism as a set of naturally occurring variations in human cognition, a disability with both strengths and weaknesses, rather than as a disease to be cured or a medical disorder, diverging from the medical model of disability.
Ole Ivar Løvaas was a Norwegian-American clinical psychologist and professor at the University of California, Los Angeles. He is most well known for his research on what is now called applied behavior analysis (ABA) to teach autistic children through prompts, modeling, and positive reinforcement. His application of the science was also noted for its use of aversives (punishment) to reduce undesired behavior, which are no longer supported as a part of most ABA treatment plans.
High-functioning autism (HFA) was historically an autism classification to describe a person who exhibited no intellectual disability but otherwise showed autistic traits, such as difficulty in social interaction and communication, as well as repetitive, restricted patterns of behavior. The term is often applied to autistic people who are fluently verbal and of at least average intelligence. However, many in medical and autistic communities have called to stop using the term, finding it simplistic and unindicative of the difficulties some autistic people face.
Mind-blindness, mindblindness or mind blindness is a theory initially proposed in 1990 that claims that all autistic people have a lack or developmental delay of theory of mind (ToM), meaning they are unable, or less able, to attribute mental states to others. According to the theory, a lack of ToM is considered equivalent to a lack of both cognitive and affective empathy. In the context of the theory, mind-blindness implies being unable to predict behavior and attribute mental states including beliefs, desires, emotions, or intentions of other people. The mind-blindness theory asserts that children who delay in this development will often develop autism.
In psychology and sociology, masking, also known as social camouflaging, is a defensive behavior in which an individual conceals their natural personality or behavior in response to social pressure, abuse, or harassment. Masking can be strongly influenced by environmental factors such as authoritarian parents, social rejection, and emotional, physical, or sexual abuse. Masking can be a behavior individuals adopt subconsciously as coping mechanisms or a trauma response, or it can be a conscious behavior an individual adopts to fit in within perceived societal norms. Masking is interconnected with maintaining performative behavior within social structures and cultures.
Autism therapies include a wide variety of therapies that help people with autism, or their families. Such methods of therapy seek to aid autistic people in dealing with difficulties and increase their functional independence.
Self-stimulatory behavior, also known as "stimming" and self-stimulation, is the repetition of physical movements, sounds, words, moving objects, or other behaviors. Stimming is a type of restricted and repetitive behavior (RRB). Such behaviors are found to some degree in all people, but is especially prevalent in those with developmental disabilities such as attention deficit hyperactivity disorder (ADHD) and autism. People diagnosed with sensory processing disorder are also known to potentially exhibit stimming behaviors.
The autism-spectrum quotient (AQ) is a questionnaire published in 2001 by Simon Baron-Cohen and his colleagues at the Autism Research Centre in Cambridge, UK. Consisting of fifty questions, it aims to investigate whether adults of average intelligence have symptoms of autism spectrum conditions. More recently, versions of the AQ for children and adolescents have also been published.
Societal and cultural aspects of autism or sociology of autism come into play with recognition of autism, approaches to its support services and therapies, and how autism affects the definition of personhood. The autistic community is divided primarily into two camps; the autism rights movement and the pathology paradigm. The pathology paradigm advocates for supporting research into therapies, treatments, and/or a cure to help minimize or remove autistic traits, seeing treatment as vital to help individuals with autism, while the neurodiversity movement believes autism should be seen as a different way of being and advocates against a cure and interventions that focus on normalization, seeing it as trying to exterminate autistic people and their individuality. Both are controversial in autism communities and advocacy which has led to significant infighting between these two camps. While the dominant paradigm is the pathology paradigm and is followed largely by autism research and scientific communities, the neurodiversity movement is highly popular among most autistic people, within autism advocacy, autism rights organizations, and related neurodiversity approaches have been rapidly growing and applied in the autism research field in the last few years.
Classic autism, also known as childhood autism, autistic disorder, (early) infantile autism, infantile psychosis, Kanner's autism, Kanner's syndrome, or (formerly) just autism, is a neurodevelopmental condition first described by Leo Kanner in 1943. It is characterized by atypical and impaired development in social interaction and communication as well as restricted, repetitive behaviors, activities, and interests. These symptoms first appear in early childhood and persist throughout life.
Autism, or autism spectrum disorder (ASD), is a neurodevelopmental disorder characterized by repetitive, restricted, and inflexible patterns of behavior, interests, and activities, as well as deficits in social communication and social interaction, and the presence of high or low sensory sensitivity. The underlying spectrum of ASD results in a variety of manifestations and support needs of the disorder. For example, some are nonverbal, while others have proficient spoken language.
Diagnosis, treatment, and experiences of autism varies globally. Although the diagnosis of autism is rising in post-industrial nations, diagnosis rates are much lower in developing nations.
Sex and gender differences in autism exist regarding prevalence, presentation, and diagnosis.
Discrimination against autistic people involves any form of discrimination, persecution, or oppression against people who are autistic. Despite contention over its status as a disability, discrimination against autistic people is considered to be a form of ableism.
Current research indicates that autistic people have higher rates of LGBTQ identities and feelings than the general population. A variety of explanations for this have been proposed, such as prenatal hormonal exposure, which has been linked with sexual orientation, gender dysphoria and autism. Alternatively, autistic people may be less reliant on social norms and thus are more open about their orientation or gender identity. A narrative review published in 2016 stated that while various hypotheses have been proposed for an association between autism and gender dysphoria, they lack strong evidence.
The theory of the double empathy problem is a psychological and sociological theory first coined in 2012 by Damian Milton, an autistic autism researcher. This theory proposes that many of the difficulties autistic individuals face when socializing with non-autistic individuals are due, in part, to a lack of mutual understanding between the two groups, meaning that most autistic people struggle to understand and empathize with non-autistic people, whereas most non-autistic people also struggle to understand and empathize with autistic people. This lack of understanding may stem from bidirectional differences in dispositions, and experiences between autistic and non-autistic individuals, but not necessarily an inherent deficiency. Studies from the 2010s and 2020s have shown that most autistic individuals are able to socialize, communicate effectively, empathize well or build good rapport, and display social reciprocity with most other autistic individuals. A 2024 systematic review has found that most autistic people have mostly pleasant experiences interacting with most autistic people, and autistic-autistic interactions were generally associated with better quality of life across various domains. This theory and subsequent findings challenge the commonly held belief that the social skills of all autistic individuals are inherently and universally impaired across contexts, as well as the theory of "mind-blindness" proposed by prominent autism researcher Simon Baron-Cohen in the mid-1990s, which suggested that empathy and theory of mind are universally impaired in autistic individuals.
Autistic burnout is a prolonged state of intense fatigue, decreased executive functioning or life skills, and increased sensory processing sensitivity experienced by autistic people. Autistic burnout is thought to be caused by stress arising from masking or living in a neurotypical environment that is not autism-friendly. While not formally recognized as a medical condition, autistic burnout has become increasingly recognized within the autistic community and has gained attention among researchers, clinicians, and autistic people themselves as a significant aspect of the autistic experience.
