title: Quantifying and exploring camouflaging in men and women with autism.
abstract: Autobiographical descriptions and clinician observations suggest that some individuals with autism, particularly females, 'camouflage' their social communication difficulties, which may require considerable cognitive effort and lead to increased stress, anxiety and depression. Using data from 60 age- and IQ-matched men and women with autism (without intellectual disability), we operationalized camouflaging in adults with autism for the first time as the quantitative discrepancy between the person's 'external' behavioural presentation in social-interpersonal contexts (measured by the Autism Diagnostic Observation Schedule) and the person's 'internal' status (dispositional traits measured by the Autism Spectrum Quotient and social cognitive capability measured by the 'Reading the Mind in the Eyes' Test). We found that the operationalized camouflaging measure was not significantly correlated with age or IQ. On average, women with autism had higher camouflaging scores than men with autism (Cohen's d = 0.98), with substantial variability in both groups. Greater camouflaging was associated with more depressive symptoms in men and better signal-detection sensitivity in women with autism. The neuroanatomical association with camouflaging score was largely sex/gender-dependent and significant only in women: from reverse inference, the most correlated cognitive terms were about emotion and memory. The underlying constructs, measurement, mechanisms, consequences and heterogeneity of camouflaging in autism warrant further investigation.
authors.affiliation: 1 Centre for Addiction and Mental Health, Canada.|2 The Hospital for Sick Children, Canada.|3 University of Toronto, Canada.|4 University of Cambridge, UK.|5 National Taiwan University Hospital, Taiwan.
authors.forename: Meng-Chuan
authors.initials: MC
authors.lastname: Lai
authors.affiliation: 4 University of Cambridge, UK.|6 University of Cyprus, Cyprus.
authors.forename: Michael V
authors.initials: MV
authors.lastname: Lombardo
authors.affiliation: 4 University of Cambridge, UK.
authors.forename: Amber Nv
authors.initials: AN
authors.lastname: Ruigrok
authors.affiliation: 4 University of Cambridge, UK.|7 University of Reading, UK.
authors.forename: Bhismadev
authors.initials: B
authors.lastname: Chakrabarti
authors.affiliation: 4 University of Cambridge, UK.|8 The University of Edinburgh, UK.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Auyeung
authors.affiliation: 1 Centre for Addiction and Mental Health, Canada.|2 The Hospital for Sick Children, Canada.|3 University of Toronto, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Szatmari
authors.affiliation: 9 King's College London, UK.
authors.forename: Francesca
authors.initials: F
authors.lastname: Happé
authors.affiliation: 4 University of Cambridge, UK.|10 Cambridgeshire and Peterborough NHS Foundation Trust, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Baron-Cohen
mesh_terms: D000293:Adolescent; D000328:Adult; D001321:Autistic Disorder / Q000175:diagnosis / Q000523:psychology*; D003863:Depression / Q000523:psychology; D005260:Female; D006801:Humans; D007360:Intelligence; D008297:Male; D008875:Middle Aged; D012919:Social Behavior; D055815:Young Adult
keywords: adults; autism; brain structure; camouflage; camouflaging; cognition; coping; gender; sex; sex differences