Camouflaging in autistic adults From measurement to mental health care

Autistic individuals often report to use strategies through which they hide their autism traits to appear non-autistic, which is referred to as camouflaging behavior. While camouflaging can help navigate the demands of our mostly non-autistic society, it may also contribute to late or missed autism diagnoses and mental health difficulties, such as anxiety and depression. This thesis aimed to 1) increase understanding about camouflaging by investigating how to measure camouflaging, 2) investigate for whom camouflaging is an important concept and 3) disentangle the relationship between camouflaging and mental health difficulties, 4) in order to find out how camouflaging can be included in specialized mental health care.
We found that camouflaging can be measured in autistic individuals, but their scores cannot be meaningfully compared to scores of non-autistic individuals. Camouflaging may also be important for people with ADHD. However, due to the heterogeneity within autism, we should be careful with drawing group-based conclusions about positive or negative consequences of camouflaging. That is, we observed that the association between camouflaging and mental health differed between subgroups of autistic adults. Moreover, we did not find that camouflaging was directly associated to a change in mental health difficulties and therefore, more research is necessary to disentangle the causal mechanisms underlying this association. Clinicians can already start by making a holistic overview with their autistic clients of how camouflaging may be related to important concepts, such as mental health difficulties, stigma, mastery and self-esteem. By doing this while creating an open, accepting, and equal environment, autistic people can try to find a balance between camouflaging and allowing themselves to be who they are and want to be.