Camouflaging might not be unique to autistic individuals

A study in the Netherlands investigated differences in camouflaging between individuals with autism and those with attention-deficit/hyperactivity disorder (ADHD). The results showed that while autism traits are linked to camouflaging, this behavior is not unique to those diagnosed with autism. The paper was published in Autism Research.

Autism, or autism spectrum disorder, is a neurodevelopmental condition marked by difficulties in social interaction, communication challenges, and restricted, repetitive behaviors. Symptoms typically appear in early childhood and can vary widely in severity and presentation. Common signs include trouble understanding social cues, maintaining eye contact, and engaging in back-and-forth conversations.

Many autistic individuals are aware of their social difficulties. To counter this, they often develop strategies to mask or hide their symptoms in social situations, a behavior known as camouflaging. This can include mimicking social behaviors, rehearsing conversations, suppressing repetitive behaviors, and forcing eye contact to blend in with neurotypical peers.

Autistic individuals use camouflaging to avoid social rejection or misunderstandings. While it helps them navigate social interactions, it is mentally and emotionally exhausting. Over time, the effort required to maintain this facade can lead to mental health issues such as depression and burnout. Additionally, successful camouflaging may contribute to the late or missed diagnosis of autism.

Study author W. J. van der Putten and his colleagues note that individuals with ADHD also face social interaction and communication difficulties. While autistic individuals struggle due to repetitive behaviors and specific communication styles, those with ADHD struggle due to inattention, impulsivity, and hyperactivity. Therefore, individuals with ADHD might also use camouflaging strategies to blend in better, possibly using different tactics compared to those with autism.

The study included 352 autistic adults, 123 adults with ADHD, and 312 adults without either condition. All were participants in a larger study called “Autism & Aging.” The average age of participants was 51-52 years, with slightly more males than females. The researchers divided this group into two parts for separate analyses.

Participants completed assessments of camouflaging behavior (the CAT-Q-NL questionnaire), ADHD traits (the ADHD Self-Report), autism traits (the Autism Spectrum Quotient), and diagnostic interviews for ADHD (the Mini International Neuropsychiatric Interview Plus) and autism (Module 4 of the Autism Diagnostic Observation Scale, version 2).

Results showed that, on average, individuals with ADHD camouflage less than those with autism. Autistic individuals more frequently used compensation and assimilation strategies compared to those with ADHD. Compensation involves consciously mimicking neurotypical behaviors to fit in socially, while assimilation involves adopting behaviors that help blend into social settings.

Individuals with ADHD were slightly more prone to using assimilation strategies than those without ADHD or autism. Further analysis revealed that individuals with more pronounced autistic traits, regardless of diagnosis, tended to show more camouflaging behaviors, particularly compensation and assimilation strategies. ADHD traits were not associated with camouflaging behaviors.

“Based on this study we can conclude that adults with ADHD show more camouflaging than a comparison group, but less than autistic adults. This study highlights the need for more general measures of camouflaging behavior, independent of diagnosis, to be able to compare camouflaging across different groups. Also, more in-depth studies are necessary to fully grasp how people with ADHD camouflage, whether this differs from camouflaging in autistic adults and to what extent camouflaging may be a source for mental health difficulties and late diagnoses in people with ADHD,” the study authors concluded.

The paper, “Is camouflaging unique for autism? A comparison of camouflaging between adults with autism and ADHD,” was authored by W. J. van der Putten, A. J. J. Mol, A. P. Groenman, T. A. Radhoe, C. Torenvliet, J. A. Agelink van Rentergem, and H. M. Geurts.