Showing posts with label Camouflaging. Show all posts
Showing posts with label Camouflaging. Show all posts

CAT-Q measure to measure camouflaging in autistic females.

The Camouflaging Autistic Traits Questionnaire (CAT-Q) was introduced in 2019 by Laura Hull and colleagues. 

What is Camouflaging
 Camouflaging involves modifying one's behaviors, such as suppressing stimming, forcing eye contact, or preparing jokes or phrases in advance, to conform to societal norms or to mask traits that might be socially stigmatized. This behavior is reported to be more common among autistic females and is hypothesized to contribute to the underdiagnosis or late diagnosis of autism in this group. 

What It Measures

The CAT-Q aims to quantify the effort and strategies employed by autistic individuals (particularly focusing on females or those assigned female at birth, AFAB) to camouflage their autistic traits.CAT-Q measures the discrepancy between the individual's natural autistic behaviors and the behaviors they exhibit in social contexts, essentially capturing the social coping strategies that are not naturally aligned with their intrinsic autistic characteristics.

The CAT-Q is a self-report questionnaire, meaning that it relies on individuals' own perceptions and reflections on their behavior. Respondents rate their agreement with various statements about their social strategies and experiences on a Likert scale. This approach allows for the collection of subjective data on camouflaging behaviors, which are inherently internal and personal.

Submeasures: 
The questionnaire is divided into multiple items that assess various dimensions of camouflaging, such as:
  • Masking: Efforts to hide autistic characteristics.
  • Compensation: Strategies to offset difficulties in social situations (e.g., memorizing social scripts).
  • Assimilation: Efforts to fit in with others by copying or mimicking non-autistic behaviors.


References
    • Hull, L., Petrides, K. V., Allison, C., Smith, P., Baron-Cohen, S., Lai, M. C., & Mandy, W. (2019). Development and validation of the Camouflaging Autistic Traits Questionnaire (CAT-Q). Journal of Autism and Developmental Disorders, 49(3), 819-833. doi:10.1007/s10803-018-3792-6
    • Hull, L., Lai, M. C., Baron-Cohen, S., Allison, C., Smith, P., Petrides, K. V., & Mandy, W. (2020). Gender differences in self-reported camouflaging in autistic and non-autistic adults. Autism, 24(2), 352-363. doi:10.1177/1362361319864804
    • Cassidy, S., Bradley, L., Shaw, R., & Baron-Cohen, S. (2018). Risk markers for suicidality in autistic adults. Molecular Autism, 9(1), 42. doi:10.1186/s13229-018-0226-4
    • Livingston, L. A., Colvert, E., Social, A., Happé, F., & the EU-AIMS LEAP group. (2019). Good social skills despite poor theory of mind: Exploring compensation in autism spectrum disorder. Journal of Child Psychology and Psychiatry, 60(1), 102-110. doi:10.1111/jcpp.12886
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Triple Bind and Masking in Autistic Females





The concept of the "Triple Bind," as discussed by Stephen Hinshaw, poses a multifaceted challenge for women, requiring them to navigate a complex labyrinth of societal expectations. Hinshaw's framework suggests that women are pressured to excel in traditionally male-dominated arenas, asserting themselves competitively and ambitiously. Concurrently, they are expected to embody the nurturing, demure qualities historically associated with femininity. Adding a third layer, women are also pressured to adhere to stringent standards of attractiveness and sexuality (Hinshaw, 2009). This triadic set of expectations creates a near-impossible standard for women to live up to, encapsulating the pervasive societal pressures that contribute to stress, anxiety, and a multitude of other psychological burdens.

For autistic females, these societal pressures are compounded through the phenomenon of masking or camouflaging. Masking refers to the efforts individuals on the spectrum make, either consciously or unconsciously, to conceal their autistic traits and adhere to neurotypical norms. This can involve mimicking social interactions, suppressing stimming (self-stimulatory behaviors), or forcing oneself to maintain eye contact during conversations (Hull et al., 2017). Autistic women, therefore, must navigate not only the stringent expectations laid out by the Triple Bind but also the added layer of disguising their neurodivergence to blend into a world that predominantly values neurotypical behaviors.

The practice of masking, while a means to facilitate social integration, exacts a significant psychological toll. It can lead to feelings of alienation, increased susceptibility to mental health issues, and the exhaustion that comes from the perpetual performance of neurotypicality (Lai et al., 2011). For women, who are already disproportionately affected by the Triple Bind, the requirement to mask autistic traits intensifies their burden, magnifying the challenges they face in their daily lives.

Exploring the intersection of the Triple Bind and masking through the lens of Critical Disability studies and Crip Theory offers profound insights. These academic disciplines critique societal norms that marginalize those with disabilities, advocating for a broader, more inclusive definition of normalcy. They emphasize the value of diversity and challenge the structures that define disability as a deviation from an arbitrary norm (Goodley, 2014). Queer Theory, in particular, enriches this analysis by highlighting how gender and sexuality norms intersect with disability, further complicating the social experiences of autistic women who may also identify as LGBTQ. By examining the experiences of autistic women in the context of these theories, we can uncover the systemic barriers that perpetuate exclusion and advocate for a society that celebrates rather than stigmatizes difference. We can challenge and dismantle the societal constructs that marginalize those who diverge from the so-called norm, paving the way for a more equitable and understanding world.

References
Goodley, D. (2014). Dis/ability studies: Theorising disablism and ableism. Routledge.
Hinshaw, S. (2009). The triple bind: Saving our teenage girls from today's pressures. Ballantine Books.
Hull, L., Petrides, K. V., Allison, C., Smith, P., Baron-Cohen, S., Lai, M.-C., & Mandy, W. (2017). "Putting on My Best Normal": Social Camouflaging in Adults with Autism Spectrum Conditions. Journal of Autism and Developmental Disorders, 47(8), 2519–2534.
Lai, M.-C., Lombardo, M. V., Pasco, G., Ruigrok, A. N. V., Wheelwright, S. J., Sadek, S. A., ... & Baron-Cohen, S. (2011). A behavioral comparison of male and female adults with high functioning autism spectrum conditions. PLOS ONE, 12(6), e0177835.

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Masking as an evolutionary advantage



What is Masking & Camouflaging
Masking and camouflaging are terms used to describe strategies autistics might employ to hide or minimize their autistic traits in social situations. These behaviors can include mimicking NT behaviors, suppressing stimming, or forcing oneself to make eye contact during conversations. 

It is often a coping strategy used by autistics to navigate social situations that can be overwhelming or challenging. It is a means to "fit-in" and also a question of basic safety for some, as the display of atypical behaviors can lead to aversive/negative reactions from others.  

There are subtle distinctions between the two terms.
  • Masking refers to the conscious or unconscious effort to hide or suppress autistic traits or behaviors to fit into social situations. This can include copying social behaviors, hiding interests that might be deemed atypical, or suppressing feelings of discomfort in social settings.
  • Camouflaging, while similar to masking, can sometimes be seen as a broader concept that includes masking as a subset. Camouflaging may involve more active efforts to construct a persona that is socially acceptable or to "pass" as neurotypical. This could involve learning and implementing specific social strategies, such as scripts for conversation or specific body language cues.
Consequences
  • The effort to constantly hide one's true self can be exhausting and damaging to one's sense of identity and self-esteem (ie: more cognitive effort + more mental health issues). Can contribute to autistic burnout. 

Do only certain "type" of autistics engage in masking/camouflaging?
  • No. Masking and Camouflaging is engaged in by autistics across the spectrum. 
  • People with higher support needs very much try, but just may be "less adept" at pulling off camouflaging due to communication and sensory challenges. Everyone has the desire to be safe from potential negative consequences. For higher support needs autistics, it can come down to basic safety as the display of atypical behaviors can lead to negative reactions and consequences from others. eg: you can get thrown off a plane for displaying stims or you get additional security screenings at airports because you engage in some repetitive stims which cops may perceive as "suspicious."  

More common or effectively practiced by females.

While research shows both male and female autistics engage in masking/camouflaging, there is evidence to suggest that it might be more common or effectively practiced by females. 


Could Camouflaging be a contributing factor in the later dx in female autistics?

This difference has been proposed as one reason for under-dx or late dx in females.  Females might be better at hiding their autistic traits, leading to their struggles being overlooked or attributed to other factors.

In Prof Steve Hinshaw's class, I also learned that 'externalizing behaviors' is often more observable in boys from their first decade itself (eg: acting out, aggression, boisterous) - so they catch the boys early in terms of dx. In girls the externalizing behaviors become more observable in their second decade (eg: eating disorders, NSSI - non suicidal self injurious behaviors etc) - so catching them later. 


Can Camouflaging be an evolutionary advantage for females?

I think the idea that females are better at camouflaging as an evolutionary advantage is an intriguing hypothesis. The argument would be that this ability allows female autistics to better integrate into social groups, potentially providing benefits in terms of social integration. 

However, it's important to note the negative effects on mental health that come with having to continually engage (cognitive effort) in camouflaging.


When Masking/Camouflaging is layered onto Triple-Bind

I first heard of Triple-Bind in Professor Steve Hinshaw's class and immediately thought of how Masking would be layered on top of Triple-Bind

"Triple Bind," poses a multifaceted challenge for women (disabled or non-disabled), requiring them to navigate a complex labyrinth of societal expectations. Hinshaw's framework suggests that women are pressured to excel in traditionally male-dominated arenas, asserting themselves competitively and ambitiously. Concurrently, they are expected to embody the nurturing, demure qualities historically associated with femininity. Adding a third layer, women are also pressured to adhere to stringent standards of attractiveness and sexuality. This triadic set of expectations creates a near-impossible standard for women to live up to, encapsulating the pervasive societal pressures that contribute to stress, anxiety, and a multitude of other psychological burdens.

Autistic females, therefore, must navigate not only the stringent expectations laid out by the Triple Bind but also the added layer of disguising their neurodivergence (camouflaging) to blend into a world that predominantly values neurotypical behaviors.

A Disability Studies Perspective
Exploring the intersection of the Triple Bind and Masking/Camouflaging through the lens of Critical Disability studies and Crip Theory offers profound insights. These academic disciplines critique societal norms that marginalize those with disabilities, advocating for a broader, more inclusive definition of normalcy. They emphasize the value of diversity and challenge the structures that define disability as a deviation from an arbitrary norm. Queer Theory, in particular, enriches this analysis by highlighting how gender and sexuality norms intersect with disability, further complicating the social experiences of autistic women who may also identify as LGBTQ. By examining the experiences of autistic women in the context of these theories, we can uncover the systemic barriers that perpetuate exclusion and advocate for a society that celebrates rather than stigmatizes differences.


Psychological Measures 

The Camouflaging Autistic Traits Questionnaire (CAT-Q) was introduced in 2019 by Laura Hull and colleagues. It aims to quantify the effort and strategies employed by autistic individuals (particularly females or AFAB, assigned female at birth) to camouflage their autistic traits. It measures the discrepancy between the individual's natural autistic behaviors and the behaviors they exhibit in social contexts, essentially capturing the social coping strategies that are not naturally aligned with their intrinsic autistic characteristics.  A self-report  approach allows for the collection of subjective data on camouflaging behaviors, which are inherently internal and personal.

The questionnaire is divided into multiple items that assess various dimensions of camouflaging
  • Masking: Efforts to hide autistic characteristics.
  • Compensation: Strategies to offset difficulties in social situations (e.g., memorizing social scripts).
  • Assimilation: Efforts to fit in with others by copying or mimicking non-autistic behaviors.


Research Citations
  • Lai, M.C., Lombardo, M.V., Pasco, G., et al. (2011). A behavioral comparison of male and female adults with high functioning autism spectrum conditions. PLoS ONE, 6(6), e20835. This study provides insights into the behavioral patterns of adults with autism, including aspects that might relate to masking and camouflaging.
  • Hull, L., Petrides, K.V., Allison, C., et al. (2017). “Putting on My Best Normal”: Social Camouflaging in Adults with Autism Spectrum Conditions. Journal of Autism and Developmental Disorders, 47(8), 2519–2534. This article explores the concept of social camouflaging in adults with autism and discusses the implications for mental health.
  • Dean, M., Harwood, R., & Kasari, C. (2017). The art of camouflage: Gender differences in the social behaviors of girls and boys with autism spectrum disorder. Autism, 21(6), 678–689. This study specifically addresses gender differences in social behaviors, including masking and camouflaging, among children with autism.
  • Goodley, D. (2014). Dis/ability studies: Theorising disablism and ableism. Routledge.
  • Hinshaw, S. (2009). The triple bind: Saving our teenage girls from today's pressures. Ballantine Books.

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