Camouflaging in Autism: Age Effects and Cross-Cultural Validation of the Camouflaging Autistic Traits Questionnaire (CAT-Q).
Karl Lundin Remnélius, Sven Bölte
PMID 36757540WHAT IT FOUND
The Swedish Camouflaging Autistic Traits Questionnaire is reliable for adults but cannot diagnose autism.
It fails to distinguish autistic from non-autistic children under 15. Scores correlate strongly with anxiety and depression, meaning high scores may reflect distress rather than autism traits.
Key findings
01The questionnaire did not accurately distinguish autistic individuals from non-autistic people in the full sample, and performed poorly for children under 15.
02Camouflaging scores correlated more strongly with depression, anxiety, and social functioning difficulties than with autistic traits, raising concerns that the scale measures general distress or impression management rather than autism-specific masking.
03The original three-factor structure of the questionnaire did not fit the Swedish data, suggesting the subscales (Compensation, Masking, Assimilation) may not be valid in this population.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
Autism diagnoses were self-reported and not clinically verified. The sample of autistic children under 15 was small (n = 28), limiting conclusions for this age group. The study relied entirely on self-report measures, which may be subject to bias. The AQ-10 was used as the sole measure of autistic traits, which has questioned psychometric properties. The cross-sectional design cannot confirm causal age trajectories for camouflaging.
Declared interests
The authors declared no conflicts of interest. The study was funded by Vetenskapsrådet and Karolinska Institute.
The easy way to misread this
Do not interpret a high CAT-Q/SE score as evidence of autism. The scale correlates more strongly with anxiety and depression than with autistic traits, and it fails to distinguish autistic from non-autistic children. High scores likely indicate significant social distress or effortful coping, which requires a broader mental health assessment rather than an autism diagnosis.