The impact of camouflaging autistic traits on psychological and physiological stress: a co-twin control study.

The camouflaging measure was indirect: it compared clinician-rated autism signs with questionnaire-reported autistic traits, rather than directly asking participants about masking strategies. For many younger participants, autistic traits came from parent report, which may differ from self-report and could affect camouflaging scores. The discrepancy score did not correlate with the self-report camouflaging questionnaire in the full sample, and questionnaire data were often collected years later. The stress symptom measure was not an established psychological stress measure and was not validated for adolescents and adults. Self-rated stress was available only for the adult subsample, which may have affected the stress results and the lack of association between stress symptoms and cortisol. The study did not test an intervention, so it cannot show that camouflaging causes stress or that stress causes camouflaging. Within-pair analyses were limited by small numbers of informative twin pairs and smaller autistic and adult subgroups, so they were not adequately powered for small effects. The sample excluded participants with intellectual disability, so results cannot be generalized to that group. Anxiety and depression were not controlled, and they could be associated with stress and camouflaging. In the autistic subgroup, the camouflaging-cortisol association became non-significant when asthma and allergy were adjusted.

The supplied text states that Karolinska Institute funded the study. It does not report author conflicts of interest.

Do not conclude that camouflaging causes higher cortisol. The association was found when comparing different people, but it was not found within twin pairs, and adjusted within-pair models showed the opposite direction.