Linking Social Camouflaging and Mental Health in Autistic Adolescents

The Role of Stigma 

Authors

DOI:

https://doi.org/10.15173/cjae.v6i1.6910

Keywords:

social camouflaging, adolescents, autism, internalized stigma, mental health

Abstract

Background: Autistic individuals are subject to social stigma due to their identity-based minority status. To avoid stigmatization, some Autistic individuals engage in social camouflaging (SC), in which a person utilizes cognitive and/or behavioural strategies to conceal their autistic traits and compensate for socio-cognitive differences. SC is linked with poorer mental health outcomes in Autistic people; similar patterns have been found between internalized stigma and mental health among those with concealable minority statuses (e.g., sexual identity). There is limited understanding as to why adolescents use SC, so we examined the potential role of internalized stigma in explaining SC’s effects on mental health (i.e., anxiety and depressive symptoms). We hypothesized that the association between SC and mental health is mediated by internalized stigma. Method: Preliminary testing of our hypothesis was conducted using a small pilot sample of Autistic adolescents (n = 9). Results: Preliminary analyses suggested that SC was significantly associated with internalized stigma and mental health. Conclusions: Use of SC by Autistic adolescents may partially contribute to greater levels of internalized stigma, which may then have negative impacts on mental health. Given the preliminary nature of the findings and small sample size, research with larger samples of Autistic adolescents is needed to further disentangle these associations and replicate findings.

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References

Ai, W., Cunningham, W. A., & Lai, M. -C. (2022). Reconsidering autistic ‘camouflaging’ as transactional impression management. Trends in Cognitive Sciences, 26(8), 631–645. https://doi.org/10.1016/j.tics.2022.05.002

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Atherton, G., Edisbury, E., Piovesan, A., & Cross, L. (2022). Autism through the ages: A mixed methods approach to understanding how age and age of diagnosis affect quality of life. Journal of Autism and Developmental Disorders, 52(8), 3639–3654. https://doi.org/10.1007/s10803-021-05235-x

Bargiela, S., Steward, R., & Mandy, W. (2016). The experiences of late-diagnosed women with autism spectrum conditions: An investigation of the female autism phenotype. Journal of Autism and Developmental Disorders, 46(10), 3281–3294. https://doi.org/10.1007/s10803-016-2872-8

Bernardin, C. J., Lewis, T., Bell, D., & Kanne, S. (2021a). Associations between social camouflaging and internalizing symptoms in autistic and non-autistic adolescents. Autism, 25(6), 1580–1591. https://doi.org/10.1177/1362361321997284

Bernardin, C. J., Mason, E., Lewis, T., & Kanne, S. (2021b). “You must become a chameleon to survive”: Adolescent experiences of camouflaging. Journal of Autism and Developmental Disorders, 51(12), 4422–4435. https://doi.org/10.1007/s10803-021-04912-1

Botha, M., & Frost, D. M. (2020). Extending the minority stress model to understand mental health problems experienced by the autistic population. Society and Mental Health, 10(1), 20–34. https://doi.org/10.1177/2156869318804297

Brickhill, R., Atherton, G., Piovesan, A., & Cross, L. (2023). Autism, thy name is man: Exploring implicit and explicit gender bias in autism perceptions. PLOS ONE, 18(8), e0284013. https://doi.org/10.1371/journal.pone.0284013

Cage, E., & Troxell-Whitman, Z. (2019). Understanding the reasons, contexts and costs of camouflaging for autistic adults. Journal of Autism and Developmental Disorders, 49(5), 1899–1911. https://doi.org/10.1007/s10803-018-03878-x

Cassidy, S., Bradley, L., Shaw, R., & Baron-Cohen, S. (2018). Risk markers for suicidality in autistic adults. Molecular Autism, 9(1), 42. https://doi.org/10.1186/s13229-018-0226-4

Cassidy, S. A., Gould, K., Townsend, E., Pelton, M., Robertson, A. E., & Rodgers, J. (2020). Is camouflaging autistic traits associated with suicidal thoughts and behaviours? Expanding the interpersonal psychological theory of suicide in an undergraduate student sample. Journal of Autism and Developmental Disorders, 50(10), 3638–3648. https://doi.org/10.1007/s10803-019-04323-3

Chaudoir, S. R., Earnshaw, V. A., & Andel, S. (2013). “Discredited” versus “discreditable”: Understanding how shared and unique stigma mechanisms affect psychological and physical health disparities. Basic and Applied Social Psychology, 35(1), 75–87. https://doi.org/10.1080/01973533.2012.746612

Chorpita, B. F., Yim, L., Moffitt, C., Umemoto, L. A., & Francis, S. E. (2000). Assessment of symptoms of DSM-IV anxiety and depression in children: A revised child anxiety and depression scale. Behaviour Research and Therapy, 38(8), 835–855. https://doi.org/10.1016/S0005-7967(99)00130-8

Cook, A., Ogden, J., & Winstone, N. (2018). Friendship motivations, challenges and the role of masking for girls with autism in contrasting school settings. European Journal of Special Needs Education. https://www.tandfonline.com/doi/abs/10.1080/08856257.2017.1312797

Cook, J., Crane, L., Bourne, L., Hull, L., & Mandy, W. (2021). Camouflaging in an everyday social context: An interpersonal recall study. Autism, 25(5), 1444–1456. https://doi.org/10.1177/1362361321992641

Dean, R. B., & Dixon, W. J. (1951). Simplified statistics for small numbers of observations. Analytical Chemistry, 23(4), 636–638. https://doi.org/10.1021/ac60052a025

Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. Englewood Cliffs, NJ: Prentice-Hall.

Gotham, K., Bishop, S. L., Brunwasser, S., & Lord, C. (2014). Rumination and perceived impairment associated with depressive symptoms in a verbal adolescent-adult ASD sample. Autism Research: Official Journal of the International Society for Autism Research, 7(3), 381–391. https://doi.org/10.1002/aur.1377

Halsall, J., Clarke, C., & Crane, L. (2021). “Camouflaging” by adolescent autistic girls who attend both mainstream and specialist resource classes: Perspectives of girls, their mothers and their educators. Autism, 25(7), 2074–2086. https://doi.org/10.1177/13623613211012819

Hannon, B., Mandy, W., & Hull, L. (2023). A comparison of methods for measuring camouflaging in autism. Autism Research: Official Journal of the International Society for Autism Research, 16(1), 12–29. https://doi.org/10.1002/aur.2850

Harris, P. A., Taylor, R., Minor, B. L., Elliott, V., Fernandez, M., O’Neal, L., McLeod, L., Delacqua, G., Delacqua, F., Kirby, J., Duda, S. N., & REDCap Consortium. (2019). The REDCap consortium: Building an international community of software partners. Journal of Biomedical Informatics, 95, 103208. https://doi.org/10.1016/j.jbi.2019.103208

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. https://doi.org/10.1007/s10803-017-3166-5

Hull, L., Mandy, W., Lai, M.-C., Baron-Cohen, S., Allison, C., Smith, P., & Petrides, K. V. (2019). Development and validation of the camouflaging autistic traits questionnaire (CAT-Q). Journal of Autism and Developmental Disorders, 49(3), 819–833. https://doi.org/10.1007/s10803-018-3792-6

Hull, L., Petrides, K. V., & Mandy, W. (2020a). The female autism phenotype and camouflaging: A narrative review. Review Journal of Autism and Developmental Disorders, 7(4), 306–317. https://doi.org/10.1007/s40489-020-00197-9

Hull, L., Lai, M.-C., Baron-Cohen, S., Allison, C., Smith, P., Petrides, K., & Mandy, W. (2020b). Gender differences in self-reported camouflaging in autistic and non-autistic adults. Autism, 24(2), 352–363. https://doi.org/10.1177/1362361319864804

Hull, L., Levy, L., Lai, M.-C., Petrides, K. V., Baron-Cohen, S., Allison, C., Smith, P., & Mandy, W. (2021a). Is social camouflaging associated with anxiety and depression in autistic adults? Molecular Autism, 12(1), 13. https://doi.org/10.1186/s13229-021-00421-1

Hull, L., Petrides, K. V., & Mandy, W. (2021b). Cognitive predictors of self-reported camouflaging in autistic adolescents. Autism Research, 14(3), 523–532. https://doi.org/10.1002/aur.2407

Jedrzejewska, A., & Dewey, J. (2022). Camouflaging in autistic and non-autistic adolescents in the modern context of social media. Journal of Autism and Developmental Disorders, 52(2), 630–646. https://doi.org/10.1007/s10803-021-04953-6

Jorgenson, C., Lewis, T., Rose, C., & Kanne, S. (2020). Social camouflaging in autistic and neurotypical adolescents: A pilot study of differences by sex and diagnosis. Journal of Autism and Developmental Disorders, 50(12), 4344–4355. https://doi.org/10.1007/s10803-020-04491-7

Kanne, S. M., Gerber, A. J., Quirmbach, L. M., Sparrow, S. S., Cicchetti, D. V., & Saulnier, C. A. (2011). The role of adaptive behavior in autism spectrum disorders: Implications for functional outcome. Journal of Autism and Developmental Disorders, 41(8), 1007–1018. https://doi.org/10.1007/s10803-010-1126-4

King, M., Dinos, S., Shaw, J., Watson, R., Stevens, S., Passetti, F., Weich, S., & Serfaty, M. (2007). The stigma scale: Development of a standardised measure of the stigma of mental illness. The British Journal of Psychiatry, 190(3), 248–254. https://doi.org/10.1192/bjp.bp.106.024638

Klein, J., Krahn, R., Howe, S., Lewis, J., McMorris, C., & Macoun, S. (2025). A systematic review of social camouflaging in autistic adults and youth: Implications and theory. Development and psychopathology, 37(3), 1320–1334. https://doi.org/10.1017/S0954579424001159

Klein, J., Krahn, R. L, Howe, S. J., Cormier, A., Rush, J., Ames, M. E., McMorris, C. A., & Macoun, S. (accepted). Study protocol: Examining social camouflaging and its cognitive, mental health and neurophysiological correlates in Autistic adolescents through triangulation-based assessment using self, parent, and daily diary-reports. BMJ Open.

Lai, M.-C., Lombardo, M. V., Ruigrok, A. N., Chakrabarti, B., Auyeung, B., Szatmari, P., Happé, F., & Baron-Cohen, S. (2017). Quantifying and exploring camouflaging in men and women with autism. Autism, 21(6), 690–702. https://doi.org/10.1177/1362361316671012

Lei, J., Leigh, E., Charman, T., Russell, A., & Hollocks, M. J. (2024). “Understanding the relationship between social camouflaging in autism and safety behaviours in social anxiety in autistic and non-autistic adolescents.” Journal of Child Psychology and Psychiatry, 65(3), 285–297. https://doi.org/10.1111/jcpp.13884.

Livingston, L. A., & Happé, F. (2017). Conceptualising compensation in neurodevelopmental disorders: Reflections from autism spectrum disorder. Neuroscience and Biobehavioral Reviews, 80, 729–742. https://doi.org/10.1016/j.neubiorev.2017.06.005

Livingston, L. A., Colvert, E., Social Relationships Study Team, Bolton, P., & Happé, F. (2019). Good social skills despite poor theory of mind: Exploring compensation in autism spectrum disorder. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 60(1), 102–110. https://doi.org/10.1111/jcpp.12886

Mantzalas, J., Richdale, A. L., & Dissanayake, C. (2022). A conceptual model of risk and protective factors for autistic burnout. Autism Research, 15(6), 976–987. https://doi.org/10.1002/aur.2722

McQuaid, G. A., Lee, N. R., & Wallace, G. L. (2022). Camouflaging in autism spectrum disorder: Examining the roles of sex, gender identity, and diagnostic timing. Autism, 26(2), 552–559. https://doi.org/10.1177/13623613211042131

Milner, V., Mandy, W., Happé, F., & Colvert, E. (2023). Sex differences in predictors and outcomes of camouflaging: Comparing diagnosed autistic, high autistic trait and low autistic trait young adults. Autism, 27(2), 402–414. https://doi.org/10.1177/13623613221098240

Milton, D. E. M. (2012). On the ontological status of autism: The ‘double empathy problem.’ Disability & Society, 27(6), 883–887. https://doi.org/10.1080/09687599.2012.710008

Moore, H. L., Cassidy, S., & Rodgers, J. (2024). Exploring the mediating effect of camouflaging and the moderating effect of autistic identity on the relationship between autistic traits and mental wellbeing. Autism Research, 17(7), 1391–1406. https://doi.org/10.1002/aur.3073

Moyse, R., & Porter, J. (2014). The experience of the hidden curriculum for autistic girls at mainstream primary schools. European Journal of Special Needs Education, 30(2), 187–201. https://doi.org/10.1080/08856257.2014.986915

Pearson, A., & Rose, K. (2021). A conceptual analysis of autistic masking: Understanding the narrative of stigma and the illusion of choice. Autism in Adulthood: Challenges and Management, 3(1), 52–60. https://doi.org/10.1089/aut.2020.0043

Perry, E., Mandy, W., Hull, L., & Cage, E. (2022). Understanding camouflaging as a response to autism-related stigma: A social identity theory approach. Journal of Autism and Developmental Disorders, 52(2), 800–810. https://doi.org/10.1007/s10803-021-04987-w

Pledger, L. M. (1992). Development of self-monitoring behavior from early to late adolescence. Adolescence, 27(106), 329–338.

Pyszkowska, A. (2025). It is more anxiousness than role-playing: Social camouflaging conceptualization among adults on the autism spectrum compared to persons with social anxiety disorder. Journal of Autism and Developmental Disorders, 55, 3154–3166. https://doi.org/10.1007/s10803-024-06416-0

Raymaker, D. M., Teo, A. R., Steckler, N. A., Lentz, B., Scharer, M., Delos Santos, A., Kapp, S. K., Hunter, M., Joyce, A., & Nicolaidis, C. (2020). “Having all of your internal resources exhausted beyond measure and being left with no clean-up crew”: Defining autistic burnout. Autism in Adulthood, 2(2), 132–143. https://doi.org/10.1089/aut.2019.0079

Rim, S. J., Kwak, K., & Park, S. (2023). Risk of psychiatric comorbidity with autism spectrum disorder and its association with diagnosis timing using a nationally representative cohort. Research in Autism Spectrum Disorders, 104, 102134. https://doi.org/10.1016/j.rasd.2023.102134

Simcoe, S. M., Gilmour, J., Garnett, M. S., Attwood, T., Donovan, C., & Kelly, A. B. (2023). Are there gender-based variations in the presentation of autism amongst female and male children? Journal of Autism and Developmental Disorders, 53(9), 3627–3635. https://doi.org/10.1007/s10803-022-05552-9

Schuck, R. K., Flores, R. E., & Fung, L. K. (2019). Brief report: Sex/gender differences in symptomology and camouflaging in adults with autism spectrum disorder. Journal of Autism and Developmental Disorders, 49(6), 2597–2604. https://doi.org/10.1007/s10803-019-03998-y

Tierney, S., Burns, J., & Kilbey, E. (2016). Looking behind the mask: Social coping strategies of girls on the autistic spectrum. Research in Autism Spectrum Disorders, 23, 73–83. https://doi.org/10.1016/j.rasd.2015.11.013

Wood-Downie, H., Wong, B., Kovshoff, H., Mandy, M., Hull, L., Hadwin, J. A. (2021). Sex/gender differences in camouflaging in children and adolescents with autism. Journal of Autism and Developmental Disorders, 51, 1353–1364. https://doi.org/10.1007/s10803-020-04615-z

Vivanti, G. (2020). Ask the editor: What is the most appropriate way to talk about individuals with a diagnosis of autism? Journal of Autism and Developmental Disorders, 50(2), 691–693. https://doi.org/10.1007/s10803-019-04280-x

Zhuang, S., Bougoure, M., Leong, D.-J., Dean, L., Reddrop, S., Naragon-Gainey, K., Maybery, M., Tan, D. W., & Magiati, I. (2024). Examining an integrated path model of psychological and sociocultural predictors of camouflaging in autistic adults. Autism, 13623613241262110. https://doi.org/10.1177/13623613241262110

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Published

2026-04-10

How to Cite

Punt, K., Ames, M., Kim, Y., Klein, J., Krahn, R., Rush, J., … Macoun, S. (2026). Linking Social Camouflaging and Mental Health in Autistic Adolescents: The Role of Stigma  . Canadian Journal of Autism Equity, 6(1), 25–59. https://doi.org/10.15173/cjae.v6i1.6910