Exploring Camouflaging in Autism Beyond the Diagnostic/Disability Threshold

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Authors
Man, Louisa
Keyword
Autism , Camouflaging , Gender Diversity , Autistic Traits , Healthcare
Abstract
There are different ways to conceptualize autism, which can impact how autistic people navigate the world and are treated by others. It has been conceptualized through a medical model that identifies deficits (Ritvo, 1983) and through a neurodiversity/disability model that depicts autistic traits as natural variations (Den Houting, 2019). Camouflaging, behaviours that adjust for autistic trait, complicate the diagnostic/disability threshold is camouflaging (Hull et al., 2019) and can differentially impact autistic people with marginalized identities (Kalb et al., 2022). In this dissertation, we furthered the understanding of autism and camouflaging by examining a) impacts of gender differences, b) camouflaging-like behaviour beyond the diagnostic/disability threshold, and c) how camouflaging impacted diagnosis, therapy, and accommodations. Study 1 examined whether social desirability is an underlying mechanism for gender differences in autistic camouflaging. We found that camouflaging was distinct from social desirability and only partially accounted for gender differences; gender diverse autistic adults endorsed higher camouflaging than cisgender autistic adults (men or women), suggesting that higher camouflaging in gender diverse autistic adults may be motivated by reducing stigma associated with being gender diverse and autistic. Study 2 examined camouflaging-like behaviour across the autistic trait continuum using the autism quotient and measured cognitive tasks. We found variability in goal-oriented (i.e., more social, more camouflaging) vs. adjustment behaviour (i.e., less neurotypical social cognition, more camouflaging). Whether individuals were self-aware of their social cognitive differences also impacted camouflaging behaviour. Study 3 recruited autistic adults in a mixed methods design to explore the impact of diagnosis, therapy, and accommodations, and their relation to camouflaging. The qualitative study revealed that stigma prevented autistic adults from fully realizing the benefits from their care. We found that higher camouflaging tendencies correlated with a more recent diagnosis and with higher use of emotion regulation psychotherapy, whereas camouflaging tendencies were associated with higher access to social skills groups. Thus, stigma experienced from healthcare and the community was associated with camouflaging as an adjustment behaviour, potentiating long-term ‘autistic burnout’. These studies suggest that to best support autistic adults, systemic change is needed to foster safe spaces for autistic adults to decrease camouflaging (i.e., ‘unmask’).
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