Quantifying and exploring camouflaging in men and women with autism

Abstract

Autobiographical descriptions and clinician observations suggest that some individuals with autism, particularly females, 'camouflage' their social communication difficulties, which may require considerable cognitive effort and lead to increased stress, anxiety and depression. Using data from 60 age- and IQ-matched men and women with autism (without intellectual disability), we operationalized camouflaging in adults with autism for the first time as the quantitative discrepancy between the person's 'external' behavioural presentation in social-interpersonal contexts (measured by the Autism Diagnostic Observation Schedule) and the person's 'internal' status (dispositional traits measured by the Autism Spectrum Quotient and social cognitive capability measured by the 'Reading the Mind in the Eyes' Test). We found that the operationalized camouflaging measure was not significantly correlated with age or IQ. On average, women with autism had higher camouflaging scores than men with autism (Cohen's d = 0.98), with substantial variability in both groups. Greater camouflaging was associated with more depressive symptoms in men and better signal-detection sensitivity in women with autism. The neuroanatomical association with camouflaging score was largely sex/gender-dependent and significant only in women: from reverse inference, the most correlated cognitive terms were about emotion and memory. The underlying constructs, measurement, mechanisms, consequences and heterogeneity of camouflaging in autism warrant further investigation.

Keywords: adults; autism; brain structure; camouflage; camouflaging; cognition; coping; gender; sex; sex differences.

Figure 1.

Sex/gender differences in camouflaging and its association with depressive symptoms and signal-detection sensitivity: (a) a dot and box-and-whisker plot showing the distribution of camouflaging (quantified by the measure CF) in men and women with autism; (b) CF-BDI score correlations stratified by sex/gender; (c) CF-sensitivity correlations stratified by sex/gender.

Figure 2.

Sagittal slices illustrating grey matter regions showing sex/gender-differential associations between CF and regional volume (in red, involving left medial temporal lobe and cerebellum), overlaid with regions showing negative correlations between CF and regional volume in women with autism (in blue, involving cerebellum, occipital and medial temporal structures); threshold for visualization follows that described in the ‘Methods’ section.

Figure 3.

Word-clouds showing (a) the top 60 terms correlated with brain regions associated with camouflaging in women with autism, based on reverse inference using the Neurosynth Image Decoder, and (b) the top 30 terms after excluding anatomical terms.