A Systematic Review of Passing as Non-autistic in Autism Spectrum Disorder
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Abstract
While long described in anecdotal accounts of the lived experiences of autistic individuals, the phenomenon of behaving in ways that appear inconsistent with the presence of autism (or passing as non-autistic; PAN) has recently seen a dramatic increase in scrutiny in the published scientific literature. Increased research attention has coincided with a proliferation of methods, definitions, measures, and population assumptions associated with PAN. To date, however, no review has sought to systematically identify and synthesize the literature on PAN. This systematic review reflects the state of the PAN literature as of May 2020. Ninety articles were screened, 66 were identified for evaluation, and 46 met inclusion criteria and were reliably coded for study characteristics and participant characteristics. Results reveal that the PAN literature includes a relatively even mix of qualitative, quantitative, and mixed-method studies, and that a variety of terms are used for PAN (with masking and camouflage being the most frequent). Sample sizes varied widely (from one to 832 participants), with 63.06% of participants being categorized as autistic. Nearly all studies reported methods for confirming autism diagnoses, with community and clinical diagnoses being most common. The majority of studies reported participant gender, with slightly more females included than males on average, but fewer than half of all studies compared PAN across genders. Nearly all studies reported participant age, demonstrating a wide range of 2 to 79 years, with a mean age of 23.85. Conversely, only 23.91% of studies provided participant race or ethnicity data. Nearly all studies formally or informally excluded participants with intellectual disability. Finally, measures of internalizing symptoms, which are often thought to be linked to PAN, were reported in only 17.4% of studies. Implications for gaps in understanding of PAN and future directions for the field are discussed.
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Discussions about the validity and conceptual clarity of the so-called female autism phenotype, camouflaging and the female protective effect are ongoing.
“Discussions about the validity and conceptual clarity of the so-called female (autism) phenotype106,309,310, camouflaging109,311–315 and female protective effect226,316 are ongoing.”
From Sex and gender in neurodevelopmental conditions (2023) · cites this paper as [313]
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References 132 · Cited by 68
- Authors
- Libsack, E. J., Keenan, E. G., Freden, C. E., Mirmina, J., Iskhakov, N., Krishnathasan, D., & Lerner, M. D.
- Affiliations
- Stony Brook University (US)
- University of California, Los Angeles (US)
- Corresponding author
- Libsack, Erin J.
- Lerner, Matthew D.
- Venue
- Clinical Child and Family Psychology Review
- Published
- 2021-09-09
- Volume
- 24
- Issue
- 4
- Pages
- 783-812
- ISSN
- 1096-4037 (ISSN-L)
- 1573-2827
- PMC
- PMC10613328
- OpenAlex
- W3198707363
- Cited by
- 68
- References
- 132
- Citations by year
- 2026: 12 · 2025: 14 · 2024: 17 · 2023: 14 · 2022: 9 · 2021: 1 · 2013: 1
- FWCI
- 1.51
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Locations
- Clinical Child and Family Psychology Review (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- OSF Preprints (OSF Preprints) (submittedVersion, cc-by)
- OSF Preprints (OSF Preprints) (submittedVersion)
- Funders
- National Institute of Mental Health (1R01MH110585)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
- Keywords
- autism spectrum disorder, masking, camouflage, autistic identity, autism diagnosis, internalizing problems, gender differences, race and ethnicity, lived experience
- MeSH terms
- Autism Spectrum Disorder, Adolescent, Adult, Aged, Autistic Disorder, Child, Child, Preschool, Female, Humans, Male, Middle Aged, Young Adult
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