Development and validation of the camouflaging autistic traits questionnaire (CAT-Q)
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There currently exist no self-report measures of social camouflaging behaviours (strategies used to compensate for or mask autistic characteristics during social interactions). The Camouflaging Autistic Traits Questionnaire (CAT-Q) was developed from autistic adults' experiences of camouflaging, and was administered online to 354 autistic and 478 non-autistic adults. Exploratory factor analysis suggested three factors, comprising of 25 items in total. Good model fit was demonstrated through confirmatory factor analysis, with measurement invariance analyses demonstrating equivalent factor structures across gender and diagnostic group. Internal consistency (α = 0.94) and preliminary test-retest reliability (r = 0.77) were acceptable. Convergent validity was demonstrated through comparison with measures of autistic traits, wellbeing, anxiety, and depression. The present study provides robust psychometric support for the CAT-Q.
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Researchers have begun to study how autistic women (not excluding men) modify their behaviour to fit in and pass as 'neurotypical' through camouflaging and compensation (Hull et al, 2019; Livingston & Happé, 2017).
“Regarding autistic females, researchers have begun to study how autistic women (not excluding men) modify their behaviour to fit in and pass as 'neurotypical' through camouflaging and compensation (Hull et al, 2019; Livingston & Happé, 2017).”
From Annual Research Review: Looking back to look forward – changes in the concept of autism and implications for future research (2020) · cites this paper as Hull et al, 2019
Camouflaging encompasses hiding autistic characteristics (masking) and employing strategies to overcome autistic cognitive difficulties/differences (compensation).
“camouflaging encompasses the complementary elements of hiding autistic characteristics (‘masking’; Hull et al., 2019) and employing strategies to overcome autistic cognitive difficulties/differences (‘compensation’; Livingston & Happé, 2017).”
From Camouflaging in an everyday social context: An interpersonal recall study (2021) · cites this paper as Hull et al., 2019
Nine adult studies and four child/adolescent studies used the Camouflaging Autistic Traits Questionnaire (CAT-Q).
“Nine adult studies and four child/adolescent studies used the Camouflaging Autistic Traits Questionnaire (CAT-Q; Hull et al., 2019).”
From Camouflaging in autism: A systematic review (2021) · cites this paper as Hull et al., 2019
Formally diagnosed autistic individuals scored higher than non-autistic individuals on the CAT-Q Total and subscale scores.
“In a large sample of adults, formally diagnosed autistic individuals scored higher than nonautistic individuals on the CAT-Q Total and subscale scores (Hull et al., 2019).”
From Camouflaging in autism: A systematic review (2021) · cites this paper as Hull et al., 2019
Greater self-reported camouflaging is associated with decreased well-being, though one study did not find this.
“decreased well-being (Hull et al., 2019; although see Perry et al., 2021).”
From Camouflaging in autism: A systematic review (2021) · cites this paper as Hull et al., 2019
Greater self-reported camouflaging is associated with increased social anxiety, general anxiety, and depressive symptoms.
“increased social anxiety, general anxiety, and depressive symptoms (Hull et al., 2019;Hull, Levy, et al., 2021)”
From Camouflaging in autism: A systematic review (2021) · cites this paper as Hull et al., 2019
Self-report approaches measure self-perceived engagement in camouflaging independently of observable behavioural presentation.
“self-report approaches measure selfperceived engagement in camouflaging independent of observable behavioural presentation (Hull et al., 2019).”
From Camouflaging in autism: A systematic review (2021) · cites this paper as Hull et al., 2019
The CAT-Q showed potential as a measure of self-perceived camouflaging, with sound internal consistency and test-retest reliability and generally expected relations with gender, autistic traits, and mental health and wellbeing.
“the CAT-Q showed potential as measure of self-perceived camouflaging, demonstrating sound internal consistency and test-retest reliability and performing generally as expected when tested in relation to gender, autistic traits, and mental health and wellbeing”
From Camouflaging in autism: A systematic review (2021) · cites this paper as Hull et al., 2019
The CAT-Q is a camouflaging measure validated in a large sample of autistic and non-autistic adults.
“a camouflaging measure validated in a large sample of autistic and non-autistic adults (Hull et al., 2019;Williams, 2021).”
From Camouflaging in autism: A systematic review (2021) · cites this paper as Hull et al., 2019
Emerging evidence suggests that adults with higher self-reported autistic traits report greater camouflaging efforts.
“emerging evidence suggests that adults with higher self-reported autistic traits report greater camouflaging efforts (Brown et al., 2020;Hull et al., 2019;Livingston et al., 2020).”
From Camouflaging in autism: A systematic review (2021) · cites this paper as Hull et al., 2019
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“You Must Become a Chameleon to Survive”: Adolescent Experiences of Camouflaging
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Cognitive Predictors of Self‐Reported Camouflaging in Autistic Adolescents
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Self-citationAutism and autistic traits in those who died by suicide in England
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Gender differences in mental health prevalence in autism
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Sex Differences in Autism Spectrum Disorder: Focus on High Functioning Children and Adolescents
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Camouflaging in an everyday social context: An interpersonal recall study
Cook, J., Crane, L., Bourne, L., Hull, L., & Mandy, W. (2021) · Autism · doi:10.1177/1362361321992641 · Cited by 78 · see citing works
Self-citationJorgenson, C. D., Lewis, T., Rose, C. A., & Kanne, S. M. (2020) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-020-04491-7 · Cited by 78 · see citing works
Commentary: ‘Camouflaging’ in autistic people – reflection on Fombonne (2020)
Lai, M., Hull, L., Mandy, W., Chakrabarti, B., Nordahl, C. W., Lombardo, M. V., Ameis, S. H., Szatmári, P., Baron‐Cohen, S., Happe, F. G. E., et al. (2020) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13344 · Cited by 78 · see citing works
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Milner, V. L., Mohamed, L., & Happe, F. G. E. (2025) · Neurodiversity · doi:10.1177/27546330251326056 · Cited by 75 · see citing works
Understanding the Relationships Between Autistic Identity, Disclosure, and Camouflaging
Cage, E., & Troxell-Whitman, Z. (2020) · Autism in Adulthood · doi:10.1089/aut.2020.0016 · Cited by 60 · see citing works
Lei, J., Jones, L., & Brosnan, M. (2021) · Autism · doi:10.1177/1362361320987963 · Cited by 72 · see citing works
Big five model and trait emotional intelligence in camouflaging behaviours in autism
Robinson, E., Hull, L., & Petrides, K. V. (2020) · Personality and Individual Differences · doi:10.1016/j.paid.2019.109565 · Cited by 70 · see citing works
Self-citationA Systematic Review of Passing as Non-autistic in Autism Spectrum Disorder
Libsack, E. J., Keenan, E. G., Freden, C. E., Mirmina, J., Iskhakov, N., Krishnathasan, D., & Lerner, M. D. (2021) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-021-00365-1 · Cited by 68 · see citing works
Milner, V. L., Mandy, W., Happe, F. G. E., & Colvert, E. (2022) · Autism · doi:10.1177/13623613221098240 · Cited by 68 · see citing works
Self-citationThe relationship between camouflaging and mental health in autistic children and adolescents
Ross, A., Grove, R., & McAloon, J. (2022) · Autism Research · doi:10.1002/aur.2859 · Cited by 66 · see citing works
Camouflaging in Autistic and Non-autistic Adolescents in the Modern Context of Social Media
Jedrzejewska, A., & Dewey, J. (2021) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-021-04953-6 · Cited by 52 · see citing works
Doyle, N., McDowall, A., & Waseem, U. (2022) · Autism in Adulthood · doi:10.1089/aut.2021.0082 · Cited by 64 · see citing works
Williams, Z. J. (2022) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13468 · Cited by 59 · see citing works
A comparison of methods for measuring camouflaging in autism
Hannon, B., Mandy, W., & Hull, L. (2022) · Autism Research · doi:10.1002/aur.2850 · Cited by 56 · see citing works
Self-citationThe longitudinal heterogeneity of autistic traits: A systematic review
Pender, R., Fearon, P., Heron, J., & Mandy, W. (2020) · Research in Autism Spectrum Disorders · doi:10.1016/j.rasd.2020.101671 · Cited by 55 · see citing works
Self-citationAutistic adults’ experience of restricted repetitive behaviours
Collis, E., Gavin, J., Russell, A., & Brosnan, M. (2022) · Research in Autism Spectrum Disorders · doi:10.1016/j.rasd.2021.101895 · Cited by 54 · see citing works
Friend matters: sex differences in social language during autism diagnostic interviews
Cola, M., Yankowitz, L. D., Tena, K. G., Russell, A. R. B., Bateman, L., Knox, A., Plate, S. N., Cubit, L. S., Zampella, C., Pandey, J., et al. (2022) · Molecular Autism · doi:10.1186/s13229-021-00483-1 · Cited by 65 · see citing works
Dell’Osso, L., Cremone, I. M., Amatori, G., Cappelli, A., Cuomo, A., Barlati, S., Massimetti, G., Vita, A., Fagiolini, A. M., Carmassi, C., et al. (2021) · Brain Sciences · doi:10.3390/brainsci11050621 · Cited by 54 · see citing works
Centering the Inner Experience of Autism: Development of the Self-Assessment of Autistic Traits
Ratto, A. B., Bascom, J., daVanport, S., Strang, J. F., Anthony, L. G., Verbalis, A. D., Pugliese, C. E., Nadwodny, N., Brown, L. X. Z., Cruz, M., et al. (2022) · Autism in Adulthood · doi:10.1089/aut.2021.0099 · Cited by 54 · see citing works
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When Disability Is Defined by Behavior, Outcome Measures Should Not Promote “Passing”
(2021) · AMA Journal of Ethics · doi:10.1001/amajethics.2021.569 · Cited by 56 · see citing works
Towards the measurement of autistic burnout
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Improving Diagnostic Procedures in Autism for Girls and Women: A Narrative Review
Cook, J. M., Hull, L., & Mandy, W. (2024) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s372723 · Cited by 47 · see citing works
Self-citationA Review of Research Studying Film and Television Representations of ASD
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Neurodiversity-Affirming Applied Behavior Analysis
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Field, S. L., Williams, M. O., Jones, C. R. G., & Fox, J. R. E. (2024) · Autism · doi:10.1177/13623613231223036 · Cited by 45 · see citing works
“The Camouflaging Autistic Traits Questionnaire (CAT-Q; Hull, Mandy, et al., 2019) has been used to research the association between self-reported engagement with cam-ouflaging and a variety of factors, including gender (Hull, Lai, et al., 2019) and personality (Robinson et al., 2020).”
MethodMeasuring Social Camouflaging in Individuals with High Functioning Autism: A Literature Review
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Camouflaging: psychopathological meanings and clinical relevance in autism spectrum conditions
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Camouflaging Intent, First Impressions, and Age of ASC Diagnosis in Autistic Men and Women
Belcher, H., Morein‐Zamir, S., Mandy, W., & Ford, R. M. (2021) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-021-05221-3 · Cited by 46 · see citing works
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They have a Voice; are we Listening?
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Autistic camouflaging across the spectrum
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Oshima, F., Takahashi, T., Tamura, M., Guan, S., Seto, M., Hull, L., Mandy, W., Tsuchiya, K. J., & Shimizu, E. (2024) · Molecular Autism · doi:10.1186/s13229-023-00579-w · Cited by 41 · see citing works
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Understanding camouflaging and identity in autistic children and adolescents using photo-elicitation
Howe, S. J., Hull, L., Sedgewick, F., Hannon, B., & McMorris, C. A. (2023) · Research in Autism · doi:10.1016/j.rasd.2023.102232 · Cited by 39 · see citing works
Self-citationInformation transfer within and between autistic and non-autistic people
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Self-citationDoes camouflaging predict age at autism diagnosis? A comparison of autistic men and women
Milner, V. L., Colvert, E., Hull, L., Cook, J. M., Ali, D., Mandy, W., & Happe, F. G. E. (2023) · Autism Research · doi:10.1002/aur.3059 · Cited by 44 · see citing works
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A systematic review of social camouflaging in autistic adults and youth: Implications and theory
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Self-citationQuantity and quality of empathic responding by autistic and non-autistic adolescent girls and boys
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- Authors
- Hull, L., Mandy, W., Lai, M.-C., Baron-Cohen, S., Allison, C., Smith, P., & Petrides, K. V.
- Affiliations
- University College London (GB)
- Centre for Addiction and Mental Health (CA)
- University of Cambridge (GB)
- Corresponding author
- Hull, Laura
- Venue
- Journal of Autism and Developmental Disorders
- Published
- 2018-10-25
- Volume
- 49
- Issue
- 3
- Pages
- 819-833
- ISSN
- 0162-3257 (ISSN-L)
- 1573-3432
- PMC
- PMC6394586
- OpenAlex
- W2898221520
- Cited by
- 496
- References
- 51
- Citations by year
- 2026: 99 · 2025: 102 · 2024: 89 · 2023: 70 · 2022: 42 · 2021: 56 · 2020: 25 · 2019: 12 · 2018: 1
- FWCI
- 14.00
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Autism and Developmental Disorders (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Explore Bristol Research (submittedVersion)
- Apollo (University of Cambridge) (submittedVersion, cc-by)
- Apollo (cc-by)
- Funders
- Wellcome Trust (091774, 091774/Z/10/Z)
- Centre for Addiction and Mental Health
- National Institute for Health and Care Research (NF-SI-0515-10097)
- University of Toronto
- Hospital for Sick Children
- Medical Research Council
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- social camouflaging, autistic traits, self-report questionnaire development, psychometric validation, autistic adults, masking, well-being, anxiety, depression
- MeSH terms
- Autism Spectrum Disorder, Adolescent, Adult, Aged, Anxiety Disorders, Depressive Disorder, Factor Analysis, Statistical, Female, Humans, Interpersonal Relations, Male, Middle Aged, Psychometrics, Surveys and Questionnaires, Social Behavior, Reproducibility of Results, Young Adult, Self Report
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