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Development and Validation of the Camouflaging Autistic Traits Questionnaire (CAT-Q)
Open accessAbstract
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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“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
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In the citing paper
“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
In the citing paper
“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
In the citing paper
“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
In the citing paper
“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
In the citing paper
“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
In the citing paper
“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
In the citing paper
“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
In the citing paper
“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
In the citing paper
“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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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 44
Self-citationRemnélius, K. L., & Bölte, S. (2023) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-023-05909-8 · Cited by 48
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 45
Self-citationInformation transfer within and between autistic and non-autistic people
Crompton, C. J., Foster, S. J., Wilks, C. E. H., Dodd, M., Efthimiou, T. N., Ropar, D., Sasson, N. J., Lages, M., & Fletcher‐Watson, S. (2025) · Nature Human Behaviour · doi:10.1038/s41562-025-02163-z · Cited by 45
El Baou, C., Bell, G., Saunders, R., Buckman, J. E. J., Mandy, W., Dagnan, D., O'Nions, E., Pender, R., Clements, H., Pilling, S., et al. (2023) · The Lancet Psychiatry · doi:10.1016/s2215-0366(23)00291-2 · Cited by 37
“GAD7 and WSAS were previously used in autistic populations, 26,27 but their psychometric properties have not been fully validated in this population, and the extent of their validity in representative autistic cohorts is unknown.”
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
Self-citationCamouflaging, internalized stigma, and mental health in the general population
Ai, W., Cunningham, W. A., & Lai, M. (2024) · International Journal of Social Psychiatry · doi:10.1177/00207640241260020 · Cited by 36
Self-citationKhudiakova, V., Russell, E., Sowden, S., & Surtees, A. D. R. (2024) · Research in Autism · doi:10.1016/j.rasd.2024.102492 · Cited by 44
Lei, J., Lecarie, E. K., Jurayj, J., Boland, S. M., Sukhodolsky, D. G., Ventola, P. E., Pelphrey, K. A., & Jou, R. J. (2019) · Autism Research · doi:10.1002/aur.2180 · Cited by 36
Banker, S. M., Harrington, M., Schafer, M., Na, S., Heflin, M., Barkley, S., Trayvick, J., Peters, A. W., Thinakaran, A. A., Schiller, D., et al. (2025) · Nature Mental Health · doi:10.1038/s44220-025-00385-8 · Cited by 36
A systematic review of social camouflaging in autistic adults and youth: Implications and theory
Klein, J. L., Krahn, R., Howe, S. J., Lewis, J., McMorris, C. A., & Macoun, S. J. (2024) · Development and Psychopathology · doi:10.1017/s0954579424001159 · Cited by 40
Khudiakova, V., Alexandrovsky, M., Ai, W., & Lai, M.-C. (2024) · Autism Research · doi:10.1002/aur.3299 · Cited by 34
Self-citationQuantity and quality of empathic responding by autistic and non-autistic adolescent girls and boys
Rieffe, C. J., O’Connor, R., Bülow, A., Willems, D., Hull, L., Sedgewick, F., Stockmann, L., & Blijd-Hoogewys, E. M. A. (2020) · Autism · doi:10.1177/1362361320956422 · Cited by 33
Self-citationRethinking psychological interventions in autism: Toward a neurodiversity‐affirming approach.
Graf‐Kurtulus, S., & Gelo, O. C. G. (2025) · Counselling and Psychotherapy Research · doi:10.1002/capr.12874 · Cited by 34
Metadata
- 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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