Cited by 554Autism Spectrum Disorder ResearchFamily and Disability Support ResearchChild Nutrition and Feeding Issues

The DOI matches its Crossref record; 85 of the 86 references it cites were found in a registry or an index; none of the 127 sources its claims cite is checked for support yet.

Camouflaging in autism: A systematic review

Open access
Cook, Julia, Hull, Laura, Crane, Laura, Mandy, William·2021·Clinical Psychology Review

Abstract

Some autistic people employ strategies and behaviours to cope with the everyday social world, thereby 'camouflaging' their autistic differences and difficulties. This review aimed to systematically appraise and synthesise the current evidence base pertaining to autistic camouflaging. Following a systematic search of eight databases, 29 studies quantifying camouflaging in children and adults with autism diagnoses or high levels of autistic traits were reviewed. The multiple methods used to measure camouflaging broadly fell under two different approaches: internal-external discrepancy or self-report. These approaches appear to relate to two distinct but potentially connected elements of camouflaging: observable behavioural presentations and self-perceived camouflaging efforts. While significant variation was noted across individual study findings, much of the existing literature supported three preliminary findings about the nature of autistic camouflaging: (1) adults with more self-reported autistic traits report greater engagement in camouflaging; (2) sex and gender differences exist in camouflaging; and (3) higher self-reported camouflaging is associated with worse mental health outcomes. However, the research base was limited regarding participant characterisation and representativeness, which suggests that conclusions cannot be applied to the autistic community as a whole. We propose priorities for future research in refining the current understanding of camouflaging and improving measurement methods.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review synthesizes 29 quantitative studies of camouflaging in autistic people and those with high autistic traits. It finds consistent links between self-reported camouflaging and higher autistic traits/diagnosis, female gender, and poorer mental health, but measurement heterogeneity and unrepresentative samples limit firm conclusions.

Key findings

  • Adults with more self-reported autistic traits, and often those with an autism diagnosis, report greater camouflaging; one study suggested the diagnostic association was driven by autistic traits rather than the label itself.
  • Most included studies found autistic females/girls/women camouflaged more than autistic males/boys/men, with no study showing the reverse; evidence on non-binary people was limited, though one study found non-binary autistic people camouflaged at levels similar to autistic women.
  • Eight of ten adult studies supported an association between greater self-reported camouflaging and poorer mental health, including anxiety, depression, psychological distress, suicidality, and lower wellbeing; findings using internal-external discrepancy measures were less consistent.
  • Two broad measurement approaches emerged: self-report methods, which may capture “camouflaging intent,” and internal-external discrepancy methods, which may capture “camouflaging efficacy”; the CAT-Q was used in 13 of 19 self-report studies.

Methods

  • PROSPERO-registered systematic review following PRISMA; databases searched from inception to October 2020, with an updated search in May 2021, plus grey literature and reference checking.
  • From 2160 unique citations and 104 full-text reviews, 29 studies met inclusion criteria: 18 adult studies and 11 child/adolescent studies, totaling 2254 adults and 1077 children/adolescents with autism diagnoses or high autistic traits.
  • Data were extracted and cross-checked by reviewers, study quality was assessed with the Mixed Methods Appraisal Tool, and findings were narratively grouped by five research questions; meta-analysis was not possible due to measurement differences.

Limitations

  • The authors state that the search may not have been exhaustive, that their own involvement in the camouflaging field may have introduced bias, and that the review lacked participatory design and autistic input.
  • The review reports that most studies failed to obtain representative samples (n=23) and many did not describe participant flow (n=17); participant characterization was generally poor, with samples mostly white, university-educated adult females/women diagnosed in adulthood and mostly white male children/adolescents.
  • The text makes evident further constraints: cross-sectional designs prevent causal inference, non-binary samples were underpowered, online questionnaire recruitment likely excluded some autistic people, and the CAT-Q had not been validated for adolescents in several included studies.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.cpr.2021.102080

Cites

85 of 85 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

0 of 127 cited sources checked · 0 supported · 0 flagged

Show all 128 claims

  • Probably not a substantial claim. 56
  • It may state two separate claims as one. 38
  • The quote only partly states this claim. 1
86 of 86

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Citations

Cites

Flagged first, then by citations

Show all 86 references

1 of the 86 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. Gould, 2006, Missed diagnosis or misdiagnosis? Girls and women on the autism spectrum, Good Autism Practice (GAP), 12, 34

Cited by

Sorted by citations

Items 301–400 of 553

Metadata

Authors
Cook, J., Hull, L., Crane, L., & Mandy, W.
Affiliations
University College London (GB)
Corresponding author
Cook, Julia
Venue
Clinical Psychology Review
Publisher
Elsevier BV
Published
2021-11
Volume
89
Pages
102080
ISSN
0272-7358 (ISSN-L)
OpenAlex
W3198172085
Cited by
554
References
86
Citations by year
2026: 157 · 2025: 134 · 2024: 124 · 2023: 82 · 2022: 49 · 2021: 5
FWCI
9.51
Type
journal article
Language
en
Open access
Locations
  • Clinical Psychology Review (publishedVersion)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
  • University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
  • Bristol Research (University of Bristol) (submittedVersion)
  • Explore Bristol Research (submittedVersion)
Funders
University College London
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
  • Social Sciences › Psychology › Clinical Psychology › Family and Disability Support Research
  • Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
Keywords
autism spectrum disorder, autistic traits, coping strategies, sex and gender differences, mental health outcomes, children and adults with autism
MeSH terms
Adaptation, Psychological, Adult, Autistic Disorder, Child, Humans, Sex Factors, Self Report

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

A language model drew the claims from the paper on 2026-10-05, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).

A second model labelled each claim on 2026-10-05 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review