The DOI matches its Crossref record; 78 of the 79 references it cites were found in a registry or an index.
Understanding and recognising the female phenotype of autism spectrum disorder and the “camouflage” hypothesis: a systematic PRISMA review
Open accessAbstract
Purpose: Females with autism spectrum disorder (ASD) may display superficial social skills which may mask their ASD symptomology impacting on the identification of the disorder – known as the “camouflage” hypothesis. Compared to males with ASD, it is increasingly recognised that females with ASD have a stronger ability to imitate behaviour which is socially acceptable, particularly those females who have higher cognitive abilities (i.e. intelligence considered to be within the normal range) (Ehlers and Gillberg, 1993). The paper aims to discuss this issue. Design/methodology/approach: This paper will explore the literature on camouflaging or masking behaviour in females with ASD. A systematic PRISMA review was conducted. Findings: The capacity to “camouflage” social difficulties in social situations is considered to be one of the main features of the female phenotype of ASD (e.g. Kenyon, 2014). Social imitation or camouflaging enables some level of success and coping, which results in some females never receiving a diagnosis of ASD. They typically may not exhibit any observable functional impairments. However, under the surface of the camouflage, females may experience high levels of subjective stress, anxiety and exhaustion and a need to re-charge or recuperate by withdrawing from any social interaction. Research limitations/implications: There is relatively little understanding and knowledge of the female phenotype of ASD. This lack of understanding and knowledge impacts significantly on the ability to identify females with ASD (Lai et al. , 2015; Bargiela et al. , 2016), which can have a number of negative consequence (Adamou et al. , 2018; National Collaborating Centre for Mental Health (UK), 2012). Practical implications: There is a need for the development of a camouflaging measure. Originality/value: There is a real need for further research exploring the positive and negative impact of the phenomenon of “camouflaging”, or “pretending to be normal” in females with ASD.
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“Importantly, however reported co-occurrences are potentially skewed by underdiagnosis of neurodivergence in females.45”
From Variant connective tissue (joint hypermobility) and its relevance to depression and anxiety in adolescents: a cohort-based case–control study (2022) · cites this paper as [45]
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Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & the PRISMA Group* (2009) · Annals of Internal Medicine · doi:10.7326/0003-4819-151-4-200908180-00135 · Cited by 37,554
Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P. A., Clarke, M., Devereaux, P. J., Kleijnen, J., & Moher, D. (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000100 · Cited by 28,164
Diagnostic and Statistical Manual of Mental Disorders
(2012) · Springer eBooks · doi:10.1007/springerreference_121117 · Cited by 20,772
Lord, C., Rutter, M., & Le Couteur, A. (1994) · Journal of Autism and Developmental Disorders · doi:10.1007/bf02172145 · Cited by 9,065
What Is the Male-to-Female Ratio in Autism Spectrum Disorder? A Systematic Review and Meta-Analysis
Loomes, R., Hull, L., & Mandy, W. P. L. (2017) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2017.03.013 · Cited by 2,804
Lord, C., Rutter, M., Goode, S., Heemsbergen, J., Jordan, H., Mawhood, L., & Schopler, E. (1989) · Journal of Autism and Developmental Disorders · doi:10.1007/bf02211841 · Cited by 2,030
Epidemiology of Pervasive Developmental Disorders
Fombonne, E. (2009) · Pediatric Research · doi:10.1203/pdr.0b013e31819e7203 · Cited by 1,971
Prevalence of Autism Spectrum Disorders in a Total Population Sample
Kim, Y. S., Leventhal, B. L., Koh, Y.-J., Fombonne, E., Laska, E., Lim, E.-C., Cheon, K.-A., Kim, S.-J., Kim, Y.-K., Lee, H., et al. (2011) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2011.10101532 · Cited by 1,524
Epidemiological Surveys of Autism and Other Pervasive Developmental Disorders: An Update
Fombonne, E. (2003) · Journal of Autism and Developmental Disorders · doi:10.1023/a:1025054610557 · Cited by 1,505
“Putting on My Best Normal”: Social Camouflaging in Adults with Autism Spectrum Conditions
Hull, L., Petrides, K. V., Allison, C., Smith, P., Baron-Cohen, S., Lai, M.-C., & Mandy, W. (2017) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-017-3166-5 · Cited by 1,365
Research works printed but not linked: 4
- Exploring the female autism phenotype of repetitive behaviours and restricted interests (RBRIs): a literature review
- 2006, Asperger’s and Girls
- 2011, Missed diagnosis or misdiagnosis? Girls and women on the autism spectrum, Good Autism Practice (GAP), 12, 34
- 2015, Pretending to be Normal: Living with Asperger’s Syndrome (Autism Spectrum Disorder)
Cited by
Sorted by citations
Camouflaging in autism: A systematic review
Cook, J., Hull, L., Crane, L., & Mandy, W. (2021) · Clinical Psychology Review · doi:10.1016/j.cpr.2021.102080 · Cited by 554
Cassidy, S., Gould, K., Townsend, E., Pelton, M., Robertson, A., & Rodgers, J. (2019) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-019-04323-3 · Cited by 372
Autism and the double empathy problem: Implications for development and mental health
Mitchell, P., Sheppard, E., & Cassidy, S. (2021) · British Journal of Developmental Psychology · doi:10.1111/bjdp.12350 · Cited by 311
Zawadzka, A., Cieślik, M., & Adamczyk, A. (2021) · International Journal of Molecular Sciences · doi:10.3390/ijms222111516 · Cited by 197
Radulski, E. M. (2022) · Human Development · doi:10.1159/000524122 · Cited by 194
Metadata
- Authors
- Allely, C. S.
- Affiliations
- University of Salford (GB)
- Corresponding author
- Allely, Clare Sarah
- ORCID
- Allely, Clare Sarah
- Venue
- Advances in Autism
- Publisher
- Emerald
- Published
- 2019-03-12
- Volume
- 5
- Issue
- 1
- Pages
- 14-37
- ISSN
- 2056-3868 (ISSN-L)
- OpenAlex
- W2906540201
- Cited by
- 123
- References
- 79
- Citations by year
- 2026: 13 · 2025: 17 · 2024: 20 · 2023: 16 · 2022: 17 · 2021: 25 · 2020: 9 · 2019: 6
- FWCI
- 5.96
- Type
- journal article
- Language
- en
- Open access
- green
- usir.salford.ac.uk
- Licence
- Locations
- Advances in Autism (publishedVersion)
- University of Salford Institutional Repository (University of Salford) (submittedVersion, cc-by)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetics and Neurodevelopmental Disorders
- Keywords
- autism spectrum disorder, female phenotype, camouflaging, social imitation, underdiagnosis, social skills, anxiety, exhaustion, gender differences
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