Camouflaging, or masking, has become an increasingly prominent concept in autism research and clinical practice. Autistic people describe modifying their behaviour to conceal autistic traits, imitate expected social behaviours, or reduce the likelihood of rejection. While experiences are often linked with exhaustion, anxiety, depression, loss of identity, delayed diagnosis, and autistic burnout, the research evidence is more complicated than the conclusion that “masking harms mental health.” Khudiakova, Alexandrovsky, Ai, and Lai (2025) argue that current research does not yet establish a straightforward causal relationship between camouflaging and poorer wellbeing and enstead they propose understanding autistic camouflaging within the broader concept of impression management, the ways all people regulate how they present themselves according to social circumstances. Their framework shifts attention from asking simply how much someone masks to asking why, where, how, with what effort, and under what social pressures does someone change their presentation. It is suggested that camouflaging should neither be assumed to be inherently pathological nor encouraged unquestioningly as a social skill. Consequences depend on the interaction between the young person, their abilities and motivations, and the environments in which they are expected to function.
What do we mean by camouflaging?
Camouflaging refers to strategies used to minimise the visibility of autistic characteristics in social situations, including rehearsing conversations, imitating other people’s gestures, deliberately maintaining eye contact, suppressing stimming, concealing confusion, or adopting a social persona that feels more acceptable to others. The Camouflaging Autistic Traits Questionnaire (CAT-Q) has become the most widely used self-report measure in this field, and conceptualises camouflaging through three dimensions: compensation, masking, and assimilation (Hull et al., 2019). Compensation involves strategies designed to overcome or work around social-communication difficulties. Masking involves concealing behaviours or characteristics perceived as socially unacceptable. Assimilation reflects attempts to fit in or appear similar to others. These categories have helped establish camouflaging as a measurable research construct, but Khudiakova et al. (2025) argue that the concept is more complicated than a score on a single questionnaire can capture since someone might use the same observable strategy for very different reasons. One person may deliberately adjust their communication style because doing so helps them succeed in a job interview, while another may suppress natural behaviour because previous experiences have taught them that appearing autistic leads to bullying, humiliation, or exclusion. The behaviour may look similar, but the psychological meaning may be completely different.
From masking to impression management
This is where the concept of impression management becomes useful. Impression management refers broadly to attempts to influence how other people perceive us. It is not specific to autism and people routinely adjust language, clothing, facial expression, humour, emotional disclosure, and behaviour according to context. Ai, Cunningham, and Lai (2022) proposed that autistic camouflaging could be understood within this wider human process while recognising that autistic people may experience particularly intense demands to modify themselves in predominantly neurotypical social environments. This framing avoids two problematic extremes: the first is treating camouflaging as a uniquely autistic deficit or behaviour. The second is suggesting that because everybody modifies their behaviour socially, autistic camouflaging is therefore unremarkable. The critical question is the transaction between the person and their environment and how much adaptation is demanded, how difficult is it, how voluntary is it, what happens if the person chooses not to do it, and what psychological resources are required to sustain it. Khudiakova et al. (2025) argue that these questions may explain why camouflaging is beneficial in some circumstances yet extremely costly in others.
Is camouflaging harmful to mental health?
Autistic accounts provide powerful evidence that camouflaging can be distressing. In a study of autistic adults, Bradley et al. (2021) identified experiences including exhaustion, isolation, poorer mental and physical health, loss of identity, and delayed diagnosis. Participants also described positive consequences, including gaining access to social situations and protecting themselves from harm. Similarly, autistic burnout has been described as profound exhaustion and loss of functioning associated with chronic demands and insufficient support (Raymaker et al., 2020). These lived experiences deserve serious clinical attention. However, Khudiakova et al. (2025) emphasise an important distinction: an association between camouflaging and mental health difficulties does not establish that camouflaging causes those difficulties. A systematic review and meta-analysis found that greater camouflaging was associated with more anxiety, depression and social anxiety and with lower mental wellbeing (Khudiakova et al., 2024). Yet the available studies were overwhelmingly cross-sectional, leaving several possibilities open. Camouflaging may contribute to distress. Distressed or socially anxious people may camouflage more. Hostile or stigmatising environments may simultaneously increase both camouflaging and distress. Or these processes may reinforce one another over time. Currently, the evidence cannot fully distinguish between these explanations. That uncertainty is clinically important, since it is suggested to take distress associated with camouflaging without turning a correlation into a direct established causal pathway.
The role of stigma and compelled camouflaging
Pearson and Rose (2021) argued that describing masking as a freely chosen strategy can obscure the social pressures under which many autistic people use it. Avoiding bullying, rejection, discrimination, or being perceived as difficult may leave relatively little meaningful choice. Khudiakova et al. (2025) incorporate this idea into the transactional model. Impression management can sometimes be instrumental: we adapt how we present ourselves because doing so helps us achieve something we value. But it may become psychologically different when adaptation is required simply to remain safe or accepted. Research outside exclusively autistic samples also supports the importance of stigma. Ai et al. (2024) found relationships between internalised stigma, social anxiety, camouflaging/impression management, and mental health in a large general-population sample. The effects also varied according to neurodivergent traits and gender. This suggests that intervention should not focus only on teaching an autistic person to cope better with the demands placed upon them, but sometimes the relevant clinical question is: why does this environment require so much camouflaging in the first place?
Measurement matters
A major argument in Khudiakova et al. (2025) is that current measurement may be too blunt to answer some of the field’s most important questions. The CAT-Q has played a fundamental role in making camouflaging measurable (Hull et al., 2019). But a total camouflaging score does not necessarily tell us:
- why the person is camouflaging;
- whether it is voluntary or compelled;
- how difficult it is;
- how effective the person believes it to be;
- how much cognitive effort it requires;
- in which settings it occurs;
- whether it is experienced as useful, harmful, or both.
Different aspects of camouflaging may have very different relationships with wellbeing. Cultural context presents another challenge. The original CAT-Q structure does not reproduce identically everywhere. In Taiwanese autistic and non-autistic adolescents, for example, Liu et al. (2024) identified a two-factor rather than three-factor structure. This is relevant to clinical work because social expectations themselves are culturally situated and what counts as appropriate eye contact, emotional expression, conversational style, deference, or social competence varies between communities. Camouflaging cannot therefore be understood independently of the environment into which someone is attempting to fit.
What about sex and gender?
Camouflaging has often been discussed as an explanation for why autistic girls and women may be overlooked and there is evidence supporting some sex/gender differences. In an early quantitative study, Lai et al. (2017) found higher average camouflaging in autistic women than autistic men. But the conclusion should not be simplified into “girls mask and boys do not.” There was substantial variation within both groups in that study, and subsequent findings have not produced one consistent sex/gender pattern. Bradley et al. (2021) also documented substantial camouflaging among autistic people across genders. The clinical danger of treating masking as a specifically female presentation is that it can create a new stereotype while attempting to correct an older one. Khudiakova et al. (2025) therefore argue for an intersectional approach in which gender is considered alongside culture, neurodivergent characteristics, cognitive abilities, social position, and context.
Children and adolescents: a major evidence gap
Most camouflaging research has been carried out with adults. We know considerably less about how impression management develops during childhood, how it changes across adolescence, or how young people understand the strategies they use. Liu et al. (2024) provide one useful exception by studying 100 autistic and 105 non-autistic Taiwanese adolescents aged 12–18, they found higher overall camouflaging and assimilation among autistic adolescents. Female autistic adolescents showed higher assimilation than males, but sex differences were not found for compensation-masking. Greater assimilation was also associated with greater perceived stress. These findings demonstrate both the relevance and complexity of camouflaging during adolescence and that social awareness, identity, executive abilities, autonomy, peer relationships, and the demands of school environments all change substantially across development. We need more longitudinal research examining not only whether children camouflage, but how and why impression-management strategies develop over time.
Implications for autism assessment
Camouflaging also complicates diagnostic assessment. Observable social behaviour during one appointment may not fully reflect the effort required to produce it. Someone who appears socially fluent may be relying on rehearsed strategies, intensive monitoring, or learned rules. This does not mean that clinicians should assume hidden autism whenever someone reports masking. Rather, it supports broadening assessment beyond surface behaviour. Clinicians can ask about:
- how social interaction is achieved;
- whether behaviours are consciously rehearsed;
- differences between home, school, and less familiar settings;
- exhaustion following social interaction;
- suppression of natural behaviours;
- the young person’s own internal experience;
- developmental history and observations across multiple contexts.
Camouflaging is therefore best understood as additional clinical information, not as a diagnostic test in itself.
What should clinicians do about masking?
Perhaps most importantly, Khudiakova et al. (2025) do not support a simple message that autistic people should “stop masking.” Camouflaging may sometimes provide real benefits, helping people navigate environments, build relationships, gain employment, protect privacy, or avoid discrimination. Removing a coping strategy without changing the environment that made it necessary could leave someone more vulnerable. The more useful aim is to reduce compelled camouflaging. Clinicians can explore when a young person feels they must conceal themselves, what they fear would happen otherwise, how effortful the strategy is, and whether there are environments in which they feel safer behaving naturally. Intervention can then operate at multiple levels: supporting the young person while also working with families, schools, peer groups, and wider systems to reduce unnecessary pressure to perform neurotypicality. The target is not conformity, nor is it the prohibition of social adaptation.
Conclusion
Khudiakova et al. (2025) challenge an increasingly common but overly simple narrative: autistic people camouflage, camouflaging causes poor mental health, and therefore masking should be stopped. The evidence is not yet that straightforward. Camouflaging is better understood as a form of impression management arising from transactions between the individual and their social environment. Its consequences depend on motivation, cognitive effort, effectiveness, stigma, social context, culture, developmental stage, and the extent to which adapting oneself is chosen or compelled. For clinicians, this leads to a more useful set of questions: not simply ¿Does this young person mask? but: When do they change how they present themselves? Why? How much effort does it take? What happens if they do not? And what could change in their environment so that adaptation becomes more genuinely optional? Those questions move clinical practice beyond identifying the mask and towards understanding the person, the context, and the pressures that made the mask necessary.
Where next?
Join us on 10 November 2026 for a fantastic event on ‘Autism: Camouflaging and Masking (Impression Management) — Evidence and Clinical Implications‘, with Associate Professor Dr. Meng-Chuan Lai.
Explore the latest evidence on camouflaging and masking in autism (also known as Impression Management), including developmental considerations, clinical debates, and implications for assessment and support.
References
- Ai, W., Cunningham, W. A., & Lai, M.-C. (2022). Reconsidering autistic ‘camouflaging’ as transactional impression management. Trends in Cognitive Sciences, 26(8), 631–645. https://doi.org/10.1016/j.tics.2022.05.002
- Ai, W., Cunningham, W. A., & Lai, M.-C. (2024). Camouflaging, internalized stigma, and mental health in the general population. International Journal of Social Psychiatry, 70(7), 1239–1253. https://doi.org/10.1177/00207640241260020
- Bradley, L., Shaw, R., Baron-Cohen, S., & Cassidy, S. (2021). Autistic adults’ experiences of camouflaging and its perceived impact on mental health. Autism in Adulthood, 3(4), 320–329. https://doi.org/10.1089/aut.2020.0071
- Hull, L., Mandy, W., Lai, M.-C., Baron-Cohen, S., Allison, C., Smith, P., & Petrides, K. V. (2019). Development and validation of the Camouflaging Autistic Traits Questionnaire (CAT-Q). Journal of Autism and Developmental Disorders, 49(3), 819–833. https://doi.org/10.1007/s10803-018-3792-6
- Khudiakova, V., Alexandrovsky, M., Ai, W., & Lai, M.-C. (2025). What we know and do not know about camouflaging, impression management, and mental health and wellbeing in autistic people. Autism Research, 18(2), 273–280. https://doi.org/10.1002/aur.3299
- Khudiakova, V., Russell, E., Sowden-Carvalho, S., & Surtees, A. D. R. (2024). A systematic review and meta-analysis of mental health outcomes associated with camouflaging in autistic people. Research in Autism Spectrum Disorders, 118, 102492. https://doi.org/10.1016/j.rasd.2024.102492
- Lai, M.-C., Lombardo, M. V., Ruigrok, A. N. V., Chakrabarti, B., Auyeung, B., Szatmari, P., Happé, F., Baron-Cohen, S., & MRC AIMS Consortium. (2017). Quantifying and exploring camouflaging in men and women with autism. Autism, 21(6), 690–702. https://doi.org/10.1177/1362361316671012
- Liu, C.-H., Chen, Y.-L., Chen, P.-J., Ni, H.-C., & Lai, M.-C. (2024). Exploring camouflaging by the Chinese version Camouflaging Autistic Traits Questionnaire in Taiwanese autistic and non-autistic adolescents: An initial development. Autism, 28(3), 690–704. https://doi.org/10.1177/13623613231181732
- Pearson, A., & Rose, K. (2021). A conceptual analysis of autistic masking: Understanding the narrative of stigma and the illusion of choice. Autism in Adulthood, 3(1), 52–60. https://doi.org/10.1089/aut.2020.0043
- Raymaker, D. M., Teo, A. R., Steckler, N. A., Lentz, B., Scharer, M., Delos Santos, A., Kapp, S. K., Hunter, M., Joyce, A., & Nicolaidis, C. (2020). “Having all of your internal resources exhausted beyond measure and being left with no clean-up crew”: Defining autistic burnout. Autism in Adulthood, 2(2), 132–143. https://doi.org/10.1089/aut.2019.0079