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Autistic masking

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Autistic masking, also referred to as camouflaging, is the conscious or subconscious suppression of autistic behaviors and the compensation of difficulties in social interaction by autistic people with the goal of being perceived as neurotypical.[1][2] Autistic masking is a learned coping strategy[3][4] that can be successful from the perspective of the autistic person, but can also lead to adverse mental health outcomes.[1][5]

There is no universally agreed-upon terminology for the concept.[1][6][5] While some use the terms masking and camouflaging synonymously,[1][2][5] others distinguish between masking (the suppression of behaviors) and compensation (of social difficulties) as the two main forms of camouflaging.[1][3][7]

Typical examples of autistic masking include the suppression of stimming and meltdowns, a common reaction to sensory overload.[3] To compensate difficulties in social interaction with neurotypical peers, autistic people might maintain eye contact despite discomfort, use rehearsed conversational scripts, or mirror the body language and tone of others.[1][2][3][8]

Masking requires an exceptional effort.[3][9][10][11] Most studies found that camouflaging is linked with adverse mental health outcomes such as stress[12], burnout[2][13], anxiety, depression, and other psychological disorders[12], loss of identity[12], and suicidality.[2][12][14][15][16] Some studies found that some autistic people perceive compensation strategies as sometimes contributing to leading a successful life despite mental health costs sometimes.[17][18][10] Since many studies on masking focus on autistic adults without cognitive impairments only, it is questionable whether their findings generalize across the autism spectrum.[1]

Masking may conceal the person's need for support.[19] It has been hypothesized that masking may play an important role in explaining why autistic women and non-binary persons[20] are significantly less often recognized and diagnosed as autistic compared to men.[20][21][8][9] This hypothesis was put forward by Lorna Wing as early as 1981.[5]: 20 [22]

Camouflaging research in autism has grown from a rarely investigated topic before 2016 to a highly influential research topic within the fields of autism and neurodiversity, and has potential to substantially change the diagnosis processes and intervention goals (e.g., minimizing risks of promoting masking, addressing excessive masking, emphasis on well-being but not social normalization, recognizing purposes of some autistic traits and behaviors, recognizing and detecting masking during diagnosis processes, etc.).[23] Therapies that may reinforce autistic people to mask, such as some forms of applied behavior analysis, are controversial.[24] Because of such research findings and similarities with implicit or explicit targets of some behavioral interventions,[25][26] there have been reforms of some interventions in recent years to minimize risks of promoting excessive camouflaging.[23][27]

Some autistic people have been described as being able to "mask" or "camouflage" their signs of autism in order to meet social expectations. This may involve suppressing self-calming repetitive movements, faking a smile in an environment that they find uncomfortable or distressing, consciously evaluating their own behavior and mirroring others, or choosing not to talk about their special interests. Autistic people with conversational difficulties may also use more complex strategies such as scripting a conversation outline and developing conscious 'rules' for conversations, and carefully monitoring if these are being followed.[3] Autistic people often learn conversational rules, social behaviors, and masking techniques by watching television shows and other media, often learning how to mimic a character's behavior.[28] As masking is often a conscious effort, it can be exhausting for autistic people to mask for an extended period of time. Autistic people have cited social acceptance, the need to get a job, avoiding ostracism, or avoiding verbal or physical abuse as reasons for masking.[19]

References

  1. ^ a b c d e f g Petrolini, Valentina; Rodríguez-Armendariz, Ekaine; Vicente, Agustín (2023-01-01). "Autistic camouflaging across the spectrum". New Ideas in Psychology. 68: 100992. doi:10.1016/j.newideapsych.2022.100992. ISSN 0732-118X.
  2. ^ a b c d e Pearson, Amy; Rose, Kieran (2021-03-01). "A Conceptual Analysis of Autistic Masking: Understanding the Narrative of Stigma and the Illusion of Choice". Autism in Adulthood. 3 (1): 52–60. doi:10.1089/aut.2020.0043. ISSN 2573-9581. PMC 8992880. PMID 36601266.
  3. ^ a b c d e f Hull, Laura; Petrides, K. V.; Allison, Carrie; Smith, Paula; Baron-Cohen, Simon; Lai, Meng-Chuan; Mandy, William (2017-08-01). ""Putting on My Best Normal": Social Camouflaging in Adults with Autism Spectrum Conditions". Journal of Autism and Developmental Disorders. 47 (8): 2519–2534. doi:10.1007/s10803-017-3166-5. ISSN 1573-3432. PMC 5509825. PMID 28527095.
  4. ^ Lawson, Wenn B. (2020-09-14). "Adaptive Morphing and Coping with Social Threat in Autism: An Autistic Perspective". Journal of Intellectual Disability - Diagnosis and Treatment. 8 (3): 519–526. doi:10.6000/2292-2598.2020.08.03.29. ISSN 2292-2598.
  5. ^ a b c d Sedgewick, Felicity; Hull, Laura; Ellis, Helen (2022). Autism and masking : how and why people do It, and the impact it can have. London: Jessica Kingsley Publishers. ISBN 1-78775-580-0. OCLC 1287133295.
  6. ^ Cook, Julia; Hull, Laura; Crane, Laura; Mandy, William (2021-11-01). "Camouflaging in autism: A systematic review". Clinical Psychology Review. 89: 102080. doi:10.1016/j.cpr.2021.102080. ISSN 0272-7358.
  7. ^ Livingston, Lucy Anne; Shah, Punit; Happé, Francesca (2019). "Compensatory strategies below the behavioural surface in autism: a qualitative study". The Lancet Psychiatry. 6 (9): 766–777. doi:10.1016/s2215-0366(19)30224-x. ISSN 2215-0366. PMC 6706698. PMID 31350208.
  8. ^ a b Hull, Laura; Petrides, K. V.; Mandy, William (2020-12-01). "The Female Autism Phenotype and Camouflaging: a Narrative Review". Review Journal of Autism and Developmental Disorders. 7 (4): 306–317. doi:10.1007/s40489-020-00197-9. ISSN 2195-7185.
  9. ^ a b "6A02 Autism spectrum disorder". ICD-11 for Mortality and Morbidity Statistics. Retrieved 2023-05-05. Some individuals with Autism Spectrum Disorder are capable of functioning adequately by making an exceptional effort to compensate for their symptoms during childhood, adolescence or adulthood. Such sustained effort, which may be more typical of affected females, can have a deleterious impact on mental health and well-being.
  10. ^ a b Miller, Danielle; Rees, Jon; Pearson, Amy (2021-12-01). ""Masking Is Life": Experiences of Masking in Autistic and Nonautistic Adults". Autism in Adulthood. 3 (4): 330–338. doi:10.1089/aut.2020.0083. ISSN 2573-9581. PMC 8992921. PMID 36601640.
  11. ^ Russo, Francine (21 February 2018). "The Costs of Camouflaging Autism". Spectrum News.
  12. ^ a b c d Radulski, Elizabeth M. (2022-03-21). "Conceptualising Autistic Masking, Camouflaging, and Neurotypical Privilege: Towards a Minority Group Model of Neurodiversity". Human Development. 66 (2): 113–127. doi:10.1159/000524122. ISSN 0018-716X.
  13. ^ Shaw, Sebastian C. K.; Doherty, Mary; McCowan, Sue; Eccles, Jessica A. (2022-07-11). "Towards a Neurodiversity-Affirmative Approach for an Over-Represented and Under-Recognised Population: Autistic Adults in Outpatient Psychiatry". Journal of Autism and Developmental Disorders. 52 (9): 4200–4201. doi:10.1007/s10803-022-05670-4. ISSN 0162-3257.
  14. ^ Cassidy, Sarah; Bradley, Louise; Shaw, Rebecca; Baron-Cohen, Simon (2018-07-31). "Risk markers for suicidality in autistic adults". Molecular Autism. 9 (1): 42. doi:10.1186/s13229-018-0226-4. ISSN 2040-2392. PMC 6069847. PMID 30083306.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  15. ^ Cassidy, S. A.; Gould, K.; Townsend, E.; Pelton, M.; Robertson, A. E.; Rodgers, J. (2020-10-01). "Is Camouflaging Autistic Traits Associated with Suicidal Thoughts and Behaviours? Expanding the Interpersonal Psychological Theory of Suicide in an Undergraduate Student Sample". Journal of Autism and Developmental Disorders. 50 (10): 3638–3648. doi:10.1007/s10803-019-04323-3. ISSN 1573-3432. PMC 7502035. PMID 31820344.
  16. ^ Cage, Eilidh (2017). "Experiences of Autism Acceptance and Mental Health in Autistic Adults". Journal of Autism and Developmental Disorders. 49 (2): 473–484. doi:10.1007/s10803-017-3342-7. PMC 5807490. PMID 29071566.
  17. ^ Petrolini, Valentina; Rodríguez-Armendariz, Ekaine; Vicente, Agustín (2023-01-01). "Autistic camouflaging across the spectrum". New Ideas in Psychology. 68: 100992. doi:10.1016/j.newideapsych.2022.100992. ISSN 0732-118X.
  18. ^ Livingston, Lucy Anne; Shah, Punit; Happé, Francesca (2019). "Compensatory strategies below the behavioural surface in autism: a qualitative study". The Lancet Psychiatry. 6 (9): 766–777. doi:10.1016/s2215-0366(19)30224-x. ISSN 2215-0366. PMC 6706698. PMID 31350208.
  19. ^ a b Haelle, Tara (2018). "The Consequences of Compensation in Autism". Neurology Advisor.
  20. ^ a b Pearson, Amy; Rose, Kieran (2021-03-01). "A Conceptual Analysis of Autistic Masking: Understanding the Narrative of Stigma and the Illusion of Choice". Autism in Adulthood. 3 (1): 52–60. doi:10.1089/aut.2020.0043. ISSN 2573-9581. PMC 8992880. PMID 36601266.
  21. ^ Hull, Laura; Petrides, K. V.; Allison, Carrie; Smith, Paula; Baron-Cohen, Simon; Lai, Meng-Chuan; Mandy, William (2017-08-01). ""Putting on My Best Normal": Social Camouflaging in Adults with Autism Spectrum Conditions". Journal of Autism and Developmental Disorders. 47 (8): 2519–2534. doi:10.1007/s10803-017-3166-5. ISSN 1573-3432. PMC 5509825. PMID 28527095.
  22. ^ Wing, Lorna (1981). "Sex ratios in early childhood autism and related conditions". Psychiatry Research. 5 (2): 129–137. doi:10.1016/0165-1781(81)90043-3.
  23. ^ a b Schuck, Rachel K.; Tagavi, Daina M.; Baiden, Kaitlynn M. P.; Dwyer, Patrick; Williams, Zachary J.; Osuna, Anthony; Ferguson, Emily F.; Jimenez Muñoz, Maria; Poyser, Samantha K.; Johnson, Joy F.; Vernon, Ty W. (2022-10-01). "Neurodiversity and Autism Intervention: Reconciling Perspectives Through a Naturalistic Developmental Behavioral Intervention Framework". Journal of Autism and Developmental Disorders. 52 (10): 4625–4645. doi:10.1007/s10803-021-05316-x. ISSN 1573-3432. PMC 9508016. PMID 34643863.
  24. ^ DeVita-Raeburn, Elizabeth (August 11, 2016). "Is the Most Common Therapy for Autism Cruel?". The Atlantic.
  25. ^ McGill, Owen; Robinson, Anna (2021-10-26). ""Recalling hidden harms": autistic experiences of childhood applied behavioural analysis (ABA)". Advances in Autism. 7 (4): 269–282. doi:10.1108/AIA-04-2020-0025. ISSN 2056-3868.
  26. ^ Anderson, Laura K (2022). "Autistic experiences of applied behavior analysis". Autism. 27 (3): 737–750. doi:10.1177/13623613221118216. ISSN 1362-3613.
  27. ^ Dawson, Geraldine; Franz, Lauren; Brandsen, S. (2022-09-01). "At a Crossroads—Reconsidering the Goals of Autism Early Behavioral Intervention From a Neurodiversity Perspective". JAMA Pediatrics. 176 (9): 839. doi:10.1001/jamapediatrics.2022.2299. ISSN 2168-6203. PMC 10069446. PMID 35816341.
  28. ^ Hull, Laura; Petrides, K. V.; Mandy, William (2020). "The Female Autism Phenotype and Camouflaging: A Narrative Review". Review Journal of Autism and Developmental Disorders. 7 (4): 306–317. doi:10.1007/s40489-020-00197-9. S2CID 214314845.

Further reading

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