The Use and Misuse of the Camouflaging Autistic Traits Questionnaire in Autism Research and Clinical Practice: Issues,Considerations,and Suggestions

Abstract

In this Perspective, we summarize the evidence to date around the use of the Camouflaging Autistic Traits Questionnaire (CAT-Q) as a tool in research and clinical settings, and offer suggestions for its future use. We highlight that the CAT-Q is a useful measure of camouflaging/masking for research purposes, although questions remain regarding sociocultural variation in camouflaging experiences, and its specificity regarding autistic camouflaging compared with impression management more generally. With respect to clinical practice, we note that very little research has examined the use of the CAT-Q in clinical settings to date, and we encourage clinicians to be mindful of this limited evidence base and to refrain from using CAT-Q scores in diagnostic decision-making or as an intervention monitoring/outcome tool.

Community Brief

Why is this topic important?

Camouflaging or masking has received a lot of interest from autistic people, researchers, and clinicians, and the Camouflaging Autistic Traits Questionnaire (CAT-Q) is one of the most common ways to measure camouflaging. However, we have noticed some issues in the ways the CAT-Q is used, which might impact research and clinical outcomes.

What is the purpose of this article?

In this article, we aim to summarize the evidence around using the CAT-Q in research and in clinical settings, and give recommendations for future use, so that researchers and clinicians are less likely to make mistakes.

What personal or professional perspectives do the authors bring to this topic?

The authors are researchers and clinicians who work closely with autistic people who camouflage/mask. Some of the authors were involved in developing the CAT-Q, but do not make any money from it.

What is already known about this topic?

There has been a lot of research using the CAT-Q, and showing that it is a good tool for measuring camouflaging, but not much evidence for it being used in clinical settings, such as autism assessment or postdiagnostic support.

What do the authors recommend?

We recommend more research to evaluate the CAT-Q, particularly across different countries and cultures. We also recommend that other methods of measuring camouflaging are developed to capture aspects of camouflaging that the CAT-Q does not measure. We recommend that clinicians are careful with how they use the CAT-Q, and do not use it to assess whether or not someone is autistic.

How will these recommendations help autistic adults now or in the future?

We hope that more research based on these recommendations will mean we have a more accurate understanding of camouflaging in the future. By following these recommendations, clinicians working with autistic people should use the CAT-Q more accurately and so help autistic people understand themselves and their camouflaging better.