Autistic traits show moderate association with camouflaging at 0.34 effect size
This meta-analysis evaluated the relationship between autistic traits and camouflaging behaviors across a broad population. The study included 16,895 participants drawn from autistic people and general population samples spanning ages 10 to 90. The setting was not reported for the individual studies included in the synthesis. The primary exposure was autistic traits, and the comparator was not reported as a distinct group but rather as the variation within the population. The study design combined observational and quantitative designs to assess associations rather than causation. Funding was not obtained for this specific meta-analysis, and no conflicts of interest were declared.
The primary outcome measured the association between autistic traits and camouflaging. The analysis reported a moderate association with an effect size of 0.34. The 95% confidence interval for this effect size ranged from 0.30 to 0.39. The direction of the association was positive, indicating that higher levels of autistic traits were linked to higher levels of camouflaging. This quantitative finding provides a baseline for understanding the prevalence of camouflaging behaviors relative to trait severity.
Secondary outcomes examined potential moderators of this relationship. Depression was found to moderate the relationship between autistic traits and camouflaging, though specific effect sizes were not reported for this moderation. In contrast, anxiety and social anxiety did not moderate the relationship. Age was also not a moderator of the association. The analysis further explored how association strength varied by sample type. The relationship was stronger in general population samples than in diagnosed samples. Measurement type also influenced the strength of the association, with self-reported autism measures showing a stronger association than observational measures. Regarding camouflaging measurement methods, the discrepancy method yielded a stronger association than self-report methods.
Subdomain analysis revealed differences in effect strength across specific camouflaging behaviors. Assimilation showed the strongest effect, followed by compensation and masking. Specific effect sizes for these subdomains were not reported. Safety and tolerability findings were not reported because the study design was observational and did not involve active intervention or medication administration. Adverse events, serious adverse events, discontinuations, and overall tolerability were not reported.
Methodological limitations included limited sample diversity, which constrains inferences across the full spectrum of autism. The study quality was rated as medium to high with no evidence of publication bias. However, the observational nature of the included studies prevents causal inference. Clinicians must be aware that the potential for camouflaging to disrupt the diagnostic process is a critical consideration. Campaigns that aim to reduce stereotypes of autism and promote acceptance of neurodiversity may help to reduce the stigma that drives camouflaging. These findings may help establish the foundation needed to develop targeted interventions for camouflaging behaviors.
Key questions remain unanswered regarding the specific mechanisms driving camouflaging in different subpopulations. The lack of data on adverse events is expected in observational research but highlights the need for future studies to monitor the impact of camouflaging on mental health. The moderate effect size suggests that while camouflaging is associated with autistic traits, other factors also play a significant role. The stronger association in general population samples suggests that diagnostic status may influence how camouflaging is measured or expressed. Clinicians should interpret these results with caution and avoid generalizing beyond the full spectrum due to limited sample diversity.
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