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Autistic masking

From Wikipedia, the free encyclopedia
Autistic masking is the act of concealing autistic traits to come across as neurotypical, as if behind a mask

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

Terminology

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There is no universally agreed-upon terminology for the concept.[1][5]: 16–17 [6] While some use the terms masking and camouflaging synonymously,[1][2][5]: 16–17  others distinguish between masking (the suppression of behaviors) and compensation (of social difficulties) as the two main forms of camouflaging.[1][3][7] Among autistic people, masking is the most commonly used umbrella term.[5]: 16 [8]

The process of consciously giving up masking, which some autistic people see as a desirable goal, is referred to as unmasking.[2][9][10] Motivations for unmasking include no longer hiding one's true identity and avoiding adverse mental health outcomes.[2][8][9]

Forms

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Typical examples of autistic masking include the suppression of stimming and reactions to sensory overload.[3] To compensate difficulties in social interaction with neurotypical peers, autistic people might maintain eye contact despite discomfort or mirror the body language and tone of others.[1][2][3][11]

Autistic people with conversational difficulties may also use more complex strategies such as scripting a conversation outline, developing conscious "rules" for conversations, carefully monitoring if these are being followed.[3] Many autistic people learn conversational rules and social behaviors by watching television shows and other media and by observing and mimicking a character's behavior.[11] Masking may also include refraining from talking about passionate interests.[2][3]

Autistic people have cited social acceptance, the need to get a job, and the avoidance of ostracism or verbal or physical abuse as reasons for masking.[12]

Consequences

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Masking requires an exceptional effort[3][13] and is a main cause of autistic burnout.[14][15] It is linked with adverse mental health outcomes[16][17] such as stress,[18] anxiety, depression, and other psychological disorders,[18] loss of identity,[18] and suicidality.[19][20][21] Some studies find that compensation strategies are seen as contributing to leading a successful and satisfactory life.[1][7][13] Since many studies on masking focus on autistic adults without cognitive impairments, it is questionable whether their findings generalize across the autism spectrum.[1]

Masking may conceal the person's need for support.[12] It can complicate a diagnosis of autism spectrum disorder (ASD), particularly past childhood, as relevant symptoms are suppressed or compensated for.[22]: 60–62  The diagnostic criteria for ASD in the DSM-5 published in 2013 explicitly state that while symptoms "must be present in the early developmental period", these "may be masked by learned strategies in later life", allowing for a diagnosis even if autistic behaviors and difficulties are successfully masked.[22]: 57 [23] Addition of such a formulation was proposed to the workgroup drafting the criteria by representatives of the Autistic Self Advocacy Network.[23] The diagnostic criteria for ASD in the ICD-11 (2022) contain a similar provision.[16]

It has been hypothesized that masking may play an important role in explaining why autistic women and non-binary persons[2] are significantly less often recognized and diagnosed as autistic compared to men.[2][3][11] This hypothesis was put forward by Lorna Wing as early as 1981[5]: 20 [24]: 134  and is recognized in the DSM-5-TR published in 2022.[22]: 65 

Research

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While masking was written about and discussed among autistic people, it has only become a focus of academic research since the 2010s.[5]: 18  The Camouflaging Autistic Traits Questionnaire (CAT-Q), a first self-report measure for camouflaging, was published in 2018.[25][26] Across 25 items, it measures the extent to which a person utilizes strategies to actively compensate for difficulties in social situations (Compensation, 9 items), uses strategies to hide autistic characteristics or portray a non-autistic persona (Masking, 8 items), and employs strategies to fit in with others in social situations (Assimilation, 8 items).[25]

In light of rising awareness of the adverse mental health outcomes of masking and insight into the double empathy problem, therapies and interventions with implicit or explicit targets of instilling neurotypical behavior in autistic people and suppression of autistic traits are controversial.[27][28] Some autistic adults subjected to applied behavior analysis therapies as children describe being forced to behave like neurotypical peers, contrary to their true identity, with detrimental effects on their mental and overall well-being.[29][30]

There are some research studies centering around the experiences of masking by comparing different groups of people. In 2021, researchers conducted an online survey that compares the experiences of masking in autistic people, neurodivergent people who are not autistic, and neurotypical people.[31] They found that the behavior of masking is shared across all types of people, but some aspects of masking are more specific to autistic people, such as sensory suppression and suppression of stimming. Researchers also situated this into a workplace context and examined workplace masking experiences for autistic, non-autistic, and neurotypical adults in the UK. They identified eight emerging themes from the survey and reported large overlap among three groups such as reasonings and perceptions of benefits and drawbacks: both neurodivergent and neurotypical people adopted masking strategies to achieve social goals, indicating that masking is more like a common rather exclusive experience.[32]

Some qualitative research focused more on the masking experiences specifically for autistic people. A study in 2022 conducted semi-structured interviews with twenty autistic teenagers and observed how masking is associated with mental health (but not necessarily in linear relationship) and how both of them are affected by social and environmental factors. They stressed the need of approaching masking, authenticity, and mental health through the context of people's identities and also the environment, additionally providing some implications to diagnostic services and interventions.[33] Across autism spectrum, there's also an overview of masking/camouflaging characterizations which explores the analogy between camouflaging and passing and argues how masking may be further different for understudied groups across the spectrum like children and adults with linguistic disabilities.[34]

In addition to masking, researchers investigated the "authenticity" autistic people feel while socializing and observed how supportive environments like being around people who accept and understand them can lead to their self-awareness and bring more positive socializing experiences than camouflaging.[35] However, this doesn't imply that autistic "masking" is equivalent to non-authenticity. Researchers proposed that the focus should not be encouraging masking, but promoting autistic authenticity which brings more positive self-image and better mental health.[33]

References

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  1. ^ a b c d e f g h Petrolini, Valentina; Rodríguez-Armendariz, Ekaine; Vicente, Agustín (2023). "Autistic camouflaging across the spectrum". New Ideas in Psychology. 68: 100992. doi:10.1016/j.newideapsych.2022.100992. hdl:10810/59712. S2CID 253316582. Archived from the original on 2023-04-22. Retrieved 2023-05-05.
  2. ^ a b c d e f g h Pearson, Amy; Rose, Kieran (2021). "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. PMC 8992880. PMID 36601266.
  3. ^ a b c d e f g h Hull, Laura; Petrides, K. V.; Allison, Carrie; Smith, Paula; Baron-Cohen, Simon; Lai, Meng-Chuan; Mandy, William (2017). ""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. PMC 5509825. PMID 28527095. Archived from the original on 2024-08-03. Retrieved 2023-05-05.
  4. ^ Lawson, Wenn B. (2020). "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. S2CID 224896658.
  5. ^ a b c d e f Sedgewick, Felicity; Hull, Laura; Ellis, Helen (2021). Autism and Masking: How and Why People Do It, and the Impact It Can Have. London: Jessica Kingsley Publishers. ISBN 978-1-78775-580-2. OCLC 1287133295. Archived from the original on 2024-08-03. Retrieved 2023-05-05.
  6. ^ Cook, Julia; Hull, Laura; Crane, Laura; Mandy, William (2021). "Camouflaging in autism: A systematic review". Clinical Psychology Review. 89: 102080. doi:10.1016/j.cpr.2021.102080. ISSN 0272-7358. PMID 34563942. S2CID 237942158.
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  11. ^ a b c 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 256402443.
  12. ^ a b Haelle, Tara (2018-04-18). "The Consequences of Compensation in Autism". Neurology Advisor. Haymarket Media Group. Archived from the original on 2022-12-14. Retrieved 2023-05-08.
  13. ^ 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.
  14. ^ Deweerdt, Sarah (2020-03-30). "Autistic burnout, explained". Spectrum. Simons Foundation. doi:10.53053/bpzp2355. S2CID 251634477. Archived from the original on 2023-05-08. Retrieved 2023-05-09.
  15. ^ Arnold, Samuel RC; Higgins, Julianne M; Weise, Janelle; Desai, Aishani; Pellicano, Elizabeth; Trollor, Julian N (2023). "Confirming the nature of autistic burnout". Autism. 27 (7): 1906–1918. doi:10.1177/13623613221147410. PMID 36637293. S2CID 255773489. Archived from the original on 2023-05-09. Retrieved 2023-05-09.
  16. ^ a b "6A02 Autism spectrum disorder". ICD-11 for Mortality and Morbidity Statistics. World Health Organization. 2023. Archived from the original on 2018-08-01. Retrieved 2023-05-05.
  17. ^ Russo, Francine (21 February 2018). "The Costs of Camouflaging Autism". Spectrum. Simons Foundation. Archived from the original on 2022-12-14. Retrieved 2023-05-08.
  18. ^ a b c Radulski, Elizabeth M. (2022). "Conceptualising Autistic Masking, Camouflaging, and Neurotypical Privilege: Towards a Minority Group Model of Neurodiversity". Human Development. 66 (2): 113–127. doi:10.1159/000524122. S2CID 248864273.
  19. ^ Cassidy, Sarah; Bradley, Louise; Shaw, Rebecca; Baron-Cohen, Simon (2018). "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.
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  22. ^ a b c American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision. Washington, DC: American Psychiatric Association. doi:10.1176/appi.books.9780890425787. ISBN 978-0-89042-575-6. S2CID 249488050.
  23. ^ a b Kapp, Steven K.; Ne'eman, Ari (2020), Kapp, Steven K. (ed.), "Lobbying Autism's Diagnostic Revision in the DSM-5" (PDF), Autistic Community and the Neurodiversity Movement: Stories from the Frontline, Singapore: Palgrave Macmillan, pp. 167–194, doi:10.1007/978-981-13-8437-0_13, ISBN 978-981-13-8437-0, S2CID 209465381, archived (PDF) from the original on 2023-06-08, retrieved 2023-06-08
  24. ^ 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. PMID 6945608. S2CID 41912698. Archived from the original on 2022-04-14. Retrieved 2023-05-07.
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  29. ^ McGill, Owen; Robinson, Anna (2020). ""Recalling hidden harms": autistic experiences of childhood applied behavioural analysis (ABA)" (PDF). Advances in Autism. 7 (4): 269–282. doi:10.1108/AIA-04-2020-0025. S2CID 225282499. Archived (PDF) from the original on 2022-07-03. Retrieved 2023-05-12 – via Strathprints (University of Strathclyde).
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  31. ^ 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.
  32. ^ Pryke-Hobbes, Amber; Davies, Jade; Heasman, Brett; Livesey, Adam; Walker, Amy; Pellicano, Elizabeth; Remington, Anna (2023-09-06). Rosenbaum, Janet E. (ed.). "The workplace masking experiences of autistic, non-autistic neurodivergent and neurotypical adults in the UK". PLOS ONE. 18 (9): e0290001. Bibcode:2023PLoSO..1890001P. doi:10.1371/journal.pone.0290001. ISSN 1932-6203. PMC 10482295. PMID 37672533.
  33. ^ a b Chapman, Louise; Rose, Kieran; Hull, Laura; Mandy, William (2022-11-01). ""I want to fit in… but I don't want to change myself fundamentally": A qualitative exploration of the relationship between masking and mental health for autistic teenagers". Research in Autism Spectrum Disorders. 99: 102069. doi:10.1016/j.rasd.2022.102069. ISSN 1750-9467. S2CID 253495529.
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  35. ^ Cook, Julia M; Crane, Laura; Mandy, William (2023-07-05). "Dropping the mask: It takes two". Autism. 28 (4): 831–842. doi:10.1177/13623613231183059. ISSN 1362-3613. PMC 10981180. PMID 37403917. S2CID 259335250.

Further reading

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