A Systematic Review of Passing as Non-autistic in Autism Spectrum Disorder

Abstract

While long described in anecdotal accounts of the lived experiences of autistic individuals, the phenomenon of behaving in ways that appear inconsistent with the presence of autism (or passing as non-autistic; PAN) has recently seen a dramatic increase in scrutiny in the published scientific literature. Increased research attention has coincided with a proliferation of methods, definitions, measures, and population assumptions associated with PAN. To date, however, no review has sought to systematically identify and synthesize the literature on PAN. This systematic review reflects the state of the PAN literature as of May 2020. Ninety articles were screened, 66 were identified for evaluation, and 46 met inclusion criteria and were reliably coded for study characteristics and participant characteristics. Results reveal that the PAN literature includes a relatively even mix of qualitative, quantitative, and mixed-method studies, and that a variety of terms are used for PAN (with masking and camouflage being the most frequent). Sample sizes varied widely (from one to 832 participants), with 63.06% of participants being categorized as autistic. Nearly all studies reported methods for confirming autism diagnoses, with community and clinical diagnoses being most common. The majority of studies reported participant gender, with slightly more females included than males on average, but fewer than half of all studies compared PAN across genders. Nearly all studies reported participant age, demonstrating a wide range of 2 to 79 years, with a mean age of 23.85. Conversely, only 23.91% of studies provided participant race or ethnicity data. Nearly all studies formally or informally excluded participants with intellectual disability. Finally, measures of internalizing symptoms, which are often thought to be linked to PAN, were reported in only 17.4% of studies. Implications for gaps in understanding of PAN and future directions for the field are discussed.

Friend matters: sex differences in social language during autism diagnostic interviews

“…The overall pattern of results reported here could be interpreted in a variety of ways, all of which warrant future research. First, some researchers posit that autistic girls and women without ID may use intact cognitive processes to compensate for social difficulties by “masking” or “camouflaging” their autistic symptoms and actively working to appear non-autistic, leading them to present with better social skills than autistic boys and men [ 110 – 114 ]. Thus, autistic girls may be using more social words or talking about friends as a way to mirror their NT peers (who demonstrated a similar pattern of sex-differentiated social talk in the current study) or to improve their chances of fitting in.…”

Autistic camouflaging across the spectrum

“…In the next section we assess whether camouflaging may be better understood through the analogy of passing, as it has been proposed in some recent contributions (Pearson & Rose, 2021;Ai et al, 2022;Libsack et al, 2021). Although the analogy with passing allows us to describe camouflaging as a complex and heterogeneous phenomenon, we argue that we should be wary of overstretching it.…”

“…Overall, both quantitative and qualitative studies report a complex picture, with some respondents emphasizing that they camouflage to avoid appearing autistic in front of others, while others stress the need for social contact (see Libsack et al, 2021;Cook et al, 2021 for some recent reviews). This may very well vary across contexts: an autistic child may camouflage at school mostly -maybe even uniquely -out of fear, whereas the same child may camouflage with the main purpose of fitting in when interacting with their longtime friends.…”

Intersectional Stigma for Autistic People at Work: A Compound Adverse Impact Effect on Labor Force Participation and Experiences of Belonging

“…A similar concept is called 'code-switching,' which originated in understanding second language acquisition in linguistics and now adopted in gender, race and sexual orientation research. [48][49][50] Both phrases refer to a process where individuals attempt to minimize differences in their speech, body language and cultural references compared to the dominant identity in order to 'fit in' and therefore to reduce any stigma they might experience.…”