Quantifying compensatory strategies in adults with and without diagnosed autism

Abstract

Background: There is growing recognition that some autistic people engage in 'compensation', showing few behavioural symptoms (e.g. neurotypical social skills), despite continuing to experience autism-related cognitive difficulties (e.g. difficulties in social cognition). One way this might be achieved is by individuals consciously employing 'compensatory strategies' during everyday social interaction. However, very little is currently known about the broad range of these strategies, their mechanisms and consequences for clinical presentation and diagnosis. Methods:We aimed to measure compensatory strategies in autism for the first time. Using a novel checklist, we quantified self-reported social compensatory strategies in 117 adults (58 with autism, 59 without autism) and explored the relationships between compensation scores and autism diagnostic status, autistic traits, education level, sex and age at diagnosis.Results: Higher compensation scores-representing a greater repertoire of compensatory strategies-were associated with having an autism diagnosis, more autistic traits and a higher education level. The link between autism diagnostic status and compensation scores was, however, explained by autistic traits and education level. Compensation scores were unrelated to sex or age at diagnosis. Limitations: Our sample was self-selected and predominantly comprised of intellectually able females; therefore, our findings may not generalise to the wider autistic population.Conclusions: Together, our findings suggest that many intellectually able adults, with and without a clinical diagnosis of autism, report using compensatory strategies to modify their social behaviour. We discuss the clinical utility of measuring self-reported compensation (e.g., using our checklist), with important implications for the accurate diagnosis and management of autism and related conditions.

Understanding camouflaging as a response to autism-related stigma: A Social Identity Theory approach

“…These findings suggest that stigma is more likely to be attached to behaviours associated with being autistic, rather than the label or identity of being autistic, supporting previous research which also notes this differentiation (Butler & Gillis, 2011). If this is the case, this would explain why camouflaging is also noted in non-autistic people who report higher autistic traits (Livingston et al, 2020). The measure of autismrelated stigma used in the current study looked at awareness of stigma and does not tell us whether perceived stigma was based on discreditation of an autistic identity or autistic behaviours.…”

“…Diagnosis in adulthood is potentially related to camouflaging of autistic traits (Hull et al, 2017). Camouflaging refers to strategies that function to mask features of autism and enable "passing" as non-autistic in social situations or to hide or compensate for social difficulties (Hull et al, 2017;Livingston et al, 2020). It can include conscious and unconscious attempts to hide autistic behaviours and the use of techniques to appear socially competent, such as rehearsing facial expressions, eye contact and social scripts (Bargiela et al, 2016).…”

‘I just rolled up my sleeves’: Mothers’ perspectives on raising girls on the autism spectrum

“…The same core difficulties may be expressed differently in males and females, with males’ tendency towards externalised behaviours rendering them more identifiable (Mandy et al, 2012). In addition, while some studies have found both males and females engage in compensation strategies (Hull et al, 2017; Livingston et al, 2020), other research finds women and girls engage in more ‘camouflaging’ of their social communication difficulties (Hull et al, 2020; Lai et al, 2017). Due to some or all these factors, females are less likely to receive a diagnosis than males with equivalent symptom severity (Dworzynski et al, 2012).…”

A Conceptual Analysis of Autistic Masking: Understanding the Narrative of Stigma and the Illusion of Choice

“…Masking is an emerging research area, and as such there is variation in the terminology used to describe these experiences. Although some scholars draw a conceptual distinction between masking/camouflaging/compensation 1,4 and which aspects constitute subcomponents of another, we use masking here holistically as an umbrella term to refer to the collection of these experiences, as it is the term that has been used by the autistic community themselves. [5][6][7] Masking has been suggested to relate to several key issues in the lives of autistic people, such as relationships and diagnosis, 8 suicidality, 9 and burnout.…”