The CAT-Q

The Camouflaging Autistic Traits Questionnaire (CAT-Q) is a self-report measure of social camouflaging behaviours in adults. It may be used to identify autistic individuals who do not currently meet diagnostic criteria due to their ability to mask their autistic proclivities.

Take the test here:

Who the test is designed for

• Adults (age 16+) of average to higher intelligence.^[1]Development and Validation of the Camouflaging Autistic Traits Questionnaire (CAT-Q) (Hull et al., 2018)

What it tests

The CAT-Q measures the degree to which you use camouflaging strategies. The more you camouflage, the more of your autistic proclivities you are likely able to suppress. As such, a high camouflaging score can also account for lower scores on other autism tests. So if you don’t currently meet the diagnostic criteria but you still think you have autistic traits, then this could be why.

The CAT-Q measures camouflaging in general, as well as three subcategories:

• Compensation — Strategies used to actively compensate for difficulties in social situations.
  • Examples: copying body language and facial expressions, learning social cues from movies and books (see Autism & movie talk).
• Masking — Strategies used to hide autistic characteristics or portray a non-autistic persona.
  • Examples: adjusting face and body to appear confident and/or relaxed, forcing eye contact.
• Assimilation — Strategies used to try to fit in with others in social situations.
  • Examples: Putting on an act, avoiding or forcing interactions with others.

Taking the test

The CAT-Q consists of 25 statements, giving you 7 choices for each statement:

1. Strongly Disagree
2. Disagree
3. Somewhat Disagree
4. Neither Agree Nor Disagree
5. Somewhat Agree
6. Agree
7. Strongly Agree

The 25 statements relate to 3 subcategories of camouflaging:^[2]Development and Validation of the Camouflaging Autistic Traits Questionnaire (CAT-Q) (Hull et al., 2018)

• 9 statements (compensation)
• 8 statements (masking)
• 8 statements (assimilation)

Scoring

• Scoring range: 25–175
• Threshold score: 100↑
• All items are scored 1–7, with higher scores reflecting greater camouflaging.

We added auto-scoring for the CAT-Q, but should you want or need to self-score, we will explain how to do that in the Self-scoring section. To see how autistic people and neurotypicals score on the CAT-Q, go to the Average scores section. For more information on how to interpret your scores, read the post below.

Interpreting your CAT-Q scores

Validity

How reliable, accurate, valid, and up to date is the test?

• Research shows robust psychometric support for the CAT-Q.
• High internal consistency was found for the total scale (Cronbach’s α = 0.94), and the Compensation (α = 0.91), Masking (α = 0.85), and Assimilation (α = 0.92) factors.^[3]Development and Validation of the Camouflaging Autistic Traits Questionnaire (CAT-Q) (Hull et al., 2018)
• Test–retest reliability was good; 30 autistic individuals retook the test 3 months later, and no significant differences were found between scores at both times.^[4]Development and Validation of the Camouflaging Autistic Traits Questionnaire (CAT-Q) (Hull et al., 2018)
• The stability was good for the total scale and the Compensation factor, while moderate stability was found for the Masking and Assimilation factors.^[5]Development and Validation of the Camouflaging Autistic Traits Questionnaire (CAT-Q) (Hull et al., 2018)

Discussion

Dr. Natalie Engelbrecht:

I like that the CAT-Q addresses some of the problems with the outdated definitions of autism in the research literature. It can also identify a person with autism who might score below the threshold of other autism tests due to Masking.

I scored 143, which is significantly higher than most autistic females (124), and autistics in general. That is not a surprise as I have always camouflaged so much that therapists never diagnosed me with autism until age 47. In other words, we can say that my impression management—behaviours that occur in front of others—is excellent.

My Compensation (strategies used to compensate for difficulties in social situations) score of 49 is higher than the 42 average of autistic females. My Masking (strategies used to hide autistic characteristics or pretend to be a non-autistic persona) score is 52 compared to the average 38 of autistic females. And in terms of Assimilation (strategies to fit in with others in social situations), I score 45, which is average for autistic females.

• Total = 143; Compensation = 49; Masking = 52; Assimilation = 45

Kendall:

The choices ‘Strongly Agree’ and ‘Strongly Disagree’ were an unnecessary complication for me. I often wasn’t sure whether to answer strongly, feeling that agreeing or disagreeing was enough. Do I feel strongly? I don’t know. Compared to what or who?

Several questions are duplicated with one word slightly changed—they seem to be asking the same thing. I found this puzzling and distracting.

Surprisingly, the test results show I camouflage more than I realize:

• Total = 131; Compensation = 41; Masking = 42; Assimilation = 48

Martin:

I noted some very similar statements, such as #9 (I always think about the impression I make on other people) and #18 (I am always aware of the impression I make on other people). This kind of repetition can be particularly helpful for alexithymic people like me who have challenges accessing their emotions at times. By asking something in different ways, I might be urged to explore my feelings more and reflect on my behavior. But also, how you respond to each variation or related concept can reveal new things, and add nuance to your understanding of yourself.

However, I wonder if people would meaningfully differentiate between #9 and #18 when doing the test. And if not, does adding a substantially different statement relating to masking not result in a better metric to quantify masking?

I also wonder why Compensation consists of 9 items, while the other two categories consist of 8 items. Does this not result in skewed subscales? Either way, intuitively my scores seem to reflect my social behavior; and having done the test twice, my results are pretty consistent.

• Total = 121; Compensation = 38; Masking = 34; Assimilation = 49
• Total = 125; Compensation = 37; Masking = 35; Assimilation = 53

The self-scoring process is daunting though, especially if you have dyscalculia. I kept having a discrepancy between my total scores (118 and 128) and adding up the subscale scores (121 and 125), so clearly I kept miscounting somewhere. But we implemented an auto-scoring script to the test below, so no one needs to struggle any longer to do the CAT-Q.

The CAT-Q

Please read each statement below and choose the answer that best fits your experiences during social interactions.

Self-scoring

If auto-scoring isn’t working, or you want to self-score your answers instead, follow the steps below.

CAT-Q total score

• Reverse the scores of the answers for statements 3, 12, 19, 22, and 24, like so:
• Original scoring: a=1, b=2, c=3, d=4, e=5, f=6, g=7
• Reverse scoring: a=7, b=6, c=5, d=4, e=3, f=2, g=1

Then, add up all answers for statements 1–25.

Compensation score

• Add up all answers for statements 1, 4, 5, 8, 11, 14, 17, 20, and 23.

Masking score

• .Add up all answers for statements 2, 6, 9, 12, 15, 18, 21, and 24.
• ☞ Use the reversed scoring for statements 12 and 24.

Assimilation score

• Add up all answers for statements 3, 7, 10, 13, 16, 19, 22, and 25.
• ☞ Use the reversed scoring for statements 3, 19, and 22.

Average scores

A total score of 100 or above indicates you camouflage autistic traits. But other than knowing the threshold, making sense of your scores can be challenging. It may be helpful to compare your results to the average scores of autistics and non-autistics. The highest scores are denoted by a star (★).

Average CAT-Q scores of autistics: Autistic females and autistic non-binary people camouflage the most.^[6]Gender differences in self-reported camouflaging in autistic and nonautistic adults (Hull et al., 2019)

Average CAT-Q scores: autistics

Average CAT-Q scores of neurotypicals: Surprisingly, neurotypical females camouflage the least!^[7]Gender differences in self-reported camouflaging in autistic and nonautistic adults (Hull et al., 2019)

Average CAT-Q scores: neurotypicals

And in the table below, you can see the differences in the average scores of autistic people compared to neurotypicals. As you can see, autistic males and autistic non-binary people mask less than their neurotypical counterparts, but do score higher in Compensation and Assimilation.

CAT-Q scores: Autistic–neurotypical differences

It’s also interesting that autistic males don’t camouflage much more than neurotypical men. The same is true for non-binary people. If you look at the previous two diagrams, you will see that is because non-binary people camouflage a lot in general, irrespective of whether they are autistic or neurotypical.

Correlations

Another way to make sense of your scores is to look at the correlations. All CAT-Q scores significantly correlate with autistic-like traits, but there are some other correlations:^[8]Gender differences in self-reported camouflaging in autistic and nonautistic adults (Hull et al., 2019)

• High CAT-Q scores correlate with social anxiety in both autistics and neurotypicals, with the exception of Masking.
• In autistic people, the total CAT-Q score and the Assimilation score negatively correlate with well-being. The higher your scores on these measures, the lower your well-being tends to be.
• In neurotypical people, all CAT-Q scores negatively correlate with well-being—not just total score and Assimilation.
• In autistic people, all CAT-Q scores were correlated with depression and generalised anxiety. This wasn’t tested for in the neurotypical group.

For more information on the correlations with and consequences of camouflaging, have a look at the following post:

Autism & camouflaging

And for more information on how to interpret your CAT-Q scores, have a look at this post:

Interpreting your CAT-Q scores

If you are looking for an autism assessment,
Dr. Natalie Engelbrecht ND RP can offer help!
You can find more information here:

Autism assessments