Interpreting your CAT-Q scores

If you want to know if you camouflage your autistic traits, you should take the Camouflaging Autistic Traits Questionnaire (CAT-Q). It gives you a total camouflaging score, as well as scores in three subtypes: Compensation, Masking, and Assimilation.^[1]Development and Validation of the Camouflaging Autistic Traits Questionnaire (CAT-Q) (Hull et al., 2018) But what do your scores in each category actually mean? In this post, we will give more context, examples, and comparisons.

Camouflaging

Everyone—with or without autism—camouflages at times. If you feel shy about meeting someone new, you might pretend to be brave even though you do not feel that way. But for autistic people, camouflaging is not just about acting confident; many autistic people feel the need to hide their autistic traits in order to avoid stigma and unwanted attention, but the deeper goal is generally because they want to make friends and form connections.^[2]“Putting on My Best Normal”: Social Camouflaging in Adults with Autism Spectrum Conditions (Hull et al., 2017)^[3]Development and Validation of the Camouflaging Autistic Traits Questionnaire (CAT-Q) (Hull et al., 2018)^[4]Quantifying and exploring camouflaging in men and women with autism (Lai et al., 2017)^[5]Social camouflaging in autism: Is it time to lose the mask? (Mandy, 2019)^[6]Good social skills despite poor theory of mind: exploring compensation in autism spectrum disorder (Livingston et al., 2019) That might include forcing yourself to make eye contact (masking) or thinking of—and potentially rehearsing—a list of questions to ask when you meet someone new so you may avoid social faux pas (compensation).

Some people might camouflage when they are at school or work so that people do not treat them differently. Some autistics camouflage when they meet new people, to make a good impression, and maybe a new friend. Others will stop camouflaging once they get to know someone and think they will accept their natural selves. Camouflaging isn’t necessarily conscious or deliberate; finding ways to hide autistic proclivities or trying to be perceived as socially appropriate can happen even when the autistic person is unaware. In many cases, camouflaging starts out as a conscious strategy, but quickly evolves into an automatic process. You can read more on the consequences of that here:

Masking: is it good or bad?

Camouflaging subtypes

Before we get to the CAT-Q scores, we will briefly explain what the CAT-Q actually measures. The psychometric test is based on the social camouflaging model,^[7]Development and Validation of the Camouflaging Autistic Traits Questionnaire (CAT-Q) (Hull et al., 2018) which consists of three subcategories.

Compensation

People use various strategies to camouflage their autism. They might practice making friendly faces in the mirror, finding it hard to make those faces naturally. We call this compensation, because these autistic people are compensating for certain social shortcomings—or rather, differences from the majority group conventions. Examples:

• Copying and practicing others’ body language or facial expressions.
• Learning social cues and skills from television, films, or books.
• Repeating others’ phrasing and tone.

Masking

Another strategy is masking, where autistic people hide how they are feeling. For instance, they may copy what someone else is talking about if they do not know what to say. Examples:

• Monitoring and adjusting your face and body to appear relaxed or interested in others.
• Feeling pressured to make eye contact.
• Thinking about the impression made on others.

Assimilation

Often autistic people try to fit in with others so they are not bullied or singled out. This is called assimilation. For example, these people might stand near others in a crowd but not interact with them. Examples:

• Feeling the need to put on an act while socializing.
• Avoiding interacting with others in social situations.
• Needing others’ support to socialize.

In the diagram below, you can see the three categories and the 25 items that the CAT-Q measures.

Average CAT-Q scores

Higher scores are associated with psychological distress and functional challenges, so ideally you want your score to be as low as possible. Unfortunately, that is not likely to be the case if you are autistic; total scores above 100 are indicative of camouflaging autistic traits.

But that score alone may not be very meaningful to you. Let’s have a look at the average scores of autistic and non-autistic people, so you get an idea of where the most significant differences are, as well as whether you score in the autistic or neurotypical range. The stars (★) denote who got the highest average score in that category. The average scores are based on a study from 2019 by Laura Hull et al.^[8]Gender differences in self-reported camouflaging in autistic and nonautistic adults (Hull et al., 2019)

Average CAT-Q scores: autistics

Surprisingly, neurotypical women score the lowest in all categories!

Average CAT-Q scores: neurotypicals

In the table below, you can see which categories show the greatest differences between autistics and neurotypicals.

CAT-Q scores: Autistic–neurotypical differences

Camouflaging autistic traits

The higher your camouflaging score, the less autistic you likely appear. And the less autistic you appear, the more difficult it is to identify your autism. Consequently, a lot of autistic people that camouflage their autistic traits either have their diagnosis delayed, are misdiagnosed, or escape diagnosis completely.^[9]The Experiences of Late-diagnosed Women with Autism Spectrum Conditions: An Investigation of the Female Autism Phenotype (Bargiela, Steward & Mandy, 2017) As early as 1981, Lorna Wing, the British psychiatrist and pioneer of autism practice, hypothesized that some autistic girls without an intellectual disability may escape diagnosis on account of appearing to have better social and communication abilities compared to males.^[10]Sex ratios in early childhood autism and related conditions (Wing, 1981)

So camouflaging likely accounts—at least in part—for the different ratios of diagnosis between men and women. But note also that the higher your camouflaging score, the more likely you are to score lower on other autism tests. Because the thing about camouflaging is that a lot of us have a long history of doing it, so a large part of camouflaging becomes second nature. And the trouble with that is that you may very well camouflage even when doing a psychometric test. So try to be mindful of that, and try to answer questions on an autism test as authentically as possible. So that means you should try to answer questions based on your actual proclivities and preferences, rather than how you behave based on social expectations.

The CAT-Q can reveal the difference between your true self and the person you present as when you are with other people. If you score inconsistently on autism tests, it may be that you are not autistic, but it can also mean you just camouflage your autistic traits considerably. A trained medical professional should be able to assess which of the two applies to you, though sadly there are still a lot of medical professionals who fail to account for camouflaging.

Have you not taken the CAT-Q yet? Take it here:

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