Social motivators

Adults. Maintaining the comfort of others was reported as a motivation for SC by autistic adults (Baldwin & Costley, Reference Baldwin and Costley2016; Cage & Troxell-Whitman, Reference Cage and Troxell-Whitman2019; Hull et al., Reference Hull, Petrides, Allison, Smith, Baron-Cohen, Lai and Mandy2017; Livingston et al., Reference Livingston, Shah and Happé2019a, Reference Livingston, Colvert, Bolton and Happé2019b; Sullivan, Reference Sullivan2021). Additionally, evidence suggested that autistic adults camouflage to achieve social acceptance (Cage & Troxell-Whitman, Reference Cage and Troxell-Whitman2019; Cook et al., Reference Cook, Crane, Bourne, Hull and Mandy2021a; Hull et al., Reference Hull, Petrides, Allison, Smith, Baron-Cohen, Lai and Mandy2017; Livingston et al., Reference Livingston, Shah and Happé2019a, Reference Livingston, Colvert, Bolton and Happé2019b; Sullivan, Reference Sullivan2021) or meet social expectations (Cage & Troxell-Whitman, Reference Cage and Troxell-Whitman2019; Hull et al., Reference Hull, Petrides, Allison, Smith, Baron-Cohen, Lai and Mandy2017; Livingston et al., Reference Livingston, Shah and Happé2019a, Reference Livingston, Colvert, Bolton and Happé2019b). Autistic adults indicated beliefs that they had to change themselves to assimilate into wider society (Cook et al., Reference Cook, Crane, Bourne, Hull and Mandy2021a; Hull et al., Reference Hull, Petrides, Allison, Smith, Baron-Cohen, Lai and Mandy2017; Sullivan, Reference Sullivan2021), avoid social rejection/negative perception (Cook et al., Reference Cook, Crane, Bourne, Hull and Mandy2021a, Hull et al., Reference Hull, Petrides, Allison, Smith, Baron-Cohen, Lai and Mandy2017, Livingston et al., Reference Livingston, Shah and Happé2019a, Reference Livingston, Colvert, Bolton and Happé2019b; Schneid & Raz, Reference Schneid and Raz2020; Sullivan, Reference Sullivan2021) and protect their safety and well-being from verbal, emotional, and physical attacks (Cage & Troxell-Whitman, Reference Cage and Troxell-Whitman2019; Hull et al., Reference Hull, Petrides, Allison, Smith, Baron-Cohen, Lai and Mandy2017; Livingston et al., Reference Livingston, Shah and Happé2019a, Reference Livingston, Colvert, Bolton and Happé2019b; Sullivan, Reference Sullivan2021). Similarly, social stigma was qualitatively reported by some autistic individuals as a motivator for SC (Cage & Troxell-Whitman, Reference Cage and Troxell-Whitman2019 Hull et al., Reference Hull, Petrides, Allison, Smith, Baron-Cohen, Lai and Mandy2017; Schneid & Raz, Reference Schneid and Raz2020).

Another social motivator endorsed by autistic adults was to increase connections both for platonic and romantic relationships (Cook et al., Reference Cook, Crane, Bourne, Hull and Mandy2021a; Hull et al., Reference Hull, Petrides, Allison, Smith, Baron-Cohen, Lai and Mandy2017). A desire to obtain employment, educational opportunities and achievements were additionally identified as motivators (Hull et al., Reference Hull, Petrides, Allison, Smith, Baron-Cohen, Lai and Mandy2017; Livingston et al., Reference Livingston, Shah and Happé2019a, Reference Livingston, Colvert, Bolton and Happé2019b; Sullivan, Reference Sullivan2021). Cage and Troxell-Whitman (Reference Cage and Troxell-Whitman2019) noted that participants reported SC for ‘conventional reasons’ (i.e., SC that serves a practical function such as at school or work) more frequently than for ‘relational reasons’ (i.e., SC that helps in facilitating relationships and socializing), and females were more likely to SC for conventional reasons than males. The same study suggested that SC was potentially conditioned from childhood.

Youth. Researchers found that autistic youth camouflage to avoid negative perceptions and experiences (Bernardin et al., Reference Bernardin, Mason, Lewis and Kanne2021b; Cook et al., Reference Cook, Ogden and Winstone2018), worrying that being their authentic selves would lead to rejection, bullying, humiliation, being labeled, and/or being treated differently than their non-autistic peers (e.g., being talked down to, or not being listened to) (Bernardin et al., Reference Bernardin, Mason, Lewis and Kanne2021b; Halsall et al., Reference Halsall, Clarke and Crane2021). Bernardin et al. (Reference Bernardin, Mason, Lewis and Kanne2021b) and Jedrzejewska and Dewey (Reference Jedrzejewska and Dewey2022) found that SC in autistic youth was a response to stigma and allowed for a sense of control about how one is perceived in social contexts. Youth also reported SC to make one’s social partner more comfortable (Bernardin et al., Reference Bernardin, Mason, Lewis and Kanne2021b; Jedrzejewska & Dewey, Reference Jedrzejewska and Dewey2022). Additionally, autistic youth were found to camouflage to be perceived positively/be taken seriously (Bernardin et al., Reference Bernardin, Mason, Lewis and Kanne2021b). Camouflaging was perceived as a strategy for overcoming social barriers to developing and maintaining friendships (Bernardin et al., Reference Bernardin, Mason, Lewis and Kanne2021b; Cook et al., Reference Cook, Ogden and Winstone2018; Tierney et al., Reference Tierney, Burns and Kilbey2016). Bernardin et al. (Reference Bernardin, Mason, Lewis and Kanne2021b) found gender differences in the motivations to SC, where males were more likely to camouflage to make friends, and females were more likely to camouflage to avoid teasing and bullying. One study suggested possible gender role expectations for girls influencing SC (Anderson et al., Reference Anderson, Marley, Gillespie-Smith, Carter and MacMahon2020). Additionally, while some autistic youth reported that SC strategies came intuitively (Halsall et al., Reference Halsall, Clarke and Crane2021; Tierney et al., Reference Tierney, Burns and Kilbey2016) others felt that SC was learned from peers or teachers (Halsall et al., Reference Halsall, Clarke and Crane2021; Jedrzejewska & Dewey, Reference Jedrzejewska and Dewey2022).

Contexts

Adults. Camouflaging behavior was found to be influenced by an individuals’ social environment (Cook et al., Reference Cook, Ogden and Winstone2018; Hull et al., Reference Hull, Petrides, Allison, Smith, Baron-Cohen, Lai and Mandy2017; Livingston et al., Reference Livingston, Colvert, Bolton and Happé2019b). For example, less pressure to camouflage was felt when the conversation partner held less personal stigma towards autism (Cook et al., Reference Cook, Ogden and Winstone2018) or when conversing with trusted individuals (Cook et al., Reference Cook, Ogden and Winstone2018; Hull et al., Reference Hull, Petrides, Allison, Smith, Baron-Cohen, Lai and Mandy2017). Alternatively, more SC was reported with strangers (Cook et al., Reference Cook, Ogden and Winstone2018; Hull et al., Reference Hull, Petrides, Allison, Smith, Baron-Cohen, Lai and Mandy2017). Individuals in one study reported more pressure to SC when interacting with extraverted people, and less pressure when interacting with other autistic individuals (Livingston et al., Reference Livingston, Colvert, Bolton and Happé2019b). The same study highlighted that autistic adults felt less pressure to SC in environments where presenting overly friendly social traits was not necessarily a cultural norm, referencing British culture (Livingston et al., Reference Livingston, Colvert, Bolton and Happé2019b). Lastly, Cage and Troxell-Whitman (Reference Cage and Troxell-Whitman2019) identified two common contexts of SC: interpersonal, referring to between friends and family, and formal, referring to work colleagues or medical professionals.

Youth. Autistic youth reported feeling less need to camouflage with trusted individuals (Bernardin et al., Reference Bernardin, Lewis, Bell and Kanne2021a, Reference Bernardin, Mason, Lewis and Kanne2021b; Jedrzejewska & Dewey, Reference Jedrzejewska and Dewey2022; Tierney et al., Reference Tierney, Burns and Kilbey2016) and when interacting with other neurodiverse individuals (Cook et al., Reference Cook, Crane, Bourne, Hull and Mandy2021a; Halsall et al., Reference Halsall, Clarke and Crane2021). Moreover, youth reported more SC behavior at school rather than at home (Anderson et al., Reference Anderson, Marley, Gillespie-Smith, Carter and MacMahon2020; Cook et al., Reference Cook, Ogden and Winstone2018; Halsall et al., Reference Halsall, Clarke and Crane2021; Moyse & Porter, Reference Moyse and Porter2014). Halsall et al. (Reference Halsall, Clarke and Crane2021) found that participants reported less SC in their school’s resource center or special education classrooms within a school (Halsall et al., Reference Halsall, Clarke and Crane2021). Autistic youth in one study reported less SC on social media; they found it was easier to bond over genuine interests and to present oneself authentically when social interactions were online (Jedrzejewska & Dewey, Reference Jedrzejewska and Dewey2022).

Behaviors

Adults. Masking behaviors reported included stopping behavioral presentations of autism (e.g., suppressing stimming or sensory overload) (Cage et al., Reference Cage, Di Monaco and Newell2018, Cook et al., 2021a, Cook et al., 2022; Hull et al., Reference Hull, Petrides, Allison, Smith, Baron-Cohen, Lai and Mandy2017; Sullivan, Reference Sullivan2021). Four studies reported forced eye contact in social situations (Cook et al., 2022, Cook et al., 2021a, ; Hull et al., Reference Hull, Petrides, Allison, Smith, Baron-Cohen, Lai and Mandy2017; Tint and Weiss, Reference Tint and Weiss2018). Additionally, autistic adults reported continuous monitoring of social interactions (Cook et al., Reference Cook, Crane, Bourne, Hull and Mandy2021a; Hull et al., Reference Hull, Petrides, Allison, Smith, Baron-Cohen, Lai and Mandy2017; Livingston et al., Reference Livingston, Colvert, Bolton and Happé2019b) and deliberate concealment of personal interests, sharing only selective interests (Cook et al., 2021a, Reference Cook, Crane, Hull, Bourne and Mandy2022; Hull et al., Reference Hull, Petrides, Allison, Smith, Baron-Cohen, Lai and Mandy2017), or adapting voice tone (Cook et al., 2021a, Reference Cook, Crane, Hull, Bourne and Mandy2022). Autistic adults further reported concealing the need for extra support due to autism (Schneid & Raz, Reference Schneid and Raz2020; Sullivan, Reference Sullivan2021). Faking interest on another person’s conversational topic or deliberately focusing on interests that were not of interest were also reported (Cook et al., Reference Cook, Crane, Hull, Bourne and Mandy2022; Hull et al., Reference Hull, Petrides, Allison, Smith, Baron-Cohen, Lai and Mandy2017). Further, autistic adults reported faking positive affect, interest, and emotion during conversations (Baldwin & Costley, Reference Baldwin and Costley2016; Cook et al., Reference Cook, Crane, Hull, Bourne and Mandy2022). Divulging little personal information was also described by autistic adults (Hull et al., Reference Hull, Petrides, Allison, Smith, Baron-Cohen, Lai and Mandy2017), including deliberately not disclosing one’s autistic status (Cook et al., Reference Cook, Crane, Hull, Bourne and Mandy2022; Schneid & Raz, Reference Schneid and Raz2020). Finally, hiding emotion was reported by one study (Schneid & Raz, Reference Schneid and Raz2020) as a behavior associated with SC, as was not disclosing honest information about oneself (Cook et al., Reference Cook, Crane, Hull, Bourne and Mandy2022).

Compensation behaviors were reported in several studies (Baldwin & Costley, Reference Baldwin and Costley2016; Cook et al., 2021a,; Hull et al., Reference Hull, Petrides, Allison, Smith, Baron-Cohen, Lai and Mandy2017; Livingston et al., Reference Livingston, Colvert, Bolton and Happé2019b; Schneid & Raz, Reference Schneid and Raz2020). Some studies found that autistic adults practised scripted responses prior to conversing (Baldwin & Costley, Reference Baldwin and Costley2016; Cook et al., 2021a, Reference Cook, Crane, Hull, Bourne and Mandy2022; Hull et al., Reference Hull, Petrides, Allison, Smith, Baron-Cohen, Lai and Mandy2017). Autistic adults also disclosed making an active effort to ask their conversation partner personal questions during conversations (Cook et al., Reference Cook, Crane, Bourne, Hull and Mandy2021a; Hull et al., Reference Hull, Petrides, Allison, Smith, Baron-Cohen, Lai and Mandy2017), in addition to imitating peers’ non-verbal and verbal communicative behaviors (Cook et al., Reference Cook, Crane, Bourne, Hull and Mandy2021a; Hull et al., Reference Hull, Petrides, Allison, Smith, Baron-Cohen, Lai and Mandy2017). Livingston et al. (Reference Livingston, Colvert, Bolton and Happé2019b) reported two different types of imitation behavior. When imitation occurred without regard for context, it was classified as shallow compensation, and when imitation was produced from internal algorithms that analyzed contexts, it was classified as deep compensation (Livingston et al., Reference Livingston, Colvert, Bolton and Happé2019b). Additional findings were that autistic adults allowed conversational partners to guide the conversation and disclosed personal information as an intentional strategy to socially camouflage. They also exerted energy monitoring conversations with a focus on balancing listening and responding, forcing laughter in conversations, intentionally expressing vulnerability, telling well-practised jokes, and prioritizing small talk (Cook et al., Reference Cook, Crane, Hull, Bourne and Mandy2022). Hull et al. (Reference Hull, Petrides, Allison, Smith, Baron-Cohen, Lai and Mandy2017) described autistic individuals as creating social rules to help guide interactions and Schneid and Raz (Reference Schneid and Raz2020) reported that participants would intentionally talk about topics with a connection to the current conversation.

Finally, assimilation behaviors were reported (Cook et al., 2021a, Reference Cook, Crane, Hull, Bourne and Mandy2022; Hull et al., Reference Hull, Petrides, Allison, Smith, Baron-Cohen, Lai and Mandy2017; Schneid & Raz, Reference Schneid and Raz2020). Autistic adults reported that they would over-exaggerate body language to appear interested in conversation (Cook et al., Reference Cook, Crane, Bourne, Hull and Mandy2021a; Hull et al., Reference Hull, Petrides, Allison, Smith, Baron-Cohen, Lai and Mandy2017) or would deliberately play a social role (Hull et al., Reference Hull, Petrides, Allison, Smith, Baron-Cohen, Lai and Mandy2017; Schneid & Raz, Reference Schneid and Raz2020). In one study, autistic adults reported apologizing for social errors, intentionally attempting to gain validation from others, and avoiding confrontation or rudeness (Cook et al., Reference Cook, Crane, Hull, Bourne and Mandy2022).

Youth. Evidence indicated compensation behaviors in youth are used to camouflage (Anderson et al., Reference Anderson, Marley, Gillespie-Smith, Carter and MacMahon2020; Cook et al., Reference Cook, Ogden and Winstone2018; Halsall et al., Reference Halsall, Clarke and Crane2021; Tierney et al., Reference Tierney, Burns and Kilbey2016), including various types of imitation (Anderson et al., Reference Anderson, Marley, Gillespie-Smith, Carter and MacMahon2020; Cook et al., Reference Cook, Ogden and Winstone2018; Tierney et al., Reference Tierney, Burns and Kilbey2016) such as copying facial expressions, posture, tone of voice, topic of conversation and choice of interests (Tierney et al., Reference Tierney, Burns and Kilbey2016). One study reported that autistic youth observed/researched the behavior of others and imitated these behaviors (Anderson et al., Reference Anderson, Marley, Gillespie-Smith, Carter and MacMahon2020). Related to this, researching the interests of others was also reported (Halsall et al., Reference Halsall, Clarke and Crane2021), along with memorizing social patterns to compensate for autistic traits in a social environment (Tierney et al., Reference Tierney, Burns and Kilbey2016).

Autistic youth additionally reported masking behaviors (Bernardin et al., Reference Bernardin, Lewis, Bell and Kanne2021a, Reference Bernardin, Mason, Lewis and Kanne2021b; Halsall et al., Reference Halsall, Clarke and Crane2021; Tierney et al., Reference Tierney, Burns and Kilbey2016). They reported faking positive affect or faking understanding throughout conversations (Bernardin et al., Reference Bernardin, Lewis, Bell and Kanne2021a, Reference Bernardin, Mason, Lewis and Kanne2021b; Halsall et al., Reference Halsall, Clarke and Crane2021; Tierney et al., Reference Tierney, Burns and Kilbey2016), and hiding personal interests that might have appeared immature to their conversation partner (Halsall et al., Reference Halsall, Clarke and Crane2021).

Lastly, assimilation behaviors were reported in youth (Cook et al., Reference Cook, Ogden and Winstone2018; Jedrzejewska & Dewey, Reference Jedrzejewska and Dewey2022). Autistic youth described “acting likeable” with their peers (Bernardin et al., Reference Bernardin, Lewis, Bell and Kanne2021a, Reference Bernardin, Mason, Lewis and Kanne2021b; Jedrzejewska & Dewey, Reference Jedrzejewska and Dewey2022), changing their personality with certain individuals (Cook et al., Reference Cook, Ogden and Winstone2018; Jedrzejewska & Dewey, Reference Jedrzejewska and Dewey2022), and changing the type of language they used to suit certain conversation partners (Jedrzejewska & Dewey, Reference Jedrzejewska and Dewey2022).

Gender

Adults. The quantitative data was variable with respect to gender identity and SC behaviors. In five studies, females reported significantly more SC behavior than males on the CAT-Q (Bowri et al., Reference Bowri, Hull, Allison, Smith, Baron-Cohen, Lai and Mandy2021; Hull et al., Reference Hull, Lai, Baron-Cohen, Allison, Smith, Petrides and Mandy2020; McQuaid et al., Reference McQuaid, Lee and Wallace2022; Milner et al., Reference Milner, Mandy, Happé and Colvert2023; Perry et al., Reference Perry, Mandy, Hull and Cage2022). A similar result was found in two studies which used the discrepancy method (the difference between observed SC behavior and self-reported internal state/theory of mind ability) (Lai et al., Reference Lai, Lombardo, Ruigrok, Chakrabarti, Auyeung, Szatmari, Happé and Baron-Cohen2017; Schuck et al., Reference Schuck, Flores and Fung2019). Conversely, five studies found no significant difference between genders and self-reports of SC frequency (Belcher et al., Reference Belcher, Morein-Zamir, Mandy and Ford2022; Cage et al., Reference Cage, Di Monaco and Newell2018; Cage & Troxell-Whitman, Reference Cage and Troxell-Whitman2019; Hull et al., Reference Hull, Lai, Baron-Cohen, Allison, Smith, Petrides and Mandy2020; Perry et al., Reference Perry, Mandy, Hull and Cage2022). Further, Cassidy et al. (Reference Cassidy, Bradley, Shaw and Baron-Cohen2018) found that there was no significant difference between genders regarding likelihood to self-report SC with their self-developed SC questionnaire. However, of the participants that indicated engaging in SC behavior, females reported increased SC as compared to males.

Qualitatively, autistic adults in some studies reported personal impressions that autistic females camouflage more than autistic males (Baldwin & Costley, Reference Baldwin and Costley2016; Hull et al., Reference Hull, Petrides, Allison, Smith, Baron-Cohen, Lai and Mandy2017; Livingston et al., Reference Livingston, Colvert, Bolton and Happé2019b). Further, autistic females reported “learning social behaviour” as a means of counteracting social exclusion more so than autistic males (Baldwin & Costley, Reference Baldwin and Costley2016).

Moreover, there was some quantitative evidence that non-binary genders may be more likely to SC than males. Gender diverse adults reported significantly elevated SC on the compensation subscale compared to cisgender adults (McQuaid et al., Reference McQuaid, Lee and Wallace2022). Hull et al. (Reference Hull, Lai, Baron-Cohen, Allison, Smith, Petrides and Mandy2020a, Reference Hull, Petrides and Mandy2020b) found that non-binary genders scored higher on the CAT-Q overall when controlling for age, though this result was not upheld when controlling for autistic traits (Hull et al., Reference Hull, Lai, Baron-Cohen, Allison, Smith, Petrides and Mandy2020). In Perry et al. (Reference Perry, Mandy, Hull and Cage2022), non-binary groups reported more SC on the CAT-Q.

Youth. Within autistic youth, there was evidence for female gender being associated with SC; Simcoe et al. (Reference Simcoe, Gilmour, Garnett, Attwood, Donovan and Kelly2022) used the Questionnaire for Autism Spectrum Conditions (Q-ASC) survey and found that, compared to autistic males, autistic females scored higher on subscales associated with SC (“social masking” and “imitation”). Jorgenson et al. (Reference Jorgenson, Lewis, Rose and Kanne2020) found that female participants reported higher overall levels of SC as determined by the CAT-Q, but only when age was not accounted for. Conversely, Livingston and colleagues (2019a) classified participants into four groups (High (good ADOS + poor ToM), Low (poor ADOS + poor ToM), Deep (good ADOS + good ToM), and Unknown (poor ADOS + good ToM) compensation) and found no significant difference between genders when measuring compensation as the discrepancy between observable autistic presentation and neurodevelopmental ability. Using the same four quadrant model for compensation, Corbett et al. (Reference Corbett, Schwartzman, Libsack, Muscatello, Lerner, Simmons and White2021) found that autistic males were more likely than autistic females to be high compensators, whereas females were more likely to be unknown compensators.

Finally, two qualitative studies (Anderson et al., Reference Anderson, Marley, Gillespie-Smith, Carter and MacMahon2020; Jedrzejewska & Dewey, Reference Jedrzejewska and Dewey2022) reported that autistic participants held the personal belief that females were more likely to use SC behaviors.

Personality

Adults. Robinson et al. (Reference Robinson, Hull and Petrides2020) explored SC in relation to Big Five personality traits in both autistic and non-autistic adults and found that SC, as measured by the CAT-Q, was negatively correlated with openness to experience, and positively correlated with neuroticism in autistic adults. Additionally, extraversion was positively correlated with the assimilation category in the CAT-Q in autistic adults, but not with masking or compensation. Conscientiousness and agreeableness were not significantly correlated with SC behavior on the CAT-Q (Robinson et al., Reference Robinson, Hull and Petrides2020). Robinson et al. (Reference Robinson, Hull and Petrides2020) suggest that non-autistic people may be more likely to camouflage due to individual differences such as personality, while autistic people may be more influenced by situational pressures such as social stigma. Schuck et al. (Reference Schuck, Flores and Fung2019) found that SC was negatively correlated with emotional expressivity and positive expressivity in females. In males, SC did not correlate with emotional or positive expressivity. Similarly, negative expressivity and impulse strength were not significant predictors of SC in either gender. Lastly, Schuck et al. (Reference Schuck, Flores and Fung2019) found no statistically significant association between SC and social phobia.

Youth. No studies that met our inclusion criteria reported on personality traits associated with SC in autistic youth.

Interpersonal outcomes

Adults. Livingston et al. (Reference Livingston, Colvert, Bolton and Happé2019b) found that compensation helped with fostering confidence and developing feelings of connectedness to others. Autistic adults in two other studies reported that SC helped them build relationships (Cook et al., Reference Cook, Crane, Bourne, Hull and Mandy2021a; Hull et al., Reference Hull, Petrides, Allison, Smith, Baron-Cohen, Lai and Mandy2017). In contrast, two studies found that while SC helped autistic adults build social connections, these relationships were reported as unstable, inauthentic, or not satisfying (Hull et al., Reference Hull, Petrides, Allison, Smith, Baron-Cohen, Lai and Mandy2017; Livingston et al., Reference Livingston, Colvert, Bolton and Happé2019b). Across three studies, autistic adults reported that they developed superficial connections because of SC (Cook et al., Reference Cook, Crane, Bourne, Hull and Mandy2021a; Hull et al., Reference Hull, Petrides, Allison, Smith, Baron-Cohen, Lai and Mandy2017; Livingston et al., Reference Livingston, Colvert, Bolton and Happé2019b). Moreover, one study reported that SC impacted autistic adults’ ability to fully engage and communicate during social interactions (Cook et al., Reference Cook, Crane, Bourne, Hull and Mandy2021a). Additionally, Cook et al. (Reference Cook, Crane, Bourne, Hull and Mandy2021a) found that SC limited feelings of closeness and connectedness with others. In addition to this, one quantitative study found that the intent to SC did not significantly predict first impressions (Belcher et al., Reference Belcher, Morein-Zamir, Mandy and Ford2022). Finally, one study found that SC wasn’t related to misuse of alcohol or the likelihood of increased alcohol consumption (Bowri et al., Reference Bowri, Hull, Allison, Smith, Baron-Cohen, Lai and Mandy2021).

Four studies found that SC was perceived by autistic adults as helping them to meet their professional goals (Hull et al., Reference Hull, Petrides, Allison, Smith, Baron-Cohen, Lai and Mandy2017; Livingston et al., Reference Livingston, Colvert, Bolton and Happé2019b; Sullivan, Reference Sullivan2021). Autistic adults reported experiencing a sense of relief when they felt SC went well (Hull et al., Reference Hull, Petrides, Allison, Smith, Baron-Cohen, Lai and Mandy2017) and attained success professionally (Livingston et al., Reference Livingston, Colvert, Bolton and Happé2019b; Sullivan, Reference Sullivan2021). However, although some participants reported that SC helped them professionally, this was not always sufficient for them to successfully maintain their employment (Livingston et al., Reference Livingston, Colvert, Bolton and Happé2019b).

Youth. Two qualitative studies found that despite camouflaging, autistic youth were unable to build and maintain meaningful social connections (Cook et al., Reference Cook, Ogden and Winstone2018; Halsall et al., Reference Halsall, Clarke and Crane2021). One study reported a related finding that autistic youth who camouflaged experienced lower levels of acceptance from their peers (Corbett et al., Reference Corbett, Schwartzman, Libsack, Muscatello, Lerner, Simmons and White2021).

Moreover, two studies found that when autistic youth formed social connections, they described them as feeling superficial (Bernardin et al., Reference Bernardin, Mason, Lewis and Kanne2021b; Halsall et al., Reference Halsall, Clarke and Crane2021). With respect to positive impacts, three studies found that SC was perceived by autistic youth as helping them achieve their interpersonal goals (Bernardin et al., Reference Bernardin, Mason, Lewis and Kanne2021b; Cook et al., Reference Cook, Ogden and Winstone2018; Halsall et al., Reference Halsall, Clarke and Crane2021). Two studies reported that through SC, autistic youth felt they were able to avoid being bullied (Bernardin et al., Reference Bernardin, Mason, Lewis and Kanne2021b; Halsall et al., Reference Halsall, Clarke and Crane2021). Likewise, two studies found that camouflaging helped autistic youth with building and maintaining friendships, as well as feeling included (Bernardin et al., Reference Bernardin, Mason, Lewis and Kanne2021b; Cook et al., Reference Cook, Ogden and Winstone2018). Results suggest that young autistic males may perceive SC more positively than autistic females, with males being more likely to report SC as easy, positive, or neutral, and females being more likely to report SC as difficult, draining, and resulting in negative feelings (Bernardin et al., Reference Bernardin, Mason, Lewis and Kanne2021b).

Personal identity

Adults. As a result of SC, autistic adults reported experiencing feelings of inauthenticity (Cook et al., Reference Cook, Crane, Bourne, Hull and Mandy2021a, Reference Cook, Hull, Crane and Mandy2021b; Hull et al., Reference Hull, Petrides, Allison, Smith, Baron-Cohen, Lai and Mandy2017; Livingston et al., Reference Livingston, Colvert, Bolton and Happé2019b; Schneid & Raz, Reference Schneid and Raz2020; Sullivan, Reference Sullivan2021) and that they had lost their sense of self (Hull et al., Reference Hull, Petrides, Allison, Smith, Baron-Cohen, Lai and Mandy2017). One study reported on an individual who felt they were deceiving themselves regarding their identity (Schneid & Raz, Reference Schneid and Raz2020). Cook et al. (Reference Cook, Ogden and Winstone2018) found that through SC, autistic adults felt they were being superficial or portraying themselves as someone else. Furthermore, autistic adults experienced identity confusion after camouflaging (Hull et al., Reference Hull, Petrides, Allison, Smith, Baron-Cohen, Lai and Mandy2017; Sullivan, Reference Sullivan2021). Lastly, Cook et al. (Reference Cook, Crane, Bourne, Hull and Mandy2021a) found that as SC decreased and autistic socializing increased, autistic adults reported a greater sense of personal authenticity.

Youth. Two studies reported that autistic youth experienced identity confusion because of their camouflaging, specifically, not feeling like their true selves (Halsall et al., Reference Halsall, Clarke and Crane2021), or feeling like they don’t know who they are anymore (Tierney et al., Reference Tierney, Burns and Kilbey2016). Moreover, one study found that autistic youth felt inauthentic to themselves after SC. Particularly, they felt misunderstood by others and stated that no one understood their true selves (Bernardin et al., Reference Bernardin, Mason, Lewis and Kanne2021b). In one study, autistic youth described conflicting feelings around changing themselves to meet others’ expectations (Jedrzejewska & Dewey, Reference Jedrzejewska and Dewey2022).

Support needs

Adults. Four studies found that due to their camouflaging, autistic adults’ support needs were either overlooked or inadequately met (Baldwin & Costley, Reference Baldwin and Costley2016; Hull et al., Reference Hull, Petrides, Allison, Smith, Baron-Cohen, Lai and Mandy2017; Livingston et al., Reference Livingston, Colvert, Bolton and Happé2019b; Tint & Weiss, Reference Tint and Weiss2018). Similarly, in one study SC led to lack of support and accommodations while at work (Livingston et al., Reference Livingston, Colvert, Bolton and Happé2019b). Two studies found that autistic adults refrained from seeking help due to shame, difficulty finding proper support, or simply disbelief from others (Sullivan, Reference Sullivan2021; Baldwin & Costley, Reference Baldwin and Costley2016; Tint & Weiss, Reference Tint and Weiss2018).

Youth. Three studies (Anderson et al., Reference Anderson, Marley, Gillespie-Smith, Carter and MacMahon2020; Cook et al., Reference Cook, Ogden and Winstone2018; Halsall et al., Reference Halsall, Clarke and Crane2021) found themes surrounding unmet support needs resulting from SC in youth. Additionally, two studies found that because these youths masked their learning needs, they were not receiving proper supports in school (Cook et al., Reference Cook, Ogden and Winstone2018; Halsall et al., Reference Halsall, Clarke and Crane2021). Moreover, one study found that autistic youth avoided certain topics that may expose their autistic traits and concealed their learning challenges, resulting in unmet needs and lack of support (Halsall et al., Reference Halsall, Clarke and Crane2021).

Cognitive and neural traits

Adults. Cognitive and neural traits related to SC were largely framed as predictors of SC in the written reports of study findings. However, quantitative relationships between SC and cognitive/neural factors were exclusively correlational, and some qualitative reports suggested possible post-SC cognitive effects. One study found an association between “female-typical” brain connectivity patterns and SC levels as measured by the CAT-Q in autistic females (Walsh et al., Reference Walsh, Pagni, Monahan, Delaney, Smith, Baxter and Braden2022). Gender atypical functional connectivity associations with SC were found in the precuneus and hypothalamus for both males and females (Walsh et al., Reference Walsh, Pagni, Monahan, Delaney, Smith, Baxter and Braden2022). Using a discrepancy approach for SC assessment, Lai et al. (Reference Lai, Lombardo, Chakrabarti, Ruigrok, Bullmore, Suckling, Auyeung, Happé, Szatmari, Baron-Cohen, Bailey, Bolton, Carrington, Catani, Craig, Daly, Deoni, Ecker, Henty, Jezzard, Johnston, Jones, Madden, Mullins, Murphy, Murphy, Pasco, Sadek, Spain, Stewart, Wheelwright and Williams2019) found higher levels of SC behavior in autistic females was associated with greater activity in brain regions responsible for self-representation (Lai et al., Reference Lai, Lombardo, Chakrabarti, Ruigrok, Bullmore, Suckling, Auyeung, Happé, Szatmari, Baron-Cohen, Bailey, Bolton, Carrington, Catani, Craig, Daly, Deoni, Ecker, Henty, Jezzard, Johnston, Jones, Madden, Mullins, Murphy, Murphy, Pasco, Sadek, Spain, Stewart, Wheelwright and Williams2019). Using the discrepancy approach in autistic females, Lai et al. (Reference Lai, Lombardo, Ruigrok, Chakrabarti, Auyeung, Szatmari, Happé and Baron-Cohen2017) found that SC behaviors were positively associated with higher signal detection sensitivity (Lai et al., Reference Lai, Lombardo, Ruigrok, Chakrabarti, Auyeung, Szatmari, Happé and Baron-Cohen2017). The same study found that smaller gray matter volumes in cerebellar, occipital, and medial temporal structures were associated with higher SC in autistic females when compared with autistic males. However, no association was found between SC and gray matter volumes in autistic males (Lai et al., Reference Lai, Lombardo, Ruigrok, Chakrabarti, Auyeung, Szatmari, Happé and Baron-Cohen2017). No significant correlations were found between verbal and full-scale IQ, and SC as measured with the discrepancy approach (Lai et al., Reference Lai, Lombardo, Ruigrok, Chakrabarti, Auyeung, Szatmari, Happé and Baron-Cohen2017). Moreover, functional connectivity associated with increased SC was correlated with higher EF abilities in autistic females, yet lower EF abilities in autistic males (Lai et al., Reference Lai, Lombardo, Ruigrok, Chakrabarti, Auyeung, Szatmari, Happé and Baron-Cohen2017). Two more studies found the converse, with one showing no significant correlation between EF or ToM and CAT-Q SC scores (Belcher et al., Reference Belcher, Morein-Zamir, Mandy and Ford2022), and one study finding no significant correlation between SC and working memory when using the discrepancy approach (Schuck et al., Reference Schuck, Flores and Fung2019).

In qualitative reports, cognition was reportedly affected post-SC. More specifically, aspects of SC were reported as cognitively taxing for autistic adults, which they felt ultimately impacted both their daily living skills and energy levels (Cook et al., Reference Cook, Crane, Bourne, Hull and Mandy2021a; Livingston et al., Reference Livingston, Colvert, Bolton and Happé2019b). Furthermore, Cook et al. (Reference Cook, Crane, Bourne, Hull and Mandy2021a) discovered that participants experienced difficulties when learning as a result of the cognitive fatigue attributed to SC.

Youth. Similarly to adults, all correlations between SC and cognitive traits were correlational. Further, impacts on cognition post-SC were also indicated qualitatively in autistic youth. There was some evidence that EF ability may be associated with SC behaviors (Hull et al., Reference Hull, Levy, Lai, Petrides, Baron-Cohen, Allison, Smith and Mandy2021a; Livingston et al., Reference Livingston, Shah and Happé2019a). Hull et al. (Reference Hull, Levy, Lai, Petrides, Baron-Cohen, Allison, Smith and Mandy2021a) found that SC composite scores on the CAT-Q, as well compensation subscale scores, were associated with stronger EF. Conversely, EF had a negative predictive association with SC on the masking and assimilation subscales. Livingston et al. (Reference Livingston, Shah and Happé2019a) found that high social compensators performed better on a battery of EF tasks when compared to low compensators. However, there was no significant difference in EF ability between deep and unknown compensators. One study also found that high compensators had higher IQ scores than low compensators, but no association was found between any other group of compensators (unknown/deep compensators) (Livingston et al., Reference Livingston, Shah and Happé2019a). Conversely, two more studies found that IQ was not associated with SC behavior (Corbett et al., Reference Corbett, Schwartzman, Libsack, Muscatello, Lerner, Simmons and White2021; Hull et al., Reference Hull, Levy, Lai, Petrides, Baron-Cohen, Allison, Smith and Mandy2021a). Finally, one study found no significant relation between ToM and SC using the CAT-Q (Hull et al., Reference Hull, Levy, Lai, Petrides, Baron-Cohen, Allison, Smith and Mandy2021a).

Similar to with adults, youth found SC to be cognitively taxing. Two studies found that autistic youth masked their learning challenges within the classroom, which ultimately affected their ability to access support and learn (Cook et al., Reference Cook, Ogden and Winstone2018; Halsall et al., Reference Halsall, Clarke and Crane2021). Two studies found that the exhaustion and burnout resulting from SC had a negative impact on youth’s learning (Anderson et al., Reference Anderson, Marley, Gillespie-Smith, Carter and MacMahon2020; Halsall et al., Reference Halsall, Clarke and Crane2021). In Halsall et al. (Reference Halsall, Clarke and Crane2021), autistic youth reported avoiding topics in school that might expose their autistic traits. Moreover, the combination of both SC and the demands of school negatively impacted youth academic performance. Autistic youth showed improved learning when they were in a resource or special education classroom and didn’t feel the need to camouflage as much (Halsall et al., Reference Halsall, Clarke and Crane2021).

Mental health and well-being

Adults. In quantitative research, the correlations between SC and mental health/well-being were non-directional, whereas qualitative reports suggested that mental health concerns may stem directly from SC. One study found that SC significantly predicted suicidality in autistic individuals (Cassidy et al., Reference Cassidy, Bradley, Shaw and Baron-Cohen2018). Livingston et al. (Reference Livingston, Colvert, Bolton and Happé2019b) found that SC led to reports of suicidal ideation, depression, and self-isolation. Additionally, Milner et al. (Reference Milner, Mandy, Happé and Colvert2023) found that SC was significantly correlated with loneliness. Camouflaging was additionally found to be associated with overall depressive symptoms (Cage & Troxell-Whitman, Reference Cage and Troxell-Whitman2019; Hull et al., Reference Hull, Levy, Lai, Petrides, Baron-Cohen, Allison, Smith and Mandy2021a, Reference Hull, Petrides and Mandy2021b; Bowri et al., Reference Bowri, Hull, Allison, Smith, Baron-Cohen, Lai and Mandy2021). Cage and Troxell-Whitman (Reference Cage and Troxell-Whitman2019) found that spontaneous reports of SC (i.e., individuals who spontaneously reported SC within a text response to questions regarding mental health and acceptance) were associated with increased depression. Another study found that higher SC was associated with higher depressive symptoms in males but not females (Lai et al., Reference Lai, Lombardo, Ruigrok, Chakrabarti, Auyeung, Szatmari, Happé and Baron-Cohen2017). Additionally, two studies reported that SC negatively impacted autistic adults’ self-esteem/self-concept (Hull et al., Reference Hull, Petrides, Allison, Smith, Baron-Cohen, Lai and Mandy2017; Livingston et al., Reference Livingston, Shah and Happé2019a, Reference Livingston, Colvert, Bolton and Happé2019b).

Camouflaging was found to induce stress in autistic individuals (Hull et al., Reference Hull, Petrides, Allison, Smith, Baron-Cohen, Lai and Mandy2017; Livingston et al., Reference Livingston, Colvert, Bolton and Happé2019b) and one study reported that distress is directly associated with perceived success of SC (Hull et al., Reference Hull, Petrides, Allison, Smith, Baron-Cohen, Lai and Mandy2017). Cage and Troxell-Whitman (Reference Cage and Troxell-Whitman2019) found that autistic individuals who reported infrequent SC experienced less stress compared to those who reported SC at both moderate and high levels. Cage et al. (Reference Cage, Di Monaco and Newell2018) found that SC was correlated with overall Depression scores. Two studies documented a significant relationship between generalized social anxiety and SC in autistic individuals (Bowri et al., Reference Bowri, Hull, Allison, Smith, Baron-Cohen, Lai and Mandy2021; Hull et al., Reference Hull, Petrides and Mandy2021b). Autistic adults additionally reported that SC increased their anxiety levels (Cook et al., Reference Cook, Crane, Bourne, Hull and Mandy2021a; Hull et al., Reference Hull, Petrides, Allison, Smith, Baron-Cohen, Lai and Mandy2017; Livingston et al., Reference Livingston, Colvert, Bolton and Happé2019b; Sullivan, Reference Sullivan2021). One study analyzed the mental health impacts across three sets of individuals grouped according to the amount they reported camouflaging (Cage & Troxell-Whitman, Reference Cage and Troxell-Whitman2019). Here, a significant difference was observed between those with consistently low SC behaviors and those with high SC behaviors, with the high and moderate SC experiencing greater anxiety.

Various forms of fatigue among autistic individuals were found to be related to SC (Baldwin & Costley, Reference Baldwin and Costley2016; Cook et al., Reference Cook, Crane, Bourne, Hull and Mandy2021a; Hull et al., Reference Hull, Petrides, Allison, Smith, Baron-Cohen, Lai and Mandy2017; Livingston et al., Reference Livingston, Colvert, Bolton and Happé2019b; Sullivan, Reference Sullivan2021; Tint & Weiss, Reference Tint and Weiss2018). Camouflaging was challenging and draining to sustain, and led to complete exhaustion (Cook et al., Reference Cook, Crane, Bourne, Hull and Mandy2021a; Hull et al., Reference Hull, Petrides, Allison, Smith, Baron-Cohen, Lai and Mandy2017; Sullivan, Reference Sullivan2021; Tint & Weiss, Reference Tint and Weiss2018). Camouflaging was a significant contributor to burnout, (as defined using the conceptualization posited by Raymaker et al. (Reference Raymaker, Alan, Teo, Steckler, Lentz, Delos Santos, Kapp, Hunter, Joyce and Nicolaidis2020)) including exhaustion, decreased tolerance of stimuli, and decreased function (Cage & Troxell-Whitman, Reference Cage and Troxell-Whitman2019; Livingston et al., Reference Livingston, Colvert, Bolton and Happé2019b; Raymaker et al., Reference Raymaker, Alan, Teo, Steckler, Lentz, Delos Santos, Kapp, Hunter, Joyce and Nicolaidis2020; Tint & Weiss, Reference Tint and Weiss2018). Additionally, participants felt they needed to be alone to recover after camouflaging (Hull et al., Reference Hull, Petrides, Allison, Smith, Baron-Cohen, Lai and Mandy2017; Livingston et al., Reference Livingston, Colvert, Bolton and Happé2019b). Lastly, one study found that greater SC predicted lower social quality of life (Milner et al., Reference Milner, Mandy, Happé and Colvert2023). In terms of improving mental health outcomes, Cook et al. (Reference Cook, Crane, Bourne, Hull and Mandy2021a) found that less SC and more socializing with autistic social partners lead to better reported mental health.

In contrast, Perry et al. (Reference Perry, Mandy, Hull and Cage2022) examined the association between stigma and well-being and found that SC did not have a mediating effect. Lai et al. (Reference Lai, Lombardo, Ruigrok, Chakrabarti, Auyeung, Szatmari, Happé and Baron-Cohen2017) found no significant associations between anxiety and SC. In Cage and Troxell-Whitman’s (Reference Cage and Troxell-Whitman2019) study, they found depression levels were high across all three SC groups (low, moderate, high) compared to a non-autistic sample, however, they did not find any significant differences in the level of depression across levels of SC. Further, Cage and Troxell-Whitman (Reference Cage and Troxell-Whitman2019) found that spontaneous reports of SC were not associated with increased stress or anxiety, and Cage et al. (Reference Cage, Di Monaco and Newell2018) found no significant association between SC and the anxiety subscale on the DASS.

Youth. In qualitative research, mental health issues were reported as both potential motivators for, and consequences of, SC behavior in autistic youth. Autistic youth who display comorbid mental health difficulties report a desire to camouflage their mental health concerns along with their autistic traits, thus motivating camouflaging behavior (Anderson et al., Reference Anderson, Marley, Gillespie-Smith, Carter and MacMahon2020; Moyse & Porter, 2015; Jedrzejewska & Dewey, Reference Jedrzejewska and Dewey2022; Tierney et al., Reference Tierney, Burns and Kilbey2016). Conversely, some youth reported higher levels of anxiety and depression as a result of SC (Cook et al., Reference Cook, Ogden and Winstone2018; Halsall et al., Reference Halsall, Clarke and Crane2021; Tierney et al., Reference Tierney, Burns and Kilbey2016).

Non-directional quantitative associations between various mental health outcomes were also found. Bernardin et al. (Reference Bernardin, Lewis, Bell and Kanne2021a) discovered there was a significant quantitative association between SC and both anxiety and depression using the CAT-Q. When using the discrepancy approach, Corbett et al. (Reference Corbett, Schwartzman, Libsack, Muscatello, Lerner, Simmons and White2021) and Livingston et al. (Reference Livingston, Colvert, Bolton and Happé2019b) analysed the four quadrants (High (good ADOS + poor ToM), Low (poor ADOS + poor ToM), Deep (good ADOS + good ToM), and Unknown (poor ADOS + good ToM) of compensation and mental health impacts. Participants in one study reported feeling of suicidality related to SC (Tierney et al., Reference Tierney, Burns and Kilbey2016), and reported participating in self-harming behavior in another (Bernardin et al., Reference Bernardin, Lewis, Bell and Kanne2021a). Corbett et al. (Reference Corbett, Schwartzman, Libsack, Muscatello, Lerner, Simmons and White2021) found that in contrast to the high-compensation group, the low-compensation group had significantly higher rates of social anxiety. Additionally, when comparing high versus unknown compensators, the unknown compensators had greater social and state anxiety. Conversely, Corbett et al. (2019) found no differences between the high and low-compensation group’s scores on trait anxiety scales. Finally, Livingston et al. (Reference Livingston, Colvert, Bolton and Happé2019b), found that individuals in the high-compensation group had greater anxiety compared to the low-compensation group. Further, Bernardin et al. (Reference Bernardin, Lewis, Bell and Kanne2021a, Reference Bernardin, Mason, Lewis and Kanne2021b) found that higher SC levels were associated with higher stress levels in females only. Additionally, Halsall et al. (Reference Halsall, Clarke and Crane2021) found that autistic youth felt distress and uncertainty over whether their SC attempts were successful.

Similarly to adults, there was evidence that camouflaging may cause fatigue in autistic youth (Anderson et al., Reference Anderson, Marley, Gillespie-Smith, Carter and MacMahon2020; Bernardin et al., Reference Bernardin, Mason, Lewis and Kanne2021b; Halsall et al., Reference Halsall, Clarke and Crane2021; Tierney et al., Reference Tierney, Burns and Kilbey2016). One study reported that autistic youth felt they needed to be alone after camouflaging (Bernardin et al., Reference Bernardin, Mason, Lewis and Kanne2021b). Similarly, resulting from their camouflaging, autistic youth in two studies reported feeling lonely (Halsall et al., Reference Halsall, Clarke and Crane2021; Tierney et al., Reference Tierney, Burns and Kilbey2016). An additional study reported that because of camouflaging, autistic youth developed a negative self-esteem/concept (Halsall et al., Reference Halsall, Clarke and Crane2021). Extending from this, one study found that mental health challenges due to SC caused perceptual distortions (e.g., hearing voices; Tierney et al., Reference Tierney, Burns and Kilbey2016). Masking of other mental health difficulties predicted somatic symptoms in one study (Cook et al., Reference Cook, Ogden and Winstone2018).

Conversely, Corbett et al. (2022) found there was no difference between positive affect when comparing deep and unknown compensators, and no high versus low compensation-based group differences across state or trait anxiety. Lastly, Bernardin et al. (Reference Bernardin, Mason, Lewis and Kanne2021b) found certain gender differences in mental health outcomes related to SC: autistic boys reported feeling neutral to positive, whereas autistic girls reported feeling more negative.

Social skills

Adults. No studies included in this review reported the relationship between social skills and SC in autistic adults.

Youth. In autistic youth, one study found that deep compensators had better vocal expression and rapport than unknown compensators, high compensators had better social communication and rapport than low compensators, and high compensators had better use of gestures/asking questions than deep compensators (Corbett et al., Reference Corbett, Schwartzman, Libsack, Muscatello, Lerner, Simmons and White2021). In contrast, there was no difference between gestures used, or overall social involvement when comparing deep and unknown compensators (Corbett et al., Reference Corbett, Schwartzman, Libsack, Muscatello, Lerner, Simmons and White2021). These associations were correlational and non-directional.

Age of diagnosis

Adults. Three studies that used qualitative methodologies found that SC was associated with late diagnosis or wrong diagnosis (Baldwin & Costley, Reference Baldwin and Costley2016; Hull et al., Reference Hull, Petrides, Allison, Smith, Baron-Cohen, Lai and Mandy2017; Livingston et al., Reference Livingston, Colvert, Bolton and Happé2019b). Another study discovered an association between late diagnosis and increased SC (Perry et al., Reference Perry, Mandy, Hull and Cage2022). Similarly, one study found that higher assimilation and compensation scores on the CAT-Q, were associated with later (adult) autism diagnoses (McQuaid et al., Reference McQuaid, Lee and Wallace2022). In contrast, two quantitative studies did not find an association between age at autism diagnosis and SC (Belcher et al., Reference Belcher, Morein-Zamir, Mandy and Ford2022; Cassidy et al., Reference Cassidy, Bradley, Shaw and Baron-Cohen2018). As all of the quantitative studies were correlational, it is possible that late diagnosis may contribute to and/or be a consequence of SC.

Youth. Qualitative reports indicated that SC may be associated with late/wrong diagnosis in youth (Anderson et al., Reference Anderson, Marley, Gillespie-Smith, Carter and MacMahon2020; Cook et al., Reference Cook, Ogden and Winstone2018; Halsall et al., Reference Halsall, Clarke and Crane2021). Similarly to adults, direction of this association cannot be ascertained.