Camouflaging Autistic Traits Questionnaire (CAT-Q)

The Camouflaging Autistic Traits Questionnaire (CAT-Q) is a 25-item self-report measure of social camouflaging behaviours for individuals of age 16 and above. It is used to identify individuals who compensate for or mask autistic characteristics during social interactions and who might not immediately present with autistic traits due to their ability to mask. This can be especially relevant for women with autism.

The CAT-Q measures the degree of use of camouflaging strategies among people with autism. The more an individual can camouflage, the more of their autistic inclinations they are likely able to suppress. As such, a high camouflaging score can also account for lower scores on standard autism psychometric scales.

Importantly, there are significant differences between males and females, so interpretation of scores should be considered in light of gender factors.

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

  1. Compensation
  2. Masking
  3. Assimilation

Psychometric Properties

Research shows robust psychometric support for the CAT-Q. High internal consistency was found for the total scale (Cronbach’s alpha = 0.94), and the Compensation (0.91), Masking (0.85), and Assimilation (0.92) factors (Hull et al., 2019).

Test–retest reliability was good for the total scale (0.77) and no significant differences were found between scores at both times (3 months apart; Hull et al., 2019). The stability was good for the Compensation factor (0.78), while moderate stability was found for the Masking (0.70) and Assimilation factors (0.73; Hull et al., 2019).

The CAT-Q was validated on 306 autistic and 472 non-autistic individuals between the ages of 16 and 82 years of age (Hull et al., 2020). The means and standard deviations are as follows and are used to calculate percentiles:

  • Autistic Individuals (Mean (SD)):
    • Total Score (Female 124.35 (23.27); Male 109.64 (26.50))
    • Compensation (Female 41.85 (11.11); Male 36.81 (12.14))
    • Masking (Female 37.87 (10.54); Male 32.90 (10.57)
    • Assimilation (Female 44.63 (7.82); Male 39.93 (11.26))
  • Neurotypical Individuals (Mean (SD)):
    • Total Score (Female 90.87 (27.67); Male 96.89 (24.22))
    • Compensation (Female 27.18 (11.5); Male 30.06 (10.92))
    • Masking (Female 34.69 (9.05); Male 36.34 (8.13))
    • Assimilation (Female 29.00 (11.73); Male 30.48 (10.33))

Scoring and Interpretation 

The total score ranges from 25–175 with higher scores reflecting greater camouflaging.

There are three subscales:

  1. Compensation — (items 1, 4, 5, 8, 11, 14, 17, 20, and 23)
    Strategies used to actively compensate for difficulties in social situations. Examples: copying body language and facial expressions, learning social cues from movies and books.
  2. Masking — (items 2, 6, 9, 12, 15, 18, 21, and 24)
    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.
  3. Assimilation — (items 3, 7, 10, 13, 16, 19, 22, and 25)
    Strategies used to try to fit in with others in social situations. Examples: Putting on an act, avoiding or forcing interactions with others.

Percentiles are calculated, comparing scores against neurotypical and ASD males, females, or combined males/females (if your client’s gender is not specified; Hull et al., 2020), indicating how the respondent scored in relation to a typical pattern of responding for neurotypical and autistic adults.

For example, a clinical percentile of 50 for females indicates the individual has typical Camouflaging compared to the ASD population, which corresponds to an approximate 89th percentile compared with a normative population i.e., what is “normal” for someone with autism is unusual compared to people without autism.

Below are some considerations relevant for interpreting scores:

  • High total scores correlate with social anxiety in both individuals with autism and neurotypicals. Therefore, high percentile scores relative to the normative sample (i.e. above 84) indicates either neurotypical social anxiety or camouflaging of autistic traits.
  • Autistic females demonstrate higher total camouflaging scores than autistic males, but there is no camouflaging gender difference for non-autistic people.
  • Autistic males score lower on Masking than their neurotypical counterparts, but do score higher in Compensation and Assimilation.
  • In individuals with autism, the total score and the Assimilation score negatively correlate with well-being.
  • In neurotypical people, all scores negatively correlate with well-being.
  • In individuals with autism, all scores were correlated with depression and generalised anxiety.

Developer

Hull, L., Mandy, W., Lai, M.-C., Baron-Cohen, S., Allison, C., Smith, P., & Petrides, K. V. (2019). Development and Validation of the Camouflaging Autistic Traits Questionnaire (CAT-Q). Journal of Autism and Developmental Disorders, 49(3), 819–833. https://doi.org/10.1007/s10803-018-3792-6

References

Hull, L., Lai, M.-C., Baron-Cohen, S., Allison, C., Smith, P., Petrides, K. V., & Mandy, W. (2020). Gender differences in self-reported camouflaging in autistic and non-autistic adults. Autism: The International Journal of Research and Practice, 24(2), 352–363. https://doi.org/10.1177/1362361319864804