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:
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:
The total score ranges from 25–175 with higher scores reflecting greater camouflaging.
There are three subscales:
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:
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
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