Exploring the association between social camouflaging and self- versus caregiver-report discrepancies in anxiety and depressive symptoms in autistic and non-autistic socially anxious adolescents

Abstract

Social camouflaging in autism involves hiding social differences and autistic traits to fit in with neurotypical settings and is associated with poorer mental health in both autistic adolescents and adults. This study explored the association between self-reported social camouflaging behaviours and adolescents’ self-report of generalised anxiety disorder and depressive symptoms compared with caregiver reports. A clinical sample of 43 autistic and 39 non-autistic adolescents (14–19 years), without intellectual disability and matched on social anxiety, and their primary caregiver completed questionnaires reporting the young person’s autistic traits, generalised anxiety disorder and depression symptoms. Using response surface analysis, congruence between adolescent and caregiver rated autistic traits, generalised anxiety disorder and depression symptoms were not associated with greater camouflaging scores. Response surface analysis parameters showed that camouflaging was greater when both adolescent and caregivers rated high levels of autistic traits and generalised anxiety disorder symptoms, and when adolescents exceeded caregiver ratings on autistic traits, generalised anxiety disorder and depression symptoms. Adolescents who experience greater anxiety and autistic traits may engage in more (though less effective) social camouflaging behaviours, which in turn may contribute towards poorer mental health outcomes. Clinicians may benefit from collaboratively creating with adolescents a person-centred formulation that considers the associations between autistic traits and mental health outcomes. Lay abstract: Social camouflaging or masking refers to strategies autistic individuals adopt to hide their autism persona when trying to fit in. It is unclear whether camouflaging is only applicable to social differences unique to autism, or more generally to any types of social difference, such as experiences of mental health difficulties. We asked 43 autistic and 39 non-autistic adolescents (aged 14–19 years, all of whom showed similarly high levels of social anxiety) and their primary caregivers to complete questionnaires about their mental health (anxiety and depression) and autistic traits, and adolescents self-reported camouflaging behaviours. We wondered if camouflaging may be used to hide mental health difficulties reported by young people and affect caregiver report on symptom severity. We found that adolescents who self-reported greater levels of autistic traits, anxiety and depression symptoms compared with their caregivers reported greater camouflaging. Adolescents who agreed on having high levels of autistic traits and anxiety symptoms with their caregivers reported greater camouflaging behaviours. We discuss how having high levels of autistic traits and anxiety may increase adolescents’ camouflaging behaviours to hide social differences, which may contribute towards poor mental health outcomes. We think it is important to talk with adolescents about how camouflaging social and mental health difference can have negative impacts for mental health as well as possible positive social gains.