Thread by @neuroqueery

A 2020 study on #autistic camouflaging strategies! They identified four types and made some interesting observations on how they affect diagnosis.

[a thread]

molecularautism.biomedcentral.com/articles/10.11…

Participants were mostly intellectually-able female autistics, and they looked at differences between diagnosed and undiagnosed people. /2

This line in the beginning was hilarious to me:

“there is growing evidence to suggest that neurotypically presenting autistic people continue being autistic at the cognitive level”

lol do you think???? /s

/3

Let's look at the four types of "compensatory strategies" they identified: masking, shallow compensation, deep compensation, and accommodations /4

1. Masking:

“strategies that involve regulating pre-existing behaviors”

IE censoring your true thoughts, dressing like the group, remaining silent in conversations /5

this was not associated with autistic traits, supporting prior evidence that non-autistic people mask certain behaviors socially, too /6

2. Shallow Compensation:

“Strategies that enable production of neurotypical behaviour without solving the cognitive difference in question”

IE: learning scripts + social rules, faking eye contact /7

Shallow comp was associated with diagnosis, as they "may not always be sophisticated enough to disguise autistic tendencies from others, such as clinicians” /8

3. Deep Compensation:

“Strategies that enable an alternative route to solve the cognitive difficulty in question”

IE: using a catalog of learned human behavior + logic to navigate social situations + infer others' mental states /9

Deep comp can “operate without awareness” + become automatic over time. It's more flexible and was linked to being undiagnosed.

“..Diagnosed individuals have few deep compensation strategies, which may be indicative of why they required a diagnosis in the first place.” /10

4. Accommodations:

“Strategies that help accommodate, but do not necessarily alter, one’s cognitive difference”

IE: choosing to work in a specific environment or structure your life differently /11

Overall, the study found that “Higher compensation scores—representing a greater repertoire of compensatory strategies—were associated with having an #autism diagnosis, more #autistic traits and a higher education level.” /12

They also found that it is autistic traits, not diagnosis, that are linked to more compensatory strategies.

“This accords with qualitative studies in which #autistic adults report using strategies from a young age, before recognition and diagnosis of ASD” /13

They found a positive correlation between compensatory strategies and education level, suggesting that these methods “demand intellectual abilities” which “may aid learning and implementation of multiple strategies” /14

Doctors, please take note:

“We suggest that clinicians should be aware of compensatory strategies in intellectually-able individuals reporting autistic-like difficulties, even if they do not meet strict behavioural criteria for ASD." /15

"Indeed, these individuals may require a similar level of support to diagnosed individuals, particularly as compensation is linked with poor mental wellbeing.” /16