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Exploring the Construct Validity of the Camouflaging Autistic Traits Questionnaire: A Factor Analytic Study

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Title: Exploring the Construct Validity of the Camouflaging Autistic Traits Questionnaire: A Factor Analytic Study
Language: English
Authors: Katharine McKinnon (ORCID 0009-0001-5448-2098), Mackenzie Bougoure (ORCID 0000-0002-5739-8537), Sici Zhuang (ORCID 0000-0002-9850-7218), Diana Weiting Tan (ORCID 0000-0002-6394-8435), Iliana Magiati
Source: Autism: The International Journal of Research and Practice. 2025 29(3):642-658.
Availability: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
Peer Reviewed: Y
Page Count: 17
Publication Date: 2025
Document Type: Journal Articles
Reports - Research
Descriptors: Foreign Countries, Adults, Autism Spectrum Disorders, Attitudes toward Disabilities, Normalization (Disabilities), Inclusion, Interpersonal Competence, Test Reliability, Sense of Belonging, Test Validity, Anxiety, Acculturation, Social Differences, Social Adjustment, Social Desirability, Social Distance, Social Behavior, Behavior Standards, Social Cognition
Geographic Terms: Australia
DOI: 10.1177/13623613241287964
ISSN: 1362-3613
1461-7005
Abstract: 'Camouflaging' is a set of strategies used by autistic people to hide or compensate for their autistic characteristics to fit into predominantly non-autistic social environments. Many researchers have used the Camouflaging Autistic Traits Questionnaire (CAT-Q) to measure camouflaging. However, there have been questions about the construct validity of the CAT-Q as a measurement of camouflaging. The present study examined the extent to which CAT-Q items were distinguishable from other theoretically and empirically related measures of social anxiety, fear of negative evaluation and autistic social traits. Autistic adults (N = 308) completed the CAT-Q and social anxiety, fear of negative evaluation and autistic social traits measures. The small-to-large positive associations between camouflaging and social anxiety, fear of negative evaluation and autistic social traits (r = 0.14-0.65) were not indicative of collinearity. Three exploratory factor analyses, in which CAT-Q items were factor-analysed together with social anxiety, fear of negative evaluation and autistic social traits items respectively, showed that CAT-Q items generally loaded onto different factors from social anxiety, fear of negative evaluation and autistic social traits items, with the exception of the CAT-Q Assimilation subscale items, which cross-loaded mostly with autistic social traits items. Overall, the CAT-Q items were positively associated with, but also differentiated from, most social anxiety, fear of negative evaluation and autistic social traits items, providing support for the measure's construct validity.
Abstractor: As Provided
Entry Date: 2025
Accession Number: EJ1465396
Database: ERIC
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  Value: <anid>AN0183571282;f9d01mar.25;2025Mar12.05:16;v2.2.500</anid> <title id="AN0183571282-1">Exploring the construct validity of the Camouflaging Autistic Traits Questionnaire: A factor analytic study </title> <p>'Camouflaging' is a set of strategies used by autistic people to hide or compensate for their autistic characteristics to fit into predominantly non-autistic social environments. Many researchers have used the Camouflaging Autistic Traits Questionnaire (CAT-Q) to measure camouflaging. However, there have been questions about the construct validity of the CAT-Q as a measurement of camouflaging. The present study examined the extent to which CAT-Q items were distinguishable from other theoretically and empirically related measures of social anxiety, fear of negative evaluation and autistic social traits. Autistic adults (N = 308) completed the CAT-Q and social anxiety, fear of negative evaluation and autistic social traits measures. The small-to-large positive associations between camouflaging and social anxiety, fear of negative evaluation and autistic social traits (r = 0.14–0.65) were not indicative of collinearity. Three exploratory factor analyses, in which CAT-Q items were factor-analysed together with social anxiety, fear of negative evaluation and autistic social traits items respectively, showed that CAT-Q items generally loaded onto different factors from social anxiety, fear of negative evaluation and autistic social traits items, with the exception of the CAT-Q Assimilation subscale items, which cross-loaded mostly with autistic social traits items. Overall, the CAT-Q items were positively associated with, but also differentiated from, most social anxiety, fear of negative evaluation and autistic social traits items, providing support for the measure's construct validity. Autistic people describe having to mask or 'camouflage' their autistic selves to fit into certain social settings. Many researchers have used the CAT-Q to measure the extent to which autistic people engage in camouflaging. However, some researchers have questioned whether the CAT-Q measures camouflaging or whether it measures other related experiences and behaviours associated with social anxiety, fear of being negatively judged or social autistic traits. In our study, we analysed the CAT-Q to check whether it is indeed similar to or different from these related experiences. To do this, we asked 308 autistic adults to complete the CAT-Q and questionnaires about social anxiety, fear of being negatively judged and autistic social features. Then, we put all the CAT-Q items together with the items from each of the other measures in three separate analyses (called factor analyses) to see how the items would group together. These analyses showed us whether camouflaging behaviours are distinguishable and different from, or cluster together with, these other experiences. We found that most of CAT-Q items grouped together separately from the other measures' items, suggesting that camouflaging differs from these other related experiences. Only some items from one of the CAT-Q subscales clustered together with some social anxiety and autistic items, suggesting these may need to be teased out better in the future. Generally, our findings show that we can use the CAT-Q to measure camouflaging behaviours among autistic people.</p> <p>Keywords: adults; anxiety; autism spectrum disorders; camouflaging</p> <p>Autistic[<reflink idref="bib4" id="ref1">4</reflink>] people commonly experience co-occurring mental health difficulties and are diagnosed with anxiety, social anxiety, depression and other mental health difficulties at rates ranging between 20% and 80%, considerably higher than those reported in the general population ([<reflink idref="bib20" id="ref2">20</reflink>]; [<reflink idref="bib29" id="ref3">29</reflink>]). Psychosocial experiences contribute to explaining these high rates, as autistic people often encounter more social and communicative challenges than their non-autistic peers, including being misunderstood, stigmatised, discriminated against and excluded ([<reflink idref="bib49" id="ref4">49</reflink>]). Resultantly, many autistic people camouflage[<reflink idref="bib5" id="ref5">5</reflink>] their autistic traits to navigate non-autistic social landscapes – a concept called 'autistic camouflaging' (hereafter 'camouflaging').</p> <p>Although strategies to monitor and modify social behaviours to fit in and to manage the challenges of the social world are also common in non-autistic people and in other groups (see, for example, [<reflink idref="bib1" id="ref6">1</reflink>], [<reflink idref="bib2" id="ref7">2</reflink>], on camouflaging as impression management and a shared social coping response; see also [<reflink idref="bib27" id="ref8">27</reflink>]; [<reflink idref="bib58" id="ref9">58</reflink>] on camouflaging in ADHD and developmental language disorder), many autistic adults (e.g. [<reflink idref="bib11" id="ref10">11</reflink>]), and possibly more autistic women than men ([<reflink idref="bib18" id="ref11">18</reflink>]), engage in autistic camouflaging, which involves the conscious and deliberate or unconscious use of several strategies specifically to hide one's autism and to 'pass' as non-autistic, for example, forcing eye contact or preparing social conversation 'scripts' ([<reflink idref="bib32" id="ref12">32</reflink>]; [<reflink idref="bib44" id="ref13">44</reflink>]). Camouflaging strategies have been described by autistic adolescents and adults as often necessary, adaptive, and helpful for social acceptance, employment, and educational opportunities and as a set of strategies to defend oneself against bullying, discrimination and social isolation (see [<reflink idref="bib64" id="ref14">64</reflink>], for review; [<reflink idref="bib37" id="ref15">37</reflink>] on 'adaptive morphing'). Nevertheless, camouflaging has also been described as emotionally painful and exhausting, with more frequent camouflaging use being consistently linked to increased anxiety, depression, suicidality ([<reflink idref="bib4" id="ref16">4</reflink>]; [<reflink idref="bib11" id="ref17">11</reflink>]; [<reflink idref="bib14" id="ref18">14</reflink>]; [<reflink idref="bib45" id="ref19">45</reflink>]) and autistic burnout ([<reflink idref="bib46" id="ref20">46</reflink>]; [<reflink idref="bib54" id="ref21">54</reflink>]; [<reflink idref="bib64" id="ref22">64</reflink>]) in cross-sectional studies.</p> <p>There are different ways to measure autistic people's camouflaging in research to date. The discrepancy approach measures camouflaging by 'quantifying differences between internal autistic states reported by autistic people and observable behavioural presentations' ([<reflink idref="bib18" id="ref23">18</reflink>]; p. 7; see also [<reflink idref="bib36" id="ref24">36</reflink>]; [<reflink idref="bib62" id="ref25">62</reflink>]), and as such measures the 'outcomes' of camouflaging ([<reflink idref="bib62" id="ref26">62</reflink>]) and not the camouflaging behaviours employed or autistic people's internal processes (see also [<reflink idref="bib18" id="ref27">18</reflink>]). Most camouflaging research to date has used self-report checklists (see [<reflink idref="bib26" id="ref28">26</reflink>] for a review of camouflaging measures). The most commonly used self-report camouflaging scale, the Camouflaging Autistic Traits Questionnaire (CAT-Q; [<reflink idref="bib31" id="ref29">31</reflink>]), was developed based on autistic adults' lived experiences of camouflaging and measures the autistic adults' self-reported frequency of using different camouflaging behaviours ([<reflink idref="bib31" id="ref30">31</reflink>]), rather than the intent, effort or outcomes of camouflaging. An initial exploratory factor analysis indicated that the CAT-Q comprises three subscales ([<reflink idref="bib31" id="ref31">31</reflink>]): (a) Masking (efforts to present a non-autistic persona in social situations; e.g. 'I adjust my body language or facial expressions so that I appear interested by the person I am interacting with'); (b) Assimilation ('blending-in' and hiding one's discomfort in social situations; e.g. 'In social situations, I feel like I'm "performing" rather than being myself'); and (c) Compensation (behaviours aiming to compensate for autistic social and communication differences; e.g. 'I have developed a script to follow in social situations'). The CAT-Q has very good to excellent internal consistency, test–retest reliability, and good convergent validity through positive correlations with measures of autistic traits, social and generalised anxiety and depression ([<reflink idref="bib26" id="ref32">26</reflink>]; [<reflink idref="bib31" id="ref33">31</reflink>]).</p> <p>[<reflink idref="bib24" id="ref34">24</reflink>] questioned whether measuring camouflaging with the CAT-Q may be confounded by co-occurring social anxiety rather than measuring a distinct set of behaviours associated with camouflaging. Fombonne argued that co-occurring mental health symptoms, such as social anxiety, were not sufficiently explored in camouflaging research and that a demonstration of camouflaging's construct validity is required. [<reflink idref="bib35" id="ref35">35</reflink>] agreed that 'addressing the unsettled construct validity [of camouflaging] is a priority' (p. 1037), highlighting a need 'to identify [camouflaging's] overlapping factor structures with various current measures and associations with established constructs' (p. 1037). Similarly, [<reflink idref="bib62" id="ref36">62</reflink>] also urged future research to assess if the CAT-Q items are distinguishable from social anxiety or other mental health or neurodevelopmental features.</p> <p>In response to these suggestions, the present study examined the extent to which CAT-Q camouflaging items were distinguishable from questionnaire items measuring conceptually and empirically related constructs, namely social anxiety, fear of negative evaluation (FNE) and autistic social traits.</p> <hd id="AN0183571282-2">Social anxiety, fear of negative evaluation, and camouflaging</hd> <p>Rates of clinically elevated social anxiety and/or a diagnosis of social anxiety are common in autistic adults (26%–51%; [<reflink idref="bib29" id="ref37">29</reflink>]). Social anxiety involves persistent and disabling anxiety around social interactions ([<reflink idref="bib47" id="ref38">47</reflink>]) and camouflaging may share at least some conceptual overlap with social anxiety. Like autistic people, socially anxious people typically develop emotional, behavioural and/or social 'strategies' to avoid negative evaluation ([<reflink idref="bib60" id="ref39">60</reflink>]): these may include intense self-monitoring and a range of safety behaviours to endure or escape social interactions, such as avoidance and social impression management strategies ([<reflink idref="bib1" id="ref40">1</reflink>]; [<reflink idref="bib22" id="ref41">22</reflink>]; [<reflink idref="bib25" id="ref42">25</reflink>]; [<reflink idref="bib28" id="ref43">28</reflink>]). Similar strategies have also been described in qualitative studies of autistic camouflaging ([<reflink idref="bib18" id="ref44">18</reflink>]; [<reflink idref="bib32" id="ref45">32</reflink>]), and some are included in the CAT-Q items. For instance, the CAT-Q Masking subscale has items relating to self-monitoring, while the CAT-Q Assimilation subscale includes items relating to social avoidance.</p> <p>In the literature to date, positive associations of mostly medium effect size have been reported between the total CAT-Q and social anxiety in autistic adults (<emph>r</emph>s = 0.29 and 0.44 in [<reflink idref="bib31" id="ref46">31</reflink>], [<reflink idref="bib30" id="ref47">30</reflink>], respectively) and camouflaging was a significant predictor of social anxiety (with a small contribution over and above age and autistic traits) in [<reflink idref="bib30" id="ref48">30</reflink>]. However, the CAT-Q Assimilation subscale was strongly positively associated with social anxiety (<emph>r</emph>s = 0.60) in [<reflink idref="bib31" id="ref49">31</reflink>]. [<reflink idref="bib42" id="ref50">42</reflink>] explored the relationship between camouflaging and safety behaviours related to social anxiety in autistic and non-autistic adolescents and found that all three CAT-Q subscales were positively associated with social anxiety (with medium effect size <emph>rs</emph> = 0.25–0.48) after controlling for autistic traits. These consistent associations across studies suggest a relationship between camouflaging and social anxiety, while also suggesting that they are not the same construct based on the effect sizes reported to date.</p> <p>Fear of negative evaluation (FNE; anxiety over the unfavourable judgement or disapproval of others; [<reflink idref="bib12" id="ref51">12</reflink>]; [<reflink idref="bib43" id="ref52">43</reflink>]) is a core construct often underlying social anxiety in the general population ([<reflink idref="bib16" id="ref53">16</reflink>]; [<reflink idref="bib53" id="ref54">53</reflink>]). Autistic people have reported that camouflaging may be driven by a fear of ostracism and bullying ([<reflink idref="bib11" id="ref55">11</reflink>]; [<reflink idref="bib32" id="ref56">32</reflink>]) and can be a way to avoid being negatively perceived (e.g. [<reflink idref="bib5" id="ref57">5</reflink>]; [<reflink idref="bib15" id="ref58">15</reflink>]). There is very limited literature on the relationship between FNE and camouflaging, although one study found that FNE was a strong predictor of camouflaging in a cross-sectional path model of sociocultural and individual psychological predictors in autistic adults ([<reflink idref="bib63" id="ref59">63</reflink>]).</p> <p>The potential conflation between camouflaging, social anxiety and FNE may not be solely due to similarities between constructs and measurement items, but also because of the high co-occurrence of autism and anxiety, including social anxiety. Twenty to thirty per cent of autistic adults experience clinically elevated social anxiety or a social anxiety disorder diagnosis, and studies employing questionnaires rather than clinical diagnostic interviews suggest rates of clinically elevated social anxiety of more than 50% ([<reflink idref="bib29" id="ref60">29</reflink>]). It is thus possible that the items developed and included in the CAT-Q based on qualitative descriptions of camouflaging by autistic adults ([<reflink idref="bib32" id="ref61">32</reflink>]) may have inadvertently captured autistic adults' anxiety or FNE relating to social situations and interactions. Given the close intertwining of social anxiety and FNE, it is important to establish that any measure of camouflaging is not conflated with social anxiety or FNE.</p> <hd id="AN0183571282-3">Autistic social traits and camouflaging</hd> <p>Most measures of autistic traits encompass a range of items assessing social interaction and social communication differences and difficulties (hereafter referred to as autistic social traits). Since camouflaging involves hiding or compensating for autistic traits in social situations, it is reasonable to expect a significant positive association between camouflaging and autistic social traits. Indeed, small to medium effect size positive correlations have been reported between autistic social traits and CAT-Q total (<emph>r</emph>s = 0.22–0.33; [<reflink idref="bib31" id="ref62">31</reflink>], [<reflink idref="bib30" id="ref63">30</reflink>]). Associations between CAT-Q subscales and autistic traits have varied, such that CAT-Q Masking was not associated with autistic social traits (<emph>r</emph>s = 0.03–0.07), but Compensation was (0.27) and Assimilation showed the strongest associations with BAPQ aloof and pragmatic language subscales at 0.62–0.63 ([<reflink idref="bib31" id="ref64">31</reflink>]). However, for the CAT-Q to demonstrate construct validity in measuring camouflaging, CAT-Q items should be distinguishable from the social characteristics commonly associated with autism.</p> <hd id="AN0183571282-4">The present study</hd> <p>Most studies reviewed thus far have examined the correlations between camouflaging and conceptually and empirically similar constructs, including social anxiety and autistic social traits. While these correlational analyses show positive associations between these measures, the construct validity of the CAT-Q has not yet been sufficiently established.</p> <p>The present study therefore examined the extent to which the CAT-Q items overlap with, or are distinct from, items that measure these related constructs. We first examined the associations between the CAT-Q total and subscale scores and measures of social anxiety, FNE and autistic social traits. Then, we examined the partial relationships between camouflaging and these three variables controlling for social anxiety or autistic social traits respectively, to explore the extent to which these associations were partially or fully explained by the third variable (autistic social traits or social anxiety). Third, we conducted three exploratory factor analyses of the CAT-Q items combined with items from the social anxiety, FNE and autistic social traits' measures, respectively. This method of combining items from two different measures in a factor analysis is a common approach to evaluate construct validity and has been previously used to investigate measurement and conceptual distinctions between autistic and alexithymic traits ([<reflink idref="bib21" id="ref65">21</reflink>]) and between autistic traits and social anxiety ([<reflink idref="bib43" id="ref66">43</reflink>]; [<reflink idref="bib61" id="ref67">61</reflink>]).</p> <p>We hypothesised that (<reflink idref="bib1" id="ref68">1</reflink>) CAT-Q will be positively associated with measures of social anxiety, FNE and autistic social traits, but that the correlation coefficients would be smaller than the 0.8 threshold for collinearity ([<reflink idref="bib6" id="ref69">6</reflink>]; [<reflink idref="bib59" id="ref70">59</reflink>]); and that (<reflink idref="bib2" id="ref71">2</reflink>) CAT-Q items will load on different factors from social anxiety, FNE, and autistic social traits' items.</p> <hd id="AN0183571282-5">Methods</hd> <p></p> <hd id="AN0183571282-6">Participants</hd> <p>Participants were recruited online in 2020–2021 through social media, autism-affiliated organisations and Prolific (https://<ulink href="http://www.prolific.com">www.prolific.com</ulink>).</p> <p>Individuals who (a) were 18 years or older; (b) had an autism diagnosis or self-identified as autistic;[<reflink idref="bib6" id="ref72">6</reflink>] and (c) could self-report via an online survey in English; were invited to participate. A total of 359 participants responded to our recruitment calls, of whom 51 were excluded due to: (a) not meeting one or more of the inclusion criteria (<emph>n</emph> = 14); (b) not providing consent or completing the survey (<emph>n</emph> = 31); (c) indicating that their data were not valid for use in research (<emph>n</emph> = 1); (d) failing our built-in bot detection for data illegitimacy (<emph>n</emph> = 3); (e) repeating the survey (<emph>n</emph> = 1); and (f) indicating 'prefer not to say' for over 30% of their responses (<emph>n</emph> = 1).</p> <p>Table 1 presents participants' demographic characteristics (<emph>N</emph> = 308).</p> <p>Table 1. Participants' socio-demographic characteristics (N = 308).</p> <p>Graph</p> <p></p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th /><th align="left"><italic>N or M</italic></th><th align="left">% or <italic>SD</italic></th></tr></thead><tbody><tr><td>Age (years)<xref ref-type="table-fn" rid="tfn1">a</xref></td><td>36.17</td><td>11.62</td></tr><tr><td colspan="3">Diagnosis<xref ref-type="table-fn" rid="tfn2">b</xref></td></tr><tr><td> Professional autism diagnosis</td><td>265</td><td>86</td></tr><tr><td> Self-identified as autistic</td><td>43</td><td>14</td></tr><tr><td colspan="3">Gender</td></tr><tr><td> Female</td><td>189</td><td>61.4</td></tr><tr><td> Male</td><td>88</td><td>28.6</td></tr><tr><td> Non-binary, other genders or undisclosed</td><td>31</td><td>10.1</td></tr><tr><td colspan="3">Educational level</td></tr><tr><td> Primary school</td><td>5</td><td>1.6</td></tr><tr><td> Secondary school</td><td>59</td><td>19.2</td></tr><tr><td> Trade/technical certificate</td><td>43</td><td>14</td></tr><tr><td> Undergraduate university education</td><td>105</td><td>34.1</td></tr><tr><td> Postgraduate higher education</td><td>82</td><td>26.6</td></tr><tr><td> Other</td><td>14</td><td>4.5</td></tr><tr><td colspan="3">Ethnicity</td></tr><tr><td> Caucasian</td><td>238</td><td>77.27</td></tr><tr><td> Mixed race</td><td>29</td><td>9.42</td></tr><tr><td> Asian</td><td>23</td><td>7.47</td></tr><tr><td> Hispanic or Latino/Latina</td><td>6</td><td>1.95</td></tr><tr><td> African or Caribbean</td><td>5</td><td>1.62</td></tr><tr><td> Other</td><td>7</td><td>2.27</td></tr><tr><td colspan="3">Employment status</td></tr><tr><td> Full-time</td><td>98</td><td>31.82</td></tr><tr><td> Part-time</td><td>69</td><td>22.40</td></tr><tr><td> Not working</td><td>86</td><td>27.92</td></tr><tr><td> Student</td><td>53</td><td>17.21</td></tr><tr><td> Prefer not to say</td><td>2</td><td>0.65</td></tr><tr><td colspan="3">Relationship status</td></tr><tr><td> Single</td><td>158</td><td>51.30</td></tr><tr><td> In a relationship</td><td>148</td><td>48.05</td></tr><tr><td> Prefer not to say</td><td>2</td><td>0.65</td></tr><tr><td colspan="3">Reported a mental health diagnosis (in past 5 years)</td></tr><tr><td> Anxiety disorders</td><td>171</td><td>55.52</td></tr><tr><td> Depressive disorders</td><td>159</td><td>51.62</td></tr><tr><td> Post-traumatic stress disorder</td><td>29</td><td>9.42</td></tr><tr><td> Obsessive-compulsive disorders</td><td>21</td><td>6.82</td></tr><tr><td> Eating disorders</td><td>5</td><td>1.62</td></tr><tr><td> Other</td><td>18</td><td>5.84</td></tr><tr><td colspan="3">Number of co-occurring mental health diagnoses reported</td></tr><tr><td> 0</td><td>95</td><td>30.84%</td></tr><tr><td> 1</td><td>71</td><td>23.05%</td></tr><tr><td> 2</td><td>102</td><td>33.12%</td></tr><tr><td> 3+</td><td>40</td><td>12.99%</td></tr></tbody></table> </ephtml> </p> <p>1 Range = 18–76 years.</p> <p>2 There were no differences between diagnosed and self-identified participants in autistic traits reported, and 96.8% of participants had a Broad Autism Phenotype Questionnaire (BAPQ) total score above 3.15, the suggested screening cut-off score for this measure ([<reflink idref="bib33" id="ref73">33</reflink>]).</p> <hd id="AN0183571282-7">Measures</hd> <p></p> <hd id="AN0183571282-8">Camouflaging</hd> <p>Rated on a 7-point Likert-type scale (from 1 'strongly disagree' to 7 'strongly agree'; total score range 25–175; higher scores = more frequent camouflaging), the 25-item Camouflaging Autistic Traits Questionnaire (CAT-Q; [<reflink idref="bib31" id="ref74">31</reflink>]) has three subscales (Compensation, Assimilation, and Masking; see Introduction). It has acceptable test–retest reliability after 3 months (<emph>r</emph> = 0.77) and excellent internal consistency (Cronbach's ⍺ = 0.94). The three-factor model demonstrated a good fit in both autistic and non-autistic samples, and in both men and women ([<reflink idref="bib31" id="ref75">31</reflink>]).</p> <hd id="AN0183571282-9">Autistic traits</hd> <p>Rated on a 6-point Likert-type scale (from 1 'very rarely' to 6 'very often'; the total score is averaged and ranges from 1 to 6; higher scores = more autistic traits), the 36-item Broad Autism Phenotype Questionnaire (BAPQ; [<reflink idref="bib33" id="ref76">33</reflink>]) measures autistic traits in the general population, relatives of autistic people, and in autistic people, and has three subscales (aloofness, rigidity, and pragmatic language). The aloofness (12 items) and pragmatic language (12 items) subscales were used in this study to measure autistic social traits. The BAPQ has excellent internal consistency (Cronbach's ⍺ = 0.91; [<reflink idref="bib33" id="ref77">33</reflink>]). Based on BAPQ cut-off scores by [<reflink idref="bib33" id="ref78">33</reflink>], 91% and 96% of our participants reported BAPQ aloof and pragmatic language subscale scores above cut-off, respectively.</p> <hd id="AN0183571282-10">Social anxiety</hd> <p>The Social Interaction Anxiety Scale (SIAS-6) and the Social Phobia Scale (SPS-6) are companion short scales ([<reflink idref="bib52" id="ref79">52</reflink>]) measuring two core related but distinct elements of social anxiety relating to social interactions and to performance under scrutiny, respectively. Each scale has six items rated on a 5-point Likert-type scale (from 0 'not at all characteristic or true of me' to 4 'extremely characteristic or true of me'; scale score range 0–24 and total score range 0–48; higher scores = greater social anxiety). These brief scales have each shown excellent convergent and divergent validity ([<reflink idref="bib52" id="ref80">52</reflink>]) and good internal consistency (α = 0.75–0.85) in anxious and non-anxious participants ([<reflink idref="bib41" id="ref81">41</reflink>]). The longer 20-item SIAS and SPS scales, from which the short forms were derived, have very good internal consistency and convergent validity with autistic adults ([<reflink idref="bib8" id="ref82">8</reflink>]). Based on the short scales' development study cut-off scores of 7 for the SIAS-6 and 2 for the SPS-6 with non-autistic participants ([<reflink idref="bib52" id="ref83">52</reflink>]), the vast majority of our participants (93%) reported social anxiety above general population cut-offs in these two short scales.</p> <hd id="AN0183571282-11">Fear of negative evaluation</hd> <p>A brief 8-item version (BFNE-II; [<reflink idref="bib13" id="ref84">13</reflink>]) of the 12-item Brief Fear of Negative Evaluation Scale (BFNES; [<reflink idref="bib39" id="ref85">39</reflink>]) was used. Responses range from 1, 'not at all characteristic of me' to 5, 'extremely characteristic of me' (total score range 8–40; higher BFNE scores = greater FNE). The 8-item BFNE-II scale had high diagnostic sensitivity and reliability (Cronbach's ⍺ = 0.95) when completed by autistic adults ([<reflink idref="bib8" id="ref86">8</reflink>]).</p> <hd id="AN0183571282-12">Procedure</hd> <p>Ethics approval was granted by The University of Western Australia (Ref 2021/ET000065). Participants were screened for eligibility before providing written informed consent and completing the questionnaires online on Qualtrics, an online survey platform. The study took about 30–60 min, as participants also completed additional questionnaires as part of a larger study of psychosocial correlates of camouflaging and autistic burnout. Two attention check questions were included and none of our participants failed these. Participants were compensated for their time with the equivalent of AUD20 via direct bank transfer or online gift cards.</p> <hd id="AN0183571282-13">Data analysis plan</hd> <p>Analyses were conducted using IBM SPSS Statistics (Version 26). To examine the first hypothesis, Pearson's <emph>r</emph> correlations between camouflaging, social anxiety, FNE, and autistic social traits were conducted (<emph>r</emph> = 0.1, 0.3 and 0.5 were considered small, medium or large effect sizes, respectively; [<reflink idref="bib17" id="ref87">17</reflink>]). In addition, partial correlations between CAT-Q and social anxiety, CAT-Q and FNE (controlling for autistic social traits) and between CAT-Q and autistic social traits (controlling for social anxiety) were calculated.</p> <p>To examine the second hypothesis, three sets of exploratory factor analyses (EFA) were performed with CAT-Q items entered with either SIAS/SPS, FNE, or autistic social traits items respectively to examine if camouflaging items would load on the same or different factors as social anxiety, FNE and autistic social traits' items. For the EFAs, maximum likelihood estimation (MLE) was used, as appropriate when factor loadings are unequal and factors are inter-correlated ([<reflink idref="bib23" id="ref88">23</reflink>]), which previous research and theory indicated is likely to be the case for all four constructs/measures in this study. Results were interpreted using the pattern matrix, as recommended when there is factor overlap and the solution is rotated ([<reflink idref="bib38" id="ref89">38</reflink>]). Oblique rotation with direct oblimin was used, as correlations between items were expected. A factor loading threshold was set as 0.3, as recommended by [<reflink idref="bib56" id="ref90">56</reflink>]. Scree plot and parallel analysis, as recommended by [<reflink idref="bib19" id="ref91">19</reflink>], were used to determine structure solutions which were interpretable, simple and meaningful.</p> <hd id="AN0183571282-14">Community involvement</hd> <p>Some of the authors are neurodivergent and were involved in all aspects of this research including conceptualisation, data analysis and interpretation, and writing up and dissemination. In addition, three paid autistic advisors (who were not authors in this psychometrically focused study on construct validity) provided consultation on the broader research conceptualisation and design, research questions, interpretation and communication of findings of the larger research project within which the current study was embedded.</p> <hd id="AN0183571282-15">Results</hd> <p></p> <hd id="AN0183571282-16">Data screening and descriptive statistics</hd> <p>Skewness and kurtosis values were within recommended limits of 2 and 9, respectively ([<reflink idref="bib23" id="ref92">23</reflink>]). Descriptive statistics are presented in Table 2. All total scales and subscales showed good to excellent internal reliability in this study (Cronbach's α = 0.75–0.95). Our study participants' total CAT-Q mean score of 129 was similar to others (e.g. 126.7 in [<reflink idref="bib51" id="ref93">51</reflink>]; 119.8 in [<reflink idref="bib31" id="ref94">31</reflink>]), but somewhat higher than CAT-Q total scores reported in other studies (e.g. 111 in [<reflink idref="bib30" id="ref95">30</reflink>]; 106–110 in [<reflink idref="bib48" id="ref96">48</reflink>]; and [<reflink idref="bib57" id="ref97">57</reflink>] with Japanese autistic adults), possibly due to differences in recruitment, sampling (e.g. Oshima and colleagues excluded self-identifying autistic participants, and both studies included more men than women compared to our sample) and/or sociocultural differences.</p> <p>Table 2. Mean, standard deviation, internal consistency, skewness and kurtosis of main measures (N = 308).</p> <p>Graph</p> <p></p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th /><th align="left">M (or <italic>N</italic>)</th><th align="left">SD (or %)</th><th align="left">Reliability (Cronbach's α)</th><th align="left">Skewness</th><th align="left">Kurtosis</th></tr></thead><tbody><tr><td>Camouflaging (CAT-Q) Total</td><td>129.58</td><td>22.94</td><td>0.91</td><td>–0.77</td><td>0.78</td></tr><tr><td> CAT-Q Compensation</td><td>44.01</td><td>11.46</td><td>0.88</td><td>–0.65</td><td>0.03</td></tr><tr><td> CAT-Q Masking</td><td>40.53</td><td>9.55</td><td>0.86</td><td>–0.96</td><td>0.87</td></tr><tr><td> CAT-Q Assimilation</td><td>45.04</td><td>7.51</td><td>0.80</td><td>–0.79</td><td>0.65</td></tr><tr><td>Autistic Social Traits (BAPQ<xref ref-type="table-fn" rid="tfn4">a</xref>,<xref ref-type="table-fn" rid="tfn5">b</xref>) Total</td><td>4.21</td><td>0.65</td><td>0.86</td><td>–0.17</td><td>–0.06</td></tr><tr><td> BAPQ Aloof</td><td>4.37</td><td>0.82</td><td>0.87</td><td>–0.34</td><td>–0.40</td></tr><tr><td> BAPQ Pragmatic Language</td><td>4.04</td><td>0.74</td><td>0.78</td><td>–0.39</td><td>0.31</td></tr><tr><td>Social Anxiety (SIAS/SPS total)</td><td>26.08</td><td>10.59</td><td>0.88</td><td>–0.15</td><td>–0.70</td></tr><tr><td> Social Interaction Anxiety Scale (SIAS-6)<xref ref-type="table-fn" rid="tfn5">b</xref></td><td>14.00</td><td>4.93</td><td>0.75</td><td>–0.36</td><td>0.03</td></tr><tr><td> Social Phobia Scale (SPS-6)<xref ref-type="table-fn" rid="tfn5">b</xref></td><td>12.08</td><td>6.88</td><td>0.89</td><td>–0.07</td><td>–1.02</td></tr><tr><td>Brief Fear of Negative Evaluation (BFNE) total</td><td>30.10</td><td>8.84</td><td>0.95</td><td>–0.67</td><td>–0.62</td></tr></tbody></table> </ephtml> </p> <ulist> <item>3 <emph>SD</emph>: standard deviation; CAT-Q: Camouflaging Autistic Traits Questionnaire; BAPQ: Broad Autism Phenotype Questionnaire; SPS: Social Phobia Scale; BFNE: Brief Fear of Negative Evaluation.</item> <item>4 Only the 'Pragmatic Language' and 'Aloof' BAPQ subscale total raw scores were included from the BAPQ in this study.</item> <item>5 For the BAPQ, the suggested cut off for the aloof subscale is 3.25 and for the pragmatic language 2.75 ([<reflink idref="bib33" id="ref98">33</reflink>]); for the SIAS the suggested clinically elevated cut-off of the short forms for the general population is 7 and for the SPS it is 2 ([<reflink idref="bib52" id="ref99">52</reflink>]); overall most of our participants (91% for aloof subscale and 96% for pragmatic language subscale) reported autistic social traits and social anxiety (93%) exceeding the suggested cut-off scores.</item> </ulist> <p>Table 3 presents inter-correlations between age, gender, diagnostic status (professionally diagnosed vs self-identified) and CAT-Q, SIAS/SPS, BFNE and BAPQ. These were all either non-significant or of small effect sizes. The main analyses were therefore carried out with the whole sample.</p> <p>Table 3. Correlations between camouflaging (CAT-Q), autistic social traits (BAPQa), social anxiety (SIAS/SPS), fear of negative evaluation (BFNE), age, gender and diagnostic status (professionally diagnosed/self-identified) [and partial correlations between CAT-Q, BAPQa, SIAS/SPS and BFNE]# [<reflink idref="bib7" id="ref100">7</reflink>].</p> <p>Graph</p> <p></p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th /><th align="left">CATQ Total</th><th align="left">CATQ Comp</th><th align="left">CATQ Masking</th><th align="left">CATQAssim</th><th align="left">BAPQ Prag + Aloof<sup>b</sup></th><th align="left">BAPQ Pragmatic Language</th><th align="left">BAPQAloof</th><th align="left">SIAS/ SPS</th><th align="left">BFNE</th><th align="left">Age</th><th align="left">Gender</th></tr></thead><tbody><tr><td colspan="12">CATQ total</td></tr><tr><td> CATQ Comp</td><td>0.87<xref ref-type="table-fn" rid="tfn8">***</xref></td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td> CATQ Masking</td><td>0.84<xref ref-type="table-fn" rid="tfn8">***</xref></td><td>0.61<xref ref-type="table-fn" rid="tfn8">***</xref></td><td /><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td> CATQ Assim</td><td>0.66<xref ref-type="table-fn" rid="tfn8">***</xref></td><td>0.37<xref ref-type="table-fn" rid="tfn8">***</xref></td><td>0.36<xref ref-type="table-fn" rid="tfn8">***</xref></td><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td> BAPQ<xref ref-type="table-fn" rid="tfn7">a</xref> Prag + Aloof</td><td>0.33<xref ref-type="table-fn" rid="tfn8">***</xref></td><td>0.24<xref ref-type="table-fn" rid="tfn8">***</xref></td><td>0.00</td><td>0.66<xref ref-type="table-fn" rid="tfn8">***</xref></td><td /><td /><td /><td /><td /><td /><td /></tr><tr><td /><td><italic>[0.09]</italic><xref ref-type="table-fn" rid="tfn7">#</xref></td><td><italic>[0.05]</italic><xref ref-type="table-fn" rid="tfn7">#</xref></td><td>[-0.18<xref ref-type="table-fn" rid="tfn8">**</xref>]<xref ref-type="table-fn" rid="tfn7">#</xref></td><td><italic>[0</italic>.49<xref ref-type="table-fn" rid="tfn8">***</xref><italic>]</italic><xref ref-type="table-fn" rid="tfn7">#</xref></td><td /><td /><td /><td /><td /><td /><td /></tr><tr><td> BAPQ Prag</td><td>0.27<xref ref-type="table-fn" rid="tfn8">***</xref></td><td>0.27<xref ref-type="table-fn" rid="tfn8">***</xref></td><td>-0.02</td><td>0.42<xref ref-type="table-fn" rid="tfn8">***</xref></td><td>0.81<xref ref-type="table-fn" rid="tfn8">***</xref></td><td /><td /><td /><td /><td /><td /></tr><tr><td> BAPQ Aloof</td><td>0.29<xref ref-type="table-fn" rid="tfn8">***</xref></td><td>0.14<xref ref-type="table-fn" rid="tfn8">*</xref></td><td>0.02</td><td>0.65<xref ref-type="table-fn" rid="tfn8">***</xref></td><td>0.85<xref ref-type="table-fn" rid="tfn8">***</xref></td><td>0.38<xref ref-type="table-fn" rid="tfn8">***</xref></td><td /><td /><td /><td /><td /></tr><tr><td> SIAS/SPS</td><td>0.45<xref ref-type="table-fn" rid="tfn8">***</xref></td><td>0.34<xref ref-type="table-fn" rid="tfn8">***</xref></td><td>0.25<xref ref-type="table-fn" rid="tfn8">***</xref></td><td>0.54<xref ref-type="table-fn" rid="tfn8">***</xref></td><td>0.60<xref ref-type="table-fn" rid="tfn8">***</xref></td><td>0.56<xref ref-type="table-fn" rid="tfn8">***</xref></td><td>0.44<xref ref-type="table-fn" rid="tfn8">***</xref></td><td /><td /><td /><td /></tr><tr><td /><td><italic>[0</italic>.<bold><italic>33***</italic></bold><italic>]</italic><xref ref-type="table-fn" rid="tfn7">#</xref></td><td>[0.25<xref ref-type="table-fn" rid="tfn8">***</xref>]<xref ref-type="table-fn" rid="tfn7">#</xref></td><td><italic>[0</italic>.30<xref ref-type="table-fn" rid="tfn8">***</xref><italic>]</italic><xref ref-type="table-fn" rid="tfn7">#</xref></td><td>[0.25<xref ref-type="table-fn" rid="tfn8">***</xref>]<xref ref-type="table-fn" rid="tfn7">#</xref></td><td /><td /><td /><td /><td /><td /><td /></tr><tr><td> BFNE</td><td>0.40<xref ref-type="table-fn" rid="tfn8">***</xref></td><td>0.28<xref ref-type="table-fn" rid="tfn8">***</xref></td><td>0.38<xref ref-type="table-fn" rid="tfn8">***</xref></td><td>0.29<xref ref-type="table-fn" rid="tfn8">**</xref></td><td>0.15<xref ref-type="table-fn" rid="tfn8">**</xref></td><td>0.26<xref ref-type="table-fn" rid="tfn8">***</xref></td><td>0.01</td><td>0.55<xref ref-type="table-fn" rid="tfn8">***</xref></td><td /><td /><td /></tr><tr><td /><td>[0.37<xref ref-type="table-fn" rid="tfn8">***</xref>]<xref ref-type="table-fn" rid="tfn7">#</xref></td><td>[0.26<xref ref-type="table-fn" rid="tfn8">***</xref>]<xref ref-type="table-fn" rid="tfn7">#</xref></td><td>[0.38<xref ref-type="table-fn" rid="tfn8">***</xref>]<xref ref-type="table-fn" rid="tfn7">#</xref></td><td>[0.25<xref ref-type="table-fn" rid="tfn8">***</xref>]<xref ref-type="table-fn" rid="tfn7">#</xref></td><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>Age</td><td>-0.02</td><td>-0.09</td><td>-0.05</td><td>0.14<xref ref-type="table-fn" rid="tfn8">*</xref></td><td>0.12<xref ref-type="table-fn" rid="tfn8">*</xref></td><td>-0.02</td><td>0.22<xref ref-type="table-fn" rid="tfn8">***</xref></td><td>-0.14<xref ref-type="table-fn" rid="tfn8">*</xref></td><td>-0.29<xref ref-type="table-fn" rid="tfn8">***</xref></td><td /><td /></tr><tr><td>Gender</td><td>0.24<xref ref-type="table-fn" rid="tfn8">***</xref></td><td>0.23<xref ref-type="table-fn" rid="tfn8">***</xref></td><td>0.22<xref ref-type="table-fn" rid="tfn8">***</xref></td><td>0.11</td><td>0.02</td><td>0.11</td><td>-0.06</td><td>0.08</td><td>0.11</td><td>-0.01</td><td /></tr><tr><td>Diagnostic status</td><td>0.04</td><td>-0.01</td><td>0.05</td><td>0.08</td><td>0.05</td><td>-0.02</td><td>0.10</td><td>-0.01</td><td>-0.01</td><td>0.10</td><td>0.10</td></tr></tbody></table> </ephtml> </p> <ulist> <item>6 <emph>Note</emph>. CAT-Q Com = CAT-Q Compensation; CAT-Q Assim = CAT-Q Assimilation; BAPQ Prag + Aloof = BAPQ Pragmatic Language' and 'Aloof' subscale; SIAS/SPS: Social Interaction Anxiety Scale/Social Phobia Scale; BFNE: Brief Fear of Negative Evaluation; Diagnostic status = professionally diagnosed or self-identifying as autistic.</item> <item>7 <emph>[partial correlations]</emph>: CAT-Q with BAPQ<sups>a</sups> controlling for social anxiety (SIAS/SPS); CAT-Q with social anxiety (SIAS/SPS) and FNE controlling for autistic social traits. In bold, correlations >0.3 and <emph>p</emph> < 0.001. <sups>a</sups>Only the 'Pragmatic Language' and 'Aloof' BAPQ subscale total raw scores were included from the BAPQ in this study.</item> <item>8 <emph>p</emph> < 0.05, ** <emph>p</emph> < 0.01, *** <emph>p</emph> < 0.001.</item> </ulist> <hd id="AN0183571282-17">Associations between camouflaging, social anxiety, FNE and autistic social traits (Hypothesis...</hd> <p>Consistent with the prediction that the CAT-Q would show positive, but not larger than 0.8, correlations with measures of social anxiety, FNE and autistic social traits, correlations between the CAT-Q total or subscale scores and SIAS/SPS, BFNE and BAPQ were all <0.66 (see Table 3), with the largest associations between CAT-Q Assimilation and BAPQ Aloof + Pragmatic Language autistic social traits (0.66).</p> <p>Partial correlations between camouflaging (CAT-Q) total and subscales and social anxiety controlling for autistic social traits ranged from 0.25 to 0.30 (Table 3), and partial correlations between autistic social traits and camouflaging controlling for social anxiety ranged from −0.18 to 0.49 (Table 3). Overall, the partial associations were mostly smaller in effect size than the Pearson's <emph>r</emph> correlations, although still significant and of medium effect size, suggesting that to some extent the relationship between the variables was partially, but not fully, accounted for by the third variable. Only the relationship between CAT-Q Compensation and autistic social traits was no longer significant (partial <emph>r</emph> = 0.05) when social anxiety was partialled out, suggesting that this relationship was fully accounted for by social anxiety. The relationships between FNE and CAT-Q remained largely the same even after partialling out autistic social traits.</p> <hd id="AN0183571282-18">Examining construct overlap between camouflaging and social anxiety, FNE and autistic social...</hd> <p>The Kaiser-Meyer-Olkin (KMO) factorability assumptions' values were 0.90 for social anxiety, 0.91 for FNE and 0.89 for autistic social traits, above the minimum of 0.70 recommended by [<reflink idref="bib34" id="ref101">34</reflink>], indicating that the data were suitable for factor analysis.</p> <p>Over all three FAs conducted, CAT-Q items generally showed little cross-loading with other non-camouflaging factors: one CAT-Q Masking item loaded on two factors with non-camouflaging items ('I always think about the impression I make on other people' cross-loaded into a social anxiety factor and a social autistic traits' factor; see Tables 4 and 5); and one CAT-Q-Assimilation item ('When talking to other people, I feel like the conversation flows naturally') cross-loaded into the social autistic traits' factor; see Table 6). In all other instances of cross-loading (see Table 4, Table 5 and Table 6), some of the CAT-Q items may have on some occasions cross-loaded with another CAT-Q factor, but not with social anxiety, FNE or social autistic traits' factors.</p> <p>Table 4. Factor loadings of exploratory factor analysis of the Camouflaging Autistic Traits Questionnaire (CAT-Q) and the Social Interaction Anxiety Scale/Social Phobia Scale (SIAS/SPS) items (N = 308).</p> <p>Graph</p> <p></p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="left" colspan="2" rowspan="2">Scale/item</th><th align="left" colspan="4">Factor loadings</th></tr><tr><th align="left">1</th><th align="left">2</th><th align="left">3</th><th align="left">4</th></tr></thead><tbody><tr><td>CAT-Q_M1</td><td>I monitor my body language or facial expressions so that I appear relaxed.</td><td>0.79</td><td /><td /><td /></tr><tr><td>CAT-Q_M2</td><td>I adjust my body language or facial expressions so that I appear interested by the person I am interacting with.</td><td>0.74</td><td /><td /><td /></tr><tr><td>CAT-Q_M3</td><td><italic>I always think about the impression I make on other people</italic></td><td><italic>0.39</italic></td><td><italic>0.33</italic></td><td /><td /></tr><tr><td>CAT-Q_M4</td><td>I don't feel the need to make eye contact with other people if I don't want to. (R)</td><td>0.40</td><td /><td /><td /></tr><tr><td>CAT-Q_M5</td><td>I monitor my body language or facial expressions so that I appear interested by the person I am interacting with.</td><td>0.72</td><td /><td /><td /></tr><tr><td>CAT-Q_M6</td><td>I am always aware of the impression I make on other people.</td><td>0.33</td><td /><td /><td /></tr><tr><td>CAT-Q_M7</td><td>I adjust my body language or facial expressions so that I appear relaxed.</td><td>0.70</td><td /><td /><td /></tr><tr><td>CAT-Q_M8</td><td>In social interactions, I do not pay attention to what my face or body are doing. (R)</td><td>0.66</td><td /><td /><td /></tr><tr><td>CAT-Q_A1</td><td><italic>I rarely feel the need to put on an act in order to get through a social situation. (R)</italic></td><td><italic>0.33</italic></td><td /><td /><td><italic>0.35</italic></td></tr><tr><td>CAT-Q_A2</td><td><italic>In social situations, I feel like I'm 'performing' rather than being myself</italic>.</td><td><italic>0.38</italic></td><td /><td /><td><italic>0.44</italic></td></tr><tr><td>CAT-Q_A3</td><td>I need the support of other people in order to socialise.</td><td /><td /><td /><td>0.36</td></tr><tr><td>CAT-Q_A4</td><td>I have to force myself to interact with people when I am in social situations.</td><td /><td /><td /><td>0.66</td></tr><tr><td>CAT-Q_A5</td><td>When in social situations, I try to find ways to avoid interacting with others.</td><td /><td /><td /><td>0.54</td></tr><tr><td>CAT-Q_A6</td><td>I feel free to be myself when I am with other people. (R)</td><td /><td /><td /><td>0.64</td></tr><tr><td>CAT-Q_A7</td><td>When talking to other people, I feel like the conversation flows naturally. (R)</td><td /><td /><td /><td>0.67</td></tr><tr><td>CAT-Q_A8</td><td>In social situations, I feel like I am pretending to be 'normal'.</td><td /><td /><td /><td>0.59</td></tr><tr><td>CAT-Q_C1</td><td><italic>When I am interacting with someone, I deliberately copy their body language or facial expressions</italic>.</td><td><italic>0.31</italic></td><td /><td><italic>-0.36</italic></td><td /></tr><tr><td>CAT-Q_C2</td><td>I have developed a script to follow in social situations (for example, a list of questions or topics of conversation).</td><td /><td /><td>-0.49</td><td /></tr><tr><td>CAT-Q_C3</td><td>I will repeat phrases that I have heard others say in the exact same way that I first heard them.</td><td /><td /><td>-0.47</td><td /></tr><tr><td>CAT-Q_C4</td><td>In my own social interactions, I use behaviours that I have learned from watching other people interacting.</td><td /><td /><td>-0.66</td><td /></tr><tr><td>CAT-Q_C5</td><td>I practice my facial expressions and body language to make sure they look natural.</td><td /><td /><td>-0.48</td><td /></tr><tr><td>CAT-Q_C6</td><td>I have tried to improve my understanding of social skills by watching other people.</td><td /><td /><td>-0.64</td><td /></tr><tr><td>CAT-Q_C7</td><td>I have researched the rules of social interactions (for example, by studying psychology or reading books on human behaviour) to improve my own social skills.</td><td /><td /><td>-0.51</td><td /></tr><tr><td>CAT-Q_C8</td><td>I learn how people use their bodies and faces to interact by watching television or films, or by reading fiction.</td><td /><td /><td>-0.91</td><td /></tr><tr><td>CAT-Q_C9</td><td>I have spent time learning social skills from television shows and films, and try to use these in my interactions.</td><td /><td /><td>-0.97</td><td /></tr><tr><td>SIAS1</td><td>I have difficulty making eye contact with others.</td><td /><td>0.35</td><td /><td /></tr><tr><td>SIAS2</td><td>I find it difficult mixing comfortably with the people I work with.</td><td /><td /><td /><td>0.48</td></tr><tr><td>SIAS3</td><td>I tense up if I meet an acquaintance on the street.</td><td /><td /><td /><td>0.54</td></tr><tr><td>SIAS4</td><td>I feel tense if I am alone with just one person.</td><td /><td>0.30</td><td /><td /></tr><tr><td>SIAS5</td><td>I have difficulty talking with other people.</td><td /><td /><td /><td>0.53</td></tr><tr><td>SIAS6</td><td>I find it difficult to disagree with another's point of view.</td><td /><td /><td /><td /></tr><tr><td>SPS7</td><td>I get nervous that people are staring at me as I walk down the street.</td><td /><td>0.77</td><td /><td /></tr><tr><td>SPS8</td><td>I worry about shaking or trembling when I'm watched by other people.</td><td /><td>0.54</td><td /><td /></tr><tr><td>SPS9</td><td>I would get tense if I had to sit facing other people on a bus or train.</td><td /><td>0.75</td><td /><td /></tr><tr><td>SPS10</td><td>I worry I might do something to attract the attention of other people.</td><td /><td>0.76</td><td /><td /></tr><tr><td>SPS11</td><td>When in an elevator, I am tense if people look at me.</td><td /><td>0.86</td><td /><td /></tr><tr><td>SPS12</td><td>I can feel conspicuous standing in a line.</td><td /><td>0.77</td><td /><td /></tr><tr><td /><td /><td /><td /><td /><td /></tr></tbody></table> </ephtml> </p> <p>9 <emph>Note</emph>. CAT-Q_M: CAT-Q Masking; CAT-Q_A: CAT-Q Assimilation; CAT-Q_C: CAT-Q Compensation; SIAS/SPS Social Interaction Anxiety Scale/Social Phobia Scale. Reverse-scored items denoted with (R). Items in <emph>italics</emph> are cross-loaded.</p> <p>Table 5. Factor loadings of exploratory factor analysis of the Camouflaging Autistic Traits Questionnaire (CAT-Q) and the Brief Fear of Negative Evaluation Scale (BFNE) items (N = 308).</p> <p>Graph</p> <p></p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="left" colspan="2" rowspan="2">Scale/item</th><th align="left" colspan="4">Factor loadings</th></tr><tr><th align="left">1</th><th align="left">2</th><th align="left">3</th><th align="left">4</th></tr></thead><tbody><tr><td>CAT-Q_M1</td><td>I monitor my body language or facial expressions so that I appear relaxed.</td><td>0.83</td><td /><td /><td /></tr><tr><td>CAT-Q_M2</td><td>I adjust my body language or facial expressions so that I appear interested by the person I am interacting with.</td><td>0.76</td><td /><td /><td /></tr><tr><td>CAT-Q_M3</td><td><italic>I always think about the impression I make on other people</italic></td><td><italic>0.32</italic></td><td><italic>-0.43</italic></td><td /><td /></tr><tr><td>CAT-Q_M4</td><td>I don't feel the need to make eye contact with other people if I don't want to. (R)</td><td>0.37</td><td /><td /><td /></tr><tr><td>CAT-Q_M5</td><td>I monitor my body language or facial expressions so that I appear interested by the person I am interacting with.</td><td>0.73</td><td /><td /><td /></tr><tr><td>CAT-Q_M6</td><td>I am always aware of the impression I make on other people.</td><td>0.31</td><td /><td /><td /></tr><tr><td>CAT-Q_M7</td><td>I adjust my body language or facial expressions so that I appear relaxed.</td><td>0.73</td><td /><td /><td /></tr><tr><td>CAT-Q_M8</td><td>In social interactions, I do not pay attention to what my face or body are doing. (R)</td><td>0.68</td><td /><td /><td /></tr><tr><td>CAT-Q_A1</td><td><italic>I rarely feel the need to put on an act in order to get through a social situation. (R)</italic></td><td><italic>0.32</italic></td><td /><td /><td><italic>0.35</italic></td></tr><tr><td>CAT-Q_A2</td><td><italic>In social situations, I feel like I'm 'performing' rather than being myself</italic>.</td><td><italic>0.33</italic></td><td /><td /><td><italic>0.50</italic></td></tr><tr><td>CAT-Q_A3</td><td>I need the support of other people in order to socialise.</td><td /><td /><td /><td>0.39</td></tr><tr><td>CAT-Q_A4</td><td>I have to force myself to interact with people when I am in social situations.</td><td /><td /><td /><td>0.69</td></tr><tr><td>CAT-Q_A5</td><td>When in social situations, I try to find ways to avoid interacting with others.</td><td /><td /><td /><td>0.60</td></tr><tr><td>CAT-Q_A6</td><td>I feel free to be myself when I am with other people. (R)</td><td /><td /><td /><td>0.65</td></tr><tr><td>CAT-Q_A7</td><td>When talking to other people, I feel like the conversation flows naturally. (R)</td><td /><td /><td /><td>0.61</td></tr><tr><td>CAT-Q_A8</td><td>In social situations, I feel like I am pretending to be 'normal'.</td><td /><td /><td /><td>0.60</td></tr><tr><td>CAT-Q_C1</td><td>When I am interacting with someone, I deliberately copy their body language or facial expressions.</td><td /><td /><td>0.36</td><td /></tr><tr><td>CAT-Q_C2</td><td>I have developed a script to follow in social situations (for example, a list of questions or topics of conversation).</td><td /><td /><td>0.46</td><td /></tr><tr><td>CAT-Q_C3</td><td>I will repeat phrases that I have heard others say in the exact same way that I first heard them.</td><td /><td /><td>0.47</td><td /></tr><tr><td>CAT-Q_C4</td><td>In my own social interactions, I use behaviours that I have learned from watching other people interacting.</td><td /><td /><td>0.65</td><td /></tr><tr><td>CAT-Q_C5</td><td>I practice my facial expressions and body language to make sure they look natural.</td><td /><td /><td>0.48</td><td /></tr><tr><td>CAT-Q_C6</td><td>I have tried to improve my understanding of social skills by watching other people.</td><td /><td /><td>0.63</td><td /></tr><tr><td>CAT-Q_C7</td><td>I have researched the rules of social interactions (for example, by studying psychology or reading books on human behaviour) to improve my own social skills.</td><td /><td /><td>0.50</td><td /></tr><tr><td>CAT-Q_C8</td><td>I learn how people use their bodies and faces to interact by watching television or films, or by reading fiction.</td><td /><td /><td>0.91</td><td /></tr><tr><td>CAT-Q_C9</td><td>I have spent time learning social skills from television shows and films, and try to use these in my interactions.</td><td /><td /><td>0.96</td><td /></tr><tr><td>BFNE1</td><td>I worry about what other people will think of me even when I know it doesn't make any difference.</td><td /><td>-0.89</td><td /><td /></tr><tr><td>BFNE2</td><td>I am frequently afraid of other people noticing my shortcomings.</td><td /><td>-0.83</td><td /><td /></tr><tr><td>BFNE3</td><td>I am afraid that others will not approve of me.</td><td /><td>-0.89</td><td /><td /></tr><tr><td>BFNE4</td><td>I am afraid that people will find fault with me.</td><td /><td>-0.88</td><td /><td /></tr><tr><td>BFNE5</td><td>When I am talking to someone, I worry about what they may be thinking about me.</td><td /><td>-0.86</td><td /><td /></tr><tr><td>BFNE6</td><td>I am usually worried about what kind of impression I make.</td><td /><td>-0.86</td><td /><td /></tr><tr><td>BFNE7</td><td>If I know someone is judging me, it tends to bother me.</td><td /><td>-0.80</td><td /><td /></tr><tr><td>BFNE8</td><td>I often worry that I will say or do the wrong things.</td><td /><td>-0.73</td><td /><td /></tr></tbody></table> </ephtml> </p> <p>10 <emph>Note.</emph> CAT-Q_M: Masking; CAT-Q_A Assimilation; CAT-Q_C Compensation; BFNE: Brief Fear of Negative Evaluation scale. Reverse-scored items denoted with (R). Items in italics are cross-loaded.</p> <p>Table 6. Factor loadings of exploratory factor analysis of the Camouflaging Autistic Traits Questionnaire (CAT-Q) and the Broad Autism Phenotype Questionnaire (BAPQ) autistic social traits' items (N = 308).</p> <p>Graph</p> <p></p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="left" colspan="2" rowspan="2">Scale/item</th><th align="left" colspan="4">Factor loadings</th></tr><tr><th align="left">1</th><th align="left">2</th><th align="left">3</th><th align="left">4</th></tr></thead><tbody><tr><td>CAT-Q_M1</td><td>I monitor my body language or facial expressions so that I appear relaxed.</td><td /><td /><td>-0.74</td><td /></tr><tr><td>CAT-Q_M2</td><td>I adjust my body language or facial expressions so that I appear interested by the person I am interacting with.</td><td /><td /><td>-0.70</td><td /></tr><tr><td>CAT-Q_M3</td><td>I always think about the impression I make on other people</td><td /><td /><td>-0.40</td><td /></tr><tr><td>CAT-Q_M4</td><td>I don't feel the need to make eye contact with other people if I don't want to. (R)</td><td /><td /><td>-0.38</td><td /></tr><tr><td>CAT-Q_M5</td><td><italic>I monitor my body language or facial expressions so that I appear interested by the person I am interacting with</italic>.</td><td><italic>0.31</italic></td><td /><td><italic>-0.69</italic></td><td /></tr><tr><td>CAT-Q_M6</td><td>I am always aware of the impression I make on other people.</td><td /><td /><td>-0.32</td><td /></tr><tr><td>CAT-Q_M7</td><td><italic>I adjust my body language or facial expressions so that I appear relaxed</italic>.</td><td><italic>0.31</italic></td><td /><td><italic>-0.64</italic></td><td /></tr><tr><td>CAT-Q_M8</td><td>In social interactions, I do not pay attention to what my face or body are doing. (R)</td><td /><td /><td>-0.63</td><td /></tr><tr><td>CAT-Q_A1</td><td>I rarely feel the need to put on an act in order to get through a social situation. (R)</td><td /><td /><td>-0.39</td><td /></tr><tr><td>CAT-Q_A2</td><td>In social situations, I feel like I'm 'performing' rather than being myself.</td><td /><td /><td>-0.48</td><td /></tr><tr><td>CAT-Q_A3</td><td>I need the support of other people in order to socialise.</td><td /><td /><td /><td /></tr><tr><td>CAT-Q_A4</td><td>I have to force myself to interact with people when I am in social situations.</td><td /><td>0.57</td><td /><td /></tr><tr><td>CAT-Q_A5</td><td>When in social situations, I try to find ways to avoid interacting with others.</td><td /><td>0.70</td><td /><td /></tr><tr><td>CAT-Q_A6</td><td><italic>I feel free to be myself when I am with other people. (R)</italic></td><td /><td><italic>0.44</italic></td><td><italic>-0.38</italic></td><td /></tr><tr><td>CAT-Q_A7</td><td><italic>When talking to other people, I feel like the conversation flows naturally. (R)</italic></td><td /><td><italic>0.48</italic></td><td /><td><italic>0.36</italic></td></tr><tr><td>CAT-Q_A8</td><td><italic>In social situations, I feel like I am pretending to be 'normal'</italic>.</td><td /><td><italic>0.31</italic></td><td><italic>-0.38</italic></td><td /></tr><tr><td>CAT-Q_C1</td><td><italic>When I am interacting with someone, I deliberately copy their body language or facial expressions</italic>.</td><td><italic>0.39</italic></td><td /><td><italic>-0.34</italic></td><td /></tr><tr><td>CAT-Q_C2</td><td>I have developed a script to follow in social situations (for example, a list of questions or topicsof conversation).</td><td>0.44</td><td /><td /><td /></tr><tr><td>CAT-Q_C3</td><td>I will repeat phrases that I have heard others say in the exact same way that I first heard them.</td><td>0.41</td><td /><td /><td /></tr><tr><td>CAT-Q_C4</td><td>In my own social interactions, I use behaviours that I have learned from watching other people interacting.</td><td>0.64</td><td /><td /><td /></tr><tr><td>CAT-Q_C5</td><td>I practice my facial expressions and body language to make sure they look natural.</td><td>0.53</td><td /><td /><td /></tr><tr><td>CAT-Q_C6</td><td>I have tried to improve my understanding of social skills by watching other people.</td><td>0.62</td><td /><td /><td /></tr><tr><td>CAT-Q_C7</td><td>I have researched the rules of social interactions (for example, by studying psychology or reading books on human behaviour) to improve my own social skills.</td><td>0.49</td><td /><td /><td /></tr><tr><td>CAT-Q_C8</td><td>I learn how people use their bodies and faces to interact by watching television or films, or by reading fiction.</td><td>0.93</td><td /><td /><td /></tr><tr><td>CAT-Q_C9</td><td>I have spent time learning social skills from television shows and films, and try to use these in my interactions.</td><td>0.94</td><td /><td /><td /></tr><tr><td>BAPQ_A1 (R)</td><td>I like being around other people. (R)</td><td /><td>0.82</td><td /><td /></tr><tr><td>BAPQ_A2</td><td>I would rather talk to people to get information than socialise.</td><td /><td>0.54</td><td /><td /></tr><tr><td>BAPQ_A3 (R)</td><td>I enjoy being in social situations. (R)</td><td /><td>0.89</td><td /><td /></tr><tr><td>BAPQ_A4 (R)</td><td>People find it easy to approach me. (R)</td><td /><td>0.38</td><td /><td /></tr><tr><td>BAPQ_A5 (R)</td><td>I look forward to situations where I can meet new people. (R)</td><td /><td>0.71</td><td /><td /></tr><tr><td>BAPQ_A6</td><td><italic>When I make conversation it is just to be polite</italic>.</td><td /><td><italic>0.36</italic></td><td><italic>-0.31</italic></td><td /></tr><tr><td>BAPQ_A7 (R)</td><td>I am good at making small talk. (R)</td><td /><td>0.43</td><td /><td /></tr><tr><td>BAPQ_A8 (R)</td><td>I feel like I am really connecting with other people. (R)</td><td /><td>0.65</td><td /><td /></tr><tr><td>BAPQ_A9</td><td>Conversation bores me.</td><td /><td>0.53</td><td /><td /></tr><tr><td>BAPQ_A10</td><td><italic>I am warm and friendly in my interactions with others. (R)</italic></td><td /><td><italic>0.47</italic></td><td><italic>0.41</italic></td><td /></tr><tr><td>BAPQ_A11</td><td>I prefer to be alone rather than with others.</td><td /><td>0.68</td><td /><td /></tr><tr><td>BAPQ_A12</td><td>I enjoy chatting with people. (R)</td><td /><td>0.86</td><td /><td /></tr><tr><td>BAPQ_PL1</td><td>I find it hard to get my words out smoothly.</td><td /><td /><td /><td>0.43</td></tr><tr><td>BAPQ_PL2</td><td>It's hard for me to avoid getting sidetracked in a conversation.</td><td /><td /><td /><td>0.61</td></tr><tr><td>BAPQ_PL3</td><td><italic>I am 'in-tune' with the other person during conversation. (R)</italic></td><td /><td><italic>0.39</italic></td><td><italic>0.31</italic></td><td><italic>0.33</italic></td></tr><tr><td>BAPQ_PL4</td><td>My voice has a flat or monotone sound to it.</td><td /><td /><td /><td /></tr><tr><td>BAPQ_PL5</td><td><italic>I feel disconnected or 'out of sync' in conversations with others</italic>.</td><td /><td><italic>0.35</italic></td><td /><td><italic>0.42</italic></td></tr><tr><td>BAPQ_PL6</td><td>People ask me to repeat things I've said because they don't understand.</td><td /><td /><td /><td>0.43</td></tr><tr><td>BAPQ_PL7</td><td>I have been told that I talk too much about certain topics.</td><td /><td /><td /><td>0.41</td></tr><tr><td>BAPQ_PL8</td><td>I speak too loudly or softly.</td><td /><td /><td /><td>0.51</td></tr><tr><td>BAPQ_PL9</td><td><italic>I can tell when someone is not interested in what I am saying. (R)</italic></td><td /><td /><td><italic>0.31</italic></td><td><italic>0.33</italic></td></tr><tr><td>BAPQ_PL10</td><td>I leave long pauses in conversation.</td><td /><td /><td /><td /></tr><tr><td>BAPQ_PL11</td><td>I lose track of my original point when talking to people.</td><td /><td /><td /><td>0.62</td></tr><tr><td>BAPQ_PL12</td><td>I can tell when it is time to change topics in conversation. (R)</td><td /><td /><td /><td>0.53</td></tr></tbody></table> </ephtml> </p> <p>11 <emph>Note</emph>. CAT-Q_M Masking; CAT-Q_A Assimilation; CAT-Q_C Compensation; BAPQ-A Aloof; BAPQ-PL pragmatic language. Reverse-scored items denoted with (R). Items in <emph>italics</emph> are cross-loaded.</p> <hd id="AN0183571282-19">Camouflaging and social anxiety items</hd> <p>Parallel analysis indicated up to eight factors could be extracted. However, on the basis of the scree plot (Figure 1(a)), four factors were retained explaining a total of 46.9% of the variance, as this provided an interpretable, simple and meaningful factor solution (Table 4). All CAT-Q items met the factor loading threshold of 0.3, and only one social anxiety item fell below this threshold. In this and the other two EFAs, these cross-loadings were not addressed and all items were retained, as the aim of the EFAs was not to extract factors, as in standard factor analysis, but rather to examine the extent to which items loaded into separable and meaningful factors.</p> <p>Graph: Figure 1. Scree plot of the three factor analyses conducted with camouflaging (CAT-Q) and social anxiety (SIAS/SPS), fear of negative evaluation (BFNE) and autistic social traits (BAPQ) respectively: (a) scree plot for CAT-Q and SIAS/SPS Items, (b) scree plot for CAT-Q and BFNE Items and (c) scree plot for CAT-Q and BAPQ Items.</p> <p>Factor 1 contained CAT-Q items only (all eight CAT-Q Masking, along with two Assimilation and one Compensation items) and explained 26.0% of the variance. Factor 2 mostly contained social anxiety items (8 of the 12 SPS/SIAS items) and one CAT-Q Masking item, explaining an additional 11.5% of the variance. Factor 3 contained only CAT-Q Compensation items, with all nine Compensation items loading on this factor explaining another 4.2% of the total variance. Finally, Factor 4 contained mostly CAT-Q Assimilation items (all eight CAT-Q Assimilation items loaded onto this factor) and three social anxiety items, explaining 4.9% of the variance.</p> <p>These results supported Hypothesis 2, as CAT-Q and social anxiety items largely loaded onto different factors.</p> <hd id="AN0183571282-20">Camouflaging and FNE items</hd> <p>Parallel analysis indicated up to eight factors could be extracted. Based on the scree plot (see Figure 1(b)), four factors explaining a total of 54.2% of the variance were retained, as this provided the most interpretable and parsimonious solution. All CAT-Q and BFNE items met the factor loading threshold of 0.3. There was a small amount of cross-loading, as only three CAT-Q items loaded on two factors (see Table 5).</p> <p>Factor 1 (29.8% of the variance) contained only CAT-Q items (all eight CAT-Q Masking and two Assimilation items). The second factor (13.5% of variance) contained mostly FNE items (all eight BFNE items and one CAT-Q Masking item). Factor 3 (4.5% of variance) comprised all nine CAT-Q Compensation items and factor four (6.5% of variance) contained all eight CAT-Q Assimilation items. These findings supported Hypothesis 2, as CAT-Q and BFNE items largely loaded onto different factors.</p> <hd id="AN0183571282-21">Camouflaging and autistic social traits' items</hd> <p>Parallel analysis indicated up to seven factors could be extracted, but based on the scree plot and the most interpretable and parsimonious solution (Figure 1(c)), four factors were retained (Table 6), explaining a total of 41.7% of the variance. Three items did not meet the factor loading threshold of 0.3 (one CAT-Q Assimilation and two BAPQ Pragmatic subscale items), which were retained.</p> <p>Compared to the previous two factor analyses, a larger number of cross-loading items was found (10 of the 49 items). Factor 1 (19.5% of variance) contained only CAT-Q items (all nine CAT-Q Compensation and two CAT-Q Masking items). Factor 2 (13.3% of variance) contained 14 BAPQ items (12 from the Aloof and two from the Pragmatic Language subscales) and five of the eight CAT-Q Assimilation items. Factor 3 (4.7% of variance) contained 13 CAT-Q items (all eight CAT-Q Masking, 4 Assimilation and one Compensation items) and four BAPQ Aloof/Pragmatic Language items. Finally, Factor 4 (4.4% of variance) contained 10 social autistic trait items (10 of the 12 BAPQ Pragmatic Language items) and one CAT-Q Assimilation item.</p> <p>These results only partially supported Hypothesis 2. Although many camouflaging and social autistic trait items loaded onto different factors, the CAT-Q Assimilation subscale items in particular appeared to be less distinct, as over half of the CAT-Q Assimilation items loaded onto Factor 2, which was otherwise a factor containing mostly BAPQ items.</p> <hd id="AN0183571282-22">Discussion</hd> <p>The present study explored the construct validity of the CAT-Q by examining the degree to which CAT-Q items were related to and/or distinct from items measuring social anxiety, FNE, and autistic social traits. Our findings indicated that the CAT-Q was significantly positively correlated with the other measures, but the strength of the associations did not indicate collinearity. Furthermore, our factor analyses showed that most CAT-Q items loaded largely separately from social anxiety, FNE, and autistic social traits' items, with the exception of CAT-Q Assimilation subscale items, some of which cross-loaded mostly with social autistic trait items. These findings overall provide support for the CAT-Q's construct validity, with some caveats that are discussed below.</p> <p>The first hypothesis that the CAT-Q and measures of social anxiety, FNE and autistic social traits would be positively related, but smaller than 0.8, was supported, as all inter-correlations were <0.66. [<reflink idref="bib31" id="ref102">31</reflink>], [<reflink idref="bib30" id="ref103">30</reflink>]) and [<reflink idref="bib42" id="ref104">42</reflink>] also found positive small-to-large effect size CAT-Q associations with autistic traits and social anxiety. The small-medium associations between the CAT-Q Masking and Compensation subscales (<emph>r</emph>s = 0.00–0.38) strongly point towards no or a weak relationship between these CAT-Q subscales and social anxiety, FNE and autistic social traits, however the medium-to-large associations between the CAT-Q Assimilation subscale and the other measures examined in this study (0.29–0.66) suggest a stronger relationship between this particular CAT-Q subscale and related social anxiety and autistic experiences and characteristics. The relationships between the CAT-Q subscales and BFNE and social anxiety respectively appeared to be generally similar in terms of the associations' effect sizes (mostly medium; see Table 3); we note, however, that the CAT-Q Assimilation subscale was more strongly correlated with social anxiety (0.54) as compared to FNE (0.29), whereas the association between CAT-Q Masking and FNE was somewhat larger (0.38) compared to its relationship with social anxiety (0.25). Tentatively, it is possible that there are differential relationships between different aspects of camouflaging, FNE and social anxiety which require further research. If replicated in future studies, such differential associations could possibly be explained by the focus of the CAT-Q Assimilation items on avoidance and 'putting on a act' to hide one's discomfort and anxiety in social interactions (which relate more to social anxiety), as compared to the CAT-Q Masking items, which describe strategies to manage others' impressions (which likely relate more closely to, and could be driven by, FNE).</p> <p>In the exploratory partial correlations, most of the relationships between CAT-Q, social anxiety and autistic social traits remained significant, but were smaller than the zero-order correlations when partialling out the effects of the other variable, suggesting direct but small/medium effect size relationships. Only the relationship between CAT-Q Compensation and BAPQ autistic social traits was fully accounted for by social anxiety.</p> <p>The factor analyses we conducted, entering CAT-Q with the other measures' items together, showed that the CAT-Q items were mostly separate from the social anxiety items, as they largely loaded onto different factors. The CAT-Q items also mostly loaded onto different factors from FNE items, indicating that they were also separable factorially from FNE items. These findings support the construct validity of the CAT-Q based on few to no cross-loadings with, and items largely separable from, social anxiety and FNE items. It is also possible that the differentiation between items in this study's factor analyses could reflect the different focus of CAT-Q and social anxiety and FNE items in the measures employed: the CAT-Q items largely reflect frequency of <emph>behaviours</emph>, while the social anxiety and FNE measures used tend to include more items focusing on anxious <emph>thoughts/cognitions and emotions</emph>, therefore it is possible that the different factor loadings may to some extent also reflect the distinction between mostly behaviourally focused versus mostly cognitively or emotionally focused experiences. In support of this possibility, [<reflink idref="bib42" id="ref105">42</reflink>] found construct overlap between the CAT-Q and the behavioural maintenance factors of social anxiety in autistic adolescents. These behavioural maintenance factors were considered to be a form of 'impression management', the processes by which people try to control how others perceive them ([<reflink idref="bib40" id="ref106">40</reflink>]). Lei and colleagues suggested that camouflaging/masking may be a perpetuating factor in maintaining social anxiety in autistic young people.</p> <p>In the third factor analysis exploring construct overlap between CAT-Q items and autistic social traits (Figure 1(c); Table 6), some CAT-Q Assimilation items loaded together with social BAPQ items in three of the four factors derived. Although most of the CAT-Q Masking and Compensation items were largely separable from social autistic trait items in terms of their factor loadings, there was some overlap between CAT-Q Assimilation and autistic social traits. Specifically, the CAT-Q Assimilation items were split between a factor mostly containing items from the CAT-Q Masking subscale and a factor with BAPQ Aloof subscale items, suggesting that these two subscales likely have some construct overlap. This finding was further corroborated by the positive correlation between the CAT-Q Assimilation and the BAPQ Aloof subscale found in both our study (<emph>r</emph> = 0.65) and in [<reflink idref="bib31" id="ref107">31</reflink>]; <emph>r</emph> = 0.63). In particular, two Assimilation items (Item 4 'I have to force myself to interact with people when I am in social situations' and Item 5 'when in social situations, I try to find ways to avoid interacting with others') loaded exclusively on a factor otherwise comprising only of BAPQ Aloof items. Given [<reflink idref="bib31" id="ref108">31</reflink>] description of the Assimilation subscale as 'attempts to blend in to social situations in which the individual is uncomfortable, without letting others see this discomfort' (p. 10), it appears these Assimilation items were intended to capture social discomfort or distress when trying to blend in socially ([<reflink idref="bib31" id="ref109">31</reflink>]), in contrast to the BAPQ Aloof items which capture reduced motivation or disinterest in social interactions ([<reflink idref="bib33" id="ref110">33</reflink>]). It is possible that these two CAT-Q Assimilation items may require refinement so they do not also inadvertently describe social motivation.</p> <p>In addition, although most CAT-Q items differentiated well from the social anxiety items in the factor analysis, there may be some overlap between the CAT-Q Assimilation items and three social interaction anxiety items ('I find it difficult mixing comfortably with the people I work with', 'I tense up if I meet an acquaintance on the street' and 'I have difficulty talking with other people'), as these loaded together on one factor. Notably, all three social interaction anxiety items were from the SIAS and all described some discomfort in social interactions, consistent with the CAT-Q Assimilation subscale items. Together with the overlap between CAT-Q Assimilation and BAPQ Aloof autistic social traits discussed earlier, these findings may indicate that the CAT-Q Assimilation items in particular may be less distinct than the other CAT-Q subscale items and may overlap to some extent with social interaction anxiety and autistic social traits. Interestingly, the CAT-Q Compensation and Masking subscales were anticipated factors in the original [<reflink idref="bib31" id="ref111">31</reflink>] factor analyses, but the Assimilation factor was unexpected. This factor was interpreted by Hull and colleagues to reflect efforts to 'fit in' and hide discomfort in social situations, an aspect of camouflaging that was conceded by the authors to be less explored in previous literature. Thus, interpretation of the latent construct assumed to underlie the CAT-Q Assimilation items may be more difficult compared to the Masking and Compensation subscale items. Another possibility may be that the CAT-Q Assimilation items, which mostly describe the person's emotional experiences in relation to camouflaging, load together with social anxiety items because they are more similar to the emotionally and cognitively focused items of the SIAS/SPS social anxiety measure. Based on our findings, the CAT-Q Assimilation subscale may need to be interpreted with more caution than the other CAT-Q subscales and may require further refinement or development. Overall, however, the construct validity of the CAT-Q as a measure of camouflaging is supported by our findings.</p> <hd id="AN0183571282-23">Strengths, limitations and future directions</hd> <p>The present study is, to the best of our knowledge, the first study specifically exploring the construct overlap of the CAT-Q with other measures. A more comprehensive and detailed approach was taken to explore the construct validity of the CAT-Q via factor analysis than had previously been explored.</p> <p>In terms of limitations, no autistic adults with verbal and/or intellectual impairments were included in our group of participants, and thus the results cannot be generalised to autistic people with these profiles and characteristics. Our participants were also predominantly White with a large percentage of females, so for greater confidence in generalisability, these analyses would need to be replicated with more diverse autistic samples, especially given that there may be important sociocultural influences in camouflaging that need to be considered and investigated further (e.g. [<reflink idref="bib48" id="ref112">48</reflink>]; [<reflink idref="bib57" id="ref113">57</reflink>]; [<reflink idref="bib63" id="ref114">63</reflink>]).</p> <p>Our analyses should be replicated and extended, and other approaches to assessing construct validity should be explored. For example, as suggested by [<reflink idref="bib62" id="ref115">62</reflink>], quantitative semantic analysis, which can detect semantic overlap between two potentially related scales ([<reflink idref="bib55" id="ref116">55</reflink>]) offers another approach to exploring construct validity. In addition, in our study, most of the autistic participants reported high social anxiety, with more than 90% exceeding the general population measure's cut-off. While not uncommon, our reported rates are higher than those found in a meta-analysis based on self-report measures (51%; [<reflink idref="bib29" id="ref117">29</reflink>]). It is possible that the brief scales used may partly explain these high rates in this study. Another possibility is that autistic participants experiencing anxiety in social interactions may have been more likely to participate in a study about camouflaging and its psychosocial correlates and consequences. Although social anxiety and camouflaging are commonly interrelated, autistic people with lower social anxiety also report camouflaging ([<reflink idref="bib11" id="ref118">11</reflink>]). For greater generalisability, future studies with larger samples could explore construct overlap separately for autistic individuals with higher versus lower social anxiety (or with and without diagnoses of social anxiety).</p> <p>The results of the present study lend more confidence to using the CAT-Q for research, while at the same time suggest that the CAT-Q should be further developed and evaluated. The relationship between camouflaging, social anxiety and impression management needs to be explored and disentangled further in autistic people as well as in other diagnostic and social groups, especially the CAT-Q Assimilation subscale items (see [<reflink idref="bib1" id="ref119">1</reflink>]). As the CAT-Q items were related with, but largely factorially separable from, the social anxiety and the autistic social traits' items, the CAT-Q could be useful in clinical practice as an additional tool aiding the exploration of psychosocial and mental health issues affecting autistic people: when issues relating to possible camouflaging are discussed in assessment or therapy, inviting autistic adults to complete the CAT-Q and to then discuss and share the extent to which they camouflage, and their person-specific reasons and consequences of camouflaging may provide additional helpful insights into some autistic people's psychosocial experiences which can improve clinicians' understanding and formulation of their mental health and wellbeing difficulties.</p> <hd id="AN0183571282-24">Summary and conclusion</hd> <p>This study examined the CAT-Q's construct validity by exploring its relationship to, and separability from, measures of related constructs (social anxiety, FNE and autistic social traits). We found that the CAT-Q items were related to, but also largely factorially separable from, social anxiety, FNE and social autistic trait items, strengthening confidence in the construct validity of the CAT-Q in measuring camouflaging behaviours. The CAT-Q Assimilation subscale items, however, showed some overlap with social anxiety and autistic social traits and may therefore require attention, more cautious interpretation and potentially refinement. It is important to continue the iterative improvement of the CAT-Q and other camouflaging measures to strengthen how we measure camouflaging, so that research can continue to answer important questions regarding autistic people's experiences.</p> <p>We are grateful to all the autistic adults who participated in this study and shared their experiences. 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Clinical Psychology Review, 105, Article 102335. https://doi.org/10.1016/j.cpr.2023.102335</bibtext> </blist> </ref> <ref id="AN0183571282-26"> <title> Footnotes </title> <blist> <bibtext> The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.</bibtext> </blist> <blist> <bibtext> The author(s) disclosed receipt of the following financial support for the research, authorship and/or publication of this article: This study was funded by the senior author's start up grant by The University of Western Australia (PG10301041). D.W.T. is supported by a Macquarie University Research Fellowship (MQRF0001113).</bibtext> </blist> <blist> <bibtext> Katharine McKinnon</bibtext> </blist> <blist> <bibtext>Graph</bibtext> </blist> <blist> <bibtext>https://orcid.org/0009-0001-5448-2098 Mackenzie Bougoure</bibtext> </blist> <blist> <bibtext>Graph</bibtext> </blist> <blist> <bibtext>https://orcid.org/0000-0002-5739-8537 Sici Zhuang</bibtext> </blist> <blist> <bibtext>Graph</bibtext> </blist> <blist> <bibtext>https://orcid.org/0000-0002-9850-7218 Diana Weiting Tan</bibtext> </blist> <blist> <bibtext>Graph https://orcid.org/0000-0002-6394-8435</bibtext> </blist> <blist> <bibtext> The <emph>Diagnostic and Statistical Manual of Mental Disorders</emph> (5th ed., text rev.; DSM-5-TR; [3]) and much previous research have adopted medical and deficit focused language and perspectives to autism. In response to the limitations of this deficit-based understanding of autism ([50]), and to align with the language preferences of the autistic community ([7]), in this study we use 'autism' instead of 'ASD', 'differences' and/or 'difficulties' instead of symptoms or deficits, and so on.</bibtext> </blist> <blist> <bibtext> Other terms related, or synonymous, to camouflaging include masking, passing, accommodation, compensation and adaptive morphing ([37]; [44]).</bibtext> </blist> <blist> <bibtext> Self-identified autistic individuals were included in line with previous studies and the acceptance of self-identification within the autistic community, and in order to increase representation of those facing barriers to professional diagnosis or not professionally diagnosed due to camouflaging ([9]; [10]; [44]; [45]).</bibtext> </blist> </ref> <aug> <p>By Katharine McKinnon; Mackenzie Bougoure; Sici Zhuang; Diana Weiting Tan and Iliana Magiati</p> <p>Reported by Author; Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib20" firstref="ref2"></nolink> <nolink nlid="nl2" bibid="bib29" firstref="ref3"></nolink> <nolink nlid="nl3" bibid="bib49" firstref="ref4"></nolink> <nolink nlid="nl4" bibid="bib27" firstref="ref8"></nolink> <nolink nlid="nl5" bibid="bib58" firstref="ref9"></nolink> <nolink nlid="nl6" bibid="bib11" firstref="ref10"></nolink> <nolink nlid="nl7" bibid="bib18" firstref="ref11"></nolink> <nolink nlid="nl8" bibid="bib32" firstref="ref12"></nolink> <nolink nlid="nl9" bibid="bib44" firstref="ref13"></nolink> <nolink nlid="nl10" bibid="bib64" firstref="ref14"></nolink> <nolink nlid="nl11" bibid="bib37" firstref="ref15"></nolink> <nolink nlid="nl12" bibid="bib14" firstref="ref18"></nolink> <nolink nlid="nl13" bibid="bib45" firstref="ref19"></nolink> <nolink nlid="nl14" bibid="bib46" firstref="ref20"></nolink> <nolink nlid="nl15" bibid="bib54" firstref="ref21"></nolink> <nolink nlid="nl16" bibid="bib36" firstref="ref24"></nolink> <nolink nlid="nl17" bibid="bib62" firstref="ref25"></nolink> <nolink nlid="nl18" bibid="bib26" firstref="ref28"></nolink> <nolink nlid="nl19" bibid="bib31" firstref="ref29"></nolink> <nolink nlid="nl20" bibid="bib24" firstref="ref34"></nolink> <nolink nlid="nl21" bibid="bib35" firstref="ref35"></nolink> <nolink nlid="nl22" bibid="bib47" firstref="ref38"></nolink> <nolink nlid="nl23" bibid="bib60" firstref="ref39"></nolink> <nolink nlid="nl24" bibid="bib22" firstref="ref41"></nolink> <nolink nlid="nl25" bibid="bib25" firstref="ref42"></nolink> <nolink nlid="nl26" bibid="bib28" firstref="ref43"></nolink> <nolink nlid="nl27" bibid="bib30" firstref="ref47"></nolink> <nolink nlid="nl28" bibid="bib42" firstref="ref50"></nolink> <nolink nlid="nl29" bibid="bib12" firstref="ref51"></nolink> <nolink nlid="nl30" bibid="bib43" firstref="ref52"></nolink> <nolink nlid="nl31" bibid="bib16" firstref="ref53"></nolink> <nolink nlid="nl32" bibid="bib53" firstref="ref54"></nolink> <nolink nlid="nl33" bibid="bib15" firstref="ref58"></nolink> <nolink nlid="nl34" bibid="bib63" firstref="ref59"></nolink> <nolink nlid="nl35" bibid="bib21" firstref="ref65"></nolink> <nolink nlid="nl36" bibid="bib61" firstref="ref67"></nolink> <nolink nlid="nl37" bibid="bib59" firstref="ref70"></nolink> <nolink nlid="nl38" bibid="bib33" firstref="ref73"></nolink> <nolink nlid="nl39" bibid="bib52" firstref="ref79"></nolink> <nolink nlid="nl40" bibid="bib41" firstref="ref81"></nolink> <nolink nlid="nl41" bibid="bib13" firstref="ref84"></nolink> <nolink nlid="nl42" bibid="bib39" firstref="ref85"></nolink> <nolink nlid="nl43" bibid="bib17" firstref="ref87"></nolink> <nolink nlid="nl44" bibid="bib23" firstref="ref88"></nolink> <nolink nlid="nl45" bibid="bib38" firstref="ref89"></nolink> <nolink nlid="nl46" bibid="bib56" firstref="ref90"></nolink> <nolink nlid="nl47" bibid="bib19" firstref="ref91"></nolink> <nolink nlid="nl48" bibid="bib51" firstref="ref93"></nolink> <nolink nlid="nl49" bibid="bib48" firstref="ref96"></nolink> <nolink nlid="nl50" bibid="bib57" firstref="ref97"></nolink> <nolink nlid="nl51" bibid="bib34" firstref="ref101"></nolink> <nolink nlid="nl52" bibid="bib40" firstref="ref106"></nolink> <nolink nlid="nl53" bibid="bib55" firstref="ref116"></nolink>
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  Label: Title
  Group: Ti
  Data: Exploring the Construct Validity of the Camouflaging Autistic Traits Questionnaire: A Factor Analytic Study
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Katharine+McKinnon%22">Katharine McKinnon</searchLink> (ORCID <externalLink term="https://orcid.org/0009-0001-5448-2098">0009-0001-5448-2098</externalLink>)<br /><searchLink fieldCode="AR" term="%22Mackenzie+Bougoure%22">Mackenzie Bougoure</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-5739-8537">0000-0002-5739-8537</externalLink>)<br /><searchLink fieldCode="AR" term="%22Sici+Zhuang%22">Sici Zhuang</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-9850-7218">0000-0002-9850-7218</externalLink>)<br /><searchLink fieldCode="AR" term="%22Diana+Weiting+Tan%22">Diana Weiting Tan</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-6394-8435">0000-0002-6394-8435</externalLink>)<br /><searchLink fieldCode="AR" term="%22Iliana+Magiati%22">Iliana Magiati</searchLink>
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  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Autism%3A+The+International+Journal+of+Research+and+Practice%22"><i>Autism: The International Journal of Research and Practice</i></searchLink>. 2025 29(3):642-658.
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  Data: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
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  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 17
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2025
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  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
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  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Adults%22">Adults</searchLink><br /><searchLink fieldCode="DE" term="%22Autism+Spectrum+Disorders%22">Autism Spectrum Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Attitudes+toward+Disabilities%22">Attitudes toward Disabilities</searchLink><br /><searchLink fieldCode="DE" term="%22Normalization+%28Disabilities%29%22">Normalization (Disabilities)</searchLink><br /><searchLink fieldCode="DE" term="%22Inclusion%22">Inclusion</searchLink><br /><searchLink fieldCode="DE" term="%22Interpersonal+Competence%22">Interpersonal Competence</searchLink><br /><searchLink fieldCode="DE" term="%22Test+Reliability%22">Test Reliability</searchLink><br /><searchLink fieldCode="DE" term="%22Sense+of+Belonging%22">Sense of Belonging</searchLink><br /><searchLink fieldCode="DE" term="%22Test+Validity%22">Test Validity</searchLink><br /><searchLink fieldCode="DE" term="%22Anxiety%22">Anxiety</searchLink><br /><searchLink fieldCode="DE" term="%22Acculturation%22">Acculturation</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Differences%22">Social Differences</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Adjustment%22">Social Adjustment</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Desirability%22">Social Desirability</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Distance%22">Social Distance</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Behavior%22">Social Behavior</searchLink><br /><searchLink fieldCode="DE" term="%22Behavior+Standards%22">Behavior Standards</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Cognition%22">Social Cognition</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Australia%22">Australia</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1177/13623613241287964
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1362-3613<br />1461-7005
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: 'Camouflaging' is a set of strategies used by autistic people to hide or compensate for their autistic characteristics to fit into predominantly non-autistic social environments. Many researchers have used the Camouflaging Autistic Traits Questionnaire (CAT-Q) to measure camouflaging. However, there have been questions about the construct validity of the CAT-Q as a measurement of camouflaging. The present study examined the extent to which CAT-Q items were distinguishable from other theoretically and empirically related measures of social anxiety, fear of negative evaluation and autistic social traits. Autistic adults (N = 308) completed the CAT-Q and social anxiety, fear of negative evaluation and autistic social traits measures. The small-to-large positive associations between camouflaging and social anxiety, fear of negative evaluation and autistic social traits (r = 0.14-0.65) were not indicative of collinearity. Three exploratory factor analyses, in which CAT-Q items were factor-analysed together with social anxiety, fear of negative evaluation and autistic social traits items respectively, showed that CAT-Q items generally loaded onto different factors from social anxiety, fear of negative evaluation and autistic social traits items, with the exception of the CAT-Q Assimilation subscale items, which cross-loaded mostly with autistic social traits items. Overall, the CAT-Q items were positively associated with, but also differentiated from, most social anxiety, fear of negative evaluation and autistic social traits items, providing support for the measure's construct validity.
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  Data: 2025
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