Understanding and recognising the
female phenotype of autism
spectrum disorder and the
“camouflage” hypothesis: a
systematic PRISMA review
Clare Sarah Allely (University of Salford, Salford, UK)
Advances in Autism: 2056-3868
Article publication date: 31 December 2018
Issue publication date: 28 February 2019
Abstract
Purpose
Females with autism spectrum disorder (ASD) may
display superficial social skills which may mask their
ASD symptomology impacting on the identification of
the disorder – known as the “camouflage” hypothesis.
Compared to males with ASD, it is increasingly
recognised that females with ASD have a stronger
ability to imitate behaviour which is socially
acceptable, particularly those females who have higher
cognitive abilities (i.e. intelligence considered to be
within the normal range) (Ehlers and Gillberg, 1993).
The paper aims to discuss this issue.
Design/methodology/approach
This paper will explore the literature on camouflaging
or masking behaviour in females with ASD. A
systematic PRISMA review was conducted.
Findings
The capacity to “camouflage” social difficulties in
social situations is considered to be one of the main
features of the female phenotype of ASD (e.g. Kenyon,
2014). Social imitation or camouflaging enables some
level of success and coping, which results in some
females never receiving a diagnosis of ASD. They
typically may not exhibit any observable functional
impairments. However, under the surface of the
camouflage, females may experience high levels of
subjective stress, anxiety and exhaustion and a need to
re-charge or recuperate by withdrawing from any
social interaction.
Research limitations/implications
There is relatively little understanding and knowledge
of the female phenotype of ASD. This lack of
understanding and knowledge impacts significantly on
the ability to identify females with ASD (Lai et al. ,
2015; Bargiela et al. , 2016), which can have a number
of negative consequence (Adamou et al. , 2018;
National Collaborating Centre for Mental Health (UK),
2012).
Practical implications
There is a need for the development of a camouflaging
measure.
Originality/value
There is a real need for further research exploring the
positive and negative impact of the phenomenon of
“camouflaging”, or “pretending to be normal” in
females with ASD.
female phenotype of autism
spectrum disorder and the
“camouflage” hypothesis: a
systematic PRISMA review
Clare Sarah Allely (University of Salford, Salford, UK)
Advances in Autism: 2056-3868
Article publication date: 31 December 2018
Issue publication date: 28 February 2019
Abstract
Purpose
Females with autism spectrum disorder (ASD) may
display superficial social skills which may mask their
ASD symptomology impacting on the identification of
the disorder – known as the “camouflage” hypothesis.
Compared to males with ASD, it is increasingly
recognised that females with ASD have a stronger
ability to imitate behaviour which is socially
acceptable, particularly those females who have higher
cognitive abilities (i.e. intelligence considered to be
within the normal range) (Ehlers and Gillberg, 1993).
The paper aims to discuss this issue.
Design/methodology/approach
This paper will explore the literature on camouflaging
or masking behaviour in females with ASD. A
systematic PRISMA review was conducted.
Findings
The capacity to “camouflage” social difficulties in
social situations is considered to be one of the main
features of the female phenotype of ASD (e.g. Kenyon,
2014). Social imitation or camouflaging enables some
level of success and coping, which results in some
females never receiving a diagnosis of ASD. They
typically may not exhibit any observable functional
impairments. However, under the surface of the
camouflage, females may experience high levels of
subjective stress, anxiety and exhaustion and a need to
re-charge or recuperate by withdrawing from any
social interaction.
Research limitations/implications
There is relatively little understanding and knowledge
of the female phenotype of ASD. This lack of
understanding and knowledge impacts significantly on
the ability to identify females with ASD (Lai et al. ,
2015; Bargiela et al. , 2016), which can have a number
of negative consequence (Adamou et al. , 2018;
National Collaborating Centre for Mental Health (UK),
2012).
Practical implications
There is a need for the development of a camouflaging
measure.
Originality/value
There is a real need for further research exploring the
positive and negative impact of the phenomenon of
“camouflaging”, or “pretending to be normal” in
females with ASD.
