Research on camouflaging in autism is built on sand

 A recent article, entitled Camouflaging in autism: A systematic review, reviews 29 studies that examine the purported tendency among autistic individuals to hide their autism in order to fit in with broader society. Given that autism is a social disorder, and that fitting in socially involves social skills, this notion has always rung false to me. I imagine it rings false to most parents as well, except perhaps for a few whose children have extremely mild symptoms to begin with.

This meta-analysis uses two measures for establishing the existence of camouflaging: self-report, and what it calls "internal-external discrepancy."

Self-reports are highly problematic. First, they're notoriously unreliable. People are often inaccurate when reporting on their motivations and behaviors: few of us know what our real motivations are, nor do we often have an accurate sense of how our behaviors come across to others. 

Second, as far as autism is concerned, those able and willing to fill out self-reports are at the mildest end of the spectrum--both in terms of language skills (able) and in terms of social motivation (willing). This limits any conclusions about camouflaging in autism to a sliver of the spectrum. The diminished social awareness that occurs even within this high-functioning sliver, furthermore, may add another layer of inaccuracy to the self-reporting.

So what about "internal-external discrepancy"? According to the authors, this means "quantifying the difference between an individual's ‘true’ autistic state and their observable behavioural presentation." But their only references on how this could possibly be measured are two papers by Lai et al. (2017 and 2019)--papers that, surprisingly, are not included in their references.

However, I managed to track down Lai et al. (2017) and Lai et al. (2019), and learned that they measure camouflaging as:

the quantitative discrepancy between the person’s ‘external’ behavioural presentation in social–interpersonal contexts (measured by the Autism Diagnostic Observation Schedule) and the person’s ‘internal’ status (dispositional traits measured by the Autism Spectrum Quotient and social cognitive capability measured by the ‘Reading the Mind in the Eyes’ Test).

But, too, is problematic. As its name suggests, the Autism Diagnostic Observation Schedule is a diagnostic tool, so it is supposed to be a measure of autism, not of the camouflaging of autism. And the Autism Spectrum Quotient is... another highly problematic self-rating tool.

Most of us camouflage, to some extent; whether individuals with autism, even at the mildest end of the spectrum, do so more than the rest of us do is a question that remains unanswered, including by the studies that purport to address it.