Camouflaging Autistic Traits Questionnaire

The Camouflaging Autistic Traits Questionnaire (CAT-Q) is a validated self-report tool used to measure social camouflaging behaviors—the deliberate or…

Questions: 25
Duration: 10 min
Original title: CAT-Q — Camouflaging Autistic Traits Questionnaire
Adaptation: Camouflaging Autistic Traits Questionnaire
Authors: Hull, L., Mandy, W., Lai, M.-C., Baron-Cohen, S., Allison, C., Smith, P., & Petrides, K. V.
Created: 2019

The Camouflaging Autistic Traits Questionnaire (CAT-Q) is a validated self-report tool used to measure social camouflaging behaviors—the deliberate or automatic strategies individuals use to conceal autistic traits or compensate for social difficulties. Initially developed to capture the experiences of autistic adults, it is a crucial clinical instrument for understanding the invisible effort patients expend to navigate neurotypical social environments, which often manifests clinically as an unmet behavior, emotion, underlying need.

In clinical practice, the CAT-Q is particularly valuable when assessing individuals who present with subclinical features, subtle social exhaustion, or long-standing burnout. It helps contextualize cases where traditional screening scores might be artificially lowered by high compensatory skills, especially in female or gender-diverse patients who often go under the diagnostic radar. By quantifying camouflaging, the instrument makes the hidden cost of social interaction visible and enriches the broader longitudinal case formulation (5 Ps).

Example result

Fictitious result, computed from a sample set of answers.

Overall score

94/ 175

A 25-item self-report questionnaire assessing social camouflaging strategies used by adults with autistic traits to mask, compensate, or adapt to neurotypical social expectations. It yields a total score and three subscores: Compensation, Masking, and Assimilation. Useful for identifying autistic individuals missed by standard diagnostic tools and for exploring the psychological toll of camouflaging (social fatigue, anxiety, depression, identity disruption).

25–51

Extremely Low

52–75

Low

76–112

Moderate

113–136

High

137–175

Extremely High

percentile between 25 and 75 compared to non-autistic adults

généralemen · community sample

25175

M = 96.89 ± 24.22

généralewomen · community sample

25175

M = 90.87 ± 27.67

cliniquemen · pathology: autism

25175

M = 109.64 ± 26.5

cliniquewomen · pathology: autism

25175

M = 124.35 ± 23.27

Scoring

Total sum and subscale sums (reverse-scored items recoded), total score ranging from 25 to 175, each item is rated on a 7-point scale (from 1 to 7).

Assimilation

31/ 56

Attempts to fit into social situations, such as modifying behaviours to blend in.

items 3, 7, 10, 13, 16, 19, 22, 25

généralemen · community sample

856

M = 30.48 ± 10.33

généralewomen · community sample

856

M = 29 ± 11.73

cliniquemen · pathology: autism

856

M = 39.93 ± 11.26

cliniquewomen · pathology: autism

856

M = 44.63 ± 7.82

Compensation

33/ 63

Strategies for overcoming social challenges, such as using learned social scripts or imitating behaviours.

items 1, 4, 5, 8, 11, 14, 17, 20, 23

généralemen · community sample

963

M = 30.06 ± 10.92

généralewomen · community sample

963

M = 27.18 ± 11.5

cliniquemen · pathology: autism

963

M = 36.81 ± 12.14

cliniquewomen · pathology: autism

963

M = 41.85 ± 11.11

Masking

30/ 56

Strategies used to hide autistic characteristics or portray a non-autistic persona.

items 2, 6, 9, 12, 15, 18, 21, 24

généralemen · community sample

856

M = 36.34 ± 8.13

généralewomen · community sample

856

M = 34.69 ± 9.05

cliniquemen · pathology: autism

856

M = 32.9 ± 10.57

cliniquewomen · pathology: autism

856

M = 37.87 ± 10.54

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What the test measures

The CAT-Q captures the cognitive and behavioral effort involved in social camouflaging across three primary dimensions:

Compensation: The active strategies used to circumvent social and communication difficulties, such as scripting conversations or consciously mirroring body language.
Masking: The deliberate suppression or concealment of natural autistic characteristics to portray a non-autistic persona, which can sometimes resemble rigid automatic behaviors designed to avoid negative judgment.
Assimilation: The deep-seated pressure to fit into social groups, often resulting in a feeling of performing a role or losing one's authentic self in interactions, distinct from a typical approval-seeking schema.

It is validated for adults (aged 16 and older) and is used in both neurodivergent and neurotypical populations to measure social adaptation efforts.

When and why to use it

Clinicians use the CAT-Q to explore the mechanics and psychological toll of social adaptation:

Intake baseline: To identify the underlying drivers of chronic social exhaustion and burnout during initial assessments.
Differential support: To clarify whether a patient's seemingly fluent social presentation relies on highly demanding compensatory strategies rather than effortless intuition.
Screening contextualization: To evaluate whether a patient with significant autistic traits might be scoring low on standard autism measures due to pronounced masking.
Monitoring change: To track shifts in self-advocacy and unmasking over the course of therapy, often as part of establishing healthy boundaries.

Integrating a validated camouflaging score offers concrete metrics to validate a patient's internal experience of effort, which pairs well with Acceptance and Commitment Therapy approaches to foster authentic living.

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The questions

For each of the following statements, please indicate the extent to which you agree or disagree. Your answers should reflect how you behave in social situations in general (for example, with people you do not know well). Please answer as honestly as possible: there are no right or wrong answers.
1. When I'm interacting with someone, I deliberately copy their body language or facial expressions.
Explores the intentional mimicking of nonverbal cues to blend into social exchanges.
- Strongly disagree
- Disagree
- Slightly disagree
- Neither agree nor disagree
- Slightly agree
- Agree
- Strongly agree
2. I monitor my body language or facial expressions so that I appear relaxed.
Assesses the conscious regulation of physical tension to project a socially acceptable demeanor.
- Strongly disagree
- Disagree
- Slightly disagree
- Neither agree nor disagree
- Slightly agree
- Agree
- Strongly agree
3. I rarely feel the need to act a part to get through a social situation.
Evaluates the patient's baseline sense of authenticity and ease during interactions.
- Strongly disagree
- Disagree
- Slightly disagree
- Neither agree nor disagree
- Slightly agree
- Agree
- Strongly agree
4. I have developed a set of scripts to follow in social situations (e.g., a list of questions or conversation topics).
Probes the reliance on pre-planned conversational templates to manage social unpredictability.
- Strongly disagree
- Disagree
- Slightly disagree
- Neither agree nor disagree
- Slightly agree
- Agree
- Strongly agree
5. I sometimes repeat phrases that others have said in the exact same way I first heard them.
Checks for echolalia used as a compensatory strategy to navigate verbal exchanges.
- Strongly disagree
- Disagree
- Slightly disagree
- Neither agree nor disagree
- Slightly agree
- Agree
- Strongly agree
6. I adjust my body language or facial expressions to make it look like I'm interested in the person I'm interacting with.
Examines the active modification of nonverbal signals to meet neurotypical expectations of engagement.
- Strongly disagree
- Disagree
- Slightly disagree
- Neither agree nor disagree
- Slightly agree
- Agree
- Strongly agree
7. In social situations, I feel like I'm 'acting' rather than being my true self.
Captures the subjective feeling of disconnection and theatricality in social settings.
- Strongly disagree
- Disagree
- Slightly disagree
- Neither agree nor disagree
- Slightly agree
- Agree
- Strongly agree
8. In my own social interactions, I use behaviors that I've learned from watching other people interact.
Assesses the application of socially observed data to guide personal behavior.
- Strongly disagree
- Disagree
- Slightly disagree
- Neither agree nor disagree
- Slightly agree
- Agree
- Strongly agree
9. I'm always thinking about the impression I'm making on other people.
Measures the degree of hyper-vigilance regarding social perception and external judgment.
- Strongly disagree
- Disagree
- Slightly disagree
- Neither agree nor disagree
- Slightly agree
- Agree
- Strongly agree
10. I need the support of other people to be able to socialize.
Probes the reliance on a social buffer or familiar peer to navigate interpersonal situations.
- Strongly disagree
- Disagree
- Slightly disagree
- Neither agree nor disagree
- Slightly agree
- Agree
- Strongly agree
11. I practice my facial expressions and body language so that they seem natural.
Explores off-stage rehearsal behaviors aimed at perfecting social presentation.
- Strongly disagree
- Disagree
- Slightly disagree
- Neither agree nor disagree
- Slightly agree
- Agree
- Strongly agree
12. I don't feel I have to make eye contact with people if I don't want to.
Evaluates the freedom the patient feels to forgo neurotypical eye-contact norms.
- Strongly disagree
- Disagree
- Slightly disagree
- Neither agree nor disagree
- Slightly agree
- Agree
- Strongly agree
13. I have to force myself to interact with people when I am in social situations.
Captures the level of internal resistance and effort required to initiate or sustain social contact.
- Strongly disagree
- Disagree
- Slightly disagree
- Neither agree nor disagree
- Slightly agree
- Agree
- Strongly agree
14. I have tried to improve my understanding of social skills by observing other people.
Assesses observational learning as a primary tool for decoding social expectations.
- Strongly disagree
- Disagree
- Slightly disagree
- Neither agree nor disagree
- Slightly agree
- Agree
- Strongly agree
15. I monitor my body language or facial expressions to appear interested in the person I am interacting with.
Examines the continuous self-surveillance used to project active listening.
- Strongly disagree
- Disagree
- Slightly disagree
- Neither agree nor disagree
- Slightly agree
- Agree
- Strongly agree
16. In social situations, I try to find ways to avoid interacting with others.
Measures social avoidance as a coping mechanism for the demands of interaction.
- Strongly disagree
- Disagree
- Slightly disagree
- Neither agree nor disagree
- Slightly agree
- Agree
- Strongly agree
17. I have researched the rules of social interaction (e.g., by studying psychology or reading books on human behavior) in order to improve my own social skills.
Probes the intellectualization of social rules as a substitute for intuitive understanding.
- Strongly disagree
- Disagree
- Slightly disagree
- Neither agree nor disagree
- Slightly agree
- Agree
- Strongly agree
18. I am constantly aware of the impression I make on others.
Captures the chronic self-monitoring of one's social footprint.
- Strongly disagree
- Disagree
- Slightly disagree
- Neither agree nor disagree
- Slightly agree
- Agree
- Strongly agree
19. I feel free to be my true self when I am with other people.
Evaluates the presence of psychological safety and authentic expression in social contexts.
- Strongly disagree
- Disagree
- Slightly disagree
- Neither agree nor disagree
- Slightly agree
- Agree
- Strongly agree
20. I learn how people use their body and face to interact by watching TV or films, or by reading fiction.
Assesses the use of media and fictional narratives as a manual for social behavior.
- Strongly disagree
- Disagree
- Slightly disagree
- Neither agree nor disagree
- Slightly agree
- Agree
- Strongly agree
21. I adjust my body language or facial expressions so that I appear relaxed.
Examines the physical compensation efforts used to mask internal anxiety or rigidity.
- Strongly disagree
- Disagree
- Slightly disagree
- Neither agree nor disagree
- Slightly agree
- Agree
- Strongly agree
22. When I'm talking to other people, I feel that the conversation flows naturally.
Checks for the subjective experience of conversational fluency and intuitive reciprocity.
- Strongly disagree
- Disagree
- Slightly disagree
- Neither agree nor disagree
- Slightly agree
- Agree
- Strongly agree
23. I have spent time learning social skills from TV shows and movies and try to use them in my interactions.
Explores the direct application of media-derived social models to real-life interactions.
- Strongly disagree
- Disagree
- Slightly disagree
- Neither agree nor disagree
- Slightly agree
- Agree
- Strongly agree
24. In social interactions, I don't pay attention to what my face or body is doing.
Evaluates the absence of somatic self-monitoring, typical of unmasked interactions.
- Strongly disagree
- Disagree
- Slightly disagree
- Neither agree nor disagree
- Slightly agree
- Agree
- Strongly agree
25. In social situations, I feel like I am pretending to be 'normal'.
Measures the overarching sense of masking one's neurodivergence to pass within a neurotypical environment.
- Strongly disagree
- Disagree
- Slightly disagree
- Neither agree nor disagree
- Slightly agree
- Agree
- Strongly agree