CAT-Q

Foundational Context

Camouflaging describes the strategies autistic individuals use (consciously or unconsciously) to fit into social environments. Examples include rehearsing social scripts, copying facial expressions, suppressing stimming, imitating peers, or actively concealing distress or confusion. Hull et al. (2019) highlighted that camouflaging is not inherently adaptive; while it can help individuals navigate social demands, it is also associated with anxiety, exhaustion, identity confusion, and autistic burnout.

The CAT-Q was developed through extensive qualitative interviews and psychometric modeling across autistic and non-autistic adult samples. Its design captures both surface-level behaviors (Masking) and deeper compensatory cognitive strategies (Compensation), as well as efforts to blend into social groups (Assimilation). Because camouflaging varies by gender, cultural expectations, and social context, the CAT-Q offers insight into lived experiences often overlooked by traditional autism measures.

What the CAT-Q measures

The CAT-Q assesses three distinct dimensions of camouflaging:

• Compensation (8 items): Cognitive strategies used to compensate for perceived social or communication difficulties (e.g., preparing scripts, analyzing interactions).
• Masking (10 items): Behaviors aimed at concealing autistic traits, including hiding stimming, controlling facial expressions, or suppressing natural responses.
• Assimilation (7 items): Efforts to blend into social environments by adapting appearance, behavior, or interests to match peers.

Together, these domains offer a comprehensive picture of how an individual navigates social expectations and the mental effort required to do so.

How to administer the CAT-Q

The CAT-Q is a self-report questionnaire completed by the respondent. It was designed for use with autistic and non-autistic adults and does not require a trained clinician to administer or score. Each of the 25 items is rated on a 7-point Likert scale (1 = Strongly Disagree to 7 = Strongly Agree).

• Particularly relevant in populations where masking is common: women, AFAB individuals, late-diagnosed autistic adults, and those who report social exhaustion
• Should be administered in environments where respondents feel safe to be candid
• Works well as part of autism assessment batteries or identity/mental health support contexts
• Not recommended as a standalone diagnostic tool
• Useful in guiding treatment discussions about masking, burnout, boundaries, and self-acceptance

Documenting CAT-Q scores in clinical notes: CAT-Q scores belong in the Objective section of your note. See our SOAP notes guide and Intake Notes guide for templates and examples.

CAT-Q scoring and interpretation

The CAT-Q yields:

• Total score: 25–175
• Three subscale scores: Compensation, Masking, Assimilation

Interpretation principles:

• Higher scores indicate more frequent or intense use of camouflaging behaviors
• Subscale patterns are often more informative than the total score
• There are no diagnostic thresholds or clinical cutoffs
• Normative group means (Hull et al., 2019) can support comparative interpretation

Interpretation Notes:

• Elevated camouflaging is associated with anxiety, stress, exhaustion, identity strain, and autistic burnout
• High scores do not confirm autism; non-autistic individuals may camouflage for different reasons (e.g., social anxiety)
• Camouflaging may vary across gender, culture, social contexts, and life stages
• Heavy camouflaging can hide autistic traits from screening tools such as the RAADS-R or AQ, contributing to missed or delayed diagnoses, particularly in women and AFAB individuals
• The CAT-Q should not be used in isolation to make diagnostic or treatment decisions

Psychometric properties

Reliability

• Internal consistency of the total score was α = 0.94 in the development sample of 354 autistic and 478 non-autistic adults (Hull et al., 2019)
• Preliminary test–retest reliability was r = 0.77 (Hull et al., 2019); a Swedish adaptation reported good-to-excellent internal consistency and test–retest reliability (Lundin Remnélius & Bölte, 2024)

Validity

• Convergent validity with measures of autistic traits, wellbeing, anxiety, and depression (Hull et al., 2019)
• Autistic participants score higher than non-autistic participants (Lundin Remnélius & Bölte, 2024)
• Confirmatory factor analysis supported the three-factor structure, with equivalent structure across gender and diagnostic group, in the development sample (Hull et al., 2019)
• The original factor structure did not fit well in Swedish data, and validity issues were found in children younger than 15 (Lundin Remnélius & Bölte, 2024)

Limitations

• Does not measure autistic traits themselves, only camouflaging behaviors
• High scores may reflect social anxiety, trauma, or cultural pressures rather than autism
• Self-report accuracy may vary depending on insight and emotional readiness
• Not validated extensively outside Western cultural contexts
• Factor structure has not replicated in every sample, and validity is uncertain in children younger than 15

CAT-Q vs Other Autism Assessment Tools

The CAT-Q serves a unique role in the autism assessment toolkit by measuring how autistic traits are hidden, not just whether they exist.

CAT-Q vs RAADS-R: Camouflaging vs Autism Traits

Clinical Guidance: Use RAADS-R for initial autism screening. Add CAT-Q when: (1) RAADS-R is borderline but clinical suspicion is high, (2) patient reports exhaustion from "acting normal," or (3) patient is female/AFAB or was diagnosed late in life. High CAT-Q + moderate RAADS-R is a strong signal for masked autism that deserves full evaluation.

See the RAADS-R assessment.

CAT-Q vs AQ: Masking vs Autism Quotient

Clinical Guidance: The AQ and CAT-Q answer different questions. AQ asks "does this person have autism traits?"; CAT-Q asks "how much is this person hiding those traits?" High AQ + high CAT-Q = classic presentation with masking on top. Low-moderate AQ + high CAT-Q = possible masked autism that standard screens are missing entirely.

Add CAT-Q to Your Assessment Workflow

HiBoop's digital platform makes it easy to administer the CAT-Q, with subscale scoring on submission, longitudinal tracking, and integration into your clinical workflow.