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 Assessment 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.

Interpretation Guidelines

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
• The CAT-Q should not be used in isolation to make diagnostic or treatment decisions

Psychometric Properties

Reliability

• Excellent internal consistency for total and subscale scores
• Strong test–retest reliability reported across adult samples

Validity

• Strong convergent validity with autistic trait measures (e.g., AQ, RAADS-R)
• Distinguishes between autistic and non-autistic populations
• Correlated with measures of anxiety, depression, and autistic burnout in research
• Factor structure consistently replicated

Administration Considerations

• 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.

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

CAT-Q Overview

What is the CAT-Q?

The Camouflaging Autistic Traits Questionnaire (CAT-Q) is a validated 25-item self-report tool that measures social camouflaging behaviors in autistic adults. Used to identify masking, understand diagnostic barriers, and assess burnout risk in neurodivergent individuals.

Camouflaging (also called masking) refers to the conscious and unconscious strategies autistic individuals use to appear neurotypical in social situations: mimicking others, suppressing natural behaviors, and developing scripts for social interactions.

The CAT-Q is particularly important because high levels of camouflaging can mask autism traits from standardized assessments, leading to missed or delayed diagnoses, especially in women, girls, and AFAB (assigned female at birth) individuals who are socialized to conform. A person can score below the autism threshold on screening tools like the RAADS-R or AQ while simultaneously spending enormous energy hiding their autistic characteristics.

Research consistently links high CAT-Q scores with increased rates of depression, anxiety, and autistic burnout. Understanding a patient's camouflaging profile provides critical clinical context: a moderate RAADS-R score paired with high CAT-Q scores suggests the patient may be more significantly autistic than the screening score indicates.

Why Camouflaging Matters for Diagnosis

Autistic individuals who camouflage heavily may score below diagnostic thresholds on standard autism assessments. The CAT-Q helps clinicians identify when masking behavior is obscuring the clinical picture, reducing missed diagnoses, particularly in women and AFAB individuals.

Camouflaging and Burnout Risk

Sustained camouflaging is energetically costly and is strongly associated with autistic burnout: a state of chronic exhaustion, loss of skills, and increased sensory sensitivity that can persist for months or years. High CAT-Q scores should prompt discussion of sustainable coping strategies and reduced masking demand.

Rate each statement based on how much it applies to you generally. Subscale scores (Assimilation, Compensation, Masking) are calculated automatically.

Response scale: 1 = Strongly Disagree  ·  4 = Neutral  ·  7 = Strongly Agree

Higher scores indicate more frequent camouflaging behavior. Total score range: 25–175.

Total CAT-Q Score

CAT-Q Score Interpretation

The CAT-Q uses a 7-point Likert scale (1 = Strongly Disagree to 7 = Strongly Agree). Higher scores indicate more camouflaging behavior.

Note: These ranges are based on published research means (~97 for non-autistic adults; ~124 for autistic adults). The CAT-Q does not have a single published diagnostic cutoff; scores should be interpreted alongside clinical assessment, RAADS-R, or other autism-specific evaluations.

Add CAT-Q to Your Assessment Workflow

HiBoop's digital platform makes it easy to administer the CAT-Q alongside RAADS-R and other autism assessments, with automated subscale scoring, longitudinal tracking, and integration into your clinical workflow.

CAT-Q Subscales

Assimilation: Fitting in and mimicking others: Measures behaviors like studying how others interact to copy their mannerisms, adjusting body language, and actively working to blend into social groups.

Compensation: Developing compensatory strategies: Assesses developing scripts for social situations, memorizing social rules, and using deliberate techniques to navigate interactions that feel unnatural.

Masking: Hiding autistic traits: Evaluates active suppression of autistic behaviors such as stimming, avoiding eye contact, and the effort to appear relaxed and neurotypical.

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.

RAADS-R at HiBoop: 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.