CAT-Q

The CAT-Q (Camouflaging Autistic Traits Questionnaire) is a 25-item self-report questionnaire that measures social camouflaging (masking) behaviours in autistic and non-autistic adults, scored 25–175 with Compensation, Masking and Assimilation subscales. It has no diagnostic cutoffs; high camouflaging is associated with anxiety, exhaustion and autistic burnout.

For professional reference, research, and education only. Not for diagnosis or medical advice.

The CAT-Q (Camouflaging Autistic Traits Questionnaire) is a 25-item self-report questionnaire that measures social camouflaging in autistic and non-autistic adults, across Compensation, Masking and Assimilation subscales [1].

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. Camouflaging can help people navigate social demands, but it has been suggested to contribute to delayed diagnosis and mental health problems among autistic people [2].

The CAT-Q was developed from autistic adults' experiences of camouflaging and tested in 354 autistic and 478 non-autistic adults [1]. Its design captures both surface-level behaviours (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 does the CAT-Q measure?

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): Behaviours 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, behaviour, 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 do you give 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 the note. See the SOAP notes guide for templates and examples.

How do you score and interpret the CAT-Q?

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 behaviours
  • Subscale patterns are often more informative than the total score
  • There are no diagnostic thresholds or clinical cutoffs
  • Normative group means [1] 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 [1]
  • Preliminary test–retest reliability was r = 0.77 [1]; a Swedish adaptation reported good-to-excellent internal consistency and test–retest reliability [2]

Validity

  • Convergent validity with measures of autistic traits, wellbeing, anxiety, and depression [1]
  • Autistic participants scored higher than non-autistic participants, and autistic females higher than autistic males, in the Swedish sample [2]
  • Confirmatory factor analysis supported the three-factor structure, with equivalent structure across gender and diagnostic group, in the development sample [1]
  • The original factor structure did not fit well in Swedish data, and validity issues were found in children younger than 15 [2]
  • A 9-item short form (CATQ-SF) replicated the three-factor structure, with internal consistency of α = 0.84 and 0.89 in two adult samples [3]
  • A parent-report version for autistic young people correlated with the self-report CAT-Q (r = 0.47); a 2023 review found all 16 camouflaging measures it identified were still in the early phases of psychometric evaluation [4]

Limitations

  • Does not measure autistic traits themselves, only camouflaging behaviours
  • 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) the client reports exhaustion from "acting normal," or (3) the client 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.

CAT-Q vs AQ: masking vs autism quotient

Clinical Guidance: The AQ and CAT-Q answer different questions. The 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.

For individuals: This page is a clinical reference, not a diagnostic tool. If you have concerns about your own symptoms, bring this information to a qualified mental health professional.

Related

FAQ

  • Is the CAT-Q self-report or clinician-administered?

    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. Results are most informative when interpreted alongside a broader clinical assessment.

  • How is the CAT-Q scored?

    The CAT-Q contains 25 items rated on a 7-point Likert scale (1 = Strongly Disagree to 7 = Strongly Agree), giving a total score range of 25–175. Three subscale scores are also calculated: Compensation (8 items), Masking (10 items), and Assimilation (7 items). Higher scores indicate more frequent use of camouflaging behaviours.

  • What does a high CAT-Q score mean?

    A high total score indicates more frequent or intensive use of social camouflaging behaviours. In validation studies, autistic participants scored higher on average than non-autistic participants. Because the CAT-Q has no published diagnostic cutoffs, scores are best interpreted against published group means and alongside other clinical information.

  • Can the CAT-Q diagnose autism spectrum conditions?

    No. The CAT-Q measures camouflaging behaviours, not autistic traits directly, and has no diagnostic cutoffs. High scores can occur in non-autistic individuals for reasons such as social anxiety or cultural pressure. The questionnaire is intended to supplement — not replace — a comprehensive autism assessment.

References

    1. 1.Hull L, Mandy W, Lai MC, Baron-Cohen S, Allison C, Smith P, Petrides KV. Development and Validation of the Camouflaging Autistic Traits Questionnaire (CAT-Q). J Autism Dev Disord. 2019;49(3):819-833.
    2. 2.Lundin Remnélius K, Bölte S. Camouflaging in Autism: Age Effects and Cross-Cultural Validation of the Camouflaging Autistic Traits Questionnaire (CAT-Q). J Autism Dev Disord. 2024;54(5):1749-1764.
    3. 3.Hull L, Mandy W, Belcher H, Petrides KV. Validation of the camouflaging autistic traits questionnaire short form (CATQ-SF). Compr Psychiatry. 2024;135:152525.
    4. 4.Hannon B, Mandy W, Hull L. A comparison of methods for measuring camouflaging in autism. Autism Res. 2023;16(1):12-29.

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