Camouflaging Autistic Traits Questionnaire (CAT-Q)

The CAT-Q is a 25-item self-report questionnaire developed in 2018 to measure social camouflaging—the strategies used by autistic and non-autistic individuals to hide, mask, or compensate for autistic traits in social situations. It evaluates three domains: Compensation, Masking, and Assimilation. The measure is designed for adolescents and adults (16+) and is widely used in autism research, particularly in studies involving late-diagnosed adults and gender-related differences in presentation.

The CAT-Q does not diagnose autism and includes no clinical cutoffs. Instead, it provides a descriptive profile of camouflaging behaviours. Scores across subscales and the total scale help contextualize how frequently an individual engages in camouflaging, which can influence their social experience, stress levels, diagnostic journey, and mental health outcomes.

Foundational Context

The CAT-Q was developed to address a significant gap in autism assessment: traditional tools measure autistic traits, but no standardized measure previously existed to assess camouflaging, a behaviour many autistic individuals use to navigate social environments. Camouflaging can mask autistic traits during clinical evaluation and is associated with increased stress, burnout, and delayed or missed diagnosis—especially among women, non-binary people, and late-diagnosed adults.

Created by Laura Hull, William Mandy, and colleagues (2018), the CAT-Q offers the first validated framework for quantifying camouflaging strategies. It spans three conceptual domains:

• Compensation: using conscious strategies to appear socially fluent
• Masking: hiding autistic traits or distress
• Assimilation: adjusting behaviour to blend into social groups

By focusing on behaviours rather than traits, the CAT-Q provides a clearer understanding of how individuals manage social expectations and present themselves in daily life.

Psychometric Properties & Accuracy

Validation studies show that the CAT-Q is a psychometrically strong tool:

• Internal consistency: High across all subscales
• Factor structure: Stable three-factor model (Compensation, Masking, Assimilation)
• Convergent validity: Strong correlations with autistic traits, social anxiety, and well-being indicators
• Group differentiation: Autistic adults consistently score higher on average than non-autistic adults
• Gender sensitivity: Highlights differences in camouflaging patterns across genders

Unlike traditional screening tools, the CAT-Q has no diagnostic thresholds. Scores are interpreted descriptively, not categorically.

Administration and Scoring Protocol

The CAT-Q consists of 25 statements rated on a 7-point Likert scale from Strongly Disagree (1) to Strongly Agree (7).

Scoring Methodology

• Total score = sum of all 25 item scores
• Subscale scores = sum of items within each domain:
  • Compensation
  • Masking
  • Assimilation
• Some items are reverse-scored

Score Range

25–175

Interpreting Scores

There are no established clinical cut-offs.

Scores should be interpreted as follows:

• Lower scores: minimal or situational camouflaging
• Moderate scores: context-dependent camouflaging strategies
• Higher scores: frequent or pervasive camouflaging behaviours often observed in autistic adults or those navigating demanding social environments

Scores do not indicate autism nor its absence.

References and Copyright

Developer

Hull, L., Mandy, W., Lai, M. C., Baron-Cohen, S., Allison, C., Smith, P., & Petrides, K. V. (2019). Development and validation of the Camouflaging Autistic Traits Questionnaire (CAT-Q). Journal of Autism and Developmental Disorders, 49(3), 819-833. https://doi.org/10.1007/s10803-018-3792-6

References

• Baker, S., Smyth, C., Bartholomew, E., Buchanan, B., & Hegarty, D. (2024). A Review of the Clinical Utility and Psychometric Characteristics of the Camouflaging Autistic Traits Questionnaire (CAT-Q): Gender-Specific Norms, Percentile Rankings, and Qualitative Descriptors.
• Cook, J., Hull, L., Crane, L., & Mandy, W. (2021). Camouflaging in autism: A systematic review. Clinical Psychology Review, 89, 102080. https://doi.org/10.1016/j.cpr.2021.102080
• Cook, J., Hull, L., & Mandy, W. (2024). Improving diagnostic procedures in autism for girls and women: A narrative review. Neuropsychiatric Disease and Treatment, 20, 505-514. https://doi.org/10.2147/NDT.S372723
• Fombonne E. (2020). Camouflage and autism. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 61(7), 735-738. https://doi.org/10.1111/jcpp.13296
• Hull, L., Mandy, W., Lai, M. C., Baron-Cohen, S., Allison, C., Smith, P., & Petrides, K. V. (2019). Development and validation of the Camouflaging Autistic Traits Questionnaire (CAT-Q). Journal of Autism and Developmental Disorders, 49(3), 819-833. https://doi.org/10.1007/s10803-018-3792-6
• Hull, L., Lai, M. C., Baron-Cohen, S., Allison, C., Smith, P., Petrides, K. V., & Mandy, W. (2020). Gender differences in self-reported camouflaging in autistic and non-autistic adults. Autism, 24(2), 352-363. https://doi.org/10.1177/1362361319864804
• Lai, M. C., Hull, L., Mandy, W., Chakrabarti, B., Nordahl, C. W., Lombardo, M. V., Ameis, S. H., Szatmari, P., Baron-Cohen, S., Happé, F., & Livingston, L. A. (2021). Commentary: ‘Camouflaging’ in autistic people – reflection on Fombonne (2020). Journal of Child Psychology and Psychiatry, and Allied Disciplines, 62(8). https://doi.org/10.1111/jcpp.13344

Copyright

The CAT-Q is copyrighted by its authors. Reproduction of item content or detailed scoring algorithms typically requires permission. Use in clinical or research settings is permitted with proper citation.