The Camouflaging Autistic Traits Questionnaire (CAT-Q): A Guide

Masking is often credited for missed autism diagnoses, especially among autistic women and girls. Popular self-assessment tools like the Autism Spectrum Quotient (AQ) have been criticized for not take camouflaging behaviors into account, and on average, autistic women and non-binary people score lower on the AQ than autistic men.

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The Camouflaging Autistic Traits Questionnaire (CAT-Q) is a self-assessment tool specifically meant to assess for social camouflaging behaviors. Though it is not a formal diagnostic tool for autism, it can provide meaningful information for individuals wondering whether they might be autistic and considering getting assessed.

The Camouflaging Autistic Traits Questionnaire (CAT-Q) is a self-assessment that was developed to measure social camouflaging behaviors associated with autism spectrum disorder. It is a relatively new test, published in 2019, and is the first self-assessment tool to explicitly evaluate for camouflaging as a behavior associated with autism. The CAT-Q measures three camouflaging behaviors:

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• Compensation, or strategies to compensate for difficulty with social interaction
  
  • For example, mirroring facial expressions or body language, or learning social cues from movies and TV
• Masking, or strategies to conceal or suppress autistic traits
  
  • For example, suppressing stimming and forcing oneself to make eye contact
• Assimilation, or strategies to fit in socially
  
  • For example, participating in social situations and feeling like you’re putting on an act

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The CAT-Q is not a formal diagnostic tool. However, it can be used by individuals hoping to gain a better understanding of themselves and their potential autistic behaviors. Many people self-administer the CAT-Q, and some clinicians, like psychotherapists or primary care providers, may also administer the CAT-Q to patients who are questioning whether they may be autistic.

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The CAT-Q is often used as a supplement to the Autism Spectrum Quotient (AQ), perhaps the most popularly used self-assessment for autistic traits. Research shows that on average, autistic women score lower on the AQ than autistic men, likely because of higher rates of masking behaviors among autistic women and girls. The CAT-Q can provide additional data for individuals who report camouflaging and paint a fuller picture of their potential autistic traits.

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The CAT-Q is a fairly short self-assessment tool. It consists of 25 statements designed to assess the three categories of social camouflaging behavior. Each question can be answered with one of the following seven options:

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• 1 - Strongly disagree
• 2 - Disagree
• 3 - Somewhat disagree
• 4 - Neither agree nor disagree
• 5 - Somewhat agree
• 6 - Agree
• 7 - Strongly agree

The CAT-Q was designed for anyone aged 16 or older who does not have an intellectual disability. The CAT-Q is suitable for people of all genders; however, because of gender and sex differences in camouflaging behavior, it may feel more resonant for autistic or potentially autistic women and non-binary people, who typically score higher than autistic men on the CAT-Q.

CAT-Q scores can range from 25 to 175, with each response corresponding to a score between 1 and 7.  A score of 100 or above indicates the potential presence of autistic camouflaging behaviors, with higher scores suggesting a greater prevalence of these behaviors.

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An above-threshold score on the CAT-Q is not the same as an autism diagnosis. An autism assessment is a much more in-depth evaluation of an individual’s potential autistic characteristics against diagnostic criteria, and it's the only way to receive a formal diagnosis. 

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The CAT-Q on this page will automatically calculate your score for you once you complete it.

Research shows that the CAT-Q is a reliable measure of social camouflaging behaviors. While camouflaging behaviors can be a sign of autism, they are not exclusive to autistic individuals. People with other mental health conditions may exhibit similar behaviors to try to blend in, conceal their conditions and gain acceptance—this is particularly true for individuals with social anxiety. These individuals might also receive higher scores on the CAT-Q.

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Though it isn’t a formal diagnostic assessment, the CAT-Q can be an illuminating tool for people who are questioning whether they might be autistic. Getting a formal autism assessment can be daunting, and often inaccessible; the CAT-Q is a quick and easy way for individuals who feel they employ camouflaging strategies to explore these behaviors. For some, the CAT-Q, often paired with the AQ, can help validate their decision to pursue a formal autism diagnosis. For those who cannot or do not wish to pursue a formal diagnosis, the CAT-Q can also provide further evidence towards a self-diagnosis. 

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Regardless of diagnoses, the CAT-Q can also support a person’s introspection and self-discovery. Taking the CAT-Q can help a person explore the extent to which they do or do not exhibit camouflaging behaviors, contributing to a fuller understanding of themself.

Social camouflaging is social behavior some autistic people exhibit to conceal autistic traits from others. Camouflaging is a protective action—autistic individuals who camouflage do so to avoid experiences like stigma, social rejection and loss of social and economic mobility.

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The term camouflaging is sometimes used interchangeably with masking. In the context of the CAT-Q, masking is considered one type of camouflaging behavior, alongside compensation and assimilation behaviors.

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Many autistic people who camouflage begin to do so in childhood, particularly girls, who may camouflage autistic traits as early as elementary school. Girls face different social demands than young boys, making autistic girls more likely to understand and respond to social expectations at a young age.

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While masking can be a lifeline for an autistic person, it can cause a number of problems. It’s associated with poorer mental health outcomes, lower self-esteem and autistic burnout. Camouflaging can also lead to autistic people being missed for assessment and diagnosis, leaving those individuals without appropriate resources and support. 

If you’d like to talk to someone more in-depth about your CAT-Q score, Prosper Health can connect you to clinicians who are highly experienced working with autistic adults. Prosper Health offers autism assessments that are 100% telehealth, covered by insurance and specifically designed for adults.

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Our providers also offer neurodiversity-affirming therapy and specialize in helping adults with a range of challenges associated with autism—including navigating a new diagnosis, or deciding to pursue a formal diagnosis in the first place.

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Wherever you are in your journey, Prosper Health is here to support you. If you’re ready to get started, click the button below to get connected to a clinician within days.