What is the term for masking in neurodiverse individuals?

From the Guidelines

Masking in neurodiverse individuals is often referred to as camouflaging, which involves hiding or downplaying existing problems, difficulties, or differences to fit in with societal norms or expectations. This concept is particularly relevant in individuals with autism spectrum disorder (ASD) or other neurodevelopmental disorders, where camouflaging can be a common strategy to cope with social and communication challenges 1. Camouflaging can manifest in various ways, such as using verbal skills to hide receptive language deficits, or employing strategies to mask difficulties with socialization, comprehension, and executive functioning. It is essential to recognize that camouflaging can be both a helpful coping mechanism and a potential barrier to accurate diagnosis and support, as it may lead to underestimation of an individual's needs or difficulties.

Some key points to consider when working with neurodiverse individuals who may be camouflaging include:

• The importance of patience and collateral information from caregivers or family members to ensure accurate understanding of an individual's needs and challenges 1
• The need for clear and careful explanations, simple written instructions, and monitoring of medication intake to support individuals with cognitive impairments or intellectual disabilities 1
• The potential for camouflaging to mask underlying difficulties, such as receptive language deficits or socialization challenges, which may require targeted support and accommodations 1
• The importance of balancing an individual's wishes and aspirations with the need to avoid repeated disappointments and discouragement, particularly in the context of employment or education 1

It is crucial to approach each individual with a nuanced understanding of their unique strengths, challenges, and coping strategies, and to provide support and accommodations that prioritize their well-being, autonomy, and quality of life. By recognizing and addressing camouflaging in neurodiverse individuals, we can work towards creating a more inclusive and supportive environment that values and celebrates diversity in all its forms.

From the Research

Definition and Diagnosis of Autism Spectrum Disorder

• Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social communication and the presence of restricted, repetitive behaviors or interests 2
• The diagnosis of ASD is based on a comprehensive evaluation with a multidisciplinary team of clinicians, using standardized measures such as the Autism Diagnostic Observation Schedule-Second Edition and the Autism Diagnostic Interview 2
• Common early signs and symptoms of ASD in a child's first 2 years of life include no response to name when called, no or limited use of gestures in communication, and lack of imaginative play 2

Prevalence and Comorbidities of Autism Spectrum Disorder

• The estimated prevalence of ASD has been increasing in the US, from 1.1% in 2008 to 2.3% in 2018 2
• Individuals with ASD have higher rates of depression, anxiety, sleep difficulties, and epilepsy compared to people without ASD 2
• Nearly 75% of ASD patients suffer from comorbid psychiatric illnesses or conditions, which may include attention-deficit hyperactivity disorder (ADHD), anxiety, bipolar disorder, depression, Tourette syndrome, and others 3

Treatment and Intervention of Autism Spectrum Disorder

• Intensive behavioral interventions, such as the Early Start Denver Model, are beneficial in children 5 years or younger for improvement in language, play, and social communication 2
• Pharmacotherapy is indicated for co-occurring psychiatric conditions, such as emotion dysregulation or attention-deficit/hyperactivity disorder 2
• Risperidone and aripiprazole can improve irritability and aggression, while psychostimulants are effective for attention-deficit/hyperactivity disorder 2

Masking in Neurodiverse Individuals

• There is no direct mention of the term for masking in neurodiverse individuals in the provided studies. However, it is known that individuals with ASD may exhibit behaviors that mask their symptoms, such as camouflaging or compensating for their social communication deficits 4, 5
• Further research is needed to understand the concept of masking in neurodiverse individuals and its implications for diagnosis and treatment.