Most autism questionnaires ask what you do. The CAT-Q asks something quieter and, for many adults, far more familiar: what do you do to hide it?
If you’ve ever rehearsed conversations in the shower, studied how other people stand at parties, forced yourself through small talk while feeling like an actor in a play about your own life, then come home utterly drained, this questionnaire will read less like a form and more like someone has been taking notes on you. It’s a newer arrival in autism assessment, and one of the most talked about, particularly among women and adults exploring a diagnosis later in life. Here’s what it is, what it measures, how to approach it, and what your score does and doesn’t mean. This information is general in nature and is not a substitute for advice from a registered health practitioner who knows your circumstances.
What is the CAT-Q?
The Camouflaging Autistic Traits Questionnaire (CAT-Q) is a 25-item self-report measure developed by Dr Laura Hull, Professor William Mandy and colleagues, published in 2019. It grew directly out of research with autistic adults describing, in their own words, the strategies they use to appear non-autistic in social situations, an experience often called masking or camouflaging.
That origin matters. Rather than clinicians deciding from the outside what masking looks like, the questionnaire’s content came from autistic people’s lived accounts. Each item is rated on a seven-point scale from strongly disagree to strongly agree, it takes around 10 minutes, and it’s designed for adolescents and adults who can reflect on their own social experiences.
What does it measure?
The CAT-Q covers three overlapping strategies. Compensation refers to actively working around social differences, like learning body language from television, scripting conversations in advance, or copying the mannerisms of socially skilled people. Masking involves concealing autistic characteristics and projecting a persona, such as constantly monitoring your facial expressions or forcing eye contact that feels unnatural. Assimilation captures the effort of blending in when social situations feel uncomfortable, including pushing yourself to interact when you’d rather not, and the pervasive sense of performing rather than being.
Scores range from 25 to 175, with higher scores reflecting more camouflaging. There are subscale scores for each of the three areas as well.
Why does camouflaging matter in an assessment?
Two big reasons. First, camouflaging can hide autism from the very tools designed to detect it. Questionnaires and observational assessments capture how a person presents, and a lifetime of skilled masking can produce a polished surface over a very different internal experience. This is one of the leading explanations for why autistic women, and many men too, have historically been missed or diagnosed late. A CAT-Q result helps a clinician understand how much conscious effort sits behind someone’s social presentation, and calibrate the rest of the assessment accordingly.
Second, camouflaging itself carries a cost. Research has linked higher levels of camouflaging with exhaustion, stress, anxiety, low mood and a shaky sense of identity, that feeling of not knowing who you are underneath the performance. Understanding a person’s masking isn’t just diagnostically useful. It often becomes one of the most personally meaningful conversations in the whole assessment.
Does the CAT-Q diagnose autism?
No, and it’s worth being extra clear here because online discussion sometimes suggests otherwise. The CAT-Q doesn’t diagnose autism, and it doesn’t diagnose camouflaging either, because camouflaging isn’t a diagnosis. It’s a behavioural strategy, and notably, non-autistic people camouflage too. Plenty of people with social anxiety, for instance, monitor themselves closely in social settings and score above zero.
There are also no formally established clinical cut-off scores. Numbers circulate online claiming that a particular score “means” something definitive, but the research doesn’t support hard thresholds, and the questionnaire’s own developers have been careful on this point. What the CAT-Q provides is a structured, validated way of describing how much someone camouflages and in what style, which a qualified clinician then interprets alongside a clinical interview, developmental history, other measures such as the RAADS-R, and sometimes observational tools, all of which we’ve covered elsewhere on this site.
Related: The ASRS in Autism Assessments: The Questionnaire That Asks Your Child’s Teacher Too
How should I prepare?
Mostly by giving yourself permission to answer as the person behind the mask, which is harder than it sounds. If you’ve camouflaged for decades, the performance can feel more familiar than the self it protects.
Practical suggestions: find unhurried, private time. Read each item and ask not “how do I come across?” but “what is actually happening inside me, and what work am I doing to produce this impression?” Think across different settings, since many people mask heavily at work but less at home. If an item stirs up more feeling than you expected, note it down, because those reactions are worth discussing with your clinician. And answer honestly in both directions. Some people discover they camouflage less than they assumed, and that’s equally useful information.
What happens with the results?
Your assessing clinician will look at your total and subscale scores, discuss the pattern with you in plain language, and weigh it within the full assessment picture. Whatever the diagnostic outcome, understanding your camouflaging profile often has practical value in itself, informing conversations about energy management, burnout, authenticity and where in life the mask might safely come off a little. In Australia, your GP, psychiatrist or psychologist can discuss relevant supports from there.
A final word
Here’s the strange gift hidden inside this questionnaire. For years, camouflaging works precisely because nobody sees it, sometimes not even you. The CAT-Q puts words to an invisible effort, and for many adults, reading those 25 items is the first time the sheer work of their daily life has been acknowledged in print. If that’s you, take a breath. The exhaustion was real. The effort was real. And answering honestly, perhaps for the first time without the mask, is a genuine act of self-respect. Whatever the scores say, you’ll understand yourself better for having looked, and that understanding is where easier days begin.
References
- 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). Journal of Autism and Developmental Disorders. 2019;49(3):819-833.
- Cook J, Hull L, Crane L, Mandy W. Camouflaging in autism: a systematic review. Clinical Psychology Review. 2021;89:102080.
- Lai MC, Lombardo MV, Ruigrok AN, Chakrabarti B, Auyeung B, Szatmari P, Happé F, Baron-Cohen S. Quantifying and exploring camouflaging in men and women with autism. Autism. 2017;21(6):690-702.