Social Camouflaging in Females with Autism Spectrum Disorder: A Systematic Review
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ORIGINAL PAPER
Social Camouflaging in Females with Autism Spectrum Disorder: A Systematic Review María Tubío‑Fungueiriño1,2,3 · Sara Cruz4,5 · Adriana Sampaio6 · Angel Carracedo1,3,7,8 · Montse Fernández‑Prieto1,7,8
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Autism spectrum disorder (ASD) is a neurodevelopmental disorder with increasing prevalence, and a male-to-female ratio of 4:1. Research has been suggesting that discrepancy in prevalence may be due to the fact that females camouflage their symptoms. In this study, we aimed to systematically review evidence on the camouflage effect in females with ASD. Following the PRISMA guidelines, we reviewed empirical research published from January 2009 to September 2019 on PubMed, Web of Science, PsychInfo and Scopus databases. Thirteen empirical articles were included in this review. Overall, evidence supports that camouflaging seems to be an adaptive mechanism for females with ASD, despite the negative implications of these behaviours in their daily life. Keywords Camouflage · Females · Autism · Systematic review Autism spectrum disorder (ASD) is characterized by the presence of core impairments in neurodevelopmental areas as communication and social interaction, restricted, repetitive and inflexible behaviours, interests and activities and sensory-perceptual alterations (American Psychiatric Association [APA] 2013). ASD has an overall prevalence of 16.8 cases per 1000 (Baio et al. 2018). ASD is diagnosed between 3 to 4 times more in males than in females (Baio et al. 2018), María Tubío-Fungueiriño and Sara Cruz have contributed equally to the study. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10803-020-04695-x) contains supplementary material, which is available to authorized users. * Montse Fernández‑Prieto [email protected] 1
Genomics and Bioinformatics Group, Centre for Research in Molecular Medicine and Chronic Diseases (CiMUS), Universidade de Santiago de Compostela (USC), Avda. de Barcelona, s/n, 15782 Santiago de Compostela, Spain
2
Grupo de Medicina Xenómica, Universidade de Santiago de Compostela (USC), Santiago de Compostela, Spain
3
Fundación Pública Galega de Medicina Xenómica, Servicio Galego de Saúde (SERGAS), Santiago de Compostela, Spain
4
Psychology for Positive Development Research Center, Universidade Lusíada - Norte, Porto, Portugal
depending on the used estimates (e.g., active and passive case ascertainment studies), suggesting a possible diagnostic gender bias, making girls less prone to be misdiagnosed, diagnosed at later ages or even missing out a clinical ASD diagnosis (Loomes et al. 2017). Sex-differences have been observed in relation to the prevalence of ASD diagnosis in females (Giarelli et al. 2010; Begeer et al. 2013; Rutherford et al. 2016; Rabbitte et al. 2017; Ratto et al. 2018), which may be associated with distinct autistic traits in females, with some studies referring the existence of a specific “female phenotype
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