Camouflaging Autism in Pursuit of Friendship and Intimate Relationships: A Systematic Review
Kathryn Ridgway, Kassandrah Cooke, David H. Demmer, Merrilyn Hooley, Elizabeth Westrupp, Mark A. Stokes
Abstract
Background: Difficulties in making and maintaining social relationships is common among autistic people. These difficulties are thought to be due to differences in autistic social interaction and social communication that have been theorized to be the result of reduced social motivation. We argue that this theory does not account for camouflaging, a combination of strategies that are employed frequently by many autistic individuals in pursuit of obtaining social relationships; however, its utility in achieving satisfactory friendship and intimate relationships for the individual is not clear. Method: This review synthesizes empirical evidence of camouflaging as a strategy for achieving friendships and/or intimate relationships among autistic adolescents and adults. A systematic search yielded 1421 records. Forty-nine full texts were screened, and eight qualitative studies were retained. Results: Results reveal that camouflaging was a main strategy in pursuit of friendship, with little evidence for intimate relationships, in this sample of autistic adolescents and adults. For most, camouflaging is exhausting, often ineffective and inefficient, and ultimately a challenge to one's social authenticity. Discussion/Conclusion: Research suggests that many autistic individuals rely on camouflaging in pursuit of friendship and intimate relationships, although this is often a nonpreferred strategy. Some autistic individuals seek to replace camouflage with alternative strategies to obtain social relationships, yet outcomes typically remain dissatisfying. This demonstrates that we need to reconsider the social motivation theory, and to better understand alternative strategies that can help autistic individuals to obtain authentic, satisfactory social relationships, and to support opportunities to achieve these desired outcomes. Community Brief: More research is needed to better understand autistic social interactions and to support alternative strategies to camouflaging, including environmental modifications and changes in the way non-autistic people understand and interact with autistic people. We recommend that autistic individuals' strengths and needs drive this area of research, and that supports address ways that all people can help to enhance autistic social outcomes. We anticipate that these strategies will promote more authentic social relationships, reduce reliance on camouflage, help to decrease loneliness, and improve well-being among autistic individuals.