Understanding and recognising the female phenotype of autism spectrum disorder and the “camouflage” hypothesis: a systematic PRISMA review

Clare Sarah Allely (University of Salford, Salford, UK)

Advances in Autism

ISSN: 2056-3868

Publication date: 12 March 2019



Females with autism spectrum disorder (ASD) may display superficial social skills which may mask their ASD symptomology impacting on the identification of the disorder – known as the “camouflage” hypothesis. Compared to males with ASD, it is increasingly recognised that females with ASD have a stronger ability to imitate behaviour which is socially acceptable, particularly those females who have higher cognitive abilities (i.e. intelligence considered to be within the normal range) (Ehlers and Gillberg, 1993). The paper aims to discuss this issue.


This paper will explore the literature on camouflaging or masking behaviour in females with ASD. A systematic PRISMA review was conducted.


The capacity to “camouflage” social difficulties in social situations is considered to be one of the main features of the female phenotype of ASD (e.g. Kenyon, 2014). Social imitation or camouflaging enables some level of success and coping, which results in some females never receiving a diagnosis of ASD. They typically may not exhibit any observable functional impairments. However, under the surface of the camouflage, females may experience high levels of subjective stress, anxiety and exhaustion and a need to re-charge or recuperate by withdrawing from any social interaction.

Research limitations/implications

There is relatively little understanding and knowledge of the female phenotype of ASD. This lack of understanding and knowledge impacts significantly on the ability to identify females with ASD (Lai et al., 2015; Bargiela et al., 2016), which can have a number of negative consequence (Adamou et al., 2018; National Collaborating Centre for Mental Health (UK), 2012).

Practical implications

There is a need for the development of a camouflaging measure.


There is a real need for further research exploring the positive and negative impact of the phenomenon of “camouflaging”, or “pretending to be normal” in females with ASD.



Allely, C. (2019), "Understanding and recognising the female phenotype of autism spectrum disorder and the “camouflage” hypothesis: a systematic PRISMA review", Advances in Autism, Vol. 5 No. 1, pp. 14-37. https://doi.org/10.1108/AIA-09-2018-0036

Download as .RIS



Emerald Publishing Limited

Copyright © 2018, Emerald Publishing Limited

Please note you might not have access to this content

You may be able to access this content by login via Shibboleth, Open Athens or with your Emerald account.
If you would like to contact us about accessing this content, click the button and fill out the form.
To rent this content from Deepdyve, please click the button.