Compensatory strategies in autistic people associated with delayed diagnosis – LDT


The first scientific study of compensatory strategies — techniques to camouflage autism — finds that they have both positive and negative outcomes, increasing social integration, but possibly also resulting in poor mental health for autistic people, and could be a barrier to diagnosis.

The research

Compensatory strategies used by autistic people have been investigated and collated in a qualitative study using an online survey of 136 adults, published in The Lancet Psychiatry journal. The authors advertised to recruit participants for their study via social media and with the National Autistic Society. 136 adults were asked to complete an online study. Of the participants, 58 had a clinical diagnosis, 19 self-identified without a formal diagnosis, and 59 were not diagnosed or self-identified but nonetheless reported social difficulties. The participants were asked to self-report autistic traits by completing a ten-item autism spectrum questionnaire and then a series of open questions about their social compensatory strategies. They also reported how successful and tiring their strategies were, and the likelihood of their recommending them to others with social difficulties.

“Compensation is born from necessity. We have extensive experience of how cruel people are.”

The study looked into what compensatory strategies participants used, whether the strategies used were similar in diagnosed and undiagnosed people, and how the strategies affected diagnosis. The team identified several strategies used by people with and without an autism diagnosis. Such strategies were used equally by people who were formally diagnosed as autistic and those who were not.


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10 comments on “Compensatory strategies in autistic people associated with delayed diagnosis – LDT
  1. Paul D says:

    Oh boy, familiar territory! So ingrained are my “compensation techniques” (prefer this term to “masking” – which I’m finding NTs wont accept) that they are subconscious, I’ve even had flashbacks to being 10 and copying others behaviour trying to fit in 🙁 Sadly its not that effective anyway, I’m 50 with no savings career or opportunity, worried about being made homeless. If I’d been diagnosed young I believe the outcome would have been better, but obviously at 10, you are deploying “coping strategies” without really thinking about it.

  2. Linda Buchan says:

    Thank you for sharing that Paul

  3. Paul D says:

    Thanks Linda, sorry not to be more positive but hopefully more people are getting caught earlier and better strategies can be deployed! Just thought I’d add though, now that I know I’m masking (I’d assumed everyone was doing to a similar extent), I’m very conscious and aware of when I’m doing it, which is pretty much during any encounter with another human.. but it’s so reflexive and ingrained – no matter how hard I try I can’t seem to drop the mask and be “my true self.” Exhausting!

  4. Linda Buchan says:

    I hope when you come to the group you can be your true self

  5. Senor Moment says:

    Perhaps also worth noting that some compensation strategies are thought to have a positive effect. I can see how such strategies might have brought me quite a few positive outcomes. But Paul is absolutely right in thinking early diagnosis would have led to significantly better outcomes. I always find myself empathising with parents and their children dealing with a diagnosis at an early age, but progress is certainly a possibility at that age. But I can also see that my compensatory strategies always just had enough of an positive outcome to fend off a more thorough investigation. But, of course, there wasn’t much information available before the 90s. Sure, I had fewer severe issues to deal with than some, but the late self-identification and diagnosis has taken quite a major toll on my social life and career. And I still can’t really discuss the issue with anyone. So much so, that I have largely given up bothering to even think about it. So, the compensatory strategies continue, although to a slightly lesser extent; and they continue to have both positive and negative outcomes.

  6. Linda Buchan says:

    I am glad you are able to discuss here with us

  7. Paul D says:

    Very interested to read your comments Senor Moment. I know I’m not alone with these late-diagnosis difficulties, but it’s the passing of time that is the problem not the diagnosis. I’m very glad to finally know what is “wrong” with me. I wish there were more resources available for adults, but understand ofc the focus toward children with the negligible public funding in 2019. Very sorry I couldn’t make the group Linda, intended to be there. I will strive to make another group, just getting about and participating in groups is very challenging. :/ Well wishes Senor!

    • Senor Moment says:

      Perhaps I’ll catch up with you at a PDSG sometime Paul. I do plan to try and make one the next time I’m in the UK.

      I finally just found one local GP in my resident country who basically gets it; the reason probably being that he has a son who got diagnosed young; thanks no doubt to there also being paediatricians in the same family. But even so, I haven’t really been encouraged much since to actually say too much about my self-ID/diagnosis at 60+. In fairness, he did refer me to a neuro, who in turn referred me to a local psychologist. But with the last one, the receptionist basically blocked me by saying her boss had no time to work with expats.

      I suspect the GP’s son is already a doctor himself, but I don’t think any communication with another adult with ASD is likely to happen here anytime soon. Especially as the whole local occupation is probably aware why it isn’t a subject they really want to discuss. (And it ISN’T being leaked!) I really got no further than a comment from the GP that such a diagnosis had its element of brilliance. (Which suggests his son is considered to have achieved something.) Nevertheless,I have always been treated at that clinic as someone who is observant; but I just thought to myself that I would not pass up the opportunity to indicate that there hadn’t really been too much career brilliance.

  8. Linda says:

    You are always welcome at the group
    I understand it takes a lot to get to the group

  9. Paul D says:

    Thanks Linda

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