Autistic Boys and Men Camouflage, Too

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If I'm talking to one of the teachers I feel connected with—instead of the ones who use my son's quietness as a form of criticism—I mention that he's an entirely different boy at home. He's one of the noisiest people I've ever met—always singing a snippet of a song, repeating a funny joke, or jumping about in some way. Far from being quiet, he can talk at great length when he's interested in something. His teachers are usually shocked when I describe the contrast between his "home self" and his "school self."

Like many autistic people, my son relies heavily on camouflaging. While we all have different versions of ourselves that we choose to present or hide in different social situations—and many children will act differently in the school and home environment—camouflaging involves monitoring everything you do and say, to the point that you present as entirely different.

That autistic girls and women often rely heavily on camouflaging behaviours—to the extent that it has contributed to significant under- and misdiagnosis of autistic females—has received considerable attention in recent years. This growing awareness has led to more girls and women receiving the correct diagnosis and support. However, as our awareness of female autism develops, it's equally important that we don't stereotype autistic males as "not camouflaging."

In my experience working with clients of all genders and interacting with male autistic friends and family members, I've come to believe that self-consciousness is at the heart of how extensively people camouflage. As humans, it's natural to focus on ourselves and other people. "Public self-consciousness" refers to our awareness of ourselves as social subjects and reflects our level of concern with how other people view us, which can include worrying about making a good impression. Public self-consciousness can be influenced by our upbringing, culture, life experiences and personality traits.

Because my son is aware that he is autistic, and because of the accepting home environment he is raised in, he doesn't appear to view his autistic traits as "bad" in any way. In fact, he's discussed on several occasions what he sees as the advantages of being autistic.

But as a teenager, he still doesn't want to draw attention to himself for being "different."

In my experience working with clients of all genders and interacting with male autistic friends and family members, I've come to believe that self-consciousness is at the heart of how extensively people camouflage. As humans, it's natural to focus on ourselves and other people. "Public self-consciousness" refers to our awareness of ourselves as social subjects2 and reflects our level of concern with how other people view us, which can include worrying about making a good impression.3 Public self-consciousness can be influenced by our upbringing, culture, life experiences and personality traits.

Because my son is aware that he is autistic, and because of the accepting home environment he is raised in, he doesn't appear to view his autistic traits as "bad" in any way. In fact, he's discussed on several occasions what he sees as the advantages of being autistic.

But as a teenager, he still doesn't want to draw attention to himself for being "different."

The adult male clients I have worked with similarly describe feeling a need to hide their autistic traits when they're with other people. Andy,* a man in his 40s, described the extreme social anxiety he had developed as a result of being bullied as a child for, "going on way too long about the things I loved." He told me, "I'm aware that I seem to annoy other people. I've been told off for talking too long. It's got to the point where I'm terrified to open my mouth in case people hate me."

Stephen described how he used alcohol to cope with social situations. "I used to think I just suffered extreme boredom when I was with people. There's definitely an element of that, but it's much deeper. I don't know how to communicate with most people. I'm not interested in the same things they are. I just drink so I can get through."

Paolo told me, "Nobody knows how difficult it is for me to even get to a social event, without thinking how I'm going to cope with it. I need to leave really early and know the route—and if anything goes wrong with my plans, I'll probably go mental and ditch the whole idea. I'm often so agitated by the time I get there I can't even focus; it takes all my energy not to start humming or saying words over and over, which would calm me down but looks really weird."

What I hear from autistic men isn't much different to what I hear from autistic women. Yet it's as important not to homogenise all men's experiences as it is not to homogenise all women's experiences, which means acknowledging that not all autistic women camouflage. In fact, "public self-consciousness" can include an active decision not to camouflage and an awareness of one's desire not to hide one's autistic traits.

Camouflaging is linked with higher levels of anxiety and depression. Some men may feel that they lack the language to understand their experience, given the relative dearth of attention that autistic male camouflaging has received; this could lead to additional frustration and further decrease well-being.

As we continue to move forward in understanding autism, we must recognise the capacity of all autistic adults to camouflage, the impact it has on their health, and the capacity it has to impact the diagnostic process. We also need to remember that, although there are differences between the male, female, and nonbinary experience of autism, there are fundamental similarities that exist regardless of gender.

*Names have been changed to protect patient privacy.