Examining social camouflaging and its cognitive, mental health and neurophysiological correlates in autistic adolescents through triangulation-based assessment using self, parent and daily diary reports: a study protocol.

Social camouflaging is associated with poor mental health, self-identity, and quality of life outcomes in autistic individuals, yet its typology, consequences, and contextual triggers remain unexplored in autistic adolescents.

• Social camouflaging (SC) is defined as the concealing of autistic traits to socially assimilate.
• The paper notes that protective factors against the potentially negative outcomes associated with SC have not yet been identified.
• The study aims to address these gaps specifically in youth populations aged 15-18 years.

The study will recruit 150 adolescents aged 15-18 years across three groups: non-autistic, self-identifying autistic, and formally diagnosed autistic.

• Total planned sample size is N=150 adolescents.
• The three-group design allows comparison between non-autistic adolescents, self-identifying autistic adolescents, and those with formal diagnoses.
• Both adolescents and their caregivers will be enrolled as participant dyads.

The study employs a triangulation-based assessment approach capturing social camouflaging through self-report, caregiver-report, and intensive longitudinal daily diary methods.

• Three sources of data on SC behaviours are used: adolescent self-report, caregiver-reported SC behaviours, and daily diary reports over 7 days.
• Daily diaries are administered via smartphones and ask about type and degree of SC behaviour, social context, individuals present, and current well-being.
• Brief performance-based cognitive assessments of attention and executive function are integrated within the daily diary surveys.
• Adolescents and parents complete a follow-up assessment of SC behaviours and mental health at 3 months.

The study measures neurophysiological and biological correlates of social camouflaging using electroencephalography (EEG) and hair cortisol samples.

• Brain neurophysiological function will be measured during an in-lab visit using electroencephalography.
• Cortisol concentration over time will be measured using hair samples collected during the same in-lab visit.
• These measures are combined with cognitive assessments of attention, executive function, intellectual ability, and theory of mind.

The study will use correlations, regression analyses, and multilevel modelling to examine associations between social camouflaging and mental health, cognitive, and neurophysiological outcomes.

• Correlations and regression analyses will explore associations between SC and mental health/cognitive outcomes.
• Baseline measures of cognition, mental health, and SC will be used to predict patterns seen on the daily diaries.
• Multilevel modelling will nest daily data to capture within-person and between-group differences in contextual predictors of camouflaging behaviour.
• The design allows examination of how social context and the individuals present influence degree and type of SC.

The study received ethics approval from two institutions and includes safety procedures to support adolescent participants should mental health concerns arise.

• Approved by the University of Victoria Human Research Ethics Board (#23-0013).
• Also approved by the University of Calgary Conjoint Faculties Research Ethics Board (#23-0641).
• Informed consent will be obtained from both caregivers and adolescent participants.
• Safety procedures will be put in place to support adolescents should mental health concerns arise during the study.

Results are intended to inform intervention development to mitigate mental health challenges for autistic youth and will be disseminated to both academic and non-academic audiences.

• The authors state results will contribute to understanding of the typology of camouflaging.
• Findings are intended to inform intervention to mitigate mental health challenges for autistic youth.
• Results will be disseminated through academic publications and conferences.
• Findings will also be summarised and communicated to interested participants and relevant stakeholders.