CAT-Q Calculator

What is the CAT-Q?

The Camouflaging Autistic Traits Questionnaire (CAT-Q) is a 25-item self-report measure designed to assess the extent to which individuals camouflage or mask autistic traits in social situations. Developed by Dr Laura Hull and colleagues at University College London, the CAT-Q was published in the Journal of Autism and Developmental Disorders in 2019.

Camouflaging refers to the strategies that autistic (and some non-autistic) individuals use to conceal autistic traits, compensate for social difficulties, and assimilate into neurotypical social environments. The CAT-Q measures three distinct camouflaging strategies: Compensation (using learned techniques to navigate social situations), Masking (concealing autistic characteristics), and Assimilation (trying to fit in with others).

Each item is scored on a seven-point Likert scale from 1 ("Strongly Disagree") to 7 ("Strongly Agree"), with five items reverse-scored. Total scores range from 25 to 175. The CAT-Q is licensed under Creative Commons Attribution 4.0 (CC BY 4.0), making it freely available for clinical and research use with attribution.

Development and Validation

The CAT-Q was developed through a rigorous process involving qualitative research with autistic adults, item generation, expert review, and psychometric validation. Hull and colleagues drew on the lived experiences of autistic individuals to ensure the instrument captured the breadth of camouflaging behaviours.

The validation study included 832 participants (354 autistic, 478 non-autistic) and demonstrated good psychometric properties. The three-factor structure (Compensation, Masking, Assimilation) was confirmed through confirmatory factor analysis. Internal consistency was strong across all subscales, with Cronbach's alpha values of 0.91 for Compensation, 0.85 for Masking, and 0.88 for Assimilation.

The CAT-Q was the first validated quantitative measure of camouflaging, addressing a significant gap in the autism assessment literature. Research using the CAT-Q has shown that camouflaging is more common among autistic women and is associated with poorer mental health outcomes, including higher rates of anxiety, depression, and burnout.

How CAT-Q Scoring Works

The CAT-Q uses a seven-point Likert scale for each of its 25 items:

1 = Strongly Disagree 2 = Disagree 3 = Somewhat Disagree 4 = Neither Agree nor Disagree 5 = Somewhat Agree 6 = Agree 7 = Strongly Agree

Five items (3, 12, 19, 22, 24) are reverse-scored, meaning their values are inverted (1 becomes 7, 2 becomes 6, etc.) before summing. Total scores range from 25 to 175.

No clinical or diagnostic cut-off has been published for the CAT-Q — the validation study (Hull et al., 2019) reports group means only, not severity bands. As a normative reference, published means (Hull et al., 2020) are approximately 91-97 for non-autistic adults and 110-124 for autistic adults, with notable variation by gender. Higher scores reflect more self-reported camouflaging, a behavioural strategy that also occurs in non-autistic people (for example with social anxiety or gender/cultural pressure) — it is not a measure of severity of disorder. The CAT-Q supplements, and does not replace, comprehensive autism assessment.

Subscale scores provide additional detail: Compensation (9 items, range 9-63): Using learned strategies to navigate social situations Masking (8 items, range 8-56): Concealing autistic characteristics Assimilation (8 items, range 8-56): Efforts to fit in with others

Clinical Applications

The CAT-Q serves multiple functions in clinical practice and research. Its primary applications include:

Supporting autism assessment, particularly for individuals (especially women and those assigned female at birth) who may have developed extensive camouflaging strategies that mask autistic traits during traditional assessment. High CAT-Q scores may prompt practitioners to consider more in-depth evaluation.

Understanding individual camouflaging profiles. The three subscales — Compensation, Masking, and Assimilation — provide a detailed picture of which camouflaging strategies an individual uses most, which can inform clinical formulation and support planning.

Monitoring wellbeing in relation to camouflaging. Research has demonstrated associations between high levels of camouflaging and poorer mental health. The CAT-Q can be used to explore whether camouflaging may be contributing to psychological distress.

Research into the lived experiences of autistic individuals, sex and gender differences in autism presentation, and the relationship between camouflaging and mental health outcomes.

The CAT-Q is not a diagnostic tool for autism. High camouflaging scores do not indicate that an individual is autistic, nor do low scores rule it out.

CAT-Q in Australian Practice

In Australia, the CAT-Q is used by psychologists and other practitioners involved in autism assessment and support. Growing awareness of camouflaging — particularly its role in the under-identification of autism in women, girls, and gender-diverse individuals — has increased interest in this instrument in Australian clinical practice.

The CAT-Q is relevant to Australian assessment practice, where there is increasing recognition that traditional autism assessment tools may not capture the presentations of individuals who camouflage extensively. Australian clinicians working in autism assessment may use the CAT-Q alongside other assessment tools to build a comprehensive clinical picture.

The instrument's Creative Commons licensing (CC BY 4.0) makes it freely available for Australian practitioners without cost barriers. Its inclusion of three distinct camouflaging dimensions supports nuanced clinical discussion about the strategies individuals use and their potential impact on wellbeing.

Australian autism advocacy organisations and researchers have contributed to the growing evidence base on camouflaging, reflecting the importance of this construct in contemporary autism research and practice.