The CAT-Q: Understanding the Camouflaging Autistic Traits Questionnaire

If your child or teenager seems to "hold it together" all day at school or work, then falls apart the moment they get home, you may already be describing something researchers call camouflaging or masking. It's one of the main reasons autism gets missed, misdiagnosed, or diagnosed late, particularly in girls, women, and gender-diverse young people. The CAT-Q is the tool built specifically to put a number on that experience. Here's what it is, what it measures, and how to make sense of a score.

What is the CAT-Q?

The CAT-Q (Camouflaging Autistic Traits Questionnaire) is a 25-item self-report questionnaire designed to measure camouflaging: the conscious or unconscious strategies autistic people use to hide their autistic traits or appear more "typical" in social situations. It was developed by Dr Laura Hull, Professor William Mandy, and colleagues, and published in the Journal of Autism and Developmental Disorders in 2019, following extensive interviews with autistic adults about their own experiences of masking.

Unlike screening tools such as the AQ-10, which look at how strongly someone shows autistic traits, the CAT-Q looks at something different: the effort someone puts into concealing or managing those traits so they're less visible to others. This distinction matters enormously, because someone can be highly autistic and still score in a way that under-represents it on a traits-based screener, precisely because they've spent years learning to mask.

Why camouflaging matters for diagnosis

Camouflaging (also called masking) helps explain one of the more frustrating patterns families and clinicians see: a child or young person who is clearly struggling, sometimes to the point of burnout, anxiety, or shutdowns at home, but who presents as sociable, coping, and "fine" everywhere else, including in a single GP appointment or classroom observation.

This isn't the young person being dishonest. Camouflaging is often an exhausting, largely automatic survival strategy built up over years, particularly for those who've learned early that their natural way of communicating or self-regulating draws unwanted attention. Research consistently shows camouflaging is more common, and more effortful, in autistic girls, women, and gender-diverse people, which is a significant part of why they are so often diagnosed later than boys, or missed altogether.

Because of this, the CAT-Q has become an important complement to more traditional trait-based tools in identifying autism that might otherwise be overlooked.

What does the CAT-Q actually measure?

The questionnaire is built around three related but distinct camouflaging strategies:

Compensation: effortful behaviours used to actively overcome social and communication difficulties, such as consciously working out what to say or do in a situation that would come more naturally to someone else.

Masking: attempts to hide autistic traits or present as more neurotypical, for example, suppressing repetitive movements, forcing eye contact, or hiding sensory distress.

Assimilation: the effort involved in trying to fit in socially, often by pushing through discomfort to appear to belong in group settings rather than withdrawing from them.

Together, these three areas capture both the behaviours (what someone does to camouflage) and the emotional cost of doing so, which is part of why camouflaging is so strongly linked to exhaustion, anxiety, and burnout in autistic people who do it consistently.

Who is the CAT-Q for?

The CAT-Q is designed as a self-report tool for individuals aged 16 and over. It relies on a level of self-reflection and insight into one's own internal experience, motivations, and effort that most younger children don't yet have, which is why it isn't used with younger age groups in the way the AQ-10 is.

For older teenagers and adults who suspect they may have been masking traits, whether from themselves, from clinicians, or from the people around them, the CAT-Q gives language and structure to something that can otherwise be very hard to describe.

How is it scored?

The CAT-Q consists of 25 statements, each rated on a 7-point scale from strongly disagree to strongly agree, producing a total score somewhere between 25 and 175. Typical descriptive bands used to interpret the total score are:

• Extremely low: 25–51
• Low: 52–75
• Moderate: 76–112
• High: 113–136
• Extremely high: 137–175

It's worth being clear about what these bands do and don't mean. Unlike the AQ-10, which has a specific referral threshold, the CAT-Q doesn't have a single clinical cutoff that confirms or rules out autism. It's a formulation tool: it helps a clinician (or an individual) understand how much camouflaging effort is present and where, which is genuinely useful context alongside other information, but it isn't diagnostic on its own.

What a high score means, and what it doesn't

A high CAT-Q score suggests significant, effortful camouflaging is taking place, which is a meaningful and often overlooked piece of the picture, especially for someone whose traits haven't been obvious to teachers, GPs, or even family in every setting. It can help explain a mismatch between how someone appears and how much effort that appearance is costing them.

It does not, on its own, confirm an autism diagnosis. High camouflaging scores have also been reported in some non-autistic people, particularly those with social anxiety or certain personality traits, since the underlying behaviours (working hard to fit in socially) aren't entirely unique to autism. This is exactly why the CAT-Q works best as one part of a fuller clinical picture, alongside developmental history, direct observation, and other measures, rather than as a stand-alone test.

CAT-Q vs AQ-10: how they fit together

These two tools are often used side by side rather than as alternatives, because they're measuring different things:

• The AQ-10 asks about the traits themselves, and works best as a first-pass, referral-triggering screen.
• The CAT-Q asks about the effort spent concealing those traits, and is particularly useful for understanding presentations that might not show up clearly on trait-based screening alone.

Used together, they can help explain why someone might score lower than expected on the AQ-10 despite strong underlying concerns: a high CAT-Q score alongside a modest AQ-10 score is itself a meaningful, well-recognised pattern, especially in older girls, women, and gender-diverse individuals.

Frequently asked questions

What is the CAT-Q used for? It measures camouflaging or masking: the effort someone puts into hiding or managing their autistic traits so they appear more typical in social situations. It's used to help build a fuller picture during an autism assessment, particularly where masking may be affecting how visible someone's traits are to others.

What age is the CAT-Q suitable for? It's designed as a self-report tool for people aged 16 and over, since it requires the kind of self-reflection younger children generally haven't yet developed.

What does a high CAT-Q score mean? It suggests significant camouflaging effort is taking place. This is a useful and often overlooked piece of context, but a high score doesn't confirm an autism diagnosis on its own, since some non-autistic people also camouflage social difficulties to a degree.

Is the CAT-Q more accurate than the AQ-10 for identifying autism in girls and women? It measures something different rather than something "more accurate." Because girls, women, and gender-diverse people are statistically more likely to camouflage their traits, the CAT-Q can pick up something a purely trait-based tool like the AQ-10 might miss, which is why the two are often used together.

Can the CAT-Q diagnose autism on its own? No. It's a formulation and screening tool, not a diagnostic instrument. A full autism diagnosis requires assessment by qualified clinicians, drawing on developmental history, direct observation, and multiple sources of information.

Is there a free CAT-Q test available online? Versions of the CAT-Q are available online and can be completed in a few minutes ahead of a GP or specialist appointment, though as with any self-report screener, it should be used alongside professional guidance rather than in isolation.

Bringing it into your assessment conversation

If you or your teenager suspect that masking might be part of the picture, mentioning it explicitly to your GP is worth doing, since it isn't always visible in a short appointment. A completed CAT-Q, alongside real examples of exhaustion, meltdowns, or withdrawal once safe environments like home allow the mask to come down, gives a much fuller and more honest account than a single snapshot conversation can.

If you're preparing for a GP appointment and want to bring evidence-based screening tools like the CAT-Q and AQ-10 into that conversation, you can take the CAT-Q online here.

Interested in learning more about the AQ-10? You can read our AQ-10 Autism Screening Guide here.

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