Social compensation and identity in adolescents with autistic spectrum disorder

Published

2024-11-16

How to Cite

Gago Ageitos, A. M., Vicente Alba, J., Álvarez Pérez, V., Garcia Hijano, C. M., & Vidal Millares, M. (2024). Social compensation and identity in adolescents with autistic spectrum disorder. Revista De Psiquiatría Infanto-Juvenil, 41(4), 45–57. https://doi.org/10.31766/revpsij.v41n4a5

Issue

Section

Review article

Authors

DOI:

https://doi.org/10.31766/revpsij.v41n4a5

Keywords:

camouflage and autism, sexual identity in autism, alcohol abuse and autism, social compensation in autism

Abstract

Introduction: In the early years of life, children with autism spectrum disorder (ASD) require appropriate diagnosis and treatment, including an understanding of comorbid neurodevelopmental disorders such as attention deficit disorder or learning disabilities. On the other hand, during adolescence and adulthood, the priority will be to deal with other difficulties such as psychosexual integration, identity construction and adequate social interaction. Objectives: The aim of this study is to carry out an updated bibliographic review to help in the diagnosis and treatment of ASD in the transition from adolescence to adulthood, by understanding the variability in the phenotypic expression of milder cases. Methods: Bibliographic review of the last 5 years in PubMed, Medline, World Health Organization, PsycINFO and Autism.org, with the following terms: “camouflage and autism”, "social compensation in autism", “sexual identity in autism”, “social compensation in autism” and “alcohol abuse and autism”. Results and conclusions: The clinical expression of ASD evolves in relation to factors inherent to the disorder, but also related to the social context. Thus, in the transition to adulthood, strategies that help to establish a well-adjusted personal and social identity are especially important in a complex society marked by the impact of image, stereotypes and assimilation. Due to their clinical relevance.

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Author Biographies

Ana María Gago Ageitos, Complexo Hospitalario Universitario de Santiago de Compostela

Psiquiatra de la Infancia y Adolescencia. Servicio de Psiquiatría. Complexo Hospitalario Universitario de Santiago de Compostela.

Javier Vicente Alba, Complexo Universitario Hospitalario de Vigo

Psiquiatra. Servicio de Psiquiatría del Complexo Universitario Hospitalario de Vigo.

Vicente Álvarez Pérez, Complexo Hospitalario de Pontevedra

Psiquiatra. Servicio de Psiquiatría del Complexo Hospitalario de Pontevedra, España

Carmen Mercedes Garcia Hijano, Psicóloga independiente

Psicóloga. Pontevedra.

María Vidal Millares, Complexo Hospitalario Universitario de Santiago de Compostela

Psiquiatra. Servicio de Psiquiatría del Complexo Hospitalario Universitario de Santiago de Compostela.

References

American Psychiatric Association. DSM-5 Task Force. Diagnostic and Statistical Manual of Mental Disorders. CBS Publishers. 2013. DOI: https://doi.org/10.1176/appi.books.9780890425596

World Health Report. Autism. 2023.

Zeidan J, Fombonne E, Scorah J, Ibrahim A, Durkin MS, Saxena S, et al. Global prevalence of autism: A systematic review update. Autism Res. 2022 May;15(5): 778-90. https://doi.org/10.1002/aur.2696 DOI: https://doi.org/10.1002/aur.2696

Hervás A. Género femenino y autismo: infra detección y mis diagnósticos. Medicina (B Aires). 2022;82: 37-42.

Ruggieri V. El autismo a lo largo de la vida. Medicina (Buenos Aires). 2022;82: 2-6.

Øverland E, Hauge ÅL, Orm S, Pellicano E, Øie MG, Skogli EW, et al. Exploring life with autism: Quality of Life, daily functioning and compensatory strategies from childhood to emerging adulthood: A qualitative study protocol. Front Psychiatry. 2022;13: 1058601. https://doi.org/10.3389/fpsyt.2022.1058601 DOI: https://doi.org/10.3389/fpsyt.2022.1058601

Bargiela S, Steward R, Mandy W. The Experiences of Late-diagnosed Women with Autism Spectrum Conditions: An Investigation of the Female Autism Phenotype. J Autism Dev Disord. 2016 Oct;46(10): 3281-94. https://doi.org/10.1007/s10803-016-2872-8 DOI: https://doi.org/10.1007/s10803-016-2872-8

Parish-Morris J, Liberman MY, Cieri C, Herrington JD, Yerys BE, Bateman L, et al. Linguistic camouflage in girls with autism spectrum disorder. Mol Autism. 2017;8(1). https://doi.org/10.1186/s13229-017-0164-6 DOI: https://doi.org/10.1186/s13229-017-0164-6

Fombonne E. Camouflage and autism. Journal of Child Psychology and Psychiatry. 2020 Jul 13;61(7): 735-8. DOI: https://doi.org/10.1111/jcpp.13296

Hull L, Lai MC, Baron-Cohen S, Allison C, Smith P, Petrides K, et al. Gender differences in self-reported camouflaging in autistic and non-autistic adults. Autism. 2020 Feb 18;24(2): 352-63.https://doi.org/10.1177/1362361319864804 DOI: https://doi.org/10.1177/1362361319864804

Alaghband-Rad J, Hajikarim-Hamedani A, Motamed M. Camouflage and masking behavior in adult autism. Front Psychiatry. 2023;14: 1108110. https://doi.org/10.3389/fpsyt.2023.1108110 DOI: https://doi.org/10.3389/fpsyt.2023.1108110

Milner V, Mandy W, Happé F, Colvert E. Sex differences in predictors and outcomes of camouflaging: Comparing diagnosed autistic, high autistic trait and low autistic trait young adults. Autism. 2023;27(2). https://doi.org/10.1177/13623613221098240

Hus Y, Segal O. Challenges Surrounding the Diagnosis of Autism in Children. Neuropsychiatr Dis Treat. 2021;17:3509–29. https://doi.org/10.2147/NDT.S282569 DOI: https://doi.org/10.2147/NDT.S282569

Rynkiewicz A, Janas-Kozik M, S?opie? A. Girls and women with autism. Psychiatr Pol. 2019 Aug 31;53(4): 737-52. https://doi.org/10.12740/PP/OnlineFirst/95098 DOI: https://doi.org/10.12740/PP/OnlineFirst/95098

Rynkiewicz A, Schuller B, Marchi E, Piana S, Camurri A, Lassalle A, et al. An investigation of the “female camouflage effect” in autism using a computerized ADOS-2 and a test of sex/gender differences. Mol Autism. 2016;7(1). https://doi.org/10.1186/s13229-016-0073-0 DOI: https://doi.org/10.1186/s13229-016-0073-0

Adhia A, Bair-Merritt M, Broder-Fingert S, Nunez Pepen RA, Suarez-Rocha AC, Rothman EF. The Critical Lack of Data on Alcohol and Marijuana Use by Adolescents on the Autism Spectrum. Autism Adulthood. 2020 Dec 1;2(4): 282-8. https://doi.org/10.1089/aut.2019.0051 DOI: https://doi.org/10.1089/aut.2019.0051

Butwicka A, Långström N, Larsson H, Lundström S, Serlachius E, Almqvist C, et al. Increased Risk for Substance Use-Related Problems in Autism Spectrum Disorders: A Population-Based Cohort Study. J Autism Dev Disord. 2017 Jan 12;47(1): 80-9. https://doi.org/10.1007/s10803-016-2914-2 DOI: https://doi.org/10.1007/s10803-016-2914-2

Bouzy J, Brunelle J, Cohen D, Condat A. Transidentities and autism spectrum disorder: A systematic review. Psychiatry Res. 2023 May;323: 115176. https://doi.org/10.1016/j.psychres.2023.115176

Moral-Martos A, Guerrero-Fernández J, Gómez-Balaguer M, Rica Echevarría I, Campos-Martorell A, Chueca-Guindulain MJ, et al. Clinical practice guidelines for transsexual, transgender and gender diverse minors. Anales de Pediatría (English Edition). 2022 Apr;96(4): 349.e1-349.e11. https://doi.org/10.1016/j.anpede.2022.02.002 DOI: https://doi.org/10.1016/j.anpede.2022.02.002

Cooper K, Russell A, Mandy W, Butler C. The phenomenology of gender dysphoria in adults: A systematic review and meta-synthesis. Clin Psychol Rev. 2020 Aug;80: 101875. https://doi.org/10.1016/j.cpr.2020.101875 DOI: https://doi.org/10.1016/j.cpr.2020.101875

Van Schalkwyk GI, Klingensmith K, Volkmar FR. Gender identity and autism spectrum disorders. Yale J Biol Med. 2015 Mar;88(1): 81-3.

Van der Miesen AIR, Hurley H, Bal AM, de Vries ALC. Prevalence of the Wish to be of the Opposite Gender in Adolescents and Adults with Autism Spectrum Disorder. Arch Sex Behav. 2018 Nov;47(8): 2307-17. https://doi.org/10.1007/s10508-018-1218-3 DOI: https://doi.org/10.1007/s10508-018-1218-3

Kallitsounaki A, Williams DM. Autism Spectrum Disorder and Gender Dysphoria/Incongruence. A systematic Literature Review and Meta-Analysis. J Autism Dev Disord. 2023 Aug;53(8): 3103-17. https://doi.org/10.1007/s10803-022-05517-y DOI: https://doi.org/10.1007/s10803-022-05517-y

Hendriks O, Wei Y, Warrier V, Richards G. Autistic Traits, Empathizing-Systemizing, and Gender Diversity. Arch Sex Behav. 2022 May;51(4): 2077-89. https://doi.org/10.1007/s10508-021-02251-x DOI: https://doi.org/10.1007/s10508-021-02251-x

Erikson E. Identity and the life cycle. New York: IUP. 1959.

Tajfel H. Social identity and intergroup behaviour. Soc.sci.inform. 1974; 65-93. DOI: https://doi.org/10.1177/053901847401300204

Livingston LA, Happé F. Conceptualising compensation in neurodevelopmental disorders: Reflections from autism spectrum disorder. Neurosci Biobehav Rev. 2017 Sep;80:729-42. https://doi.org/10.1016/j.neubiorev.2017.06.005 DOI: https://doi.org/10.1016/j.neubiorev.2017.06.005

Hull L, Mandy W, Lai MC, Baron-Cohen S, Allison C, Smith P, et al. Development and Validation of the Camouflaging Autistic Traits Questionnaire (CAT-Q). J Autism Dev Disord. 2019 Mar 25;49(3): 819-33. https://doi.org/10.1007/s10803-018-3792-6 DOI: https://doi.org/10.1007/s10803-018-3792-6

Livingston LA, Shah P, Milner V, Happé F. Quantifying compensatory strategies in adults with and without diagnosed autism. Mol Autism. 2020 Dec 12;11(1): 15. https://doi.org/10.1186/s13229-019-0308-y DOI: https://doi.org/10.1186/s13229-019-0308-y

Bach B, Vestergaard M. Differential Diagnosis of ICD-11 Personality Disorder and Autism Spectrum Disorder in Adolescents. Children. 2023 Jun 1;10(6): 992. https://doi.org/10.3390/children10060992 DOI: https://doi.org/10.3390/children10060992

Farley MA, McMahon WM, Fombonne E, Jenson WR, Miller J, Gardner M, et al. Twenty-year outcome for individuals with autism and average or near-average cognitive abilities. Autism Res. 2009 Apr;2(2): 109-18. https://doi.org/10.1002/aur.69 DOI: https://doi.org/10.1002/aur.69

Reynoso C, Rangel M, Melgar V. El trastorno del espectro autista: aspectos etiológicos, diagnósticos y terapéuticos. Rev Med Inst Mex Seguro Soc. 2017;55(2): 214-22.

Tierney S, Burns J, Kilbey E. Looking behind the mask: Social coping strategies of girls on the autistic spectrum. Res Autism Spectr Disord. 2016 Mar;23: 73–83. https://doi.org/10.1016/j.rasd.2015.11.013 DOI: https://doi.org/10.1016/j.rasd.2015.11.013

Milner V, Mandy W, Happé F, Colvert E. Sex differences in predictors and outcomes of camouflaging: Comparing diagnosed autistic, high autistic trait and low autistic trait young adults. Autism. 2023 Feb;27(2): 402-14.https://doi.org/10.1177/13623613221098240 DOI: https://doi.org/10.1177/13623613221098240

Hull L, Petrides K V., Allison C, Smith P, Baron-Cohen S, Lai MC, et al. “Putting on My Best Normal”: Social Camouflaging in Adults with Autism Spectrum Conditions. J Autism Dev Disord. 2017;47(8). https://doi.org/10.1007/s10803-017-3166-5 DOI: https://doi.org/10.1007/s10803-017-3166-5

McQuaid GA, Lee NR, Wallace GL. Camouflaging in autism spectrum disorder: Examining the roles of sex, gender identity, and diagnostic timing. Autism. 2022 Feb;26(2): 552-9. https://doi.org/10.1177/13623613211042131 DOI: https://doi.org/10.1177/13623613211042131

Bradley L, Shaw R, Baron-Cohen S, Cassidy S. Autistic Adults’ Experiences of Camouflaging and Its Perceived Impact on Mental Health. Autism Adulthood. 2021 Dec 1;3(4): 320-9. https://doi.org/10.1089/aut.2020.0071 DOI: https://doi.org/10.1089/aut.2020.0071

O’Loghlen JJ, Lang CP. High Autistic Traits or Low Social Competence? Correlates of Social Camouflaging in Non-Autistic Adults. Autism in Adulthood. 2024;6(1). https://doi.org/10.1089/aut.2022.0094 DOI: https://doi.org/10.1089/aut.2022.0094

Maitland CA, Rhodes S, O’Hare A, Stewart ME. Social identities and mental well-being in autistic adults. Autism. 2021 Aug;25(6): 1771-83. https://doi.org/10.1177/13623613211004328 DOI: https://doi.org/10.1177/13623613211004328

Riccio A, Kapp SK, Jordan A, Dorelien AM, Gillespie-Lynch K. How is autistic identity in adolescence influenced by parental disclosure decisions and perceptions of autism? Autism. 2021 Feb;25(2): 374-88. https://doi.org/10.1177/1362361320958214 DOI: https://doi.org/10.1177/1362361320958214

Wantzen P, Boursette A, Zante E, Mioche J, Eustache F, Guénolé F, et al. Autobiographical Memory and Social Identity in Autism: Preliminary Results of Social Positioning and Cognitive Intervention. Front Psychol. 2021;12: 641765. https://doi.org/10.3389/fpsyg.2021.641765 DOI: https://doi.org/10.3389/fpsyg.2021.641765

George R, Stokes MA. Gender identity and sexual orientation in autism spectrum disorder. Autism. 2018 Nov;22(8): 970-82. https://doi.org/10.1177/1362361317714587 DOI: https://doi.org/10.1177/1362361317714587

Bouzy J, Brunelle J, Cohen D, Condat A. Transidentities and autism spectrum disorder: A systematic review. Psychiatry Res. 2023 May;323: 115176. https://doi.org/10.1016/j.psychres.2023.115176 DOI: https://doi.org/10.1016/j.psychres.2023.115176

Zucker KJ. Epidemiology of gender dysphoria and transgender identity. Sex Health. 2017 Oct;14(5): 404-11. https://doi.org/10.1071/SH17067 DOI: https://doi.org/10.1071/SH17067

Fombonne E, Quirke S, Hagen A. Prevalence and interpretation of recent trends in rates of pervasive developmental disorders. Mcgill J Med. 2009 Nov 16;12(2): 73. DOI: https://doi.org/10.26443/mjm.v12i2.264

Warrier V, Greenberg DM, Weir E, Buckingham C, Smith P, Lai MC, et al. Elevated rates of autism, other neurodevelopmental and psychiatric diagnoses, and autistic traits in transgender and gender-diverse individuals. Nat Commun. 2020 Aug 7;11(1): 3959. https://doi.org/10.1038/s41467-020-17794-1 DOI: https://doi.org/10.1038/s41467-020-17794-1

Snell W, Terri D, Miller R. Development of the Sexual awareness questionnaire: components, reliability and validity. AnnSex Res. 1991;4: 62-9. DOI: https://doi.org/10.1177/107906329100400104

Ben-Sasson A, Gal E, Fluss R, Katz-Zetler N, Cermak SA. Update of a Meta-analysis of Sensory Symptoms in ASD: A New Decade of Research. J Autism Dev Disord. 2019 Dec;49(12): 4974-96. https://doi.org/10.1007/s10803-019-04180-0 DOI: https://doi.org/10.1007/s10803-019-04180-0

Bush HH, Williams LW, Mendes E. Brief Report: Asexuality and Young Women on the Autism Spectrum. J Autism Dev Disord. 2021 Feb;51(2): 725-33. https://doi.org/10.1007/s10803-020-04565-6 DOI: https://doi.org/10.1007/s10803-020-04565-6

Schöttle D, Briken P, Tüscher O, Turner D. Sexuality in autism: hypersexual and paraphilic behavior in women and men with high-functioning autism spectrum disorder. Dialogues Clin Neurosci. 2017 Dec;19(4): 381-93. https://doi.org/10.31887/DCNS.2017.19.4/dschoettle DOI: https://doi.org/10.31887/DCNS.2017.19.4/dschoettle

McDonnell CG, Boan AD, Bradley CC, Seay KD, Charles JM, Carpenter LA. Child maltreatment in autism spectrum disorder and intellectual disability: results from a population-based sample. J Child Psychol Psychiatry. 2019 May;60(5): 576-84. https://doi.org/10.1111/jcpp.12993 DOI: https://doi.org/10.1111/jcpp.12993

Guastello AD, Lieneman C, Bailey B, Munson M, Barthle-Herrera M, Higham M, et al. Case report: Co-occurring autism spectrum disorder (Level One) and obsessive-compulsive disorder in a gender-diverse adolescent. Front Psychiatry. 2023;14: 1072645. https://doi.org/10.3389/fpsyt.2023.1072645 DOI: https://doi.org/10.3389/fpsyt.2023.1072645

Jacobs LA, Rachlin K, Erickson-Schroth L, Janssen A. Gender Dysphoria and Co-Occurring Autism Spectrum Disorders: Review, Case Examples, and Treatment Considerations. LGBT Health. 2014 Dec;1(4):277-82. https://doi.org/10.1089/lgbt.2013.0045 DOI: https://doi.org/10.1089/lgbt.2013.0045

Cresswell L, Cage E. ‘Who Am I?’: An Exploratory Study of the Relationships Between Identity, Acculturation and Mental Health in Autistic Adolescents. J Autism Dev Disord. 2019 Jul 19;49(7): 2901-12. https://doi.org/10.1007/s10803-019-04016-x DOI: https://doi.org/10.1007/s10803-019-04016-x

Cooper K, Butler C, Russell A, Lei J, Smith, LG. The lived experience of gender dysphoria in autistic young people: a phenomenological study with young people and their parents. Eur Child Adolesc Psychiatry. 2023 Sep 4;32(9): 1655-66. https://doi.org/10.1177/13623613221118351 DOI: https://doi.org/10.1007/s00787-022-01979-8

Dekker LP, van der Vegt EJM, Visser K, Tick N, Boudesteijn F, Verhulst FC, et al. Improving Psychosexual Knowledge in Adolescents with Autism Spectrum Disorder: Pilot of the Tackling Teenage Training Program. J Autism Dev Disord. 2015 Jun 16;45(6): 1532-40. https://doi.org/10.1007/s10803-014-2301-9 DOI: https://doi.org/10.1007/s10803-014-2301-9

Visser K, Greaves?Lord K, Tick NT, Verhulst FC, Maras A, van der Vegt EJM. A randomized controlled trial to examine the effects of the Tackling Teenage psychosexual training program for adolescents with autism spectrum disorder. Journal of Child Psychology and Psychiatry. 2017 Jul 9;58(7): 840-50. https://doi.org/10.1111/jcpp.12709 DOI: https://doi.org/10.1111/jcpp.12709

Hervás A, Pont C. Desarrollo afectivo-sexual en las personas con trastornos del espectro autista. Medicina (Buenos Aires). 2020 Mar;80(s2): 7-11.

Bowri M, Hull L, Allison C, Smith P, Baron-Cohen S, Lai MC, et al. Demographic and psychological predictors of alcohol use and misuse in autistic adults. Autism. 2021 Jul;25(5): 1469-80. https://doi.org/10.1177/1362361321992668 DOI: https://doi.org/10.1177/1362361321992668

Rothman EF, Graham Holmes L, Brooks D, Krauss S, Caplan R. Reasons for alcohol use and non-use by underage U.S. autistic youth: A qualitative study. Autism. 2023 Jan;27(1): 213-25. https://doi.org/10.1177/13623613221091319 DOI: https://doi.org/10.1177/13623613221091319