Browsing by Author "Malcolm-Smith Susan"

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    Consolidating a Model of Camouflaging in Autism Spectrum: An Integrative Systematic Review
    (2024) Nel, Jacques; Spedding, Maxine; Malcolm-Smith Susan
    Background: Research into social ‘camouflaging' (hiding difference) in Autism Spectrum (AS) is gaining momentum. Camouflaging is one explanatory facet for individuals reaching adulthood without receiving formal diagnosis. However, the term holds a multiplicity of definitions and needs to be delineated from motivational and experiential facets of ‘neurotypical' pretence. Aims and Objectives. We conducted an unfunded, integrative systematic review towards consolidating qualitative conceptions of camouflaging in AS adults into a single model by way of thematic meta-synthesis. Our objectives were to unpack the (a) strategies and behavioural exemplars of camouflaging, (b) motivational underpinnings to strategies, and (c) current/historical precedents and triggers for camouflaging. Method. 2,346 articles were extracted from EBSCOhost, PubMed, Web of Science and Scopus (April 2022) and partly co-screened between authors. Additional sources included ‘Connected papers' and citation searching. Eligibility included peer-reviewed, English studies with AS confirmed/suspected adults providing empirical, qualitative input on camouflaging domains a, b, and/or c. The authors reached a 0.77 Kappa agreement for initial screening and full agreement in committee discussion. After screening and quality-scoring, 28 studies were included. Demographic details were tabulated, and the results sections of all studies were line-coded, clustered, and thematically synthesised. Results included 2669 men, women, and non-binary individuals, as well as ‘sub-clinical', suspected AS cases – above the age of 16 years. Thematic results were audited and mapped back onto the original cohort to reduce risk of bias. (Prospero: CRD42022324957). Results. The data consolidated eight types of camouflaging strategies, with a spotlight on the role of imitation as an entire self-training structure to grow repertoires, from the basic behavioural suppression to sophisticated cognitive templating and performativity. Fifteen motivational facets arose, underscored by the sense that camouflaging involves the performance of ‘neurotypical' behaviours, and is akin to learning to speak a second language or adapt to a foreign culture. Seven contextual factors that modulate camouflaging were raised, including crucial considerations for the role played by life-stages in pre-and-post-diagnostic performance of camouflaging, towards less or more strategized enactments. Discussion. The goal of the integrative review is to propose a tentative framework to operationalise the concept of camouflaging. The results challenge future quantitative research to concretely place measures of camouflaging within this (or other) models, towards justifying the phenomena observed and bolstering the theorised connections between model elements. Contextual results also raise considerations for what respectful and collaborative social skills training might look like. Limitations included demographic bias to females and the UK (raising a question of the degree to which the current versions of camouflaging, which inform modelling, are culturally modulated), potential pop-culture understandings of camouflaging in the qualitative input, and results only reflecting a subset of the overall AS community. Keywords: Autism Spectrum. Camouflaging. Masking. Modelling. Systematic Review. Thematic Meta-synthesis.