CAT-Q questionnaire explained for adults (non diagnostic)

Short answer

The Camouflaging Autistic Traits Questionnaire, or CAT-Q, is a 25 item self report measure developed by Laura Hull and colleagues in 2017. It measures how much an adult uses three kinds of camouflaging strategies: compensation, masking (in a narrow sense), and assimilation. The CAT-Q was developed on autistic adults and is used in autism research to describe patterns within autistic samples. It is not a diagnostic instrument. A high CAT-Q score does not confirm autism. A low CAT-Q score does not rule autism out. The questionnaire is available under a Creative Commons Attribution 4.0 license, which is why NeuroType can offer it as a free reflection tool. Used as research informed reflection material, the CAT-Q can help an adult notice which camouflaging patterns are loudest for them.

What the CAT-Q is and is not

The CAT-Q is a self report questionnaire. The respondent reads short statements about social behaviour and rates how much each statement applies to them on a seven point scale. The 25 items are grouped into three subscales of roughly equal length.

It is not a screening tool for autism in the general population. The questionnaire was developed and validated on adults who were already identified as autistic or who self identified as autistic. It measures patterns within that group. Using it to screen non autistic adults would be using it for a purpose it was not designed for.

It is not a clinical assessment. A clinician assessing autism uses developmental history, observed behaviour, multiple validated instruments, and clinical judgment. The CAT-Q is one possible data point among many. It is not, on its own, sufficient to identify autism.

It is not a measure of how autistic someone is. Two autistic adults can have the same level of underlying autistic traits while having very different camouflaging scores. The CAT-Q measures the camouflaging, not the underlying traits.

It is also not a measure of personal effort or virtue. A high score is not a sign that someone is trying harder than someone else. It is a description of the camouflaging patterns the person reports using.

The three subscales explained

Each subscale targets a distinct part of the broader camouflaging pattern.

Compensation measures the active use of strategies to manage social tasks. Items in this subscale describe behaviours like rehearsing conversations, watching others to learn how to respond, and developing rules for social situations. High compensation scores suggest significant ongoing strategic work to manage everyday social interaction.

Masking in the narrow sense measures the active hiding of autistic features. Items describe suppressing natural reactions, hiding particular interests or behaviours, and controlling facial expression. High masking scores suggest significant suppression of behaviours that would otherwise be expressed.

Assimilation measures the broader effort to fit in with the people around you. Items describe pretending to enjoy things you do not enjoy, going to social events that feel uncomfortable, and acting like other people to be accepted. High assimilation scores suggest significant ongoing effort to seem similar to people around you.

Most autistic adults show some elevation on all three subscales. The relative pattern across the three is often more informative than any single total score.

What CAT-Q scores describe and what they do not

Hull and colleagues' 2017 validation work reported average total CAT-Q scores in autistic adults around 110 to 125 out of a possible 175. Non autistic comparison samples averaged significantly lower, around 90 to 100. There is meaningful overlap between the groups, which is part of why the CAT-Q does not work as a screening tool.

Within autistic adults, higher total scores describe more camouflaging. Hull and colleagues' 2020 follow up work found that autistic women score on average higher than autistic men, with the largest gender difference on the assimilation subscale.

A high score describes a pattern that has measurable costs. Research has linked higher CAT-Q scores to higher levels of exhaustion, depression, anxiety, and suicidal thinking, even after controlling for autistic traits themselves (Cassidy et al., 2018, in related work). The clinical implication is not that camouflaging itself is bad but that high camouflaging without adequate recovery space is hard to sustain.

A low score does not mean autism does not apply. Some autistic adults camouflage very little, either because they grew up in supportive environments, because they are at a life stage where camouflaging has reduced, or for other reasons. A low score on its own is not evidence either way about autism.

For practical reflection, the subscale pattern is usually more useful than the total. NeuroType has a separate article specifically on interpreting CAT-Q subscale scores.

Important limitations of the CAT-Q

The CAT-Q has several limitations worth knowing about before interpreting your own score.

Validation sample. The questionnaire was developed on a sample of mostly white, mostly female, mostly highly educated autistic adults recruited online. Its psychometric properties in other populations are less well established.

Self report bias. The CAT-Q asks people to report their own camouflaging. Adults who have masked successfully for decades may not consciously recognise their own masking, leading to underreporting. Adults who have recently identified as autistic may suddenly recognise patterns and overreport. Both biases can shift scores.

Cultural variation. What counts as masking varies by culture. Eye contact norms, conversational rules, expressions of interest, and ideas about politeness all vary between cultures. The CAT-Q was developed primarily in UK and US samples and may behave differently in other cultural contexts.

Not a longitudinal measure. The CAT-Q captures one moment in time. Camouflaging changes with life stage, environment, hormones, mental health, and identification status. A single score is a snapshot.

Not a guide for action. A high score does not tell you what to do about it. Some adults benefit from reducing camouflaging; others find their current level sustainable. The score is information, not a prescription.

How NeuroType offers the CAT-Q

NeuroType offers the [CAT-Q reflection tool](/cat-q) as a free browser based tool. Individual answers stay local during the free flow. NeuroType does not see, store, or analyse individual responses on a server.

The tool presents the full questionnaire with adult focused framing. Attribution to Hull and colleagues (2017) is visible on the page and the Creative Commons Attribution 4.0 license is honoured throughout. The source verification is documented in the public repository.

The results page describes the score across each of the three subscales, places it in the context of published research averages, and uses non diagnostic language throughout. It does not say that the person taking it is autistic. It does not say that they are not. It describes the pattern.

NeuroType also offers a separate [original masking reflection tool](/masking) that is not CAT-Q. Some adults find it useful to take both at different sittings and compare the patterns.

Where to take this further

For the broader plain English overview of masking and camouflaging, read [autism masking in adults: how camouflaging works and why it matters](/articles/autism-masking-adults-guide). For more on how camouflaging and masking relate as terms, read [camouflaging vs masking in autism: are they actually different](/articles/camouflaging-vs-masking). For more depth on interpreting your CAT-Q subscale scores, read [what your CAT-Q score means](/articles/cat-q-score-meaning).

If the patterns described by the CAT-Q resonate strongly and you are considering formal autism assessment, a clinician with adult autism experience is the next step. NeuroType cannot diagnose, refer, or prescribe.

Source and review status

This article is original NeuroType editorial content. It references Hull and colleagues' 2017 development of the CAT-Q, the 2019 follow up on gender differences in camouflaging, and the 2020 work on female camouflaging. The CAT-Q is referenced under Creative Commons Attribution 4.0. Source verification is documented in the public NeuroType repository. No CAT-Q item text is reproduced outside the verified CAT-Q tool flow. This page is reviewed by the NeuroType editorial team and is not clinical advice. Corrections can be sent to [hello@neurotype.app](mailto:hello@neurotype.app).