Objective: Assessment of intellectual abilities in individuals with autism spectrum disorder (ASD) is a core component of a comprehensive diagnostic evaluation. However, relatively limited information is available regarding the validity of one of the most commonly-used measures of intelligence, the Wechsler Intelligence Scale for Children - 5th Edition (WISC-V) in ASD.Method: We investigated the factor structure and measurement invariance of the WISC-V in a sample of 349 children aged 6-16 diagnosed with ASD using single- and multi-group confirmatory factor analysis. The comparison group was the WISC-V standardization sample.Results: A four-index bifactor solution best fit the ASD group data. Measurement invariance analyses indicated support for configural and metric, but not scalar, invariance of the published 5-index structure, suggesting systematic differences in performance among some subscales in ASD. The 7-subtest FSIQ scale had partial scalar invariance after relaxing equality constraints on the Coding and Digit Span subtest intercepts, suggesting sources other than theorized IQ ability contribute to lower scores on these subtests within ASD. The Cognitive Proficiency Index (CPI) failed to demonstrate appropriate fit in baseline models. The General Ability Index (GAI) had full configural, metric, and scalar invariance.Conclusions: Statistical bias on the WISC-V within ASD in processing speed and working memory subtests creates significant limitations for the use of FSIQ and especially CPI index scores in ASD populations. The GAI showed strong measurement properties and should be considered as the preferred indicator of overall intellectual functioning when assessing children with ASD using the WISC-V.

“Camouflaging” in Women with Autistic Traits: Measures, Mechanisms, and Mental Health Implications Jonathan S. Beck Department of Psychology, BYU Doctor of Philosophy Autistic traits are associated with frequent psychological distress and everyday functional challenges. Some individuals with autistic traits “camouflage” these traits during social interactions by effortfully engaging in “typical” social behaviors. Camouflaging seems to be especially common in autistic girls and women. Emerging evidence proposes a role for camouflaging behaviors in poorer mental health and daily functioning. Furthermore, camouflaging efforts may delay receipt of a proper diagnosis and access to appropriate mental health care. Despite their clinical significance, camouflaging efforts remain difficult to quantify, and the mechanisms and impacts of camouflaging are poorly understood. This study aimed to compare multiple methods of quantifying camouflaging, investigate potential mechanisms of camouflaging, and describe mental health implications of camouflaging behaviors. The sample included 66 women (M age = 25:2 years, SD = 6:4; M IQ = 114, SD = 11) who reported social challenges and scored high on a measure of broad autistic traits. A minority (n = 22) had previously received an autism diagnosis. A majority reported significant anxiety, depression, or suicidality. Camouflaging was quantified using three methods: one self-report questionnaire (CAT-Q), and two discrepancy-based methods that contrasted presentation of autistic traits during the ADOS-2 with measures of less-visible autistic traits (AQ, TASIT-S). Analyses showed that the discrepancy-based measures agreed with each other, but not with the self-report measure of camouflaging. Regression analyses showed camouflaging scores were poorly predicted by age, IQ, performance on executive functioning tasks, and self-reported social cognitive abilities. Regression models including clinician-rated and self-reported autistic traits showed that autistic traits on the SRS-2, and camouflaging efforts on the CAT-Q, modestly but significantly predicted psychological distress and functional challenges. Finally, clinicianadministered and self-report diagnostic measures demonstrated only fair or poorer agreement with each other in this unique sample that includes women with elevated self-reported camouflaging. Results emphasize the clinical significance of the camouflaging construct, which may predict mental health difficulties in individuals with autistic traits better than conventional autism measures. Quantifying camouflaging remains challenging as various proposed measures disagree with each other. Disagreement on diagnostic classification between measures underscores the importance of comprehensive, multi-method assessment of mental health in women who report difficulties fitting into social situations and who may be camouflaging significant autistic traits.

Autistic traits are associated with frequent psychological distress, suicidal ideation, and everyday functional challenges. These associations may be especially prominent in women. Some women with autistic traits “camouflage” feelings of awkwardness in typical social situations by effortfully engaging in expected social behaviors. We explored camouflaging because emerging evidence posits an association between camouflaging behaviors and poorer outcomes related to mental health, daily functioning, and access to mental health care. We recruited a sample of 58 women (age M = 25 years; IQ M = 115) who reported that they find social situations confusing and who scored high on a measure of broad autistic traits ( Broad Autism Phenotype Questionnaire score > 3). The majority of participants reported significant levels of psychological distress, suicidal ideation, and daily functioning difficulties. Regression models showed that camouflaging efforts ( Camouflaging Autistic Traits Questionnaire) and autistic traits ( Social Responsiveness Scale, Second Edition) modestly but significantly predicted psychological distress and functional challenges, respectively. In a subgroup of participants with high Camouflaging Autistic Traits Questionnaire scores, camouflaging scores were significantly associated with psychological distress and functional challenges. Camouflaging may help predict when clinicians should be concerned about higher mental health distress in autistic women and may be beneficial to measure as part of a comprehensive, multimethod assessment of mental health in women who report difficulties fitting into social situations. Lay Abstract Women who try to hide or “camouflage” their autistic traits are likely to report that they feel distressed, think of suicide, and/or struggle to function in everyday life. We asked 58 women with autistic traits to complete questionnaires about camouflaging and mental health. Most of these women did not have a formal diagnosis of autism, yet a majority reported that they camouflaged autistic traits, and a large majority reported significant mental health challenges. Some researchers have suggested that women with autistic traits are more likely than autistic men to experience mental health challenges because women may try more to “fit in” socially by camouflaging their autistic traits. Analyses showed that camouflaging was associated with feeling distressed (depressed, anxious, and/or stressed). For women who reported above-average levels of camouflaging, camouflaging was also associated with having thoughts about suicide and struggling to function in everyday life. Trying to camouflage autistic traits was associated with mental health challenges, regardless of whether those traits were very mild or more severe. The findings of this study may influence how mental health professionals evaluate and treat women with autistic traits.

Functional neuroimaging research in autism spectrum disorder has reported patterns of decreased long-range, within-network, and interhemispheric connectivity. Research has also reported increased corticostriatal connectivity and between-network connectivity for default and attentional networks. Past studies have excluded individuals with autism and low verbal and cognitive performance (LVCP), so connectivity in individuals more significantly affected with autism has not yet been studied. This represents a critical gap in our understanding of brain function across the autism spectrum.