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Research Article: Clinical characteristics and camouflaging behaviors in children and adolescents with late-diagnosed autism spectrum disorder: a retrospective descriptive study

Date Published: 2026-10-08

Abstract:
Autism is a heterogeneous neurodevelopmental condition characterized by persistent difficulties in social communication and interaction, together with restricted and repetitive patterns of behavior, interests, or activities. Camouflaging-related behaviors and co-occurring psychiatric disorders may make autistic features less visible and contribute to delayed recognition. This study aimed to examine clinical characteristics and camouflaging-related behaviors among children and adolescents with late-diagnosed autism. This retrospective chart review included 46 children and adolescents aged 6–21 years who received an ASD diagnosis after the age of six. Autism diagnoses had been confirmed using a standardized observational assessment. Data were retrospectively extracted using structured case report forms based on clinical records, parental reports, and literature-informed camouflaging-related clinical features. Attention-Deficit/Hyperactivity Disorder was the most common co-occurring psychiatric condition. Masking-related social adaptation behaviors were more common among girls. Giftedness and easy temperament were also observed more frequently in girls and were identified among factors associated with delayed recognition. Boys showed greater behavioral difficulties than girls. Clinician-rated camouflaging scores demonstrated a moderate positive correlation with post-diagnosis Global Assessment Scale scores ( r =?0.38). The findings describe a clinically heterogeneous group of late-diagnosed children and adolescents and suggest that camouflaging-related behaviors, co-occurring psychiatric conditions, and contextual factors may reduce the visibility of autistic features. Given the retrospective design, small sample size, and use of a clinician-developed measure of camouflaging-related features, the findings should be interpreted as exploratory.

Introduction:
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by impairments in social communication and interaction, alongside restricted and repetitive behaviors ( 1 ). These features vary considerably in their presentation and severity and may be accompanied by differences in language, cognitive ability, adaptive functioning, sensory processing, emotional, behavioral, and neurodevelopmental challenges ( 2 , 3 ). Early diagnosis of autism improves coping mechanisms by providing access to…

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