Large-Scale Neural Network Compensation Underlying Camouflaging in Trait Autism and Its Potential Mental Health Costs

Abstract

Social camouflaging refers to strategies to hide or compensate for social difficulties, often at a significant mental health cost, and is particularly prevalent in autism. The large-scale neural network mechanisms underlying this adaptation remain poorly understood. This study aimed to identify these neural underpinnings and their link to other potential mental health issues. Using a dimensional approach, we recruited 110 healthy young adults who completed self-report questionnaires measuring autistic traits and camouflaging as well as depression and anxiety, and underwent resting-state fMRI scans. Using the 300-node Seitzman atlas encompassing 13 functional networks, we examined the interaction between camouflaging and autistic traits on brain network connectivity. Results showed that among individuals with higher autistic traits, greater camouflaging was associated with hyperconnectivities between the Default Mode (DMN) and Cingulo-Opercular Networks (CON), and within the CON. Crucially, DMN-CON hyperconnectivity mediated the relationship between camouflaging and potential mental health cost (i.e., depression and anxiety scores) but only in individuals with higher autistic traits. These findings reveal a specific neuro-compensatory mechanism underlying autistic camouflaging involving self-referential and executive control systems and provide a neurobiological explanation for its potential mental health burden, highlighting the need for societal changes that reduce the pressure for such adaptations. Lay AbstractSocial camouflaging refers to strategies autistic people often use to hide their social differences to better adapt to everyday social contexts. While it may help in the short term, this constant effort can be mentally exhausting and is often linked to severe anxiety and depression. However, little is known about how different brain networks work together to enable social camouflaging and might contribute to a greater risk of anxiety and depression. In this study, autistic traits were measured in 110 young healthy adults in addition to questionnaire-based measures of social camouflaging, anxiety, and depression. Additionally, brain activity was recorded using magnetic resonance imaging while they were resting and not doing any task. We found that, in people with higher autistic traits, social camouflaging was linked to stronger connections between the brain network involved in thinking about oneself (self-reflection; Default Mode Network) and the one in charge of maintaining goal-directed behavior (action control; Cingulo-Opercular Network), as well as stronger connections within the latter brain network. These stronger connections between the self-reflection network and action control network partly explained why camouflaging may be associated with higher levels of anxiety and depression. In short, autistic camouflaging seems to rely on a cognitively demanding neural compensatory process, which can take a toll on mental health. Understanding this underscores the importance of creating a more accepting society to support the well-being of autistic individuals.