If pretending to be normal is exhausting you, this is the test that names it.
CAT-Q — Clinician Mode.
The validated CAT-Q masking test — the same screener we use in session.
In-session administration of the CAT-Q. Three-subscale breakdown (Compensation / Masking / Assimilation), validated 100+ cutoff, printable chart-ready clinical report.
Session record (optional)
Optional: log patient name and date for the printable report.
Read each item aloud or have the patient self-administer. 25 items, 7-point Likert. Five items reverse-scored automatically. Estimated time: 3 to 5 minutes.
If you’re a clinician using this with a patient, toggle Clinician Mode at the top.
Quick answers
Common questions
Click any question to expand.
No. The CAT-Q is a screener for masking specifically, not a diagnostic instrument for autism itself. A high CAT-Q indicates the masking pattern; a full autism diagnosis requires a structured clinical interview (the ADOS-2 is the gold standard) plus developmental history.
Total score of 100 or higher (out of 175) is the validated cutoff from Hull et al. 2019, consistent with the autistic adult masking pattern. Scores from 70 to 99 are elevated and worth bringing up with a clinician. Below 70 is closer to neurotypical baseline.
Compensation captures active strategies (scripts, mimicry, rehearsal). Masking captures suppression (forcing eye contact, suppressing stims, controlling facial expressions). Assimilation captures the felt cost of blending in (the performance feeling, the exhaustion). All three are forms of camouflaging; they cost different things.
The CAT-Q measures how much energy you spend hiding autistic traits. The AQ-50 measures the underlying trait pattern itself. High CAT-Q with high AQ-50 is the strongest signal for late-diagnosed adult autism, especially in women, AFAB people, and high-achievers who learned early to mask.
Yes. Sustained high masking is one of the strongest predictors of autistic burnout. The cognitive cost of suppressing natural behaviors and performing learned ones compounds over years. Most adults at PIM who present with sudden unexplained burnout have been masking heavily for decades.
Diagnostic criteria were built around how autism presents in boys studied in the mid-twentieth century. Many women, AFAB people, and high-achievers learned to mask before any externalized autistic behaviors could be observed. The traits go underground rather than away. The CAT-Q catches the underlying work, even when external behavior looks neurotypical.
Your answers stay in your browser only (via localStorage) so you can return to them. They are never sent to us unless you choose to print your report and bring it to an intake call. If you do not book or share, we have no record.
Yes. Toggle Clinician Mode at the top of the page for in-session administration with patient name and date fields. The CAT-Q is freely available for clinical and research use. Email hello@psychiatryinmotion.com if you’d like to talk about embedding.
Understand your result
The CAT-Q — what each subscale actually measures.
The CAT-Q was developed by Laura Hull and colleagues at University College London and published in 2019. Twenty-five items, three subscales, seven-point Likert. The validated cutoff is 100 or higher (out of 175). It is the first instrument designed specifically to measure autistic masking as a quantifiable cognitive load — not just describe it qualitatively.
Most adult autistic burnout is the bill for decades of unbilled masking. The CAT-Q is the receipt — it shows you what the work actually was.
The three subscales
Camouflaging isn’t one behavior. Hull’s qualitative work identified three distinct kinds, and the CAT-Q measures each one separately. Where your highest score lands tells you which kind of masking is costing you the most.
Compensation 9 items
The active work of appearing non-autistic: scripts, mimicry, rehearsing conversations, copying others. Often invisible because it produces socially fluent behavior. People with this pattern look highly competent socially while spending enormous prep time before every interaction.
Masking 8 items
Suppression of natural autistic behaviors: forcing eye contact, controlling facial expressions, suppressing stims, performing relaxation. The most physically exhausting subscale — the nervous system is doing constant inhibition work in real time.
Assimilation 8 items
The felt cost of blending in: the “performance” quality of social interaction, the drain that follows, the sense of not being yourself. This subscale maps most directly onto autistic burnout. High Assimilation is the warning light.
Why masking compounds into burnout
Masking is cognitively expensive. Compensation requires constant cognitive load (running a parallel social model in your head). Masking requires constant inhibition (suppressing what would otherwise happen automatically). Assimilation drains emotional resources (the felt cost of not being yourself accumulates).
None of these is sustainable indefinitely. Most adults can maintain heavy masking through their twenties and into their thirties. The collapse, when it comes, usually arrives as “sudden burnout” — which is not sudden. It’s the predictable result of decades of running the cognitive equivalent of a 100% CPU load while pretending nothing is happening.
Good news
Masking is learned, and the work of unmasking is something a clinician can actually help with. Adults who get a name for the pattern and start the unmasking work usually see real change within three to six months. Add accommodations, co-occurring condition treatment, and (if needed) a medically-approved paid leave to recover, and most adults rebuild functioning — this time, on a foundation that matches how their brain actually works.
Primary references
Hull L, Mandy W, Lai MC, Baron-Cohen S, Allison C, Smith P, Petrides KV. (2019). Development and Validation of the Camouflaging Autistic Traits Questionnaire (CAT-Q). Journal of Autism and Developmental Disorders, 49(3), 819–833. PMID 30361940.
Hull L, Petrides KV, Allison C, Smith P, Baron-Cohen S, Lai MC, Mandy W. (2017). “Putting on My Best Normal”: Social Camouflaging in Adults with Autism Spectrum Conditions. Journal of Autism and Developmental Disorders, 47(8), 2519–2534. PMID 28527095.
National Institute for Health and Care Excellence (NICE). Clinical Guideline CG142 — Autism spectrum disorder in adults: diagnosis and management.nice.org.uk/guidance/cg142.
Talk it through with someone trained.
If the result resonates, book a real evaluation with a psychiatrist who understands adult autistic masking and the burnout pipeline. Intake Director Leann calls back within 1 business day. NY, FL, NJ.
Are you a clinician? Toggle Clinician Mode at the top for in-session administration. The CAT-Q is freely available for clinical and research use. Email hello@psychiatryinmotion.com if you’d like to talk about embedding or co-branding.
This screener is for educational purposes. It is not a diagnosis. Adult autism can only be diagnosed by a licensed clinician after a full evaluation. If you are in crisis, call or text 988, or go to your nearest emergency room. The CAT-Q was developed by Hull, Mandy, Lai, Baron-Cohen, Allison, Smith and Petrides (2019).
