A Systematic Review of Passing as Non-autistic in Autism Spectrum Disorder

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Libsack, E. J., Keenan, E. G., Freden, C. E., Mirmina, J., Iskhakov, N., Krishnathasan, D., & Lerner, M. D. (2021). A Systematic Review of Passing as Non-autistic in Autism Spectrum Disorder. Clinical Child and Family Psychology Review, 24(4), 783-812. https://doi.org/10.1007/s10567-021-00365-1

Publication date: 9 Sep 2021 Added to AutiHub: 9 Aug 2026 Type: Article Article language: English
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Authors

Publication authors
7
Publication authors identified as autistic
1 / 7 (14.3%)
  1. Erin J. Libsack
  2. Elliot Gavin Keenan *
  3. Caroline E. Freden
  4. Julianne Mirmina
  1. Nathaniel Iskhakov
  2. Darsiya Krishnathasan
  3. Matthew D Lerner

Abstract

While long described in anecdotal accounts of the lived experiences of autistic individuals, the phenomenon of behaving in ways that appear inconsistent with the presence of autism (or passing as non-autistic; PAN) has recently seen a dramatic increase in scrutiny in the published scientific literature. Increased research attention has coincided with a proliferation of methods, definitions, measures, and population assumptions associated with PAN. To date, however, no review has sought to systematically identify and synthesize the literature on PAN. This systematic review reflects the state of the PAN literature as of May 2020. Ninety articles were screened, 66 were identified for evaluation, and 46 met inclusion criteria and were reliably coded for study characteristics and participant characteristics. Results reveal that the PAN literature includes a relatively even mix of qualitative, quantitative, and mixed-method studies, and that a variety of terms are used for PAN (with masking and camouflage being the most frequent). Sample sizes varied widely (from one to 832 participants), with 63.06% of participants being categorized as autistic. Nearly all studies reported methods for confirming autism diagnoses, with community and clinical diagnoses being most common. The majority of studies reported participant gender, with slightly more females included than males on average, but fewer than half of all studies compared PAN across genders. Nearly all studies reported participant age, demonstrating a wide range of 2 to 79 years, with a mean age of 23.85. Conversely, only 23.91% of studies provided participant race or ethnicity data. Nearly all studies formally or informally excluded participants with intellectual disability. Finally, measures of internalizing symptoms, which are often thought to be linked to PAN, were reported in only 17.4% of studies. Implications for gaps in understanding of PAN and future directions for the field are discussed.

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Cited references
136
Total cited references integrated for this publication.
Cited references with an identified autistic author
9 / 136 (6.6%)
Cited author occurrences identified as autistic
12 / 679 (1.8%)
Among occurrences linked to AutiHub author records: 12 / 225 (5.3%). Distinct cited authors identified as autistic: 10 / 531 (1.9%).
Cited author occurrences linked to AutiHub author records
225 / 679 (33.1%)
Distinct linked cited authors: 134 / 531 (25.2%)
Linked cited-author occurrences not identified as autistic
213 / 225 (94.7%)
Among linked cited-author occurrences only. Across all cited-author occurrences: 213 / 679 (31.4%). Distinct linked cited authors not identified as autistic: 124 / 134 (92.5%).
1 cited bibliography entry could not be fully enriched from DOI metadata.
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