Masking tracks hair cortisol until one twin is compared with the other

Masking has become a fixed item in clinical talk about autistic burnout: the effort of hiding one's traits is assumed to wear a person down. A group led by Sabela Conde-Pumpido Zubizarreta of CiMUS at the University of Santiago de Compostela, working with Karolinska Institutet and Uppsala University, checked that assumption against a biological measure and against the person's own twin.

Masking scored as a gap, stress read from hair

The data come from RATSS, a Swedish twin study enriched for autism and ADHD, where families spend two and a half days at a clinical research centre. The final sample held 91 identical and 66 fraternal pairs. Camouflaging was scored as the distance between how autistic a person looked to the clinician on ADOS-2 and how many traits they, or their parents, reported on the AQ. Stress was measured twice: as symptoms on the Stress Problems Scale and as cortisol in a hair sample.

Compared person to person, those who camouflaged more carried more cortisol in their hair, and adults also reported more stress symptoms. When each twin was compared with the co-twin, the cortisol link vanished. The authors read this as familial confounding: genes and a shared upbringing shape both the masking and the cortisol.

Asking about the family before the mask

My reading is that a high masking score tells a clinician less about the person than about the family the person grew up in. On intake, it makes sense to ask what that household expected about being seen, what it lived through financially and how it handled stress.

The within-pair results also caution against treating unmasking as a default goal. Among adults, once the models were adjusted, the twin who masked more had lower cortisol. The authors offer two readings: masking spares a person some stigma, or prolonged stress blunts the cortisol response. Either way, how far to unmask is something to settle with the client, against the setting they actually live in.