CAT-Q test: Free template

Key takeaways

The CAT-Q is a free 25-item self-report questionnaire that measures autism camouflaging across three subscales.

Totals run from 25 to 175, and a score of 100 or above points to significant camouflaging.

Five items are reverse-scored, so a hand-scored form adds up wrong unless you apply the key.

The questionnaire supports formulation and never diagnoses autism on its own.

Practice management software like Pabau sends the form before the visit and files the answers in the patient record.

The CAT-Q test measures how hard a person works to mask autistic traits in everyday social situations. It is a free 25-item self-report questionnaire for adults aged 16 and over. Higher totals point to heavier camouflaging, not to a diagnosis.

Camouflaging is one reason autism goes unrecognized well into adulthood. A patient can hold eye contact, rehearse small talk, and still leave the room exhausted. The questionnaire puts a number on that effort, which gives you something concrete to open up in the assessment interview.

What is the CAT-Q test?

The CAT-Q, or Camouflaging Autistic Traits Questionnaire, is a validated self-report measure of camouflaging. Camouflaging covers the masking and compensation strategies autistic people use to appear non-autistic around others. Laura Hull, K.V. Petrides, and Will Mandy developed it at University College London and published it in 2019.

Those strategies carry a cost. Camouflaging is associated with higher anxiety and depression in autistic adults, and it runs through most accounts of autistic burnout. Measuring it gives an assessment something to work with instead of an inference.

• 25 items: Statements rated on a 7-point scale (1 = strongly disagree, 7 = strongly agree)
• Three subscales: Compensation, Masking, and Assimilation
• Total score range: 25 (minimal camouflaging) to 175 (extensive camouflaging)
• Free to use: Available for clinical, educational, and research use without a licensing fee
• Validated population: Autistic and non-autistic adults aged 16 and over

How the questionnaire was developed

The CAT-Q came out of doctoral research at University College London. Autism measures at the time focused on core traits such as social communication, restricted interests, and sensory sensitivity. Almost none of them captured the adaptive masking that lets many autistic adults hold down a job while struggling privately.

The 2019 validation study appeared in the Journal of Autism and Developmental Disorders, 49(3), 819–833. Hull, Mandy, Lai, Baron-Cohen, Allison, Smith, and Petrides tested the questionnaire in a large sample of autistic and non-autistic adults. It showed strong internal consistency and sound construct validity.

One result matters more than the rest at the bedside. Camouflaging scores are largely independent of autism severity on traditional trait scales. Someone with mild overt traits can still camouflage heavily, so trait scores alone understate how much support an adult needs. Recording both numbers in your mental health practice software keeps that contrast visible at the next appointment.

The three subscales explained

Each subscale captures a different camouflaging mechanism. Reading them separately tells you far more than the total does, because two patients can reach 120 by completely different routes.

Compensation subscale

Compensation covers the strategies a person builds to stand in for intuitive social skills. Items ask about copying body language, learning gestures from films or books, and preparing phrases ahead of a conversation. A high score usually means a well-rehearsed repertoire that took years to assemble. A biopsychosocial assessment is the natural place to ask when that learning started.

Masking subscale

Masking is the effort to hide autistic characteristics behind a non-autistic persona. Items cover monitoring facial expression, body language, and tone of voice during an interaction. High masking scores tend to sit alongside reports of exhaustion after ordinary social contact, because the monitoring never switches off.

Assimilation subscale

Assimilation measures the pressure to fit in rather than the technique used to do it. Items ask about forcing yourself to interact, feeling like you are performing, and never quite being yourself around other people. Follow-up research links this subscale most consistently to anxiety and depression, so a high score deserves time in the interview.

How to score the responses

Scoring is simple arithmetic with one trap in it. Add the responses across all 25 items, each rated from 1 to 7, then add the items within each subscale for the three profile scores.

1. Item scoring: Each statement is rated from 1 (strongly disagree) to 7 (strongly agree).
2. Reverse-scored items: Items 3, 12, 19, 22, and 24 are worded positively and must be flipped before you add them up. This is where hand-scored forms go wrong.
3. Subscale totals: Sum the nine Compensation items (9-63), the eight Masking items (8-56), and the eight Assimilation items (8-56).
4. Total score: Add all 25 responses for a figure between 25 and 175. Psychology practice software with built-in scoring removes both the arithmetic and the transcription errors.
5. Normative comparison: Compare the total against the published norms for autistic and non-autistic adults in the original validation paper.

What the scores mean

A total of 100 or above is the threshold commonly used to flag significant camouflaging. Treat it as a prompt for questions rather than evidence of autism. Camouflaging also shows up in social anxiety, in trauma histories, and anywhere standing out carries a penalty.

Your clinical documentation should carry the total, all three subscale scores, and a line on which strategies dominate. A note reading “high masking, moderate compensation, high assimilation” tells the next clinician far more than a single number.

Critical caveat: The CAT-Q is not a diagnostic tool. An autism diagnosis needs a full assessment by a qualified professional. That means developmental history, direct observation, collateral information, and usually a structured instrument such as the ADOS-2 or ADI-R.

Validity and reliability evidence

Internal consistency is strong. Cronbach’s alpha reached 0.94 for the total scale in the validation study, and sat above 0.80 for every subscale.

Test-retest reliability was measured roughly three months after the first administration. Correlations ran from 0.70 to 0.78 across the total and the subscales. The authors described that as good to moderate stability, which is a fair standard for a measure of behavior that shifts with context.

Construct validity came from correlations with autism trait, anxiety, and depression measures. The questionnaire does separate autistic from non-autistic respondents, but the two distributions overlap considerably. That overlap is exactly why a score on its own settles nothing.

How clinicians use the CAT-Q test in practice

Handing a patient their own camouflaging profile often turns an assessment collaborative. Many adults describe relief at seeing their exhaustion set out in measurable terms. That reaction is worth using, because it lifts patient engagement and opens up history the interview would otherwise miss.

Most practices administer the questionnaire early, at intake or during screening. Practices that bill screening time separately may use H0002, depending on the payer and the setting. The results then shape the rest of the pathway.

A high masking score steers the interview toward identity, authentic expression, and the settings where masking intensifies. Moderate trait scores next to high camouflaging scores often explain a referral that arrived decades late. Bring both figures into the psychiatric interview so the history covers what the patient learned to hide.

AI-assisted documentation can summarize the responses and drop them into the formulation, which takes a chunk out of report writing.

Limitations to keep in mind

The CAT-Q is self-report, so it depends on insight and honesty. A patient who has masked since childhood may not recognize the behavior as masking at all, and will score lower than their experience warrants.

Cultural context matters too. Expectations to conform vary by gender, ethnicity, and community, which changes how people read the items. Norms come mostly from Western, English-speaking samples, and cross-cultural validation is still in progress.

Responses are sensitive clinical data. Whatever platform you collect them on needs encryption in transit and at rest, plus proper access controls. Check that your patient data security setup meets your HIPAA or GDPR obligations before the first form goes out.

Administering it digitally

Sending the questionnaire before the appointment beats handing over paper in the waiting room. The patient answers at home with no audience, which matters for a measure about performing in front of other people.

Digital delivery also removes the transcription step. Responses land in the record already attached to the patient, and automated reminders chase anyone who has not finished. Digital forms can branch as well, so a high compensation score triggers a follow-up question about the strategies behind it.

The audit trail comes free. You can see who sent the form, when the patient completed it, and who has opened the result since.

How Pabau runs the CAT-Q from intake to record

Most practices still email the questionnaire as an attachment. Someone prints the reply, adds the numbers by hand, then types the total into the notes. Each of those steps is a chance to lose a form or mistype a score that a clinician will rely on for months.

Practice management software like Pabau turns that into one flow. You build the CAT-Q as a digital intake form and attach it to the assessment appointment type. The patient completes it on their phone before they arrive, and the answers appear in their record, timestamped and ready for the interview.

Everything then stays together. Treatment notes, consent, and follow-up letters sit beside the questionnaire, and Pabau Scribe, our AI scribe, can turn the session into a draft note. Your assessment history stops living across a mailbox, a scanner, and a spreadsheet.

Run screening questionnaires without the paperwork

Pabau's digital intake forms send the CAT-Q before the appointment and file every response in the patient record. Your team stops chasing paper, and you start the assessment with the answers already in front of you.

Book a demo

Conclusion

The CAT-Q earns its place because it measures effort rather than deficit. That reframing changes what an assessment can offer an adult who has spent thirty years passing as neurotypical.

Use it early, read the three subscales instead of the headline total, and file both next to the trait measures you already run. Done that way, the questionnaire helps explain why this patient reached you now, at this age.

Keep the caution attached to the number. A high score describes a coping strategy under strain, and it never replaces a diagnostic interview. Book a demo to see how Pabau delivers assessment questionnaires at intake and keeps every result in the patient record.

Continue your research

Want a related self-report screener for adults? Autism Spectrum Quotient (AQ) measures autistic traits across five domains and pairs well with CAT-Q camouflaging scores in a fuller intake picture.

Assessing an adult who was never diagnosed in childhood? Autism test for adults template gives clinicians a structured screening tool suited to late-diagnosed presentations, the same population the CAT-Q was validated for.

Need to structure the full diagnostic interview? Psychiatric evaluation template guides clinicians through a structured diagnostic interview covering developmental history, mental health, and camouflaging patterns.

Frequently asked questions