Marshae Franklin OTD, MSOT, OTR/L(she/her/hers)

Camouflaging, the masking of neurodivergent traits to blend in with the dominant neurotypical society, is reported among autistic women. At the core of camouflaging, however, is the desire to belong, which is yet to be explored in the literature despite its costly impacts on one's quality of life. Occupational science, a discipline concerned with human doing and belonging is uniquely situated to address camouflaging. Yet, camouflaging has not been explored from an occupational science lens. Therefore, in this conceptual article, we first explore the unique perspective that occupational science contributes to camouflaging scholarship. Given the dearth of camouflaging research and scholarship on autistic women with intersecting identities (e.g., Black autistic women), we draw from Bailey and Mobley's Black Feminist Disability Framework. Second, analyzing existing qualitative narratives in camouflaging research, we illuminate “occupational disruptions,” or potential risk factors of camouflaging, focusing on the work environment, educational settings, and interpersonal and intimate relationships. We highlight the importance of understanding Black autistic women's unique experiences of occupational disruptions. Third, we consider how unmasking is a privilege not granted to those beyond the margins. Finally, we conclude with implications and future directions for interdisciplinary research and scholarship, including a critique of our discipline's paradoxical relationship between belonging theory and camouflaging, therapeutic considerations (masking vs. unmasking safely), and a call to action for scholars, practitioners, and allies to challenge the need for camouflaging to belong, thereby mitigating existing occupational disruptions.

What was the purpose of this article? We (the authors) are concerned about the negative outcomes that autistic women experience related to camouflaging. Camouflaging, sometimes called “masking” or “passing as neurotypical,” is something that neurodivergent people might do to hide their neurodivergent traits so that they are accepted by other people, or to be safe in a neurotypical society. In this article, we discuss camouflaging from an occupational science perspective. Occupational science is an academic discipline that is related to occupational therapy that focuses on human doing and belonging.

Why is this article important? This article is important for several reasons. First, camouflaging impacts the quality of life of autistic people, and we believe that it is closely associated with the deep human need for belonging. In this article, we use occupational science concepts to add a new perspective to current discussions among autistic people and researchers about camouflaging. Recognizing that Black autistic women are almost entirely ignored by researchers and that they might be marginalized based on their race, gender, and neurotype, we also use a Black Feminist Disability Framework to highlight the unique experiences of people with intersecting marginalized identities. Finally, the authors, both neurodivergent and allistic (nonautistic), from various racial and ethnic backgrounds, bring a richness of perspectives based on our diverse life experiences and areas of expertise.

What did the authors do? We applied our unique occupational science perspective to camouflaging. First, we discussed camouflaging in relation to the occupational science concept of belonging and described a Black Feminist Disability Framework. Second, we analyzed the lived experiences of autistic women, using quotes from academic articles. We brought the readers' attention to the lack of diversity within camouflaging literature, which has amplified the voices of White autistic women, while marginalizing women of color. Third, we showed how unmasking is a privilege for White autistic women, but not for autistic women with intersecting identities.

What did the authors conclude? We concluded that camouflaging disrupts various occupations, or important activities people want to do. We also provided a call to action for occupational scientists, occupational therapists, the broader research community, and allies to make environments more inclusive and safer for diverse autistic people.

How does this information help autistic adults? We hope our analysis provides autistic women with the words to describe their experiences, including how camouflaging may have caused occupational disruptions in their lives. We also hope that our call to action contributes to making spaces safer for autistic women.

Pre-pandemic, telehealth occupational therapy (OT) for autistic children appeared promising, but research was limited. The pandemic provided a unique opportunity to investigate how clinics transitioned to telehealth. The purpose of this study was to examine barriers and facilitators that influenced delivery of OT services through telehealth for autistic children during the pandemic. We conducted semi-structured qualitative interviews with 13 participants (three administrators, six OTs, and four parents of autistic children) at three Los Angeles area clinics over a 7-month period. We used narrative and thematic analysis to identify four themes. We identified (a) Challenges and (b) Facilitators to Conducting Telehealth OT, including practical strategies for successful facilitation, and (c) Negative and (d) Positive Outcomes of Conducting Telehealth OT. As telehealth will likely remain a viable means of OT service delivery in the future, our findings provide insight into ways that it can be improved and sustained.

The objective of this study was to examine the application of moderate-pressure massage and kinesthetic stimulation versus light-pressure massage and kinesthetic stimulation on preterm infant behavioral states, heart rate/vagal tone, and weight. Preterm infants (n = 68; M gestational age = 30 weeks) in the neonatal intensive care unit (NICU) were randomly assigned to a moderate- or light-pressure massage therapy plus kinesthetic stimulation condition, receiving massages three times per day for 15 minutes each for 5 consecutive days. Infants who received moderate-pressure massage therapy demonstrated significant improvements in behavioral states (e.g., active sleep, fussing, crying, movement, stress behavior), deep sleep, heart rate/vagal tone, and weight gain compared to the light-pressure massage therapy group. Overall, the data indicate that providing moderate-pressure massage therapy and kinesthetic stimulation has the potential to improve outcomes for stable preterm infants in the NICU.

Keywords. occupational therapy, massage therapy, preterm infant, weight gain, vagal tone, tactile-kinesthetic stimulation