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Article

Impact of Autism Spectrum Disorder Traits and Social Camouflaging on Presenteeism Among Japanese White-Collar Workers

by
Wakaba Sato
1,*,
Tomoko Omiya
2,3,*,
Naoko Kumada-Deguchi
4,
Tomoko Sankai
5 and
Thomas Mayers
6
1
Program in Nursing Science, Graduate School of Comprehensive Human Science, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
2
Department of Public Health Nursing, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
3
Department of Public Health Nursing, Division of Health Science, Tohoku Unibersity Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan
4
Faculty of Education, Shizuoka University, Shizuoka 422-8017, Japan
5
Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
6
Department of Health Services Research, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
*
Authors to whom correspondence should be addressed.
Psychiatry Int. 2025, 6(2), 61; https://doi.org/10.3390/psychiatryint6020061
Submission received: 17 February 2025 / Revised: 29 March 2025 / Accepted: 12 May 2025 / Published: 20 May 2025
Versions Notes

Abstract

:
The decline in mental health among workers in Japan has become a serious concern. Autism spectrum disorder (ASD) traits are increasingly recognized as a potential risk factor for mental health issues, yet few individuals receive a formal ASD diagnosis. This study aims to examine whether undiagnosed but working individuals with strong ASD characteristics differ in factors related to presenteeism (low productivity) compared to their counterparts with fewer ASD traits. In particular, we investigated the impact of social camouflaging—the behavioral adaptation used to mask ASD traits—especially on workers with strong ASD characteristics. An online survey was conducted among white-collar workers aged 20 to 60. The survey included items collecting demographic information (gender, age, marital status, highest level of education completed, employment status, job title, length of employment, and working hours) and included the Japanese versions of four validated instruments to measure aspects of autism traits, social camouflaging, work functioning, and occupational stress. Of the 543 respondents, 139 (25.6%) exhibited strong ASD characteristics. These individuals reported lower productivity than their counterparts. While social camouflaging was observed across all ASD trait levels, it was specifically linked to poorer mental health and reduced productivity among workers with strong ASD characteristics. To support workplace well-being and productivity, it is crucial to increase awareness and understanding of ASD traits in professional settings and create an environment that accommodates diverse work styles.

1. Introduction

In Japan, the worsening mental health of workers has become a critical issue, with a disproportionately high number of suicides among middle-aged and older workers compared to other countries [1,2]. This trend is accompanied by a rising number of cases in which mental health conditions, such as depression, are being officially recognized as work-related injuries [1,3]. According to the National Police Agency’s suicide statistics for FY2022, the most commonly reported causes and motives for work-related suicides were “human relations at work” (26.5%), “job fatigue” (24.4%), “change in work environment” (19.8%), and “job failure” (11.8%) [4]. These statistics align with the findings of a previous study among Japanese workers that suggested the interrelated factors of workplace relationships and intra-organizational communication have an association with workplace stress [5]. Workplace culture in Japan plays a significant role in shaping mental health outcomes [6,7]. Many cases of adjustment disorders have been attributed to workplace-related stressors, particularly challenges in navigating interpersonal relationships and losing a sense of unity or belonging [8,9]. These difficulties can lead to severe psychological distress, often resulting in extended absences from work and, in some cases, an inability to continue working [8,10]. However, in many instances, rather than taking leave, affected individuals continue working despite impaired productivity and well-being—a phenomenon known as presenteeism [10,11]. Workers experiencing presenteeism may struggle with focus, decision-making, and interpersonal interactions, which can ultimately exacerbate stress and contribute to long-term mental health decline [12,13], not to mention further economic burden on industry and society [11].
In recent years, there has been growing recognition of the presence of workers with autism spectrum disorder (ASD) characteristics in discussions about workplace maladjustment and communication difficulties [14,15]. ASD is a developmental disorder characterized by challenges in communication and interpersonal interactions, a strong commitment to routines or particular pursuits, and limited interests [16,17,18]. According to the latest classification from the World Health Organization (WHO) [19], in working adults without disorder of intellectual development, a diagnosis of ASD is characterized by persistent difficulties in initiating and sustaining social communication and reciprocal social interactions that fall outside the expected range for the individual’s age and cognitive ability. These challenges may manifest as difficulties in interpreting verbal and non-verbal cues, reduced use of gestures or facial expressions, and limited ability to engage in back-and-forth conversations or adjust behavior to fit the social context. Adults with ASD may also struggle to understand others’ emotions, share interests, or develop and maintain typical peer relationships. In addition to social communication difficulties, ASD involves the presence of restricted, repetitive, and inflexible patterns of behavior, interests, or activities. These may include resistance to change, strict adherence to routines, excessive rule-following, or ritualized behaviors such as sorting or lining up objects. Some adults exhibit repetitive motor movements or atypical sensory responses, including hypersensitivity or hyposensitivity to sounds, textures, or other stimuli. While the onset of ASD occurs during early development, symptoms may not become fully evident until later in life, particularly when social demands exceed coping capabilities. Importantly, even when individuals appear to function adequately in work or social environments—often through considerable effort—a diagnosis may still be appropriate if these characteristics cause significant distress or functional impairment in daily life [19]. Some studies have also highlighted the existence of individuals who, while not meeting the full diagnostic criteria for ASD, exhibit significant social communication difficulties and sensory differences—traits commonly associated with the spectrum [20,21,22]; however, research on such individuals in the general workforce remains scarce. It is unclear how prevalent ASD-like traits are among workers in Japan, what specific challenges they face in employment, and how their experiences compare to those of neurotypical colleagues. Further investigation is needed to better understand their workplace difficulties—insights that could help towards the development of appropriate support strategies for such individuals.
The concept of “social camouflaging” has gained increasing attention in relation to individuals with ASD characteristics. Social camouflaging in the context of ASD research refers to the use of strategies to make ASD-related behaviors less noticeable in social situations [23,24,25]. This includes explicit efforts to “hide” or “compensate for” autistic traits, as well as conscious or unconscious techniques that result in behaviors appearing less characteristic of ASD [25,26,27]. Individuals who engage in social camouflaging may intentionally suppress certain behaviors, including autistic traits, and, thus, expand their behavioral repertoire to cope with social situations in which individuals with ASD typically have difficulty. Camouflaging behaviors can include mimicking neurotypical social behaviors, rehearsing conversations, or closely observing others to learn “appropriate” social scripts [23,24,25,26,27]. While these behaviors may help individuals “pass” in social or professional environments, they can obscure the underlying cognitive and sensory differences associated with ASD, leading to underdiagnosis or misdiagnosis—particularly among women and adults with high verbal ability [25,28,29,30]. What is more, this process requires significant mental and physical effort, which can deplete emotional resilience and negatively impact self-esteem. Studies have shown that social camouflage is strongly associated with worsening mental health, with increased rates of depression, social anxiety, and generalized anxiety symptoms among those who engage in it [26]. Moreover, because social camouflaging of ASD characteristics might lead to missed or delayed ASD diagnosis, it also has the potential to prevent access to necessary social supports and services [31].
Although the WHO classification does not use the specific term “social camouflaging”, it is implicit in their description of how those with ASD might make considerable effort to “compensate” for their symptoms [A]. The classifications state that sustained effort, “can have a deleterious impact on mental health and well-being”; moreover, they mention that such behavior is more typical of females with ASD [A]. Recent literature on social camouflaging in the context of ASD, particularly those that focus on women, suggests that camouflaging is not merely a coping mechanism, but also a defining feature in how autism, particularly in adults without intellectual disability, is expressed and often masked in everyday contexts [25,29,30,32]. Indeed, Bargiela and colleagues make a strong argument that camouflaging should be considered part of the female phenotype of ASD [29]. ASD has historically been reported to affect males more frequently than females, with a widely cited male-to-female ratio of approximately 4:1 [32,33,34]; however, later studies began to challenge these estimates, reporting lower gender ratios (e.g., 1.8:1 or 2.5:1), and suggesting that diagnostic biases, cultural stigma, and the reliance on male-centric diagnostic criteria may contribute to the under-identification of ASD in females, especially those who were high functioning [23,35,36]. Compared to males, high-functioning females with ASD are often more socially motivated, better at forming superficial friendships, and less likely to exhibit overt repetitive behaviors or externalizing symptoms such as hyperactivity or conduct problems [29]. Instead, they may internalize their difficulties, presenting with anxiety, depression, or eating disorders, which can mask underlying autistic traits [29]. Many women report engaging in social camouflaging behaviors, intentionally or unconsciously mimicking neurotypical social behaviors to fit in, often at great emotional cost [29,37]. These strategies could lead healthcare professionals to overlook or misattribute their difficulties, especially when their presentation does not align with male-centric diagnostic expectations [32]. As a result, many women are diagnosed only in late adolescence or adulthood—after years of mislabeling, misunderstanding, and mental health struggles [29], which sheds light on the need to consider subtler social difficulties and the impact of gendered expectations on autistic identity and expression [29,30,37]. These gendered differences in the presentation and recognition of ASD are particularly important in adult populations, many of whom engage in employment, where the sustained effort of social camouflaging may have unique implications for occupational well-being and performance.
In occupational settings, social camouflage may contribute to presenteeism, as individuals expend considerable energy masking their traits while struggling internally with stress, exhaustion, and difficulty maintaining productivity [24,38]. Despite growing research on social camouflaging, there have been no studies specifically examining ASD characteristics and camouflaging behavior among individuals in the Japanese workforce. Given that social camouflage is often invisible to others yet can have profound effects on mental health and occupational functioning, it is crucial to investigate this issue. Understanding challenges associated with social camouflage, including its impact on mental health, workplace functioning, would provide valuable evidence to inform workplace health management strategies and support systems for employees with ASD characteristics.
The purpose of this study, therefore, was to determine whether workers with strong ASD characteristics, particularly socially camouflaged workers, experience different impacts on presenteeism compared to those with low ASD characteristics. Specifically, this study aimed to investigate whether the mental and physical burden associated with sustained social camouflaging contributes to impaired workplace functioning and productivity. By focusing on a general workforce sample in Japan, where mental health issues related to occupational stress are a growing social concern, this study seeks to address a significant gap in the literature regarding the interaction of ASD traits, camouflaging behaviors, and occupational health outcomes among Japanese white-collar workers. Clarifying this relationship is useful for understanding the hidden challenges faced by employees with ASD characteristics, particularly those who may not meet formal diagnostic criteria.

2. Materials and Methods

2.1. Sample and Data Collection

This study employed a cross-sectional observational design, using data collected through an online survey conducted in 2024. The online survey was administered by a leading Japanese marketing research company, Cross Marketing Inc. (Tokyo, Japan), and targeted white-collar, Japanese workers aged 20 to 69 years. White-collar workers—those engaged in desk jobs—are often required to demonstrate advanced communication skills and flexible task management. Given that the challenges associated with these occupational demands are likely to be more pronounced among individuals exhibiting ASD characteristics, this group was specifically selected. Participants were excluded if they had been diagnosed with a developmental disability, were currently receiving medical treatment for a mental illness or another condition, worked part-time, were unable to complete the survey in Japanese, or had difficulty responding to an online questionnaire.

2.2. Ethical Considerations

This research was conducted with the approval of the Ethical Review Committee of the Institute of Medicine, University of Tsukuba (Approval No. 2016, 1 August 2024). Ethical considerations were carefully implemented to protect the research participants. Participation was entirely voluntary, and it was explicitly communicated that individuals would not be disadvantaged by choosing not to participate, that they were not obligated to respond to any questions they did not wish to answer, and that withdrawal of responses after submission was not possible. The research explanation clearly stated that all information would be handled with strict confidentiality to ensure that individual participants could not be identified.

2.3. Variables and Questionnaires

Respondents were asked to provide demographic information, including gender, age, marital status, highest level of education completed, employment status, job title, length of employment, and working hours. The survey also included Japanese versions of four validated instruments to measure aspects of autism traits, social camouflaging, work functioning, and occupational stress.

2.3.1. Autism Spectrum Quotient 16-Item Japanese Version (AQ-J-16)

The Autism Spectrum Quotient (AQ), originally developed by Baron-Cohen et al., is a 50-item self-administered questionnaire designed to measure autistic characteristics in adults with normal intelligence [39]. It serves as a screening tool for high-functioning pervasive developmental disorders in individuals with an IQ of 70 or higher. The AQ-J-16 is a 16-item shortened version of the Japanese version of the AQ scale [40], validated by Kurita et al. [41]. The AQ-J-16 demonstrated a Cronbach’s alpha coefficient of 0.82, indicating good internal consistency [41]. Responses to each item are made using a 4-point scale to indicate the level of agreement. Each item is given a score of either 1 or 0, respectively, indicating high or low autistic tendency. Based on our previous study [42], participants in the current study with an AQ-J-16 score of 9 or higher (mean + 1 SD) were classified as having strong ASD characteristics.

2.3.2. The Japanese Version of the Camouflaging Autistic Traits Questionnaire (CAT-Q-J)

The Camouflaging Autistic Traits Questionnaire (CAT-Q) was created by Hull et al. as a self-report measure designed to assess the extent to which individuals use camouflaging strategies to mask or compensate for autistic traits in social situations [43]. The 25-item questionnaire evaluates three key subdomains of camouflaging: compensation, masking, and assimilation [43]. The Japanese version of this scale (CAT-Q-J), developed by Hongo et al. [44], demonstrated sufficient internal consistency, with a Cronbach’s alpha coefficient of 0.88 for the total scale.

2.3.3. Work Functioning Impairment Scale (WFun)

The Work Functioning Impairment Scale (WFun) is a Japanese instrument developed by Fujino and colleagues, using the Rasch model, to assess the degree of occupational dysfunction caused by health-related problems [45]. It consists of seven items with responses given on a scale of 1 to 5 corresponding to a degree of frequency, evaluating the extent to which health issues impede an individual’s ability to meet job demands. Total scores range from 7 to 35 and are categorized as follows: 7–13 indicates no occupational dysfunction, 14–20 reflects mild occupational dysfunction (appearing unproblematic on the surface but potentially associated with underlying health issues upon detailed assessment), 21–27 suggests moderate occupational dysfunction (likely requiring some form of intervention), and 28–35 indicates severe occupational dysfunction, with a high likelihood of requiring clinical intervention [45]. The WFun has demonstrated high internal consistency, with a Cronbach’s alpha coefficient of 0.98 for item reliability [45]. Based on the results of a previous study in a Japanese population [46], a score of 21 or higher was considered to indicate moderate or greater impairment in labor function.

2.3.4. Brief Job Stress Questionnaire (BJSQ)

The Brief Job Stress Questionnaire (BJSQ) is a widely used instrument in Japan’s stress check system, designed to assess occupational stress and prevent the onset of mental health problems [47,48]. Applicable across various industries and job roles, the BJSQ evaluates three major domains: job stressors, which are work-related environmental factors contributing to stress; stress reactions, referring to the psychological and physical responses triggered by these stressors; and modifiers, which influence the relationship between stressors and stress reactions. The questionnaire includes specific items measuring quantitative workload (3 items), qualitative workload (3 items), and work control (3 items), as outlined by the Ministry of Health, Labor, and Welfare (MHLW). The validity and predictive validity of the BJSQ were confirmed by Tsutsumi [49], reinforcing its reliability as an occupational health assessment tool. In this study, 17 job stressors were analyzed, excluding stress response items, alongside 11 additional factors influencing stress reactions. The internal consistency of the scale was assessed, yielding a Cronbach’s alpha coefficient of 0.827, indicating good reliability.

2.4. Statistical Analysis

For the data analysis in this study, Microsoft Excel Office 365 (Microsoft Corporation, Redmond, WA, USA) and IBM SPSS Statistics Version 29 (IBM Corp., Armonk, NY, USA) were used, with the statistical significance level set at 5%.

2.4.1. Demographic Characteristics

To characterize the study population, frequencies and percentages were calculated for gender, age, marital status, highest level of education, occupation, employment status, and job position. The participants were divided into two groups based on AQ-J-16 scores, following our previously described methodology [42]. Those scoring 9 or higher (indicating strong autistic traits) were assigned to the high ASD trait group, while those scoring below 9 (indicating low to medium autistic traits) were placed in the medium-low ASD trait group. Group characteristics were compared using chi-square (χ2) tests. Additionally, means and standard deviations were calculated for the length of employment and working hours.

2.4.2. Characteristics of the High and Medium-Low ASD Trait Groups

For the AQ-J-16, CAT-Q-J, WFun, and the BJSQ, the mean, standard deviation, median, and mode were calculated. To examine differences in mean values between the high ASD trait group and the medium-low ASD trait group, normality was first confirmed following established methodology [50], after which a t-test was conducted. Additionally, correlation analysis was performed for variables that showed significance in the t-test.
The AQ-J-16 was analyzed based on its total score and four subdomains: communication, imagination, attention shift, and social Skills. The Japanese version of the CAT-Q was assessed using its total score and three subdomains: assimilation score, masking score, and compensation score.
For the Brief Job Stress Questionnaire, the mean, standard deviation, median, and mode were calculated for 13 components: quantitative job overload, qualitative job overload, physical demands, interpersonal conflict, poor physical environment, job control, skill utilization, suitable jobs, meaningfulness of work, supervisor support, coworker support, support from family and friends, and work–self balance.

2.4.3. Factors Associated with WFun and Measurement Factors

To clarify the factors associated with the WFun, Pearson’s correlation coefficients were calculated using the AQ-J-16, CAT-Q-J, and the BJSQ as independent variables for the entire population and for the two groups separately. Based on the study’s conceptual framework, multiple regression analysis using the forced entry method was conducted using independent variables identified as significantly different in the t-test.

3. Results

3.1. Characteristics of the Study Population

In total, 543 individuals completed the online survey and gave consent to participate in the study. The demographic information of the participants is shown in Table 1. Based on AQ-J-16 scores, 139 (25.6%) individuals were placed into the high ASD trait group and 404 (74.4%) in the medium-low ASD trait group. The overall gender distribution in the sample was 52.3% male (n = 284) and 47.7% female (n = 259), corresponding to an overall male-to-female ratio of approximately 1.10:1. While a higher proportion of males was observed in the high ASD trait group (male: 56.8%, n = 79; female: 43.2%, n = 60) compared to the medium-low ASD trait group (male: 50.7%, n = 205; 49.3%; female: n = 199), the male-to-female ratios in these groups (approximately 1.32:1 and 1.03:1, respectively) indicate only a modest increase in the relative number of males with higher autistic traits; however, this difference was not statistically significant (p = 0.238). Additionally, the entire data set was analyzed separately by gender; however, no statistically significant differences were observed between men and women. The analysis revealed several significant differences between the high ASD trait group and the medium-low ASD trait group. Age distribution differed notably, with a significantly higher proportion of participants in their 20s in the medium-low ASD trait group compared to the high ASD trait group (p < 0.001). Marital status also showed a significant difference, as a smaller proportion of individuals in the high ASD trait group were married compared to those in the medium-low ASD trait group (p = 0.013). Additionally, occupational differences emerged, with a slightly higher proportion of individuals in the high ASD trait group working in administrative roles compared to the medium-low ASD trait group (p = 0.028). These findings suggest potential demographic and employment-related differences between individuals with high and lower autistic traits.
Table 2 presents the results of the AQ-J-16, CAT-Q-J, Wfun, and BJSQ instruments and shows the differences in mean, median, and mode values between the two groups. The high ASD trait group had a significantly higher AQ-J-16 score (10.23 ± 1.353) compared to the medium-low ASD trait group (5.23 ± 1.931; p < 0.001), demonstrating the stronger autistic traits in this group. For the CAT-Q-J, the mean score ± standard deviation was 91.91 ± 14.856 for the high ASD trait group. The mean scores ± standard deviations for each subscale were as follows: 29.76 ± 8.09 for compensation, 29.39 ± 5.50 for masking, and 32.77 ± 5.75 for assimilation. For the medium-low ASD trait group, the mean CAT-Q-J score ± standard deviation was 91.17 ± 16.407, and the subscale scores were 29.48 ± 8.54 for compensation, 31.1 ± 6.32 for masking, and 30.59 ± 5.26 for assimilation.
The total population had a mean WFun score of 13.85 ± 7.05. In the high ASD trait group (AQ-J-16 ≥ 9), the mean WFun score was 17.15 ± 7.733, while for the medium-low ASD trait group (AQ-J-16 < 9) had a significantly lower mean WFun score of 12.71 ± 6.428 (p < 0.001), suggesting that individuals in our population with higher ASD traits tended to have higher WFun scores.
T-test analysis revealed that the high ASD trait group had higher scores for communication (4.24 ± 1.03 vs. 1.93 ± 1.11; p < 0.001), imagination (2.45 ± 0.99 vs. 1.23 ± 0.84; p < 0.001), attention shifting (2.17 ± 0.84 vs. 1.26 ± 0.97; p < 0.001), social skills (1.37 ± 0.62 vs. 0.81 ± 0.53; p < 0.001), assimilation (32.77 ± 5.75 vs. 30.59 ± 5.26; p < 0.001), WFun (17.15 ± 7.73 vs. 12.71 ± 6.43; p < 0.001), physical demands (2.32 ± 0.99 vs. 1.93 ± 0.94; p < 0.001), and poor physical environment (2.33 ± 0.89 vs. 2.15 ± 0.87; p 0.035). In contrast, the medium-low ASD trait group had higher scores for masking (29.39 ± 5.50 vs. 31.10 ± 6.32; p < 0.005), interpersonal conflict (6.63 ± 1.70 vs. 6.81 ± 1.83; p 0.306), job control (7.52 ± 1.92 vs. 8.00 ± 2.09; p 0.035), suitable jobs (2.68 ± 0.78 vs. 2.86 ± 0.78; p 0.016), meaningfulness of work (2.52 ± 0.81 vs. 2.73 ± 0.88; p 0.015), support from family and friends (8.10 ± 2.76 vs. 8.92 ± 2.53; p 0.001), and work–self balance (5.29 ± 1.51 vs. 5.70 ± 1.45; p 0.005).

3.2. Correlation Analysis

Table 3 presents the results of the correlation analysis examining the relationship between occupational stress factors and buffering factors in the two groups. In the high ASD trait group, Support from family and friends was found to be positively correlated with job control (r = 0.280, p < 0.001) and work–self balance (r = 0.424, p < 0.001). In the medium-low ASD trait group, support from family and friends was negatively correlated with poor physical environment (r = −0.200, p < 0.001) and positively correlated with suitable jobs (r = 0.208, p < 0.001), meaningfulness of work (r = 0.263, p < 0.001), and work–self balance (r = 0.495, p < 0.001).

3.3. Multiple Regression Analysis

Table 4 and Table 5, respectively, present the results of the multiple regression analysis for the high ASD trait group and the medium-low ASD trait group with WFun as the dependent variable and the independent variables that were found to be significant in the t-test. In the high ASD trait group, significant associations were found for assimilation (β = 0.370, p < 0.001), job control (β = −0.184, p = 0.032), and work–self balance (β = −0.309, p = 0.020). In the medium-low ASD trait group, significant associations were observed for communication (β = 0.150, p = 0.020), imagination (β = 0.093, p = 0.042), attention shifting (β = 0.138, p = 0.030), social skills (β = −0.098, p = 0.031), and work–self balance (β = −0.228, p < 0.001).

4. Discussion

Among our sample of 543 individuals, approximately one-fourth (25.6%) showed strong ASD traits, as determined by the AQ-J-16. Given that our study explicitly excluded individuals diagnosed with developmental disabilities, this finding suggests that a substantial proportion of workers in the general population may exhibit strong ASD characteristics despite the absence of a formal ASD diagnosis. This observation aligns with previous research in Japanese populations, which has reported similar trends in the presence of ASD traits among undiagnosed individuals [21,42,51]. In addition, the mean total AQ-J-16 score in our study (6.51 ± 2.83) was comparable to that reported in prior studies [42,51]. Specifically, our findings were consistent with a previous study conducted by our research team, which examined 614 Japanese public high school students and reported a mean score of 6.53 ± 2.47 [42]. Similarly, Ohto et al. found a mean score of 6.20 ± 3.06 in a sample of 275 university students [52]. These results indicate not only a high prevalence of strong ASD traits in the Japanese population but also suggest that ASD traits may persist from adolescence to adulthood, even among individuals without a formal diagnosis.
In a previous study by Hull et al., who developed the CAT-Q instrument to measure camouflaging autistic traits, the mean overall score for non-ASD individuals was reported to be 91.00 [26]. In the current study, which used the Japanese version of the CAT-Q, the obtained total score (91.36 ± 16.01) was considered to be strongly comparable to that reported by Hull and colleagues. While potential differences due to linguistic, cultural, or sample-specific factors should be acknowledged, we can state with some confidence that our study sample was appropriate for representing the assumed population in this study.
Regarding WFun results, mean scores from our total population (13.85 ± 7.05) indicated slight to mild occupational dysfunction, with more pronounced dysfunction in those with stronger ASD traits. Similarly, a 2023 study examining presenteeism among Japanese employees during the COVID-19 pandemic found that 60.5% of workers had WFun scores of 13 or lower [53]. In particular, individuals in the high ASD trait group were more likely to experience mild to moderate labor dysfunction, whereas those in the medium-low ASD trait group were more likely to have no to mild dysfunction. The higher WFun scores in the high ASD trait group suggest that pronounced ASD traits may be associated with distinct patterns of occupational functioning. ASD characteristics may directly or indirectly contribute to reduced work performance [54,55,56,57]. Prior research indicates that individuals with ASD traits often face challenges in workplace communication, which can hinder relationships with coworkers and supervisors and impact productivity [54,55,56]. Additionally, they may struggle with unpredictable change and ambiguity, making them particularly vulnerable in dynamic work environments. Unclear job expectations can further exacerbate performance difficulties [54].
T-test comparison of the two groups revealed no significant difference in the overall CAT-Q scores between the groups. However, the assimilation subscale scores were significantly higher (p = <0.001) in the group with stronger ASD traits. This finding is in line with a study by Kiya et al., in which interviews with adult Japanese women diagnosed with ASD revealed that assimilation was the most frequently employed among the three identified social camouflaging strategies [58]. Assimilation in the context of social camouflage refers to behaviors where individuals mimic the actions and language styles of others to adapt to the social standards of the social situation. This strategy aims to achieve social acceptance by minimizing the visibility of one’s unique (ASD) characteristics. Specific assimilation behaviors include observing and imitating others’ facial expressions and gestures, as well as adjusting one’s tone and conversational content to align with the social context [24,27]. While such behaviors can lead to immediate social harmony, they may result in long-term challenges, such as a diminished sense of self and psychological fatigue. Successful assimilation demands substantial cognitive resources, potentially impacting other activities; thus, although assimilation plays a crucial role in the social adaptation of individuals with ASD traits, its psychological costs warrant careful consideration [23,24].
Masking scores were significantly higher in the medium-low ASD trait group compared to the high ASD trait group. Masking behavior involves concealing one’s true characteristics and emotions to engage in socially expected behaviors [24]. This includes actions such as deliberately maintaining eye contact or suppressing natural behaviors to appear more neurotypical. Unlike other constructs, masking is less specific to ASD and may reflect general self-presentation and impression management strategies applied to ASD traits [43]. In the workplace, individuals, regardless of the strength of their ASD characteristics, may adopt masking as a communication strategy to adapt to organizational climates and interpersonal relationships. The findings of our study suggest that both individuals with strong and weak ASD traits engage in camouflaging behaviors like masking.
In the high ASD trait group, Assimilation scores were positively associated with WFun scores in both univariate and multivariate regression analyses. This suggests that individuals with stronger ASD traits may experience reduced work performance due to their engagement in assimilative behaviors. As previously discussed, difficulties in assimilation can increase feelings of social isolation and rejection, potentially leading to deteriorating mental health and decreased job performance. Livingston et al. also noted that sustained self-monitoring during social camouflaging may cause a decrease in concentration and work efficiency, which may directly affect job performance [27]. To alleviate the psychological burden associated with excessive assimilation, it is essential to provide support by adjusting the work environment, assigning tasks that align with individual strengths, and encouraging a deeper understanding of ASD traits among colleagues and supervisors [56,59]. The results of the multiple regression analysis indicate that social camouflaging may contribute to increased presenteeism, particularly in individuals with high ASD traits, with assimilation being a significant factor. These findings parallel the observed relationship between social camouflaging and mental health outcomes [60,61,62,63].
In the high ASD trait group, job control was negatively associated with WFun scores in multiple regression analysis. This suggests that individuals with strong ASD traits may maintain better work performance when they have greater control over their tasks and responsibilities. Conversely, it is possible that individuals with higher work performance are more likely to secure positions that offer a higher degree of job control. This autonomy may help them compensate for challenges in communication and attention shifting by allowing them to structure their work environment to suit their preferences. Interestingly, while the univariate regression analysis did not show a significant relationship between job control and WFun scores, the multiple regression analysis did. This indicates that job control may interact with other variables, and its effect on work functioning could be influenced by these interactions. Further research is needed to explore these relationships in more detail. Regarding the job control factor, Hayakawa et al. conducted a cross-sectional study at a Japanese factory and examined the relationship between job control and health-related quality of life (HRQOL) among workers exhibiting varying levels of ASD [64]. The study found a significant interaction between ASD tendencies and job control concerning physical HRQOL. Specifically, for individuals with low ASD traits, high job control was associated with better physical HRQOL. Conversely, for those with high ASD traits, increased job control correlated with poorer physical HRQOL. These findings curiously suggest that while greater job control may benefit workers with lower ASD tendencies, it could adversely affect those with higher ASD traits [64].
All participants of the current study, regardless of ASD score, variables related to job and life satisfaction were negatively associated with WFun scores in both univariate and multivariate regression analyses. This finding aligns with previous research indicating that higher work–life satisfaction contributes to better job performance. For instance, Allen et al. found that work–life balance is positively correlated with job satisfaction and productivity [65]. As suggested by many in this field, creating a supportive work environment that promotes work–life balance can enhance employee satisfaction and performance [64,65,66,67].
Although a slightly higher proportion of males were found in the high ASD trait group compared to the medium-low group, this difference was not statistically significant, suggesting that gender was not a distinguishing factor between those with higher and lower AQ-J-16 scores in this sample. The male-to-female ratio of participants who were placed in the high ASD trait group and medium-low ASD trait group were approximately 1.32:1 and 1.03:1, respectively, which—although vastly different to the often-mentioned 4:1 ratio [32,33,34]—was close to the results of a study by Mattila and colleagues, who observed a ratio of 1.7:1 in high-functioning participants with ASDs [36]. This finding suggests that prevalence of ASD traits might not be as distinct between the sexes as once estimated, particularly when we focus narrowly on the high-functioning end of the ASD spectrum. Given the historic understanding that gender is associated with various aspects of ASD, all the data in the current study were analyzed separately comparing male and female participants. As mentioned in the introduction, previous studies have shown that higher-functioning females with ASD are more likely to exhibit subtler social difficulties, higher social motivation, and increased use of compensatory strategies such as camouflaging, which can complicate detection and may result in delayed or even missed diagnoses [24,29,30]. Despite these well-documented distinctions, the present analysis revealed no statistically significant gender differences across any of the measured variables. This unexpected finding may indicate that an increased awareness of the female autism phenotype has led to better, more balanced, clinical understanding of ASD and greater acceptance of autistic traits in both men and women within the general population.

4.1. Implications

As demonstrated in the current study, workers exhibiting pronounced ASD traits often encounter challenges in mental health and job performance. ASD characteristics exist on a spectrum, varying in intensity and manifestation among individuals; consequently, comprehensive support is essential, irrespective of a formal diagnosis. Therefore, to create a more inclusive work environment, it is important to enhance the understanding of ASD among the general population and promote diverse work styles within the workplace. To this end, a number of recommendations can be put forward to help occupational health professionals, including physicians and nurses, to effectively support employees with ASD. First, recognize and appreciate the unique traits and personalities associated with ASD, thereby cultivating a more inclusive and supportive work environment. Assessing the specific challenges these individuals face in the workplace allows for targeted interventions. Implementing educational initiatives across the organization raises awareness about autism, leading to a more understanding workplace culture. Collaborating with employers to adjust job roles and responsibilities to align with the individual strengths of employees with ASD can enhance job satisfaction and performance. Additionally, offering preventive mental health interventions bespoke to the needs of these employees helps mitigate potential stressors. To mitigate the negative effects of social camouflaging among individuals with ASD, one strategy would be to establish “third places”—informal public settings separate from home and work where people can gather and interact [68]. Sociologist Ray Oldenburg introduced the concept of “third places”, emphasizing their role in enhancing community engagement and providing a sense of belonging [68]. By creating such environments within the workplace, employees with strong ASD traits can form secure relationships, reducing the psychological strain associated with masking their true selves. This approach not only benefits individuals with ASD but also enhances the overall workplace culture, making it more accommodating for all employees, including those managing chronic illnesses or personal challenges. By nurturing an inclusive environment, organizations can support the success and well-being of all employees.

4.2. Limitations

A number of limitations should be acknowledged. First, having a cross-sectional design, this study captures data at a single point in time, which precludes the establishment of causality between variables. Future research should employ longitudinal designs to better assess causal relationships. Second, the sample was drawn from individuals registered with an internet research firm, introducing potential sampling bias. Participants who have the time and resources to engage in online surveys may not represent the broader population, potentially limiting the generalizability of the findings. Although the survey company had access to a large registry of potential respondents, they reported difficulty in fulfilling our request for a balanced sample in terms of gender and age. Despite efforts to recruit 700 participants evenly distributed by sex and age group, the target sample was not reached by the deadline, particularly due to challenges in enrolling younger men in their 20s and 30s. This recruitment difficulty may have introduced sampling bias, potentially underrepresenting this demographic subgroup, which may have implications for the lack of a significant gender difference in the findings. Additionally, because the survey explicitly referenced ASD, it is possible that individuals with strong opinions or sensitivities regarding ASD were more or less likely to participate. As such, the sample may have been biased toward individuals who were either already familiar with ASD or perceived themselves as fitting within socially normative expectations, thereby limiting the generalizability of the findings. Conversely, there is also the possibility that some participants were motivated to participate due to an interest in exploring their own ASD traits, which could introduce self-selection bias. Another possible limitation of the study was its exclusive focus on white-collar workers. To enhance the applicability of the results, future studies could include a more diverse range of occupations. Furthermore, it is important to note that the level of ASD traits was based on self-reported responses to the AQ-J-16. While AQ-16 scores do not constitute an ASD diagnosis, the reliability and validity of this instrument have been repeatedly demonstrated. Finally, in this study, participants were divided into two groups based on their AQ-J-16 scores; however, a more granular analysis dividing participants into high, medium, and low ASD trait groups could provide clearer insights. Future research with larger sample sizes should consider this approach for more detailed analysis.

5. Conclusions

Workers exhibiting pronounced autism traits, particularly challenges in attention shifting, demonstrated increased presenteeism compared to their peers. Notably, while social camouflaging behaviors—efforts to mask or compensate for autistic characteristics—are observed across the spectrum, their association with adverse mental health outcomes and heightened presenteeism is predominantly evident among individuals with stronger ASD traits. The findings of our study, along with a growing body of evidence, point to the necessity for workplaces to deepen their understanding of ASD and create working environments that support diverse work styles. It is imperative for occupational health professionals to be aware of the individual characteristics and personalities of employees and assess how these may influence workplace challenges. In light of the finding that one-quarter of our study population of white-collar workers exhibited strong ASD traits, support strategies for workers should not be limited to the presence or absence of an ASD diagnosis but should encompass a broader perspective. Organizations can serve as key contributors by disseminating knowledge about ASD, educating staff, training managers, implementing preventive mental health interventions, and making necessary adjustments to work environments and roles. Future research should aim to clarify causal relationships by conducting longitudinal studies with larger, more diverse populations.

Author Contributions

Conceptualization; W.S., T.O. and N.K.-D., methodology T.O., T.S. and W.S.; formal analysis, W.S., T.O., T.S. and T.M.; investigation, W.S., T.O. and T.S.; resources, T.O. and T.M.; data curation, W.S. and T.O.; writing—original draft preparation, T.O., W.S. and T.M.; writing—review and editing W.S., T.O., N.K.-D., T.S. and T.M.; project administration, T.O., N.K.-D. and T.S.; funding acquisition, T.O., T.S. and T.M. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethical Review Committee of the Institute of Medicine, University of Tsukuba (Approval No. 2016, 1 August 2024).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The data presented in this study are available upon request from the corresponding author under certain conditions. However, please note that some measures cannot be made public due to contractual restrictions.

Acknowledgments

We would like to thank all the people who cooperated in the survey. We would also like to thank Yukari Isaka, Nako Sakaba, and the members of the Community Health and Public Health Nursing Laboratory at the University of Tsukuba for their advice in writing the paper.

Conflicts of Interest

The authors declare no conflicts of interest.

Abbreviations

The following abbreviations are used in this manuscript:
ASDAutism spectrum disorder
AQ-J-16Autism Spectrum Quotient 16-item Japanese version
CAT-Q-JThe Japanese version of Camouflaging Autistic Traits Questionnaire
WFunThe Work Functioning Impairment Scale
BJSQBrief Job Stress Questionnaire

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Table 1. Difference in means between the two groups by demographic characteristics and AQ-J-16 score.
Table 1. Difference in means between the two groups by demographic characteristics and AQ-J-16 score.
Total Population (N = 543)High ASD Trait Group
(AQ-J-16 ≥ 9)
(n = 139)		Medium-Low ASD Trait Group
(AQ-J-16 < 9)
(n = 404)		Between-Group Comparison *
n%(SD)n%(SD)n%(SD)p
Gender
Male28452.37956.820550.70.238
Female25947.76043.219949.3
Age
20s8114.93726.64410.9<0.001
30s10619.52417.38220.3
40s11120.42820.18320.5
50s13224.32518.010726.5
60s11320.82518.08821.8
Marital status
Married21639.86848.914836.60.013
Never married28151.76546.821653.5
Bereavement/separation468.564.3409.9
Highest level of education **
High school9617.72820.16816.80.380
Vocational school6812.51812.95012.4
Junior college448.175.0379.2
University28853.07856.121052.0
Graduate school458.385.8379.2
Occupation
Administrative8114.91410.16716.60.028
Professional and technical occupations17031.35036.012029.7
Administrative20237.24330.915939.4
Sales346.3128.6225.4
Other5610.32014.4368.9
Employment type
Full-time employee47286.912086.335287.10.500
Temporary employee264.896.5174.2
Contract employee458.3107.2358.7
Job position
General38070.010172.727969.10.235
Section chief/manager8515.72417.36115.1
Section chief/director7814.41410.16415.8
Length of employment8 y 9 m(38.67)8 y 10 m(44.91)8 y 9 m(36.34)
Working hours8 h 17 min(83.61)8 h 18 min(99.3)8 h 16 min(77.6)
* Pearson’s χ2 test, Fisher’s exact probability test, ** excluding 2 respondents who answered “other” for their highest level of education, SD, standard deviation; AQ-J-16, Autism Spectrum Quotient 16-item Japanese version.
Table 2. Descriptive statistics (mean, SD, median, and mode) for each variable and mean differences between the two groups.
Table 2. Descriptive statistics (mean, SD, median, and mode) for each variable and mean differences between the two groups.
Total Population (N = 543)High ASD Trait Group
(AQ-J-16 ≥ 9) (n = 139)		Medium-Low ASD Trait Group
(AQ-J-16 < 9) (n = 404)		Mean Difference Between Groups *
MeanSDMMoMeanSDMMoMeanSDMMop
AQ-J-16 Total (Range: 0–16)6.512.836710.231.351095.231.9357<0.001
Communication (Range: 0–7)2.521.49224.241.03451.931.1122<0.001
Imagination (Range: 0–4)1.541.03112.450.99331.230.8411<0.001
Attention shifting (Range: 0–3)1.501.01222.170.84231.260.9712<0.001
Social skills (Range: 0–2)0.950.06111.370.62110.810.5311<0.001
CAT-Q-J Total (Range: 25–175)91.3616.01929891.9114.86929 *91.1716.4194980.638
Compensation score (Range: 8–56)29.558.42303529.768.093027 *29.488.5430360.740
Masking score (Range: 8–56)30.666.16313229.395.50303231.106.3231320.005
Assimilation score (Range: 8–56)31.158.95313232.775.75323230.595.263132<0.001
WFun (Range: 0–70)13.857.0512717.157.7316712.716.43117<0.001
BJSQ
Quantitative job overload (Range: 3–12)7.742.34898.012.36897.652.33890.112
Qualitative job overload (Range: 3–12)7.902.17887.942.23897.892.16880.801
Physical demands (Range: 1–4)2.030.97212.320.99231.930.9421<0.001
Interpersonal conflict (Range: 3–12)6.771.78766.631.70766.811.83760.306
Poor physical environment (Range: 1–4)2.200.88222.330.89222.150.87220.035
Job control (Range: 3–12)7.872.06897.521.92768.002.09890.018
Skill utilization (Range: 1–4)2.700.87332.660.84332.710.88330.550
Suitable jobs (Range: 1–4)2.810.78332.680.78332.860.78330.016
Meaningfulness of work (Range: 1–4)2.670.87332.520.81332.730.88330.015
Supervisor support (Range: 3–12)6.682.28666.502.26666.752.29660.263
Coworker support (Range: 3–12)7.152.28766.822.29667.262.27760.051
Support from family and friends (Range: 3–12)8.712.6199 *8.102.76898.922.539120.001
Work–self balance (Range: 2–8)5.591.48665.291.51665.701.45660.005
Two-tailed p-value, SD, standard deviation; M, median; Mo, mode; AQ-J-16, Autism Spectrum Quotient 16-item Japanese version; CAT-Q-J, Japanese version of the Camouflaging Autistic Traits Questionnaire; WFun, Work Functioning Impairment Scale; BJSQ, Brief Job Stress Questionnaire. * Multiple modes existed; the smallest value was selected.
Table 3. Presenteeism and its relationship to personal background, occupational stressors, and buffering factors.
Table 3. Presenteeism and its relationship to personal background, occupational stressors, and buffering factors.
High ASD Trait Group
(AQ-J-16 ≥ 9)		Medium-Low ASD Trait Group
(AQ-J-16 < 9)
(n = 139)(n = 404)
rprp
Basic Attributes
Length of employment0.0830.3290.0030.958
Working hours0.0900.2940.0140.784
AQ-J-16
Communication−0.0790.3520.257<0.001
Imagination−0.0420.6220.1020.041
Attention shift0.278<0.0010.235<0.001
Social skills0.1170.1700.0110.832
CAT-Q-J
Compensation score−0.1050.2180.0550.266
Masking score−0.1000.239−0.0530.290
Assimilation score0.365<0.0010.219<0.001
BJSQ
Quantitative job overload0.1260.1400.1210.015
Qualitative job overload0.0330.7000.0370.455
Physical demands−0.0520.5460.0760.128
Interpersonal conflict −0.0410.6360.0270.588
Poor physical environment 0.0490.5700.197<0.001
Job control−0.1450.089−0.1260.011
Skill utilization−0.0360.677−0.212<0.001
Suitable jobs −0.1790.035−0.188<0.001
Meaningfulness of work−0.1030.229−0.220<0.001
Supervisor support−0.1240.147−0.276<0.001
Coworker support−0.1920.023−0.281<0.001
Support from family and friends−0.0820.334−0.223<0.001
Work–self balance −0.379<0.001−0.364<0.001
AQ-J-16, Autism Spectrum Quotient 16-item Japanese version; CAT-Q-J, Japanese version of the Camouflaging Autistic Traits Questionnaire; WFun, Work Functioning Impairment Scale; BJSQ, Brief Job Stress Questionnaire.
Table 4. Factors associated with presenteeism in the high ASD trait group (AQ-J16 ≧ 9; n = 139).
Table 4. Factors associated with presenteeism in the high ASD trait group (AQ-J16 ≧ 9; n = 139).
Unilateral Regression Standardized Coefficient βpBβSEp95%CI
LLUL
Basic Attributes
    Age0.0110.898−0.001−0.0020.0530.982−0.1060.104
    Marital status *0.0260.7641.5880.1191.2770.216−0.9414.116
AQ-J-16
    Communication (Range: 0–7)−0.0790.3520.1900.0250.6180.759−1.0341.414
    Imagination (Range: 0–4)−0.4940.6220.9230.1180.6700.171−0.4032.249
    Attention shifting (Range: 0–3)0.278<0.0011.5710.1710.8130.055−0.0373.180
    Social skills (Range: 0–2)0.1170.1701.6260.1301.0070.109−0.3683.620
CAT-Q-J
    Masking score (Range: 8–56)−0.1000.239−0.257−0.1830.1120.023−0.479−0.035
    Assimilation score (Range: 8–56)0.365<0.0010.4980.3700.112<0.0010.2760.720
BJSQ
    Physical demands (Range: 1–4)−0.0520.5461.0790.1390.6870.119−0.2822.439
    Poor physical environment (Range: 1–4)0.0490.5700.1460.0170.7800.852−1.3991.690
    Job control (Range: 3–12)−0.1450.089−0.741−0.1840.3420.032−1.417−0.065
    Suitable jobs (Range: 1–4)−0.1790.035−0.112−0.0110.9400.905−1.9731.749
    Meaningfulness of work (Range: 1–4)−0.1030.229−0.296−0.0310.9160.747−2.1081.517
    Support from family and friends (Range: 3–12)−0.0820.3340.3840.1370.2450.119−0.1000.868
    Work–self balance (Range: 2–8)−0.379<0.001−1.590−0.3090.4930.002−2.566−0.614
R2 0.352
Adjusted R2 0.267
B, unstandardized coefficient; β, standardized coefficient; LL, lower limit; UL, upper limit; AQ-J-16, Autism Spectrum Quotient 16-item Japanese version; CAT-Q-J, Japanese version of the Camouflaging Autistic Traits Questionnaire; BJSQ, Brief Job Stress Questionnaire. * Marital status; 0 = married, 1 = single, widowed, or divorced.
Table 5. Factors associated with presenteeism in the medium-low ASD trait group (AQ-J16 < 9; n = 404).
Table 5. Factors associated with presenteeism in the medium-low ASD trait group (AQ-J16 < 9; n = 404).
Unilateral Regression Standardized Coefficient βpBβSEp95%CI
LLUL
Basic Attributes
    Age 0.0270.587−0.005−0.0100.0250.827−0.0540.043
    Marital status *0.0860.084−0.476−0.0460.4840.327−1.4280.477
AQ-J-16
    Communication (Range: 0–7)0.257<0.0010.8710.1500.2770.002
    Imagination (Range: 0–4)0.1020.0410.7090.0930.3480.0420.0251.393
    Attention shifting (Range: 0–3)0.235<0.0010.9180.1380.3070.0030.3151.521
    Social skills (Range: 0–2)0.0110.832−1.186−0.0980.5490.031−2.265−0.106
CAT-Q-J
    Masking score (Range: 8–56)−0.0530.290−0.083−0.0820.0490.092−0.1800.014
    Assimilation score (Range: 8–56)0.219<0.0010.1010.0830.0620.107−0.0220.224
BJSQ
    Physical demands (Range: 1–4)0.0760.128−0.081−0.0120.3290.806−0.7280.566
    Poor physical environment (Range: 1–4)0.197<0.001−0.115−0.0160.3820.764−0.8660.636
    Job control (Range: 3–12)−0.1260.011−0.041−0.0130.1520.787−0.3390.257
    Suitable jobs (Range: 1–4)−0.188<0.001−0.106−0.0130.4730.823−1.0350.824
    Meaningfulness of work (Range: 1–4)−0.220<0.0010.1750.0240.4560.701−0.7221.072
    Support from family and friends (Range: 3–12)−0.223<0.001−0.023−0.0090.1330.864−0.2840.239
    Work–self balance (Range: 2–8)−0.364<0.001−1.010−0.2280.261<0.001−1.522−0.497
R2 0.255
Adjusted R2 0.224
B, unstandardized coefficient; β, standardized coefficient; LL, lower limit; UL, upper limit; AQ-J-16, Autism Spectrum Quotient 16-item Japanese version; CAT-Q-J, Japanese version of the Camouflaging Autistic Traits Questionnaire; BJSQ, Brief Job Stress Questionnaire. * Marital status; 0 = married, 1 = single, widowed, or divorced.
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Sato, W.; Omiya, T.; Kumada-Deguchi, N.; Sankai, T.; Mayers, T. Impact of Autism Spectrum Disorder Traits and Social Camouflaging on Presenteeism Among Japanese White-Collar Workers. Psychiatry Int. 2025, 6, 61. https://doi.org/10.3390/psychiatryint6020061

AMA Style

Sato W, Omiya T, Kumada-Deguchi N, Sankai T, Mayers T. Impact of Autism Spectrum Disorder Traits and Social Camouflaging on Presenteeism Among Japanese White-Collar Workers. Psychiatry International. 2025; 6(2):61. https://doi.org/10.3390/psychiatryint6020061

Chicago/Turabian Style

Sato, Wakaba, Tomoko Omiya, Naoko Kumada-Deguchi, Tomoko Sankai, and Thomas Mayers. 2025. "Impact of Autism Spectrum Disorder Traits and Social Camouflaging on Presenteeism Among Japanese White-Collar Workers" Psychiatry International 6, no. 2: 61. https://doi.org/10.3390/psychiatryint6020061

APA Style

Sato, W., Omiya, T., Kumada-Deguchi, N., Sankai, T., & Mayers, T. (2025). Impact of Autism Spectrum Disorder Traits and Social Camouflaging on Presenteeism Among Japanese White-Collar Workers. Psychiatry International, 6(2), 61. https://doi.org/10.3390/psychiatryint6020061

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