Livingston LA, et al. - Researchers here focused on the compensatory profile in autism; that is, people with autism spectrum disorder who exhibit few symptoms in their behavioral presentation, despite continuing to report autism-related cognitive difficulties or differences. They examined adults with and without autism for the social compensatory strategies and their effect on diagnosis and clinical outcome. The convenience sample comprised individuals aged 18 years or older who responded to a study advert that was distributed worldwide via social media and the UK National Autistic Society. From Oct 19, 2017, to Jan 2, 2018, the online study questions were completed by 136 adults: 58 adults who had a clinical diagnosis of autism; 19 adults who self-identified but were not formally diagnosed as autistic; and 59 adults who were not diagnosed or self-identified, but nevertheless reported social difficulties. Observations revealed multiple compensatory strategies with distinct characteristics. They identified individual and environmental factors that modify compensatory strategy use and success, positive (social relationships, independence, employment) and negative (poor mental health, late diagnosis) outcomes associated with compensatory strategy use. Further, it was observed that individuals without a diagnosis and individuals with a diagnosis use qualitatively similar compensatory strategies. Findings thereby support guiding future diagnostic guidelines, towards improved diagnostic accuracy and support for people with autism spectrum disorder whose cognitive difficulties are not immediately evident in observable behaviour, via increased awareness and measurement of compensatory strategy use in autism.