What is ADHD masking?

What is ADHD?

ADHD (attention-deficit/hyperactivity disorder) is a common neurodevelopmental disorder that can be present in both adults and children. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) ^[1], ADHD involves:

• Inattention: includes finding it difficult to focus on tasks at school or work, struggling to follow instructions, getting easily distracted, and daydreaming.
• Hyperactive-impulsive: includes struggling to sit still, moving or talking very quickly, interrupting people or speaking at inappropriate times, and finding it difficult to wait for their turn.
• Combined: a combination of symptoms, with neither specific type being more prevalent.

Living with ADHD can cause difficulties with daily functioning and school or professional work. Many people with ADHD mask their symptoms, whether intentionally or unintentionally.

What is masking in ADHD?

ADHD masking is a term that describes when someone with ADHD intentionally or unintentionally hides their symptoms from others. People may mask their symptoms to feel more ‘normal’, fit in with others, avoid being reprimanded, or to manage interpersonal relationships ^[2][3].

People with ADHD may often be disruptive in social situations; for example, in the classroom, a child with ADHD may regularly shout out, get up from their chair, or distract others. In a professional setting, an adult with ADHD may also distract others from their work, complete projects behind schedule, or struggle with time keeping ^[4].

These behaviors can lead to stigma around symptoms of ADHD, with people being labelled as difficult, annoying, unhelpful, and loud. This stigma can have hugely negative impacts on people with ADHD, affecting their self-esteem and potentially leading to mental health issues such as anxiety and depression ^[2].

As such, people may try to hide their ADHD symptoms to prevent this. Both children and adults have been found to mask symptoms, in the context of school, college, work, and personal life. This may be by developing compensatory coping strategies, such as mirroring others or sticking to regimented schedules ^[3][5].

Which symptoms do people with ADHD try to mask?

Symptoms of ADHD that are commonly masked include:

• Fidgeting
• Tapping pens, legs, or tables
• Speaking loudly, often, or quickly
• Poor concentration
• Feeling restless or agitated
• Mood changes
• Impulsive behaviors

Signs of ADHD masking

It can be very difficult to recognize when someone is masking symptoms of ADHD, but it may be possible to recognize it in yourself, if you are aware of the actions you are taking to hide your symptoms.

Many people who mask their symptoms will develop compensatory coping mechanisms, such as relying on strict routines, lists, or reminders, to help with time keeping and managing tasks; finding a job that is below their capabilities, so that they are able to complete work without mistakes and prevent task paralysis; or finding a partner or spouse who is very organized ^[6][7].

Other signs of ADHD masking include:

• Mirroring: people with ADHD might copy actions of other people, to help them fit in and avoid showing their symptoms.
• Agitation prior to tasks or appointments: people with ADHD might struggle with time management, often being late for things or struggling to complete tasks with time restrictions, so agitation might be evident prior to these circumstances, especially if they are attempting to mask these symptoms.
• Not talking: someone trying to mask their symptoms of ADHD may avoid talking or engaging in social interactions, to prevent exhibiting signs of ADHD such as speaking loudly or interrupting.
• Perfectionism: people with ADHD may commonly make mistakes, due to lack of focus or becoming distracted, so may attempt to make everything perfect in order to hide their mistakes or perceived flaws.

How does masking affect the condition?

Masking can help people with fitting in amongst others in social situations, thereby increasing potential social engagement and reducing loneliness. It may also help to prevent stigma in academic or professional circumstances from teachers and coworkers if compensatory actions aid in completing work ^[7].

However, while masking may result in certain positive immediate outcomes, it can also contribute to negative outcomes for people with ADHD. Negative consequences of masking include ^[2][6][8]:

• Delayed diagnosis: often, people who mask their symptoms take longer to reach an accurate diagnosis, or are misdiagnosed, as there are no clear signs of ADHD.
• Reduced support: people may not receive the support or treatment that they require if their symptoms are masked, as employees, teachers, and healthcare professionals may be unaware of concerns or struggles that are being experienced.
• Worsening mental health: people who consistently mask their symptoms may begin to develop worsening mental health, including anxiety and depression, as they feel pressure to maintain their presentation and may fear making mistakes or being ‘found out’.
• Poor sleep: worsening mental health may also contribute to disrupted sleep, thereby potentially exacerbating symptoms of ADHD or other mental health disorders.
• Social withdrawal: ongoing pressure to cover up symptoms may result in avoidance of social situations, to prevent the need for hiding symptoms.
• Fatigue: consistently attempting to mask symptoms may lead to excessive tiredness and fatigue, which can also contribute to poor academic or professional performance and increase the risk of mistakes or accidents.
• Low self-esteem: masking symptoms may contribute to a reduction in confidence and self-esteem, as it can reinforce the idea that the person cannot be themselves, and that their friends do not know the real person.

Which people are more likely to mask ADHD symptoms?

It has been found that females are less likely to receive a diagnosis of ADHD than males, which is believed to be, in part, due to the ability of females to mask their symptoms ^[5]. It is also thought that females experience more internalized symptoms, such as inattention, while males experience more externalized symptoms, such as hyperactivity and impulsivity ^[9].

As such, females are more able to hide their symptoms from others, as they may be able to develop coping strategies to manage, without others noticing, such as working hard to achieve academic or professional goals, to compensate for inattention ^[8].

Children and adolescents are thought to mask their symptoms in the classroom, particularly college students, as there is often a social pressure to meet the norms of this age group and a desire to fit in with peers. There may be a fear of being bullied for being different, resulting in masking of symptoms ^[2].

Adults may mask their symptoms, particularly in a professional setting, but by adulthood, many people with ADHD have learned to adapt to, understand, and accept their ADHD symptoms, thereby improving functioning and reducing the requirement for masking ^[3][6].

How to cope with ADHD

Managing symptoms of ADHD can be best helped by gaining a diagnosis from a mental health professional and receiving appropriate treatment, in the form of medication or therapy. Various types of therapy can help with managing ADHD symptoms, such as ^[10][11]:

• Psychotherapy: psychotherapy can help to manage the underlying feelings that may be causing paralysis, such as fear of failure, anxiety, low self-esteem, and frustration, and provide the skills to develop a more positive attitude toward approaching challenging tasks or decisions.
• Behavioral therapy: behavioral therapy, including cognitive behavioral therapy (CBT), can help with developing practical skills, positive coping strategies, and ways to alter negative thoughts and associated behaviors.
• Family therapy: symptoms of ADHD can cause feelings of frustration and disappointment for the person with the diagnosis, and for their family and loved ones. As such, family therapy can be a useful way to discuss and manage these feelings and to develop a better understanding and management of the symptoms of ADHD.

Other useful skills and techniques to manage ADHD symptoms include ^[4][10]:

• Routine or schedule: having a set time to do certain things can make it easier to begin or complete tasks and can help with feeling organized and focused by having the day already planned out.
• Calendars and reminders: having plans written down can help to prevent feelings of anxiety about upcoming appointments, events, and projects, help with time management, and help reduce forgetfulness.
• Organizing belongings: having a set place for certain things can help prevent searching for lost items or feeling anxious about preparing for a task.
• Writing lists: writing lists of thoughts, tasks, and plans can help to prevent feeling overloaded with information, be useful for planning and scheduling, and can help with processing feelings individually.
• Breaking down tasks: approaching tasks can be daunting, which can result in paralysis and delays, so breaking a big task down into several smaller tasks can help to make the project feel less intimidating, require shorter periods of concentration, and result in more rewarding feelings of achievement, as each item can be ticked off when completed.