What is ADHD masking?

Masking — also called camouflaging or compensation — refers to the strategies people use to hide neurodevelopmental differences and appear neurotypical in social and professional settings. While masking has been extensively studied in autism, emerging research is now confirming it as a significant and measurable phenomenon in ADHD as well.

A 2024 study by Van der Putten and colleagues, published in Autism Research, directly compared camouflaging behaviours across three groups: adults with ADHD, autistic adults, and neurotypical adults. The finding was clear: adults with ADHD reported significantly more camouflaging behaviour than neurotypical adults, and the patterns of camouflaging in ADHD overlapped substantially with those in autism — particularly strategies aimed at fitting in socially. The authors concluded that camouflaging is not an autism-specific construct, but a broader neurodevelopmental one.

Separately, a 2024 study published in PubMed examined social camouflaging specifically in Polish women with ADHD and found that higher levels of camouflaging were significantly associated with lower life satisfaction and increased depressive symptoms — confirming that the costs of ADHD masking are not merely anecdotal.

How ADHD masking differs from autism masking

While there is significant overlap, ADHD masking has some distinctive features that reflect the specific nature of ADHD difficulties:

The double exhaustion of ADHD masking: People with ADHD already experience executive function as more effortful than neurotypical people. Masking adds a second layer of cognitive demand on top of this — suppressing natural responses while simultaneously performing a different set of behaviours. The combined cognitive load is immense.

Why women mask more — the research evidence

Multiple lines of research suggest that women and girls with ADHD mask more extensively than men and boys. The 2020 expert consensus on female ADHD published in BMC Psychiatry by Young and colleagues noted that girls may employ more compensatory behaviours from an early age — observing, learning, and mimicking social norms in ways that disguise their ADHD traits more effectively than boys tend to.

This difference likely has multiple causes:

Social expectations and gender norms

Girls are socialised from early childhood to be attentive, organised, and socially attuned — qualities that directly conflict with ADHD. The social cost of failing to meet these expectations (social exclusion, criticism, being labelled "difficult" or "rude") is significant, and girls learn early that hiding their difficulties reduces these costs.

Boys with ADHD who are disruptive, impulsive, or inattentive are more likely to be referred for assessment. Girls with the same neurological profile who manage to perform expected gendered behaviour — even at enormous personal cost — are more likely to be described as capable but underperforming, disorganised, or anxious.

Academic performance as masking

A pattern identified in multiple studies is that girls with ADHD frequently maintain academic performance through compensatory effort — working significantly harder and longer than peers to achieve comparable results. This masks the impairment from teachers and parents, further reducing the likelihood of referral.

Quinn and Madhoo (2014) describe this as the "bright girl with ADHD" paradox: high intelligence and high effort combine to mask significant underlying impairment, deferring diagnosis until the combination of intellectual demands and life complexity exceeds the capacity to compensate.

Emotional masking

Women with ADHD are significantly more likely to internalise their emotional responses — suppressing anger, frustration, shame, and overwhelm rather than expressing them. Rucklidge (2010) noted that this internalising pattern means that the emotional dysregulation characteristic of ADHD in women presents as anxiety, depression, or self-criticism rather than as the outward behavioural dysregulation more visible in men.

Could you be masking ADHD?

Our free assessment includes a Social Strategies section specifically designed to identify masking and camouflaging behaviours alongside ADHD and autism trait screening.

Take the free assessment →

The cost of ADHD masking — what the science shows

Research is increasingly clear that extensive masking has serious consequences for mental and physical health.

Mental health

The 2024 study on social camouflaging and life satisfaction in women with ADHD found a significant negative correlation between camouflaging and life satisfaction, and a positive correlation between camouflaging and depression. Women who masked more extensively reported lower quality of life, higher psychological distress, and greater feelings of identity confusion.

This is consistent with findings from the autism masking literature (Hull et al., 2019) where extensive masking was strongly associated with anxiety, depression, and autistic burnout — a pattern that appears to extend to ADHD as well.

Burnout

ADHD masking burnout is increasingly recognised as a distinct phenomenon — a state of profound exhaustion that occurs when compensatory strategies that once worked simply stop being sustainable. Research on midlife women with ADHD documents a pattern in which functioning appears adequate through the 20s and early 30s, then collapses under the accumulated weight of masking in the late 30s and 40s.

The triggers for burnout typically involve a sudden increase in demands — having children, a career progression, bereavement, relationship breakdown — that pushes the system beyond its capacity to compensate.

Identity

A particularly under-researched but clinically significant cost of long-term masking is the erosion of authentic identity. Women who have masked extensively from childhood often report, post-diagnosis, significant difficulty identifying who they are without the mask — what their genuine preferences, responses, and ways of being actually are, separate from the performance they've maintained for decades.

Masking and diagnosis — the catch-22

ADHD masking creates a diagnostic paradox. The very behaviours that allow a woman to function and avoid recognition are the same behaviours that make it harder to receive a diagnosis when she seeks one.

In a clinical assessment setting, a woman who has spent 30 years perfecting the appearance of coping may present as highly competent and well-organised — particularly in the structured, short-duration context of an assessment appointment. The assessor sees the mask, not the person underneath it.

Research on autistic women (and increasingly, women with ADHD) has highlighted the need for assessors to specifically ask about internal experience, effort required to maintain functioning, and what happens when masking breaks down — rather than simply observing surface presentation.

If you believe masking is making your ADHD harder to identify, consider keeping a diary of your actual internal experience for 2–4 weeks before your assessment. Document the effort behind apparent competence, the recovery time required after social or professional interactions, and the symptoms that are present but hidden from others.

What reducing masking actually looks like

Reducing masking is not about abandoning all adaptive behaviour — some social adaptation is reasonable and necessary. It is about identifying which behaviours are genuinely chosen versus which are driven by fear of being seen as different or inadequate.

Research on autistic unmasking (a concept that extends to ADHD) identifies several stages: awareness (recognising what you're masking and why), experimentation (testing reduced masking in safer contexts), and integration (finding a sustainable balance between authentic self and necessary adaptation).

Therapy with a clinician who understands neurodivergent masking — particularly approaches like ACT (Acceptance and Commitment Therapy) and compassion-focused therapy — can be particularly helpful. Community connection with other women with ADHD, through groups like ADHD UK's peer support network, can also provide the experience of being genuinely seen and accepted that makes the mask feel less necessary.

References