When it comes to neurodivergent individuals, terms such as “high masking” and “low support needs” seem to signify that there exists a spectrum of distress, with people who are able to mask their symptoms existing on the lower end of the spectrum and therefore requiring minimal (or nonexistent) accommodations and intervention. When we pay attention to the lived experience of adults with ADHD, it becomes clear that this assumption can be far removed from the internal reality of people who are masking their symptoms and have been doing so for most of their lives.

It has been estimated that children with ADHD tend to receive over 20,000 more negative messages before they are ten years old, compared to their neurotypical peers. Add to this the fact that these children can be even more sensitive to criticism and rejection, it is no wonder why they learn at a young age that they are not accepted for who they are, that they have to change and present themselves differently in order to fit into social settings and be successful in life. This is the turning point where many of these kids start to constantly surveil their own behavior so they can avoid the criticism that awaits if they behave how they actually want to.

By the time these children with ADHD reach adulthood, they may be well-versed in the art of keeping their distress and dysfunction hidden from the outside world. Masking involves closely monitoring how their more socially successful peers are acting and attempts to replicate these patterns in their own lives. Since social learning is one of the core pathways to behavioral shaping, this is not always a bad thing. It is possible that some of the habits they adopt in this way actually help adjust to the demands placed on them by the outside world. However, the problem arises when masking continues to go against the innate needs of the ADHD individual. The child who learns that she will be punished if she swings her legs while sitting in class may have some success in sitting still if she repeatedly reminds herself of the consequences she will face, and to an unsuspecting teacher this can look as if the hyperactive behavior has been successfully eradicated. In truth, the child may still be struggling with a more internalised form of hyperactivity, where her thoughts run amok and she is unable to focus on what is being discussed in class. Going against her innate need for movement and stimulation will also lead to a constant sense of discomfort and restlessness, but she learns that this is easier to handle than a constant barrage of criticism from the adults around her.

Other examples of masking include obsessively checking belongings to see if something has been forgotten, having rehearsed social scripts to hide distractedness, developing subtle stims such as biting lips or twirling hair, excessively writing everything down so you don’t forget, channelling hyperactivity into sports, suppressing strong emotions and reacting how you are expected to etc.

In these and many other subtle ways, masking of ADHD symptoms starts to open up a rift between what is felt on the inside and what can safely be shown to people on the outside. Constant internal discomfort seems like a small price to pay when the only other option is the pain of social ostracism. This impossible conflict ultimately leads to a marked decline in quality of life. Children who have been masking ADHD for most of their lives have a much higher chance of growing into adults who may experience symptoms of anxiety, depression and the loss of a concrete sense of their own identity. This suppression of needs can even lead to health problems such as GI issues, migraines, autoimmune conditions and chronic pain etc.

Masking has commonly been the reason why many people assume that a person has grown out of ADHD and successfully assimilated into society, when the reality is that ADHD is a neurodevelopmental condition stemming from differences in brain structure so symptoms are highly unlikely to fade away with age. Masking of symptoms only makes it harder for any “red flags” of ADHD to be noticed so high masking individuals may not receive the diagnosis and accommodations that could have helped them develop healthier coping skills.

The purpose of spreading awareness of masking in ADHD is not to say that ADHD symptoms need to be fully expressed and felt in order to find healing, since it’s important to acknowledge that masking is unconsciously developed as a protective mechanism and may have served a purpose in helping people get through life in the absence of neurodiversity-accommodative structures. Simply discovering the complex interplay of their own ADHD and compensatory masking behaviors can begin to alleviate some of the heaviness that has been carried around since childhood. When people learn what has really been going on with them, they learn to have compassion for themselves and know that they are not flawed or broken, that they just needed to be supported a little differently. Now that they are adults, they can seek that support for themselves and slowly begin to take charge of the narrative around their own struggles.