ADHD is a neurodevelopmental condition involving low impulse control, hyperactivity, and difficulty focusing. Not everyone with ADHD experience these symptoms, but a combination of them is likely.
Healthcare professionals often diagnose ADHD during childhood, and symptoms frequently persist into adulthood. Sometimes, the condition goes undiagnosed for a long time because of misdiagnosis or other reasons, including ADHD masking.
Treatment for ADHD, including medication and behavioral therapy, is effective and may reduce symptoms significantly, improving your quality of life.
What is masking in ADHD?
Masking in ADHD is when you hide or disguise some of your symptoms so others don’t notice you are experiencing these challenges. Masking can be a voluntary effort or an involuntary strategy you develop.
Masking as a coping strategy is also called “camouflaging” and is not exclusive to ADHD. People with some forms of autism spectrum disorder may also mask their symptoms to blend in socially and overcompensate for what they may perceive as a vulnerability.
Masking in ADHD has limited studies compared to autistic masking, but it may function similarly.
A small 2023 study of 43 people with an ADHD diagnosis says that participants tended to mask symptoms around neurotypical people and not neurodivergent people. Neurotypical refers to people whose brains may work similarly to most other people. Neurodivergent refers to atypical neurodevelopment.
The study concludes that social stigma and ableism may significantly contribute to people needing to mask their ADHD-related challenges in front of others who do not experience them.
Symptoms of ADHD per type
According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision, there are three main types of ADHD:
- predominantly inattentive presentation
- predominantly hyperactive impulsive presentation
- combined presentation
Symptoms of inattentive ADHD may manifest as someone who:
- misses details or appears to make careless mistakes
- has difficulty holding attention during tasks or play
- doesn’t seem to listen when spoken to
- loses focus and gets sidetracked in schoolwork or work duties
- has difficulty organizing activities and tasks
- avoids tasks that require sustained mental effort
- loses items like keys and school supplies
- gets easily distracted
- seems forgetful in day-to-day activities
Symptoms of the hyperactive impulsive ADHD type may look like someone who:
- fidgets, squirms, or taps hands and feet constantly
- has difficulty remaining seated or in place
- experiences and expresses strong emotions that are hard to manage
- runs and climbs when it may be considered inappropriate (children)
- feels restless and on edge (adults)
- feels unable to engage in quiet play or leisure
- is often “on the go”
- talks without taking many pauses
- has difficulty waiting for turns
- answers questions before someone completes asking it
- speaks out of turn and over other people
Not everyone with ADHD experience all of these symptoms. The intensity differs from person to person. Someone over the age of 17 years will present at least five of them, while children will have six or more.
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Which symptoms do people commonly mask in ADHD?
ADHD may look and feel different from person to person. The condition doesn’t take away your individuality, so everyone may have a different reason to mask symptoms or when to do it.
In a 2023 study involving some lived experiences of adults with ADHD, participants described instances where they tended to mask their ADHD symptoms.
The most common examples of ADHD masking in the study were related to overcompensating. Participants reported acting in such a way that they’d engage in behaviors opposite to their actual challenges. Examples included:
- masking low impulse control with apparent delayed decision-making
- masking intense emotions with an attitude of indifference or aloofness
- masking hyperactivity common during their childhood with extreme quietness in adulthood
Studies in adults with ADHD also indicate that many have developed strategies to manage ADHD symptoms, such as masking, resulting in delayed diagnosis and treatment.
For example, a small 2020 study of 10 adults with ADHD, ages 50 years and older, found that participants engaged in different strategies. Some of these included jogging in the evening to reduce restlessness before bedtime or using Post-it notes and calendar alarms to keep track of important events they’d otherwise miss.
ADHD masking may also arise when trying to disguise:
- difficulty following a conversation
- high energy or wanting to move around
- the urge to fidget or squirm
- intense emotions
What does ADHD masking look like?
ADHD masking may look like different things depending on your personality, the reason why you’re masking, how aware you are of doing it, and social pressures that lead you to mask in certain instances
Some examples of ADHD masking may include:
- putting in excessive effort in the form of extra hours to achieve a goal you have difficulty with
- checking many times over your work for errors before presenting it to your manager
- repeating everything someone tells you during a conversation to compensate for your difficulty keeping up
- setting multiple alarms during the day to alert you about even the simplest tasks
- being purposely silent or quiet around others so you don’t get asked into conversation
- pinching yourself or doing something else to deviate you from fidgeting or squirming
- getting into minor involuntary accidents right before an important task or presentation
Treated vs. untreated ADHD
ADHD often responds well to treatment. It may improve attention and focus and reduce symptoms of hyperactivity and impulsivity.
Treatment, particularly psychotherapy, may provide resources and tools to better cope with your symptoms, reducing the need for ADHD masking.
A 2020 study mentioned earlier suggests that people who have gone undiagnosed for ADHD for a long time typically have a sense of inner chaos and report more challenges with social interactions. Once they receive the diagnosis and start treatment, their quality of life improves rapidly.
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Get free cardTreatment for ADHD masking
Treatment for ADHD does not focus specifically on masking. It usually involves behavioral therapy and medications that reduce the need for masking. Both children and adults benefit from ADHD treatment.
Behavioral therapy
Behavioral therapy involves developing practical strategies to cope with challenges. Cognitive behavioral therapy is an effective solution-focused interpersonal therapy for adults that helps you identify and achieve goals while managing challenges.
Parent training is key in behavioral therapy for children under the age of 6 years. A therapist usually focuses on helping parents learn techniques to encourage positive behaviors in children and manage unwanted behaviors.
Older children also benefit from behavioral therapy by developing organizational and socialization skills and tools for classroom success. These strategies and their parents’ understanding of their challenges may make ADHD masking less necessary for the children.
Medications
Healthcare professionals may recommend medications for adults, adolescents, and children over 6 years with ADHD.
Stimulant medications for ADHD may include:
- methylphenidate (Ritalin, Concerta)
- dextroamphetamine (Adderall)
Stimulant ADHD medications are also available in different forms and names, including:
- amphetamine patch (Xelstrym)
- amphetamine extended-release oral suspension (Dyanavel XR)
- extended-release methylphenidate (Jornay PM)
Nonstimulant ADHD medications may include:
- viloxazine (Qelbree)
- clonidine ER (Kapvay)
- atomoxetine (Strattera)
- guanfacine (Intuniv)
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Summary
Masking in ADHD is when you voluntarily or involuntarily hide or disguise symptoms so others don’t notice them. Examples may include forcing yourself to sit still, staying quiet in conversation, or working twice as hard.
Coping strategies like ADHD masking may sometimes delay a diagnosis.
Treatment for ADHD can provide tools to cope and reduce the need for masking behaviors. Stimulant and non-stimulant medications, as well as behavioral therapy, are effective options for ADHD.