While public understanding of attention deficit hyperactivity disorder (ADHD) has surged recently, the concept of ADHD masking remains largely under the radar.
In the lead-up to ADHD Awareness Month in October, specialists have outlined what it entails, the drivers behind such behaviours, and shed much-needed light on the potentially damaging consequences it can have on individuals living with it.
What is ADHD masking?
ADHD is a condition where the brain works differently to most people which can affect someone’s ability to pay attention to things, their energy levels and their ability to control their impulses, according to the NHS website.
“This can affect interactions between the individual and their immediate family and society at large,” says Dr Ahmed Shoka, consultant psychiatrist at Medical Express Clinic on Harley Street.
Some people with ADHD frequently “mask” their symptoms to appear more typical and fit into social, academic, or professional settings.
“ADHD masking is a set of learned behaviours that someone with ADHD is usually engaging in to be able to adjust or fit into social circumstances or to avoid stigma, or possibly also to compensate for challenges that they may be experiencing,” explains Dr Chetna Kang, consultant psychiatrist at Central Health London with expertise in adult ADHD.
These behaviours can be conscious or unconscious.
“When we think of the term masking, we usually think of people putting a mask on to consciously to cover something up. However, some of ADHD masking is unconscious and is learned very early in life, often in childhood,” says Kang.
What are some examples of ADHD masking behaviours?
“The behaviours can be quite varied, but are generally used to mask and cover up challenges that somebody is having with living a regulated life,” says Kang.
“For example, if someone with ADHD struggles to keep their space tidy, and have been told over and over again that they are really messy and they feel quite criticised for that, they may develop masking behaviours such as only tidying up when they have visitors.
“Furthermore, somebody who struggles to pay attention during one-to-one conversations might learn cues that make it sound like they’re generically paying attention so people don’t notice that they are drifting off or losing track. For example, they might force eye contact to look interested, but actually, they’re not really taking anything in.”
What impacts can masking have on an individual?
“When people feel like they have to engage in behaviours that cover up how they feel underneath, it can pose questions like, where can I be real? Where can I relax? Where can I be accepted? This can be quite stressful and can make people feel really anxious,” says Kang.
In addition, it can lead to burnout.
“Some masking behaviours can put people at risk of burning out and overworking,” says Kang.
“For example, some people with ADHD will work extra long hours so they don’t experience a career deficit, but this will be at the expense of their home life and health. On the surface, someone might look like they are floating, but underneath their legs might be flapping away incredibly fast.
“These kind of behaviours can lead to underdiagnosis and a delayed diagnosis of ADHD.”
Kang highlights that although masking might feel helpful to get someone through a situation in the short term, in the long term it’s an incredibly stressful state to remain in.
Is there any way to unlearn these behaviours?
“Often the best way to help people to remove conscious masks is to help them to understand the motives that is making them use a particular mask. For example, it might be driven by anxiety or judgment,” says Kang.
“When people start unearthing the motives behind the masking and also the costs of the masking, then they can start to adopt healthier attitudes.”
It’s often a long and challenging process, but can be incredibly rewarding.
“When ADHD is diagnosed and treated adequately and effectively, the reward and the response can be really pleasing and fantastic for both the patient and for the clinician,” says Shoka.
Kang agrees and says it’s often about learning a new normal.
“The whole idea around understanding and unpacking masking is about helping people to understand that once they start getting treatment, they don’t have the same deficits and drivers as before,” says Kang.
“As people do the work, they start to become aware of unconscious masking or masking that they learnt early on in childhood, because as the mask starts to come off, then all the the other masks under it also start to come off.”
