As a psychologist specialising in ADHD and ADHD masking in adult females, I've observed a recurring pattern that's both fascinating and heartbreaking.
Many women come to the realisation that they have ADHD only after becoming mothers, or maybe they don’t have kids, but they continue to struggle, and get exposed to therapy like CBT that gaslights them, and told that “it’s just anxiety”, or that ‘you’re just it bit dreamy/scatty”.
Picture this: You're a successful professional woman who's mostly been able to juggle tasks, meet deadlines (but with great stress and a rush!), and keeps most things running smoothly, but at a huge cost to your nervous system.
Then you have a child, and suddenly, your world turns upside down.
The multitasking skills you once relied on seem to evaporate.
You find yourself constantly overwhelmed, struggling to keep up with the simplest tasks.
The burnout is real, and you can't seem to bounce back like you used to.
This scenario is all too common.
The coping mechanisms that once served us well - the intricate systems of reminders, the late-night catch-up sessions, the constant mental juggling - begin to falter under the weight of motherhood's and life’s demands.
It's often at this point that many women begin to suspect that there's more at play, and we start to recognise patterns in behaviour that have been present all along, but were masked by an ability to compensate.
This realisation often leads to a journey of self-discovery, and for many, a diagnosis of ADHD. It's a moment of both relief and frustration - relief at finally having an explanation for lifelong struggles, and frustration at the years spent masking their true selves.
What is ADHD Masking?
ADHD masking is more than just hiding symptoms; it's an intricate dance of behaviours designed to help individuals blend in with societal expectations.
As psychologist Russell Barkley explains, it involves behaving in specific ways to cover up ADHD symptoms, both consciously and subconsciously. Recent research has shed light on the prevalence and impact of masking, particularly in women with ADHD[1].
Consider Sarah, a 35-year-old marketing executive - to her colleagues, she's the epitome of organisation and focus. What they don't see is the exhausting effort behind this façade – hours spent meticulously planning her day, arriving early to prepare, and constantly battling anxiety about maintaining this perfect image.
Masking ADHD traits for women is often more complex since society still often expects women to carry the mental load, be able to multi-task, and be ultimate organisers extraordinaire!
Masking is particularly prevalent among adults, especially women, who have grown up without an ADHD diagnosis. These individuals often create their own coping mechanisms, driven by the need for social acceptance and professional success. Women, in particular, may feel added pressure to mask due to gender expectations and societal norms.
Why we mask: Unravelling the motivations
Understanding why adults with ADHD engage in masking is crucial to addressing this complex behaviour. The reasons are often multifaceted and deeply rooted in personal experiences and societal expectations, with some reasons being particularly salient for women.
Social acceptance is perhaps the most common reason for masking, as society often misunderstands or stigmatises ADHD behaviours. This leads individuals to hide their true selves to avoid judgment or rejection.
For women, this can be particularly challenging as they navigate social expectations of being nurturing, organised, and emotionally stable.
In the workplace, ADHD traits like distractibility or impulsivity may be viewed negatively.
Masking becomes a strategy to appear more 'professional' and competent. Women may feel additional pressure to mask in male-dominated fields or to compete with neurotypical colleagues. The stigma associated with ADHD can be overwhelming, leading many adults to mask to avoid being labelled as 'lazy', 'unmotivated', or 'difficult'.
For women, there's often an added layer of stigma related to societal expectations of femininity and motherhood.
Years of negative feedback about ADHD behaviours can erode self-esteem, making masking a way to protect oneself from further criticism. Women may be particularly vulnerable to this due to societal pressures to be "perfect" in multiple roles. In personal relationships, individuals may mask to meet partners' expectations or to avoid conflicts arising from ADHD-related behaviours. Women often report feeling pressure to maintain harmony in relationships, which can intensify masking behaviours.
A recent study by Sedgwick et al. (2021) found that women with ADHD often engage in masking behaviours to conform to societal expectations and avoid stigma[2]. This masking can lead to delayed diagnosis and increased mental health challenges.
What we mask: The hidden aspects of ADHD
ADHD masking involves concealing a wide range of symptoms and traits. Individuals often try to hide:
Inattention
Hyperactivity
Impulsivity
Executive function challenges
Emotional dysregulation
Sensory sensitivities
Social interaction difficulties
Cognitive inconsistencies
Women may mask inattention by over-preparing, taking extensive notes, or using organisational systems that appear meticulous to others.
Hyperactivity might be masked through socially acceptable activities like leg bouncing or playing with jewellery.
Impulsivity is often concealed through elaborate internal dialogues to filter thoughts before speaking.
Executive function challenges, such as difficulties with time management and organisation, are frequently masked by creating complex organisational systems or by staying up late to complete tasks. Emotional dysregulation, including intense emotional reactions and mood swings, is another area where masking is common. Women may be particularly prone to masking emotional dysregulation due to societal expectations of women being emotionally stable and nurturing.
Sensory sensitivities, such as overwhelm from noisy environments or discomfort with certain textures, are often hidden, with women often appearing "put together" despite sensory discomfort.
Social interaction difficulties, including challenges in reading social cues and maintaining expected social behaviours in long interactions, are also frequently masked. Women often develop sophisticated masking techniques to navigate social situations, which can be particularly draining.
How We Mask: Strategies and Techniques
ADHD masking involves a variety of strategies, often tailored to specific situations and symptoms. For inattention, individuals might engage in over-preparation, strategic positioning in rooms to minimise distractions, constant note-taking, and using clarification techniques.
Women may feel extra pressure to appear organised and prepared in all aspects of life.
To mask hyperactivity, people might channel restlessness through subtle energy outlets, take frequent short breaks, or practice conscious body control. Women might choose more socially acceptable forms of fidgeting, like playing with jewellery or hair. Impulsivity is often masked through delayed response techniques, scripting of responses, and quick subject changes to avoid interrupting or oversharing.
For executive function challenges, individuals might use excessive alarms and reminders, outsource organisation, or front-load work to hide struggles with time management and task initiation. Emotional regulation masking often involves active suppression of emotions, excuse-making to leave overwhelming situations, and using humour as deflection.
Emma, a 37-year-old lawyer, embodies many of these masking strategies. She arrives at court an hour early to organise her files, masking her challenges with time management. During long trials, she discreetly uses a small fidget toy in her pocket to manage her restlessness. She's memorised common legal phrases and responses to appear quick-witted and focused, masking her struggles with verbal impulsivity and attention. But behind the scenes, she struggles with the constant pressure to maintain this perfect façade, a struggle that is all too common for women with ADHD in high-pressure careers.
The hidden toll of ADHD masking
While masking may seem like a helpful strategy in the short term, it often comes with significant long-term costs. The constant effort to maintain a neurotypical façade is mentally and emotionally draining. For women, who may be juggling multiple roles and expectations, this exhaustion can be particularly acute.
The pressure to 'perform' normality can lead to increased anxiety and feelings of inadequacy. Women with ADHD may be at higher risk for these mental health issues due to societal pressures and the often later diagnosis of ADHD in females. Constantly hiding one's true self can lead to a disconnection from one's identity and strengths. This can be especially challenging for women, who may already struggle with societal expectations of femininity.
Effective masking can sometimes prevent or delay proper diagnosis and treatment. This is a particular issue for women, whose ADHD symptoms are often overlooked or misdiagnosed as anxiety or depression. The gap between the masked self and the real self can lead to intense feelings of being a fraud. Women in professional settings may be particularly vulnerable to this, especially if they feel they've succeeded by "tricking" others into not seeing their ADHD.
A recent study by Livingston et al. (2023) found that ADHD masking is associated with increased stress, anxiety, and depression, particularly in women[3]. This underscores the potential mental health risks of long-term masking and the need for better understanding and support for individuals with ADHD.
Supporting ourselves: Strategies for authenticity
Recognising and addressing ADHD masking is crucial for improving the well-being of adults with ADHD, particularly women. Here are some strategies to support ourselves:
Cultivate self-awareness by reflecting on our masking behaviours and their triggers.
Seek professional help from mental health professionals who specialise in ADHD, particularly in women.
Consider an ADHD assessment if you suspect you have ADHD or struggle with masking behaviours.
Build a support network with other adults, especially women, with ADHD who understand the challenges of masking.
Practice self-compassion and recognise that ADHD is a neurodevelopmental condition, not a personal failing.
Educate others about ADHD, particularly how it presents in women, to foster understanding and reduce the need for masking.
Embracing authenticity: The first step
ADHD masking is a complex issue that affects many adults living with the condition, with women often facing unique challenges due to societal expectations and gender norms. While it may seem like a necessary survival strategy, the long-term effects of masking can be detrimental to mental health and self-esteem.
Booking an adult ADHD assessment with us can provide crucial insights into masking behaviours and offer tailored recommendations for managing them. With the right support and understanding, it's possible to navigate the challenges of ADHD masking and embrace one's true self.
Contact us today - we live and breathe this - we GET this, and can help you understand yourself better too.
Whether you're a woman who's always felt "different" but couldn't quite put your finger on why, or anyone struggling with the exhausting act of constant masking, we're here to help you to connect with your authentic self and survive with ADHD.
References:
[1] Fugate, C. M., & Gentry, M. (2021). Understanding Adolescent Gifted Girls With ADHD: A Multiple Case Study. Roeper Review, 43(2), 136-148.
[2] Sedgwick, J. A., Merwood, A., & Asherson, P. (2021). The positive aspects of attention deficit hyperactivity disorder: a qualitative investigation of successful adults with ADHD. ADHD Attention Deficit and Hyperactivity Disorders, 13, 261-276.
[3] Livingston, L. A., Shah, P., Milner, V., & Happé, F. (2023). Quantifying compensatory strategies in adults with and without diagnosed autism. Molecular Autism, 14(1), 12.
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