Introduction
ADHD, or Attention-Deficit/Hyperactivity Disorder, is a neurodevelopmental disorder that impacts individuals’ ability to focus, control impulses, and regulate their behavior. While commonly associated with children, ADHD can persist into adulthood, posing unique challenges across various life domains. An intriguing phenomenon within ADHD is the concept of “masking,” where individuals conceal their symptoms and develop coping mechanisms to navigate daily life.
What is Masking in ADHD?
Masking refers to the conscious or unconscious hiding of ADHD symptoms to conform to societal expectations. Individuals with ADHD might develop strategies to hide their symptoms, such as intense focus on tasks to avoid appearing inattentive or rehearsing social interactions to avoid impulsive comments. This behavior is particularly common among women and girls with ADHD, who may feel additional pressure to meet gender-specific societal norms (Quinn & Madhoo, 2014).
It's important to note that the concept of masking is not yet a fully established scientific body of research. Most current understanding comes from anecdotal evidence and studies discussing masking as a potential explanation for observed behaviors, particularly in women with ADHD.
Research Insights
Gender Differences:
Research indicates that women and girls with ADHD may utilise compensatory strategies to mask their symptoms, potentially leading to underdiagnosis within this demographic (Quinn & Madhoo, 2014). Understanding masking in ADHD is crucial for acknowledging the varied experiences of individuals with the condition and tailoring support and interventions effectively.
Psychological Impact:
The constant effort to suppress natural behaviors and mask ADHD symptoms can be emotionally draining and exhausting. Individuals may expend significant mental and emotional energy to hide their neurodiversity (Syharat, n.d.). This can lead to burnout and emotional exhaustion, especially in demanding environments like graduate programs (Syharat, n.d.). Addressing emotion dysregulation in ADHD can improve emotional control and overall quality of life (Asherson et al., 2015). Effective management of ADHD symptoms, including emotional dysregulation, is crucial for alleviating adverse functional outcomes and improving overall quality of life (Hosiri, 2024; Asherson et al., 2015; Rosen et al., 2015).
Social Implications:
A study by Ginapp et al. (2023) delves into the experiences of adults with ADHD in interpersonal relationships and online communities. While specific studies on masking are limited, research has shown that girls with a childhood ADHD diagnosis continue to experience impairment into adulthood (Hinshaw et al., 2012). Social isolation and peer rejection are common, but attributing these directly to masking requires further research.
Intelligence and Masking ADHD Symptoms
Intelligence can play a significant role in masking ADHD symptoms. Individuals with higher intelligence and better executive functioning during childhood may develop effective coping mechanisms that allow them to adapt socially and academically, thereby masking their ADHD symptoms (Kosaka et al., 2019). This can result in a delayed diagnosis, as their intellectual abilities may compensate for their ADHD-related challenges until adulthood.
Burnout and ADHD
The emotional and psychological strain of masking ADHD symptoms can lead to burnout. Individuals with ADHD are at an increased risk of psychological distress and burnout, particularly in high-demand environments that require extensive interpersonal communication (Higuchi et al., 2016). The constant effort to manage and conceal symptoms can be exhausting, highlighting the need for early intervention and support to prevent long-term mental health issues.
Why Do People Hide Their ADHD?
Stigma and Misunderstanding
There is a significant stigma attached to ADHD, with misconceptions about laziness or lack of discipline. This societal misunderstanding can drive individuals to mask their symptoms to avoid negative labels.
Professional Pressures
In workplaces, the pressure to perform and conform to expected standards can push
individuals with ADHD to hide their symptoms. They may fear that disclosing their condition could affect their career prospects.
Personal Relationships
In personal relationships, individuals with ADHD might mask symptoms to avoid conflict or to fit in better with peers and family members.
Consequences of Masking ADHD
The following examples are taken from a mixture of research and anecdotal information gathered from the ADHD community sharing their lived experience.
Emotional Exhaustion:
The continuous effort to hide symptoms can lead to chronic stress and emotional exhaustion, negatively affecting mental health.
Delayed Diagnosis and Treatment:
Masking can delay proper diagnosis and treatment, as the symptoms are not fully visible to healthcare providers.
Identity Struggles:
Constantly hiding a part of oneself can lead to identity issues and low self-esteem, as individuals may feel they are not being true to themselves.
Conclusion
While masking ADHD symptoms might provide short-term relief from societal pressures, it can lead to significant long-term psychological and emotional challenges. It is crucial to foster a more accepting and understanding environment where individuals with ADHD feel safe to express their true selves and seek the support they need. Encouraging open discussions and increasing awareness about ADHD can help reduce the stigma and improve the quality of life for those affected.
References
Asherson, P., et al. (2015). Addressing emotion dysregulation in ADHD. Journal of Clinical Psychiatry, 76(5), e684-e685.
Ginapp, C. M., Greenberg, N. R., Macdonald-Gagnon, G., Angarita, G. A., Bold, K. W., & Potenza, M. N. (2023). The experiences of adults with ADHD in interpersonal relationships and online communities: A qualitative study. SSM - Qualitative Research in Health, 3, 100223.
Hinshaw, S. P., et al. (2012). Prospective follow-up of girls with attention-deficit/hyperactivity disorder into early adulthood: Continuing impairment includes elevated risk for suicide attempts and self-injury. Journal of Consulting and Clinical Psychology, 80(6), 1041-1051.
Hosiri, R. (2024). Managing ADHD symptoms for better functional outcomes. Clinical Psychology Review, 32(2), 123-135.
Kosaka, H., Fujioka, T., & Jung, M. (2019). Symptoms in individuals with adult-onset ADHD are masked during childhood. European Archives of Psychiatry and Clinical Neuroscience, 269(8), 753-755.
Normand, S., et al. (2010). The role of executive function in ADHD: Implications for behavioral and emotional symptoms. Journal of Child Psychology and Psychiatry, 51(8), 891-898.
Quinn, P. O., & Madhoo, M. (2014). A Review of Attention-Deficit/Hyperactivity Disorder in Women and Girls: Uncovering This Hidden Diagnosis. Primary Care Companion for CNS Disorders, 16(3).
Rosen, P. J., et al. (2015). Emotional lability in children with ADHD. Journal of Attention Disorders, 19(3), 217-224.
Syharat, J. (n.d.). The energy cost of masking ADHD symptoms.
Higuchi, Y., Inagaki, M., Koyama, T., Kitamura, Y., Sendo, T., Fujimori, M., Uchitomi, Y., & Yamada, N. (2016). A cross-sectional study of psychological distress, burnout, and the associated risk factors in hospital pharmacists in Japan. BMC Public Health, 16, 534.
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