Unmasking ADHD
Recognize what's flying under the radar
ADHD is often thought of as a condition that’s easy to spot — a hyper child running around, acting impulsively, or constantly talking.
However, many children and adults with ADHD don’t exhibit these symptoms. They are able to mask their symptoms, consciously or unconsciously, to fit in or avoid criticism. This masking can make it challenging to identify ADHD, delaying proper diagnosis and treatment.
Last week I wrote about commonly missed signs of ADHD. If you missed it, you can find it here:
Understanding how ADHD is masked and how to uncover hidden symptoms is crucial for early intervention and long-term well-being.
What Is ADHD Masking?
Masking involves consciously or unconsciously suppressing or compensating for ADHD symptoms to appear more neurotypical, often in response to societal expectations or fear of judgment. This can be especially common in women, girls, and individuals from marginalized groups, who may face greater pressure to conform.
For children, this might mean staying quiet in class, meticulously following rules, or over-preparing to avoid mistakes. Adults might create elaborate systems to stay organized or over-apologize for missed deadlines. While these strategies can help individuals navigate daily life, they often come at a high cost — exhaustion, anxiety, and a deep sense of inadequacy.
How ADHD Symptoms Are Masked
Academic Achievement: Many children with ADHD are bright and capable of achieving good grades, but this can mask underlying struggles. Look beyond the grades to comments on report cards. Teachers may note issues like incomplete assignments, poor focus, or difficulty staying on task. These are often hints of ADHD.
Behavioral Compliance: Quiet, well-behaved children — especially girls — are often overlooked. Daydreaming, difficulty starting tasks, or zoning out during lessons can go unnoticed if the child isn’t disruptive.
Overcompensation: Adults and older teens may develop coping mechanisms like hyper-organization, working long hours, or avoiding challenging tasks altogether. These strategies can hide their struggles but often lead to burnout.
Social Adaptation: Kids and adults with ADHD might attempt to mirror other people’s behavior or withdraw socially to avoid situations where their symptoms could be exposed.
Uncovering the Mask: Tips for Identifying ADHD Symptoms
To see beyond the mask, you need to look for patterns and subtle signs of struggle. Here’s how:
Keep a Log of Symptoms: Track behaviors and challenges at home, school, and in community settings. Note patterns such as difficulty focusing, emotional outbursts, or frequent forgetfulness. Over time, you’ll see trends that may indicate ADHD.
Examine Report Cards: Pay close attention to teacher comments. Phrases like “needs to focus more,” “has potential but doesn’t apply themselves,” or “is easily distracted” can be red flags. Even if grades are strong, ask yourself if they come at the cost of your child’s mental health.
Observe Emotional Regulation: ADHD often affects emotional regulation. Watch for signs of frustration, difficulty handling criticism, or extreme reactions to minor problems.
Educate Yourself: Learn about ADHD symptoms and how they present differently in boys, girls, and adults. This knowledge will empower you to advocate for yourself or your child.
Consult Experts: If you suspect ADHD, speak with a healthcare professional who understands the condition. Comprehensive evaluations, including input from parents, teachers, and the individual, are essential for accurate diagnosis.
Why Early Diagnosis and Treatment Matter
Dr. Russell Barkley, a leading ADHD expert, has highlighted the risks of untreated ADHD. I was fortunate to hear him talk about his research findings twice in 2018, once in Kansas City at the Midwest ADHD Conference and then at the 2018 International ADHD Conference in St Louis.
I took this photo at the Midwest Conference, featuring Dr. Barkley alongside ADHD advocate, author, and educator Chris Dendy, as well as my good friend and ADHDKC founder, Jeremy Didier.
His talk is also recorded and free to watch on How ADHD Shortens Life Expectancy: What Parents and Doctors Need to Know. I encourage you make the time to listen to this enlightening webinar.
Key findings of Dr Barkley’s research show that people with ADHD have increased risks, including:
Shortened Lifespan: Untreated ADHD is associated with risk-taking behaviors, accidents, and health issues like obesity, diabetes, and cardiovascular disease.
Mental Health Challenges: Depression, anxiety, and even suicidal thoughts and death by suicide are more common in individuals with untreated ADHD.
Substance Abuse: Struggling to cope with symptoms often leads to self-medication with drugs or alcohol.
By identifying ADHD early and implementing effective treatments, such as therapy, medication, and lifestyle adjustments, you can help reduce these risks and improve quality of life.
Advocating for Change
Teachers, coaches, and even healthcare providers can miss ADHD symptoms, especially in those who are bright and motivated to fit in and do what is asked of them.
Share your observations, provide documentation, and push for comprehensive evaluations that involve more than just a standardized survey. Some individuals with ADHD may fail to meet the diagnostic criteria for ADHD based on standardized surveys or assessments due to masking despite actually having ADHD. The questions on surveys do not tell the whole story! Talking about the concerns can help identify masked ADHD.
Masking can include over-preparing for tasks, mimicking the behaviors of others, or developing rigid routines to avoid mistakes. While these strategies may help them "blend in," they often come at a significant emotional and cognitive cost, leading to exhaustion, anxiety, and a diminished sense of self. As a result, their struggles may go unrecognized, leaving them without the support and accommodations they need to thrive.
It is imperative that you advocate for your child (or self) if you feel a diagnosis is missed. Find a physician or psychologist with experience evaluating for ADHD using history in addition to surveys.
Remember, a proper diagnosis is the first step toward unlocking potential and ensuring long-term success.
What to do if you Suspect ADHD
If you recognize these signs in your child or yourself, consider these steps:
Track behaviors: Keep a log of symptoms and patterns at home and during community activities. Look at the comment sections of report cards — not just the grades. Many bright kids keep up their grades, but there is a cost!
Talk to the teacher: Home and school settings have different structures, so knowing how your child performs at school is important. Keep in mind though that a teacher may not recognize internal focus struggles if a student performs well academically and isn’t significantly disruptive in class.
Speak to a professional: Pediatricians, psychologists, psychiatrists and other physicians can perform evaluations to properly investigate symptoms. Start with your regular physician to see if they can do the assessment or if they have a favorite specialist.
Educate yourself: Learn about ADHD to better understand its challenges and strengths. CHADD is a national organization with many local chapters (ADHDKC is my home chapter) that provides ADHD education and support for individuals and families. Check out CHADD’s podcasts, blog, magazine, toolkits and more!
ADHD is a lifelong condition, but with proper support, individuals can thrive. Recognizing the signs — especially the subtle ones — is the first step to making a meaningful difference.
So, if you think your child is “doing okay” and you are leaning against getting a proper diagnosis or starting treatment with a diagnosis, think again. There is more at stake than just good grades.