Masking beyond spooky season: adaptations and survival for women with ADHD and Autism
Late October is the time of year when everyone agrees that wearing a mask is a reasonable thing to do. Whether trick or treating, handing out candy, going to a Halloween party, or just getting into the spirit of the season, everyone can experiment with being someone or something else.
But for folks who are neurodivergent, it often becomes apparent at an early age that to maneuver through the world you have to make slight changes with how you present yourself; your facial expressions, your tone of voice, the phrases you use, the interests you express, your desire to participate in certain obligatory interactions or activities over others. Especially for women and female-identifying folks, who are often taught that adapting to their social surroundings and people-pleasing is essential to their value as a human being, this kind of costuming becomes second nature. After years it often becomes completely subconscious, making it difficult to connect with the real you at all.
We commonly call this masking, and while we all adapt a little to the company we’re around, for neurodivergent folks it is more about survival than simply getting along with different people in our social sphere. How can becoming more aware of masking help women with autism and/or ADHD get more in touch with their true selves?
What Masking Actually Is
Masking, also called camouflaging in the research literature, refers to the conscious and unconscious strategies neurodivergent people use to appear neurotypical. Hull and colleagues (2017) described it in a study of autistic adults as the effortful management of appearing typical, and later work identified three distinct components (Hull et al., 2019):
Compensation. Actively developing workarounds for things that are genuinely harder. Rehearsing conversations in advance. Studying how other people do small talk and reverse-engineering it. Keeping a mental library of scripts for common interactions.
Masking proper. Suppressing the things that would give you away. Forcing eye contact that feels invasive. Sitting on your hands to stop them from moving. Modulating your voice. Not talking about the thing you actually want to talk about because you have learned that four minutes is the limit before people's faces change.
Assimilation. Pushing through environments that are physically uncomfortable in order to be included. Going to the loud restaurant. Staying at the party past the point your system was overwhelmed. Acting like everything is fine while the fluorescent lights are creating a low hum of distress.
ADHD masking works similarly and is often less discussed. It looks like elaborate compensatory systems nobody sees, doing three hours of prep so a thirty-minute meeting appears effortless, staying up until two to finish something you could not start until midnight, preemptively apologizing for things you have not yet failed to do, and making very sure that no one is ever in your car or your house without warning.
The unifying feature across all of it is that the effort is invisible and the output is often unnotable. Which is both the point–to blend in–and the problem.
No Two People Mask the Same Way
Masking varies enormously depending on what you were penalized for, what you were rewarded for, and what environment you were adapting to.
Some of what it looks like in practice:
Mirroring. Unconsciously adopting the speech patterns, humor, mannerisms, or interests of whoever you are with, sometimes to the point that you are a noticeably different person across friend groups.
Scripting. Preparing conversations in advance, including likely responses and your responses to those.
Overpreparation. Arriving with far more work done than anyone required, because being caught unprepared once was intolerable.
Suppressed stimming. Redirecting into socially acceptable versions: leg bouncing, hair twisting, skin picking, pen clicking, chewing.
The volume dial. Managing enthusiasm downward because being sensing you were annoying or irritating others during a moment of unawareness when you were younger stuck with you forever.
Perfectionism as camouflage. If the work is flawless, nobody asks how it got done.
Humor/Self-deprication. Getting there first with a joke about your own scatteredness so nobody else has to name it.
Selective disclosure. Presenting a curated version of your competence and hiding the parts that would raise questions.
Compliance. Going along with plans you did not want, in environments you found unbearable, because objecting drew attention.
Some people mask primarily at work and drop it at home. Some mask at home and are most themselves at work. Some people cannot identify a single context in which they are not doing it, including alone, which is incredibly disorientating, and once it comes to light, might leave you feeling as if you don’t know your true self at all.
Why This Looks Different for Women and Gender-Expansive People
Gender and neurodivergence is an important intersection, both for the impact on mental health and for how, once you identify how you’ve been masking, you get in touch with your true self.
Research on camouflaging has consistently found that autistic women engage in more of it than autistic men, and that this contributes directly to underdiagnosis and to diagnosis occurring much later in life (Lai et al., 2017; Hull et al., 2020). The same pattern holds in ADHD, where women are substantially underrecognized and where the internalized presentation is less likely to be flagged than the disruptive one (Hinshaw et al., 2022). Diagnostic criteria were built on observations of boys, and the behaviors clinicians were taught to look for are the behaviors girls are most trained to suppress.
From an interpersonal perspective, a feminist-relational lens helps us to identify how different expectations are put on children assigned female at birth, and how those expectations explicitly not just impact but encourage masking. Girls are socialized from early childhood into monitoring the emotional states of others, adjusting their behavior to maintain group harmony, being agreeable, and being pleasant. Those are the exact skills that masking requires. The culture does not merely permit girls to mask. It teaches masking explicitly, neurodivergent or not, and praises female-assigned children who perform this way consistently as well-behaved, mature, or easy.
So an autistic or ADHD girl who develops elaborate camouflaging is not seen as struggling. She is seen as a good student, daughter, or friend. Her exhaustion is invisible because the thing exhausting her is the thing everyone is applauding.
For queer and trans people, this compounds further. If you already learned to read a room before disclosing anything about yourself, adding a neurodivergent layer to that management is not a new skill, but it is a tool that must be wielded nearly constantly. Many people describe not knowing which parts of their self-editing are about their neurotype and which are about safety, because both systems were running simultaneously since childhood.
The fawn response is relevant, as well. Pete Walker described fawning as a trauma response in which a person maintains safety by accommodating, appeasing, and prioritizing others' comfort. Functionally, masking and fawning can be nearly indistinguishable from the outside, and for people with both a neurodivergent profile and a trauma history, they are frequently braided together.
What It Costs
Masking works, and that’s why it is such a regular coping strategy. Again, we all mask, or adapt to our social surroundings, in some way every day. And further, this was a tool for survival that you and your brain were absolutely brilliant to utilize. But if you’re coming to therapy with new awareness of what masking has been costing you, exploring that impact will be the motivating factor in becoming more authentically yourself.
Some ways masking weighs on us include:
Physiological depletion. Sustained masking is effortful cognitive and emotional labor running underneath everything else you are doing. Research on autistic burnout describes the cumulative exhaustion that results from prolonged masking and unaccommodated demands, with features including chronic fatigue, loss of skills you previously had, and increased sensory sensitivity (Raymaker et al., 2020).
Delayed recognition. Many neurodivergent people have reduced interoceptive awareness, which means the signals that you are past your limit arrive late or not at all. You find out you were overwhelmed after you are already in the aftermath.
The collapse pattern. Holding it together completely all day and then being unable to speak, move, or tolerate anyone in your household for the evening. If your family gets the version of you that has nothing left, that is not a statement about how much you love them.
Anxiety and depression. Camouflaging is associated with higher rates of both, and researchers have identified it as a meaningful risk marker in autistic adults, including for suicidality (Cassidy et al., 2018). This is one of the clearest reasons to take masking seriously as a clinical issue rather than a personality quirk.
Self-concept erosion. This is the one people describe as most disturbing, and it deserves its own section.
Who Is the Real You
If you have been masking since childhood, the question of what you actually like, want, and feel can be genuinely difficult to answer. You might notice you have difficulty stating your preference for a restaurant or movie, knowing what you want to do with your free time or for work, or what you really need in relationships (let alone how to communicate your preferences and needs.)
What is your favorite food? What do you want to do this weekend when no one is watching? Do you like this person or have you simply learned to be pleasant around them? What does your voice sound like when you are not adjusting it? It is not weird or bad if these questions are hard for you to answer, and it is incredibly brave to allow yourself to be curious as start from scratch.
This confusion happens because a self-concept is built partly through feedback, and if the feedback you received was always to the mask, then the version of you that got reinforced was the performance. The parts that were penalized were suppressed rather than mirrored, often before you had language, and they have not been out much since. So of course you can’t immediately recall them. In some cases, you might not have ever even gotten to figure out what you prefer or feel in the first place.
Internal Family Systems offers a useful frame here. In that model, the masking is understood as a protective part of you rather than a false self covering a true one. That part developed for a reason, at a specific age, in a specific environment, and it has been working extremely hard on your behalf ever since. The goal in therapy is not to remove it or shame it. The goal is to get to know it, understand what it has been protecting you from, and eventually give it a say in when it works and when it can rest. Not only is that part of your strong and brave, a little bit of adapting is also an important social skill and that part will know exactly what to do once we help it feel safe.
By welcoming this protector part into the whole (while also not letting it run the show!) we can stop thinking of the “real you” as something that is buried or completely absent. We all are a compilation of lived experiences, and the real you includes the person who developed a sophisticated system for staying safe in environments that were not built for them. That competence is yours. What you get to decide is where and when to deploy it.
How can therapy help with masking?
Once you’ve developed awareness around masking and how you have used it personally within your own life, a therapist who specializes in neurodivergence will help you identify the different elements that tend to come along with naming masking, and acknowledging that you’ve been utilizing it most of your life. Putting forward a self that was designed to please everyone but yourself can feel a bit complicated. But that’s where therapy comes in.
Sorting the threads. Which of your patterns are neurodivergent traits, which are masking, which are trauma responses, and which are reasonable adaptations to a specific environment. Most people arrive with all of it fused, and separating it changes what the next step is. In some cases, you might not be able to tell. And that is also ok. What matters is that you create language and a narrative about your journey that helps you make sense of how you got there, and verbalize where you want to go.
Building interoceptive awareness. Somatic approaches are particularly useful for noticing depletion earlier. If you cannot feel that you are at seventy percent, you cannot stop before you hit zero. This is slow, practical work and it makes an enormous difference. It might be as simple as the handy therapist go-to of “where do you feel that?” Connecting with your real self after you’ve been protecting and dissociating through masking for so long will often involve reconnecting to and feeling safer in your body.
Processing the grief. Recognizing that you have been performing for decades tends to bring up real loss: the versions of you throughout the years who didn’t get to be their true selves freely, for the support you did not get, the relationships in which you were never fully known, the energy that went into the performance instead of into your life. This can be especially poignant for parents who have neurodivergent kids themselves, as you see the specific support and accommodations you were never given access to, let alone the acceptance and unconditional regard from caregivers and educators. Just like any kind of grief, this grief needs room and time, and therapy is one of the best ways to take up space for your personal loss.
Reducing masking in safe contexts first. Much like exposure therapies, demasking is a gradual and intentional process, as the purpose is to build a sense of safety and self-efficacy. Therapy is often the first low-stakes environment for it, which is one reason a neurodiversity-affirming clinician matters. A therapist who reads your unmasked communication style as resistance or as poor social skills will not be useful to you. Further, you get to decide how much you want to mask or unmask. This is about values. It’s a hard conversation to acknowledge making friends or getting close to certain people will be harder if you totally demask; but choosing to value authenticity and self-love is incredibly rewarding, and the proportion of how you chose to navigate socially and how much energy you want to put into adapting each day, if at all, is completely up to you.
Developing discernment about safety. Unmasking is unfortunately not universally safe for everyone in every situation , and any framing that treats full unmasking everywhere as the goal is completely acknowledging the systemic issues at play. Workplace consequences are real. So is the compounded risk for people who are also managing racism, transphobia, or job precarity. The work is building the ability to assess accurately, not to be brave everywhere. It is possible to do this through a values-based lens, so even if you feel you need to mask in certain spaces (or even want to!) it is on your terms and in line with your goals.
Wild Hope Therapy works with neurodivergent adults, including late-diagnosed autistic and ADHD clients and people sorting out where masking ends and they begin. We see clients in person in Cleveland Heights, OH and in Upper Arlington near Columbus, OH, and offer virtual therapy for clients across Ohio, which for a lot of people means a session in your own space with your own lighting and no commute at either end.
Showing up however you choose
Everyone adjusts to their surroundings to some degree. We save certain jokes for certain groups of friends; we are more vulnerable in different settings; we bring certain parts of us forward based on the environment or task at hand. Masking that has been ingrained for survival does have the potential to become something different when awareness is developed and self-understanding is deepened. Identifying a certain coping or social skill and choosing to utilize it in a specific setting for a specific reason, or not, is working from a place of self-compassion and interpersonal effectiveness rather than survival.
You may decide to mask through a job interview, a family holiday, a conference, or a parent-teacher conference, or to meet the energy of a dear friend out of love rather than fear of abandonment. Again, mirroring is a way to reflect the good stuff back to each other. That is a strategic use of a skill you developed at real cost, and there is nothing self-betraying about it. Even if your goal is to drop masking completely, regardless of where you are, the difference is you are making a choice out of love for yourself and respect for the person you want to be and the life you want to live.
A mask is a thing you can take off
Costumes at halloween are fun and silly, while the skill of masking is a serious survival skill that can be exhausting and detrimental to anyone who has been doing it constantly their entire life. But it’s called masking for a reason. Yes, it is something we might hide behind to present a version of ourselves that is acceptable in more spaces and with more people. But at the end of the day it’s not the real you, and you can take it off whenever it feels right for you. If you feel exhausted or a deep desire to connect with your authentic self, remember that the mask has been useful, but it is not permanent.
You get to decide what you do with it now. That might mean unmasking in one relationship this year and nowhere else. It might mean simply knowing what you are doing when you do it, which by itself changes the experience. It might mean deciding that a particular environment is not worth the cost anymore.
Nobody else gets to define which version of you is the real one. You have more information about that than anyone, even if it takes some time to get to it, and the fact that the question is hard to answer says something about the environments you adapted to rather than about the person doing the adapting.
Wild Hope Therapy has therapists specializing in behavioral health for female-identifying and gender-expansive adults who are also neurodivergent including ADHD, Autism, AuDHD, or even if you are at the beginning of your journey as suspect you may be neurodivergent. Reach out today for a 15 minute consultation to learn more about how we can help.
References
Cassidy, S., Bradley, L., Shaw, R., & Baron-Cohen, S. (2018). Risk markers for suicidality in autistic adults. Molecular Autism, 9, 42. https://doi.org/10.1186/s13229-018-0226-4
Hinshaw, S. P., Nguyen, P. T., O'Grady, S. M., & Rosenthal, E. A. (2022). Annual research review: Attention-deficit/hyperactivity disorder in girls and women: Underrepresentation, longitudinal processes, and key directions. Journal of Child Psychology and Psychiatry, 63(4), 484–496. https://doi.org/10.1111/jcpp.13480
Hull, L., Mandy, W., Lai, M.-C., Baron-Cohen, S., Allison, C., Smith, P., & Petrides, K. V. (2019). Development and validation of the Camouflaging Autistic Traits Questionnaire (CAT-Q). Journal of Autism and Developmental Disorders, 49(3), 819–833. https://doi.org/10.1007/s10803-018-3792-6
Hull, L., Petrides, K. V., Allison, C., Smith, P., Baron-Cohen, S., Lai, M.-C., & Mandy, W. (2017). "Putting on my best normal": Social camouflaging in adults with autism spectrum conditions. Journal of Autism and Developmental Disorders, 47(8), 2519–2534. https://doi.org/10.1007/s10803-017-3166-5
Hull, L., Lai, M.-C., Baron-Cohen, S., Allison, C., Smith, P., Petrides, K. V., & Mandy, W. (2020). Gender differences in self-reported camouflaging in autistic and non-autistic adults. Autism, 24(2), 352–363. https://doi.org/10.1177/1362361319864804
Lai, M.-C., Lombardo, M. V., Ruigrok, A. N. V., Chakrabarti, B., Auyeung, B., Szatmari, P., Happé, F., & Baron-Cohen, S. (2017). Quantifying and exploring camouflaging in men and women with autism. Autism, 21(6), 690–702. https://doi.org/10.1177/1362361316671012
Raymaker, D. M., Teo, A. R., Steckler, N. A., Lentz, B., Scharer, M., Delos Santos, A., Kapp, S. K., Hunter, M., Joyce, A., & Nicolaidis, C. (2020). "Having all of your internal resources exhausted beyond measure and being left with no clean-up crew": Defining autistic burnout. Autism in Adulthood, 2(2), 132–143. https://doi.org/10.1089/aut.2019.0079
Walker, P. (2013). Complex PTSD: From surviving to thriving. Azure Coyote Publishing.