Doctor in a white lab coat and wearing a stethoscope holding hand out, the words "Adult ADHD" are in an invisible sphere

Adult ADHD and Masking: Hiding in Plain Sight

By J. Russell Ramsay, PhD, ABPP, author of The Adult ADHD and Anxiety Workbook

Attention-deficit/hyperactivity disorder (ADHD) is much more than the “A”(ttention) and the “H”(yperactivity). The contemporary view of ADHD is that it is a neurodevelopmental syndrome of impaired self-regulation via executive dysfunction. ADHD is a chronic delay in the developmental onset and efficient deployment of executive function capacities and skills. In fact, executive function problems are more specific and better predictors in the assessment of adult ADHD than its namesake symptoms, and are a driving force in the associated life impairments. The executive functions, which include time management, emotional self-control, and motivation, among others, are the suite of skills that help us conjure, develop, and carry out plans toward goals and objectives of our choosing—the outcome will benefit us somehow.

The vexing thing about the executive dysfunction faced by adults with ADHD is that it is not an all-or-nothing, complete incapacitation, but an infuriating variability, an unwieldy inconsistency within and across distinct roles, settings, and, importantly—relationships. Others see ample examples of intact functioning: “See, you can do it.” Hence, common ADHD-related problems of lateness, procrastination, and forgetfulness are at risk of appearing as evidence of laziness, disrespect, or other undesirable character traits.

Consequently, adults with ADHD hide or “mask” their symptoms, either knowingly or unwittingly, trying to not stick out to avoid appearing unreliable or difficult. Masking usually appears as compensations for ADHD symptoms, such as devoting inordinate time to keeping up with and completing projects, pretending to follow conversations while trying to recapture the discussion thread in between distractions, and resorting to impromptu excuses to explain away forgetfulness.

For adults already diagnosed with ADHD, compensations reflect good coping efforts, such as diligently recording things in a planner and using alarms as reminders. Despite the seeming explosion of adult ADHD as manifested on social media, more than half of adults with ADHD go undiagnosed and thereby untreated, at least with treatments targeting adult ADHD. Instead, they end up in treatment for the anxiety and depression that usually materializes from untreated ADHD. For these adults, masking is an effort to avoid anticipated rejection and criticisms; scrambling each day to keep up at work, school, and home; and simply to fit in.

ADHD is a neurodevelopmental syndrome, meaning it appears in some form in childhood or adolescence, even if it is not yet creating impairments severe enough to seek help. Hence, for adults masking undiagnosed ADHD, these struggles have often been long-standing and valid concerns based on a history of setbacks, criticisms, feeling misunderstood, and feeling like impostors.

Confirming the diagnosis of ADHD is the first step in understanding the source of the difficulties and then getting help. Such awareness is an important reconceptualization of a lifetime of puzzling, disturbing struggles as a recognized syndrome requiring more tools to manage than the often heard “try harder” or “start earlier.” There are evidence-based medical treatments as well as nonmedical, psychosocial treatments, the latter specifically focused on fostering the implementation of the necessary tools and strategies. Dealing with the emotional frustrations and self-critical views shouldered by adults with ADHD is also a focus.

Such treatments help adults with ADHD to come out from behind their masks. Self-advocacy and asking for and accepting help are useful but still underutilized skills for coping with ADHD. In fact, ADHD-friendly requests are helpful for anyone, such as asking for a follow-up, itemized, emailed list of task responsibilities just discussed in a meeting. This willingness to remove the mask and face and manage ADHD promises to open newfound opportunities and potential, especially when seeking help to do so.

J. Russell Ramsay, PhD, ABPP, is a licensed psychologist specializing in the assessment and psychosocial treatment of adult attention-deficit/hyperactivity disorder (ADHD). He has authored five books on adult ADHD, lectures internationally and virtually, and is in the Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) Hall of Fame.

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