Masking (also called camouflaging) can significantly impact the autism and ADHD assessment process, often making diagnosis more challenging and sometimes leading to missed or delayed diagnoses. Here’s how masking influences assessments:
What is Masking?
Masking refers to consciously or unconsciously hiding or suppressing natural traits and developing compensatory strategies to appear “neurotypical.” These can include:
- Mimicking others’ social behaviours
- Scripting conversations
- Suppressing stimming or fidgeting
- Creating rules for maintaining eye contact
- Developing systems to manage executive functioning challenges
- Forcing oneself to tolerate sensory discomfort
How Masking Affects Autism Assessments
- Observable behaviours may be minimal: Classic autism traits might not be readily apparent during short assessment sessions
- Social difficulties may be hidden: Years of practice may make social interactions appear more natural than they actually are
- Burnout not visible: The exhaustion that follows masking isn’t typically observable during assessments
- Gender bias: Women and girls often mask more effectively, leading to underdiagnosis
“High-functioning” misconception: People who mask well may be viewed as having fewer support needs than they actually do
How Masking Affects ADHD Assessments
- Compensation strategies hide symptoms: Systems developed to manage executive dysfunction may conceal difficulties
- Heightened focus during assessment: The novel environment of an assessment may actually increase focus temporarily
- Different presentation in clinical settings: Anxiety about the assessment may alter typical behaviours
- Symptoms dismissed as anxiety: Hyperarousal from masking might be misattributed to anxiety disorders
- Adult presentations differ: Adults with decades of masking experience present differently than the childhood model many assessments are based on
Impact on Assessment Outcomes
- Misdiagnosis: Conditions like anxiety, depression, or personality disorders may be diagnosed instead
- Delayed diagnosis: Multiple assessments over years may be needed before recognition
- Incomplete understanding of support needs: The energy cost of masking isn’t factored into support planning
- Higher diagnostic thresholds: Those who mask well may need to demonstrate more severe symptoms to receive diagnosis
Strategies for More Accurate Assessment
For individuals seeking assessment:
- Document behaviours in everyday environments over time
- Bring evidence from childhood when possible
- Ask trusted people to provide observations
- Explain your masking strategies to the assessor
- Consider bringing written examples of challenges
Your assessment team will consider:
- Using multiple sources of information beyond in-person observation
- Un-picking the developmental history carefully
- Asking specifically about coping mechanisms and “masking” strategies
- Being aware of different presentations across genders and cultures
- Allowing for multiple sessions in different environments
Many adults only discover their masking behaviours after diagnosis, having considered their coping strategies simply as “trying to fit in” rather than symptoms of neurodevelopmental conditions.
Understanding how masking affects assessment is crucial for both clinicians and individuals seeking diagnosis, as it helps ensure that neurodivergent people receive appropriate recognition and support despite their developed compensatory strategies.