Masking in Autism and ADHD: What It Is and Why It's Harmful

Calling someone “high-functioning” is usually meant as a compliment. For a lot of autistic and ADHD adults, it actually describes how well they’ve learned to hide. Masking is the effort it takes to make a brain that works differently look, from the outside, like one that doesn’t. That effort is invisible by design, which is exactly why it so rarely gets counted as a cost.

What This Page Covers

• What masking and camouflaging actually mean
• The three-stage process researchers have identified
• Why masking isn’t limited to autism
• The real mental health cost, backed by research
• How masking delays diagnosis, especially for women
• What to do if masking is costing you more than it’s giving you

What Masking and Camouflaging Actually Are

Masking refers to hiding or suppressing autistic or ADHD traits, things like stimming, intense focus on a specific interest, difficulty with eye contact, or trouble sustaining attention, in order to appear more neurotypical in a given setting. Researchers typically use “camouflaging” as the broader umbrella term. A qualitative study of 92 autistic adults found that camouflaging is not one single behavior but a combination of masking, hiding autistic characteristics outright, and compensation, actively working around underlying differences using learned strategies, even when the difference itself hasn’t gone away.

That same study identified a three-stage pattern that shows up consistently across the people it interviewed.

Stage	What Happens	Example
Motivation	A desire to fit in and build connection with others drives the effort to camouflage	Wanting to make friends or avoid standing out at work
Technique	A combination of masking and compensation strategies is used, often learned and refined over years	Scripting conversations in advance, forcing eye contact, suppressing stimming
Consequence	Short and long-term effects follow, both social and psychological	Exhaustion, and a growing threat to genuine self-perception

Masking Isn’t Only an Autism Experience

Camouflaging research has historically focused on autism, but that focus was a gap in the research, not a reflection of who actually masks. A 2024 study comparing adults with autism and ADHD found that adults with ADHD scored higher on camouflaging measures than a comparison group with neither diagnosis, though they scored lower than autistic adults on total camouflaging. Interestingly, the same study found that autism traits, not ADHD traits, predicted camouflaging levels across the board, regardless of a person’s actual diagnosis. That finding matters for people who carry both diagnoses, sometimes referred to as AuDHD, since it suggests the autistic side of that profile may be doing more of the hiding.

The Real Cost of Masking

Camouflaging is not free, and researchers have started to quantify what it costs. The same 2017 study on adult camouflaging described consequences including exhaustion, feeling forced to challenge one’s own stereotypes about autism, and genuine threats to self-perception from consistently presenting as someone other than who you are.

The cost can go further than exhaustion. A 2019 study applying the Interpersonal Psychological Theory of Suicide to camouflaging found that camouflaging autistic traits was associated with an increased risk of experiencing thwarted belongingness, the sense of not genuinely connecting with others even while appearing to, and with increased lifetime suicidality. The researchers were direct about why this matters: suicide theories need to account for camouflaging specifically, because the very strategy that makes someone look socially fine on the outside can be masking a much heavier internal cost.

Masking Delays Diagnosis, and That Delay Has a Cost of Its Own

Masking works precisely because it hides the traits a clinician would otherwise notice, which means it can also hide someone from an accurate diagnosis for years. This shows up disproportionately in women and in people who are especially motivated to avoid standing out, whether due to social pressure, past criticism, or simply having learned early that difference wasn’t safe to show. A diagnosis that arrives in adulthood instead of childhood doesn’t just delay a label. It delays access to accommodations, community, and an explanation for years of feeling like effort should have made things easier than it did.

How Siggy Approaches This

Masking often shows up alongside anxiety and depression rather than as a standalone reason someone seeks care, and that overlap is exactly where Siggy’s scope fits. Siggy’s clinical focus today is medication management for anxiety and depression, reviewed and approved by a licensed prescriber. During intake, patterns like chronic exhaustion, burnout after socializing, or a late-discovered autism or ADHD diagnosis are part of the fuller history that shapes how a treatment plan gets built, rather than being treated as a separate, disconnected issue. Ongoing support between visits also matters here specifically, because the exhaustion that comes with masking rarely shows up neatly on a schedule set months in advance.

What Members Are Saying

RH

R.H., 26

Autism Diagnosis at 24

“I spent my whole life being told I was ‘so put together’ and just felt like I was falling apart quietly the entire time. Getting diagnosed at 24 explained a decade of unexplained exhaustion.”

NP

N.P., 33

AuDHD, Diagnosed as Adult

“Nobody flagged autism in me for years because the ADHD diagnosis in childhood seemed to explain everything. Understanding that I was also masking autistic traits on top of that took way too long to figure out.”

Member stories reflect real experiences. Names and identifying details have been changed to protect privacy. Results vary. You can begin anonymous intake without an account, name, email, or payment.

If you are having thoughts of self-harm, call or text 988. If you are in immediate danger, call 911.

Masking can hide real exhaustion, anxiety, and depression behind something that looks, from the outside, like everything is fine. Start your anonymous intake with SiggyMD to get a treatment plan reviewed by a licensed prescriber that accounts for your full pattern, not just the version of you that made it through the day. If burnout is the piece hitting hardest right now, our guide to neurodivergent burnout goes deeper into recovery specifically.

Ready for care that sees the effort behind the mask? Get started with SiggyMD today.

Sources

1. Hull L, Petrides KV, Allison C, Smith P, Baron-Cohen S, Lai MC, Mandy W. “Putting on My Best Normal”: Social Camouflaging in Adults with Autism Spectrum Conditions. Journal of Autism and Developmental Disorders. 2017;47(8):2519-2534.
2. van der Putten WJ, Mol AJJ, Groenman AP, Radhoe TA, Torenvliet C, van Rentergem JAA, Geurts HM. Is Camouflaging Unique for Autism? A Comparison of Camouflaging Between Adults with Autism and ADHD. Autism Research. 2024;17(4):812-823.
3. Cassidy SA, Gould K, Townsend E, Pelton M, Robertson AE, Rodgers J. Is Camouflaging Autistic Traits Associated with Suicidal Thoughts and Behaviours? Expanding the Interpersonal Psychological Theory of Suicide in an Undergraduate Student Sample. Journal of Autism and Developmental Disorders. 2020;50(10):3638-3648.